HomeMy WebLinkAbout2017-266-E Aging - Jennifer Sugg for fit feet clinic services DocuSign Envelope ID:ED2CCF62-5EB3-44E8-BDBF-108FCDEA983A
[Departmental Use Only]
TITLE Wellness Instructor
FY 2017-18
ORANGE COUNTY
CONTRACT UNDER $15,000.00
NORTH CAROLINA
THIS AGREEMENT, made and entered into this first day of July, 2017, ("Effective Date")by and
between Orange County, North Carolina, a political subdivision 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 (hereinafter referred to collectively as "Services") to be furnished
under this Agreement are as follows: Fit Feet Clinic services at each senior center weekly
The term of this agreement rendered shall be from July 1, 2017 to June 30, 2018.
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 the lesser of
$20.00 per hour or two-thousand, five-hundred dollars, ($2500). 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.
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 County'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
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DocuSign Envelope ID:ED2CCF62-5EB3-44E8-BDBF-108FCDEA983A
http://www.orangecountync.gov/departments/purchasing division/contra cts.php). if County's Risk
Manager determines additional insurance coverage is required such additional insurance shall consist of
personal liability insurance (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
County'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, its agents, or assigns directly or indirectly related to the Services to be performed
pursuant to this Agreement 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. County may suspend this Agreement upon
reasonable 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. This
Agreement together with any amendments or modifications may be executed electronically. All electronic
signatures affixed hereto evidence the consent of the Parties to utilize electronic signatures and the intent of
the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66.
8. Priority: In determining the basic services to be provided, should any documents be
referenced in or attached to this Agreement, the terms of this Agreement shall have priority in any conflict
between the terms of referenced documents and the terms of this Agreement.
9. Governing Law: Both parties agree that this Agreement shall be governed by the laws of the
State of 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 state and federal anti-discrimination laws,
policies, rules, and regulations and the Orange County Non-Discrimination Policy and Orange County Living
Wage Policy (each policy is incorporated herein by reference and may be viewed at
http://www.orangecountync.gov/departments/purchasing_division/contracts.php.). Any violation of this
requirement is a breach of this Agreement and County may immediately terminate this Agreement without
further obligation on the part of the County. This paragraph is not intended to limit and does not limit the
definition of breach to discrimination. By executing this Agreement Provider affirms that Provider is and
shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By
executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the
services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147-86.58.
10. 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. Binding
arbitration may not be initiated by either Party, however, the Parties may agree to nonbinding mediation of
any dispute prior to the bringing of such suit or action.
11. 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
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DocuSign Envelope ID:ED2CCF62-5EB3-44E8-BDBF-108FCDEA983A
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]
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DocuSign Envelope ID:ED2CCF62-5EB3-44E8-BDBF-108FCDEA983A
IN WITNESS WHEREOF,County and the Provider have signed this Agreement, effective as of
the day first written above.
ORANGE COUNTY PROVIDER
, ---DocuSigned by: -' DocuSigned by:
By: I NIAAA t, t'Gi.tMwtt,V'Stt,t1 By: t lA iFt V Swlh
C@tia4tygu le:Hager Title: \"-76E4BF656C824A4...
200 S. Cameron St. Jennifer Sugg, R.N.
P.O. Box 8181 PO Box 272
Hillsborough,NC 27278 Bynum, NC 27228
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DocuSign Envelope ID:ED2CCF62-5EB3-44E8-BDBF-108FCDEA983A
HEALTHCARE PROVIDERS SERVICE
CNAORGANIZATION PURCHASING GROUP LtLISQ
nurses service organization-
OCCURRENCE POLICY FORM Print Date: 4/21/2017
Producer Branch Prefix Policy Number Policy Period
018098 970 HPG 0617869543 from 04/22/17to 04/22/18 at 12:01 AM Standard Time
Named Insured and Address: Program Administered by:
Jennifer Sugg Nurses Service Organization
Po Box 272 159 E. County Line Road
Bynum, NC 27228-0272 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 $6,000,000 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 F,
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 j
Total: $ 106.00
Base Premium $106.00 !°
Premium reflects Employed , Full 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 CNA80051 CNA80052 G-123846-C32
CNA81753 CNA81758 CNA82011 f,
is
Keep this document in a safe place.lt
• p , i and proof of payment are your proof of
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: