HomeMy WebLinkAboutAgenda - 10-04-1993 - III-D 1
ORANGE COUNTY
BOARD OF COMMISSIONERS
Action Agenda Item No. M1-13
ACTION AGENDA ITEM ABSTRACT
Meeting Date: October 4, 1993
SUBJECT: Professional Service Contract for Breast and Cervical
Cancer Control Program. -
DEPARTMENT: HEALTH PUBLIC HEARING: Yes X No
ATTACHMENT(S) : INFORMATION CONTACT:
HEALTH DIRECTOR'S OFFICE X2411
1) Mammography Service Contract
2 ) Colposcopy Service Contract TELEPHONE NUMBER:
Hillsborough -732-8181
Chapel Hill -968-4501
Mebane -227-2031
Durham -688-7331
PURPOSE:
To approve Mammography and Colposcopy Service Contracts for
patients of the Health Department' s Breast and Cervical Cancer
Control Program.
BACKGROUND:
The Board of Commissioners approved, at its meeting of
January 19, 1993, an expansion of the state contract to include
the Comprehensive Breast and Cervical Cancer Control Program.
Continuation funding for this project for FY93-94 was approved
by the Commissioners at its meeting of April 20, 1993.
The initial phase of planning the project and negotiating
contracts for referral services is drawing to close. Before
actually implementing the service, the attached contracts must
be approved.
The contracts are modeled after draft documents provided by
the state, but have incorporated modifications recommended
by the County Attorney and the County Purchasing Director.
Funding for these contracts is included in the approved
contract with the State. No local funds are involved.
RECOMMENDATION(S) : The County Manager recommends that the
contracts be approved and the Chair
authorized to sign.
STATE OF NORTH CAROLINA
ORANGE COUNTY
MAMMOGRAPHY
SERVICE CONTRACT
FOR THE
3--D ORANGE COUNTY HEALTH DEPARTMENT
1KJ AST AND CERVICAL CANCER CONTROL PROGRAM
Whereas the Centers for Disease Control has awarded funds to
the North Carolina Department of Environment, Health and Natural
Resources for the purpose of early detection of breast and
cervical cancer for low-income women in the state, and
Whereas the Department of Environment, Health and Natural
Resources has awarded funds to the Orange County Health Department
to assure the provision of services on the local level through
the implementation of a Breast and Cervical Cancer Control
Program (BCCCP) , and
Whereas it is necessary for Orange County Health Department
to contract for the provision of screening and diagnostic
mammography services, and
Whereas the Centers for Disease Control has mandated certain
standardized requirements,
Now, therefore, the Orange County Health Department and local
provider/contractor, as specified below, agree as follows :
•
This agreement, entered into on IN-44 (11: 013 by and between the
Orange County Health Department, hereinafter called the
"Department, " and the Chapel Hill Radiology, PA, hereinafter
called the "Contractor, " shall commence on and
shall be renewable annually. This agreement shall be for the
purpose of providing mammography services to clients referred to
the Contractor by the Department under the following conditions.
I. The Contractor agrees to:
A. Provide screening and repeat mammograms at a cost of
$55 . 00 per client. This fee includes both the
radiologist ' s fee and the cost for taking the screening
mammogram. Screening and repeat mammography shall be
defined as 2 views of each breast in asymptomatic women.
B. Provide diagnostic mammography at a cost of $55 . 00 per
client. Diagnostic mammography shall be indicated for
women over 40 years of age who are referred by the
clinician because of abnormal findings on clinical breast
examination or for women found to have abnormal screening
mammograms .
C. The Contractor shall provide documentation of current
mammography accreditation by the American College of
Radiology (ACR) .
Page 1 of 4
D. The Contractor shall provide documentation of being
certified by the Federal Health Care Financing
Administration to provide screening mammography services.
E. The Contractor agrees to see clients referred by the
Department for a screening mammogram no later than 6
weeks after receipt of referral. The Contractor also
agrees to perform repeat diagnostic mammography on
clients referred by the Department with symptoms or on
clients referred by the Department whose screening
mammograms indicate the need for further evaluation
no later than 2 weeks after receipt of the referral .
F. The Contractor shall report the mammography results of
the clients referred to the Contractor by the Department
to the Department using the lexicon recommended by the
ACR.
For results that are "Normal" on a screening or repeat
mammogram and "Negative, " "Benign" or "Probably Benign"
on a diagnostic mammogram the Contractor shall notify the
Department of results by mail no later than two weeks
after performing the mammogram.
For screening or repeat mammograms that indicate the need
for further evaluation and for diagnostic mammograms that
are "Suspicious" or have a "High Probability of
Malignancy, " the Contractor shall notify the patient ' s
primary care physician and the Department of the results
by phone or fax within 3 days of the service being
rendered, and shall send the written report by mail to
the patient' s primary care physician and to the
Department within 1 week of the service being rendered.
G. The Contractor shall have professional liability
insurance coverage with no less than a $1,000, 000
liability limit and shall provide proof of such coverage
to the Department prior to contract commencement.
H. The Contractor shall bill Medicaid directly when
providing Mammography for clients referred through the
Breast and Cervical Cancer Control Program (BCCCP) who
have Medicaid as their designated payment source. The
Contractor shall bill the Department when providing
mammography for clients referred through BCCCP who have
the Department' s BCCCP as their designated payment
source.
I. The Contractor is prohibited from billing clients for any
additional charges for the performance of Mammography.
Page 2 of 4
II . The Department agrees to:
A. Pay the Contractor $55 . 00 for screening and repeat
mammograms and $55 . 00 for diagnostic mammograms for women
referred by the Department who have the Department ' s
Breast and Cervical Cancer Control Program as their
designated source of payment.
III. Termination
This agreement between the Department and the Contractor for
the provision of Mammography services to clients referred by
the Department may be terminated by either party with 60 days
written notice, except in the case of breach of contract,
in which case, termination can be immediate.
IV. Notice
Any notice required by this agreement will be complete upon
being deposited in a depository of the US Postal Service with
1st class postage addressed as follows :
Department
Breast and Cervical Cancer Control Program
Orange County Health Deparment
P. O. Box 8181
Hillsborough, NC 27278
Primary Care Physicians
Name and address as indicated by
the patient or by the Deparment
In witness whereof, the Contractor and the Department have
executed this agreement in duplicate originals, one of which is
retained by each of the parties.
14 " J ;6( _2,l it
Daniel B. Reimer, Health Director Ric I. Suberman, MD
Orange County Health Department Chapel Hill Radiology, PA
110 S. Estes Drive
Chapel Hill, NC 27514
#1 OP MammCont Page 3 of 4
ORANGE COUNTY FINANCE DIRECTOR
"This instrument has been pre-audited
in the manner required by the Local
Government Budget and Fiscal Control
Act.
cif
Orange County Finance Director
1 7-G13
Date
0 !/
Cha 'r Orange County Boar." .L Commissioners
(O /7/ /
Date
Page 4 of 4
STATE OF NORTH CAROLINA
ORANGE COUNTY
COLPOSCOPY SERVICE CONTRACT
FOR THE
ORANGE COUNTY HEALTH DEPARTMENT
BREAST AND CERVICAL CANCER CONTROL PROGRAM
Whereas the Centers for Disease Control has awarded funds to
the North Carolina Department of Environment, Health and Natural
Resources for the purpose of early detection of breast and
cervical cancer for low-income women in the state, and
Whereas the Department of Environment, Health and Natural
Resources has awarded funds to the Orange County Health Department
to assure the provision of services on the local level through
the implementation of a Breast and Cervical Cancer Control
Program (BCCCP) , and
Whereas it is necessary for Orange County Health Department
to contract for the provision of colposcopic services .
Whereas the Centers for Disease Control has mandated certain
standardized requirements,
Now, therefore, the Orange County Health Department and local
provider/contractor, as specified below, agree as follows :
This agreement, entered into on ec 7 rc}53 by and between the
Orange County Health Department, hereinafter called the
"Department, " and the Hillsborough Family Practice Associates, PA
hereinafter called the "Contractor, " shall commence on
and shall be renewable annually. This agreemarttll be for the
purpose of providing colposcopic services to clients referred to
the Contractor by the Department under the following conditions .
I. The Contractor agrees to:
A. Provide colposcopy at the cost of $175 . 00 per patient.
This cost is inclusive of all fees and charges for the
colposcopy. --
B. Provide colposcopy and biopsy when indicated at a cost of
$225 . 00 per patient. This cost is inclusive of all fees
and charges for the colposcopy and biopsy.
C. The Contractor shall report the results of the
colposcopic evaluation and cervical biopsy to the
Department with recommendations regarding the need for
further care based on the diagnostic results .
D. For cervical biopsies that show "Low-Grade SIL, " "High-
Grade SIL, " "Squamous Cell Carcinoma, " "Adenocarcinoma, "
or other malignant neoplasms, the Contractor shall notify
the patient' s primary care provider and the Department of
the results by phone or fax no later than one week after
receiving the specimen report and shall send the written
report by mail no later than two weeks after receipt of
the specimen report.
Page 1 of 4
E. The Contractor agrees to see the patients referred by the
Department for colposcopy no later than three weeks after
receipt of referral.
F. The Contractor agrees to utilize a laboratory (for
interpretation of cervical biopsies) that is licensed in
North Carolina and that is in compliance with the rules
for cytopathology services in the Clinicial Laboratory
Improvement Amendments of 1988 (CLIA ' 88 ) . The
laboratory will provide documentation of compliance with
CLIA ' 88 by submitting to the Contractor its "Letter of
Attestation. " -
G. The Contractor shall have professioial liability
insurance of no less than $1,000, 000 liability limit and
shall provide proof of such coverage to the Department
prior to contract commencement.
H. The Contractor shall bill directly the designated payment
source of clients referred through the Breast and
Cervical Cancer Control Program (BCCCP) . BCCCP is the
designated payment source of last resort after Medicaid,
Medicare, and private insurance.
I. The Contractor is prohibited from billing clients for any
additional charges for the performance of colposcopy
service.
II . The Department agrees to:
A. Pay the Contractor $175 . 00 for colposcopy and $225 . 00 for
colposcopy and biopsy for women referred by the
Department who have the Department ' s Breast and Cervical
Cancer Control Program as their designated source of
payment.
III. Termination
This agreement between the Department and the Contractor for
the provision of colposcopy services to clients referred by
the Department may be terminated by either party with 60 days
written notice, except in the case of breach of contract,
in which case, termination can be immediate.
IV. Notice
Any notice required by this agreement will be complete upon
being deposited in a depository of the US Postal Service with
1st class postage addressed as follows:
Department
Breast and Cervical Cancer Control Program
Orange County Health Department
g Y P
P. 0. Box 8181
Hillsborough, NC 27278
Page 2 of 4
Primary Care Physician
Name and address as indicated by
the patient or by the Department
In witness whereof, the Contractor and the Department have
executed this agreement in duplicate originals, _one of which is
retained by each of the parties.
Daniel B. Reimer, Health Director Contractor '
Orange County Health Department Hillsborough Family Practice
Associates, PA
101 East Corbin Street
Hillsborough, NC 27278
#1 OP ColpCont Page 3 of 4
ORANGE COUNTY FINANCE DIRECTOR
"This instrument has been pre-audited
in the manner required by the Local
Government Budget and Fiscal Control
Act.
_Orange County Finance Director
-///'O/q3
- Date
r
C air Orange County Bo. ."d f Commissioners
7/761/
Date
•
• 1
Page 4 of 4
111 Durham County Hospital Corporation
Durham Regional Hospital
3643 N.ROXBORO ROAD
DURHAM,NORTH CAROLINA
27704-2763
919 470-4000
November 4 , 1993
Phillip Singer, -M.D. -
Hillsborough Family Practice
101 East Corbin Street
Hillsborough, NC 27278
•
Dear Phil :
I received a telephone call from Robin in your office telling me
that a letter of attestation was needed for you to utilize our
services for some work you are doing with the health department .
The laboratory at Durham Regional Hospital is accredited by the
College of American Pathologists, is licensed in the State of North
Carolina and has the appropriate CLIA certification. Should
documentation of any of this be needed, I will be happy to furnish
it .
Many thanks for your continuing support .
Sincerely,
DURHAM REGIONAL HOSPITAL LABORATORIES
_.._
John T. Daly, M.D.
Director of Laboratories
JTD/dmp
i3
EMERGENCY MEDICAL TRANSPORTATION SERVICES•HOME TREATMENT AND LIFE CARE•LINCOLN COMMUNITY HEALTH CENTER•OAKLEIGH•WATTS SCHOOL OF NURSING
PAUETWD
•
The term "totally disabled"shall mean that the Insured is permanently, wholly and continuously
disabled and prevented from performing any and every duty pertaining to his profession and is under the
regular care and attendance of a legally qualified physician other than himself
H If,at any time after reaching age 65,and having been continuously insured by the Company on a •
claims-made basis for the previous 10 years,the Insured elects to retire from his profession,the Company will
offer the"extension contract"described above,and will waive any and all premium charges normally
associated with such"extension."
I After being continuously insured by the Company on a claims-made basis for 20 years,the Insured
will be eligible to receive,at no premium charge,an'extension contract"forhispast2D years of claims-made
coverage.
J In arty event, the limits of coverage offered in G,H and I above may not exceed the lowest limits
purchased by the Insured during the five policy years immediately preceding disability or retirement.
Upon the following conditions., -
1 The Insured shall notify the Company,at its General Offices,Fort Wayne,Indiana,or its agent,as soon as possible,of
.any threatened claim, with full h.:formation relative to the services rendered;and in event such claim is filed in court shall
immediately forward any and all summons or process served together with the originator a copy of any and all other papers relating
to said claim.
2 The Insured shall not(a)make any bold harmless agreements or contract any expense nor voluntarily assume any liability
in any situation nor(b)make or contract any settlement of a claim hereunder,except at his own cost and responsibility,without the
widtten authorization of the Company.The Insured shall at all times fully cooperate with the Company in any claim hereunder
and shall attend and assist in the preparation and trial of any such claim.
3 The Insured shall be authorized topracttce its profession under the laws of the State or States in which it operates.
4 Other insurance—The insurance afforded by Ibis policy is primary insurance,except when stated to apply in excess of or
contingent upon the absence of other insurance.When this insurance is primary and the Insured bas other insurance which is
stated to be applicable o a ca
to the loss on an excess or contingent basis,the amount of the Company's liability under this policy shall not
be reduced by the existence of such other insurance.
When both this insurance and other insurance apply to the loss on the same basis,whether primary,excess or contingent,the
Company shall not be liable under this policy for a greater proportion of such loss than the applicable limit of liability under this
policy for such loss bears to the total applicable limit of liability of all valid and collectible insurance against such lass.
5 No action shall be maintained against the Company to recover a loss covered by Ibis policy unless brought after the amount
of such Tars shall have been fixed either by a final judgmont against the Insured by the court of last resort after trial of the issue or by
agreement between the parties with the written consent of the Company and unless brought within two years and one day after
such judgment or written agreement,except that,if such period is in conflict with the statutes of the state wherein this policy is
issued,it is hereby amended to conform with such statutes,Any person or his legal representative who has secured such judgment or
written agreement shall thereafter be entitled to recover under the terms of this policy in the same manner and to the same extent as
the Insured.Nothing contained in this policy shall give any person or organisntitm any right to join the Company as a codefendant
in any action against the Insured to determine the Insured's liability.Bankruptcy or insolvency of the Insured shall not relieve the
Company of any of its obligations hereunder,
6 The interest of the Insured under this policy shall not be assignable to any other person I
7 This policy may be cancelled by the Insured by mailing to the Company or any of its authorized representatives,written
notice,stating when thereafter the cancellation shall be effective.This policy may be cancelled by the Company by mailing postage
prepaid, to the Insured at the last address on record with tbo Company written notice stating when,not less than 30 days
thereafter such cancellation shall bo effective.If the Insured cancels,earned premium shall be computed in accordance with the
standard short rate tables and procedure.If the Company cancels, earned premium shall be computed pro rota.Premium
adjustments shall be made within a reasonable period of time after cancellation,but payment of or tender of such unearned .
premium shall not be a condition of cancellation
8 By acceptance of this policy the Insured agrees that this policy embodies all agreements existing between himself and the 1;;'
Company or any of its agents relating to Ibis insurance. 4
9 The following space is intended for waivers exceptions and endorsements.If any, they shall become part of Ibis policy.
125 320 390 526 603 609
Insured's Profession; MEDICINE
Retroactive Date: 02/03/89 The Insured:
Policy No. 573070 JANE SATTER MD
The Premium $ 1817 101 EAST CORBIN ST.
TOTAL 1817 HILLSBOROUGH, NC 27278 '
Per Claim Filed S 1,000,000 Annual'Aggregate s 1,000,000
The term of this policy shall begin end end at 12:01 a.m.,standard time,at the place whore the Insured resides
MO. DAY YEAR MO. DAY YEAR
and be from 02 03 94 to 02 03 95
In ZglittraS. ate.., The Medical Pro-
tective
Company has caused this policy to be signed try .... „/„...r.,..esfr,&.....________._ [
its President and its Secretary and countersigned by
its duly authorized representative. PRESIDENT
‘64."----,,■C". •,,, ,,CLZ&A.
COUNTERSIGNED SECRETARY
CMI-10-86
IN THE EVENT OF CMM.THREATENED OR FILED, .
p
IMMEDIATELY ND,PY THE MEDICAL PROTEOTIVE COMPANY,Fair WAYNE,INDIANA I;
F`
FOR SERVICE CALL- MR. ROBER,140t,AL'LtA13h X,LICY @ 919-467-8370 i.
Continuous sarvice to the professional since 1099 R N
PAGE TWO
The term "totally disabled"shall mean that the Insured is permanently, wholly and continuously
disabled and prevented from performing any and every duty pertaining to his profession and is under the
regular care and attendance of a legally qualified physician other than himself.
H If at any time after reaching age 65,and having been continuously insured by the Company on a
claims-made basis for the previous 10 years,the Insured elects to retire from his profession,the Company will
offer the"extension contract"described above,and will waive any and all premium charges normally
associated with such"extension."
I After being continuously insured by the Company on a claims-made basis for 20 years,the Insured
will be eligible to receive,at no premium charge,an"extension contract"for his past 20 years of claims-made
coverage.
J In any event, the limits of coverage offered in G,H and I above may not exceed the lowest limits
-purchased by the Insured during the five policy years immediately preceding disability or retirement.
Upon the following conditions: -
I The Insured shall notify the Company,at its General Offices,Fort Wayne,Indiana,or its agent,as soon as possible,of
any threatened claim,with full information relative to the services rendered;and its event such claim is filed in court shall
immediately forward any and all summons or process served together with the original or a copy of any and all other papers relating _
to said claim.
2 The Insured shall not(a)make any bold harmless agreements or contract any expense nor voluntarily assume any liability
in any situation nor(h)make or contract any settlement of a claim hereunder,except at his own cost and responsibility,without the
written authorization of the Company.The Insured shall at all times fully cooperate with the Company in any claim hereunder
and shall attend and assist in the preparation and trial of any such claim.
3 The Insured shall be authorized topractico its profession under tbo Taws of the State or States in which it operates.'
4 Other insurance—The insurance afforded by this policy is primary insurance,except when stated to apply in excess of or
contingent upon the absence of other insurance.When this insurance is primary and the Insured has other insurance which is
stated to be applicable to the loss on an excess or contingent basis,the amount of the Company's liability under this policy shall not
be reduced by the existence of such other hisurance.
When both this insurance and other insurance apply to the loss on the same basis,whether primary,excess or contingent,the
Company shall not be liable under this policy for a greater proportion of such loss than the applicable limit of liability under this
policy for such loss bears to the total applicable limit of liability of all valid and collectible insurance against such lats.
5 No action shall be maintained against the Company to recover a loss covered by this policy unless brought after the amount
of of such loss shall have been fixed either by a final judgment against the Insured by the court of resort after trial of the issue or by
agreement between the parties with the written consent of the Company and unless brought within two years and one day after
such judgment or written agreement except that,if such period is in conflict with the statutes of the state wherein this policy is
issued,it is hereby amended to conform with such statutes.Any person or his legal representative who has secured such judgment or
written agreement shall thereafter be entitled to recover under the terms of this policy in the same manner and to the same extent as
the Insured.Nothing contained in this policy shall give any person or organization any right to join the Company as a codefendant
in any action against the Insured to determine the Insured's liability.Bankruptcy or insolvency of lbe Insured shall not relieve the .
Company of any of its obligations hereunder.
6 The interest of tbe'nsured under this policy shall not be assignable to any other person.
7 This policy may be cancelled by the Insured by mailing to the Company or any of its authorized representatives written
notice,stating when thereafter the cancellation shall be effective.This policy may be cancelled by the Company by mailing postage
prepaid, to the Insured at the last address on record with the Company written notice stating when,not loss than 30 days
thereafter,such cancellation shall be effective.If the Insured cancels,earned premium shall be computed in accordance with the
standard short rate tables and procedure.If the Company cancels, earned premium shall be computed pro rata.Premium
adjustments shall be made within a reasonable period of time after cancellation,but payment of or tender of such unearned
premium shall not he a condition of cancellation.
8 By acceptance of this policy the Insured agrees that this policy embodies all agreements existing between himself and the
Company or any of its agents relating to this insurance.
9 The following space is intended for waivers,exceptions and endorsements.If any,they shall become part of this policy.
125 320 390 526 532 603 609
Insured's Profession: MEDICINE
Retroactive Date: 08/14/85 The insured: ■
Policy No. 582850 DANIEL DAVID CRUMMETT MD 1`
The Premium S 1817 101 EAST CORBIN ST.
TOTAL 1817 HILLSBOROUGH, NC 27278
Per Claim Filed $ 1,000,000 Annual Aggregate S 1,000,000 .,,
The term of this policy shell begin end end at 12:01 a.m.,standard lime,at the place whore the Insured resides
Mo. DAY YEAR MO. DAY YEAR
and be from 12 31 93 to -12 31 94
DoT Company =tarot,p Theo be sin Pro- /..... 71Y✓�.
tective Company bas caused this policy to be signed by
its President and its Secretary and countersigned by
its duly authorized representative. PRESIDENT
COUNTERSIGNED SECRETARY
CM1•lwSl
IN THE EVENT OF CLAIM.THREATENED OR FILED.
IMMEDIATELY NOTIFY THE MEDICAL PROTECTIVE COMPANY.FORT WAYNE.INDIANA
FOR SERVICE CALL: J. MICHAK,L,.4,Thiggp.,�Y @ 9,19-467-8370 . i
..__.,_.._..__. ..-.,ae....,u.as,n laI since 1099 RI
1,4.1.MO
The term "totally disabled"shall mean that the Insured is permanently, wholly and continuously
disabled and prevented from performing any and every duty pertaining to his profession and is under the
regular care and attendance of a legally qualified physician other than himself. .
H If,at any time after reaching age 65,and having been continuously insured by the Company on a
claims-made basis for the previous 10 years,the Insured elects to retire from his profession,the Company will
offer the"extension contract"described above, and will waive any and all premium charges normally
associated with such"extension."
I After being continuously insured by the Company on a claims-made basis for 20 years,the Insured
will be eligible to receive,at no premium charge,an"extension contract"forhis past 20 years of claims-made
coverage. -
J In any event,the limits of coverage offered in G,H and I above may not exceed the lowest limits
purchased by the Insured during the five policy years immediately preceding disability or retirement.
Upon the following conditions:
I The Insured shall notify the Company,at its General Offices,Fort Wayne,Indiana,or its agent,as soon as passible,of
any threatened claim, with full information relative to the services rendered;and in event such claim is filed in court shall
immediately forward any and all summons or process served together with the original or a copy of any and all other papers relating
to said claim.
2 The Insured shall not(a)make any bold harmless agreements or contract any expense nor voluntarily assume any liability
in any situation nor(b)make or contract any settlement of a claim hereunder,except at bit own cost and responsibility,without the
written authorisation of the Company.The Insured shall at all times fully cooperate with the Company in any claim hereunder
and shall attend and assist in tbepreparation and trial of any such claim.
3 The Insured shall be authorized to practice its profession under the laws of the State or States in which it operates.
4 Other insurance—The insurance afforded by this policy is primary insurance,except when slated to apply in excess of or
contingent upon the absence of other insurance.When this insurance is primary and the Insured has other insurance which is
stated to be applicable to the loss on an excess or contingent basis the amount of the Company's liability under this policy shall not
be reduced by the existence of such other insurance.
When both this insurance and other insurance apply to the lass on the same basis,whether primary,excess or contingent,the
Company shall not be liable under this policy for a greater proportion of such lass than the applicable limit of liability under this
policy for such loss bears to the total applicable limit of liability of all valid and collectible insurance against such loss.
5 No action shall be maintained against the Company to recover a loss covered by this policy unless brought after the amount
of such loss shall have hem:fixed either by a final Judgment against the Insured by the court of last resort after trial of the issue or by
agreement between the parties with the written consent of tba Company and unless brought within two years and one day after
such judgment or written agreement,except that,if such period is in conflict with the statutes of the state wherein this policy is .
issued,it is hereby amended to conform with such statutes.Any person or his legal representative who has secured such judgment or
written agreement shall thereafter be entitled to recover under the terms of this policy in the same manner and to the same extent as
the Insured,Nothing contained in this policy shall give any person or organization any right to join the Company as a codefendant
in any action against the Insured to determine the Insured's liability.Bankruptcy or insolvency of the Insured shall not relieve the
Company of any of its obligations hereunder.
6 The interest of the Insured under this policy shall not be assignable to any other person.
7 This policy may be cancelled by the Insured by mailing to the Company or any of its authorized representatives,written
notice,stating when thereafter the cancellation shall be effective.This policy may be cancelled by the Company by mailing,postage
id
prepaid, to the Insured at the last address on record with the Company written notice stating when, not less than 30 days
thereafter,such cancellation shall be effective.If the Insured cancels earned premium shall be computed in accordance with the
standard short rate tables and procedure.If the Company cancels, earned premium shall be computed pro rata.Premium j'
adjustments shall be made within a reasonable period of time after cancellation,but payment of or tender of such unearned !
premium shall not be a condition of cancellation.
8 By acceptance of this policy the Insured agrees that this policy embodies all agreements existing between himself and the
Company or any of its agents relating to this insurance.
9 The following space is intended for waivers,exceptions and endorsements.If any,they shall bacone part of this policy. i;
125 320 390 526 532 603 609 i'
Insured's Profession: MEDICINE
Retroactive Date: 10/07/77 The Insured:
Policy No. 582849 F PHILIP G SINGER MD
The Premiums 1817 101 EAST CORBIN ST.
TOTAL 1817 HILLSBOROUGH, NC 27278
Per Claim Filed s 1,000,000 Annual Aggregate S 1,000,000
Thu term of this policyshall begin and end at 12;01 a.m..standard time,at the place where the Insured resides i''
MO. DAY YEAR MO, DAY YEAR
and befrom 12 31 93 to 12 31 94
a11( co.itttt$5 Zintreot, The Medical Pro-
tective Company bas caused this policy to be signed by ,
its President and its Secretary and countersigned by
its duly authorized representative. PRESIDENT''�
/� .��. of z. ��r�4
COUNTERSISNED SECRETARY
CMI.10-81
IN THE EVENT OF CLAIM.THREATENED DR FILED.
IMMEDIATELY NOTIFY THE MEDICAL PROTECTNE COMPANY.FORT WAYNE.INDIANA
t.
FOR SERVICE CALL: J, MI CHAglEe�o ,D113PDIIOY @ 919-467-8370 �`
Continuous service to the professional since 1889 RN
C
G