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HomeMy WebLinkAbout2017-348-E CJRD - Freedom House Recovery Center for substance abuse education DocuSign Envelope ID: B02A2B92-39F5-4594-9D3B-CB44B8448954 NORTH CAROLINA SERVICES AGREEMENT ORANGE COUNTY This Services Agreement(hereinafter"Agreement") is made and entered into this 5th day of July, 2017 ("Effective Date") by and between Orange County, North Carolina a political subdivision of the State of North Carolina, for and on behalf of its Criminal Justice Resource Department and Misdemeanor Diversion Program (hereinafter, the "County") and Freedom House Recovery Center(the "Provider"). Background: Orange County has developed a Misdemeanor Diversion Program ("MDP"). The MDP is designed to serve 16- and 17-year-old first-time misdemeanor offenders who would otherwise be referred to traditional District Court. Instead of being referred to District Court, eligible youth will be referred pre-charge to a court session with the MDP and directed to youth-serving programs in the community. A description of the MDP is attached to this Agreement as Exhibit A. Freedom House is located in Orange County and provides services to those affected by mental illness, developmental disabilities and substance abuse. Accordingly, Freedom House has agreed to accept referrals from the MDP and provide services as further set forth herein. 1. Scope of Work. The MDP will refer appropriate individuals to Freedom House. Freedom House will provide the following services: a. Provide acknowledgement to MDP when a referral is received; b. Address referrals in a timely manner, knowing that youth are expected to complete the MDP within 90 days. MDP clients will be asked to contact Freedom House within 3 business days of being referred to Freedom House. MDP personnel should be notified if Freedom House receives a referral but has not been contacted by the client within one week of the referral. c. Notify MDP within 3 business days whether Freedom House is able to accept the client; d. Subject to federal and state privacy law, notify Freedom House if any problems (including but not limited to missed appointments/classes) arise with the referral; e. Subject to permission of the client (which will be required for MDP compliance), notify MDP within 3 business days upon the patient's completion of the Freedom House program or termination from the Freedom House program. f. Freedom House will provide up to fifteen hours of evidence-based models for group or individual therapy. g. If for any reason Freedom House is unable to provide the appropriate services to a referred youth, Freedom House will contact MDP personnel immediately, to inform MDP personnel of their inability to serve the referral and the reason for doing so. 1 DocuSign Envelope ID: B02A2B92-39F5-4594-9D3B-CB44B8448954 2. Relationship with Provider. MDP understands that once Freedom House accepts an individual referred by MDP, that individual becomes a Freedom House client. Except as specifically set forth herein, Freedom House will follow its standard policies and procedures while providing services under this Agreement. All individuals accepted into Freedom House's program under this Agreement will have the same privacy rights as all other Freedom House patients. MDP will obtain the written permission of all individuals accepted into Freedom House's program to allow Freedom House to disclose the individual's attendance at Freedom House sessions for invoice purposes. In the event the MDP terminates an individual's participation in the MDP, MDP will immediately notify Freedom House, and Freedom House will no longer provide services to that individual under this Agreement. 3. MDP Responsibilities. MDP will provide Freedom House with a referral form that includes relevant client information, including medical and payment information when available. In addition, MDP will pay Freedom House the fee of $120 per referral accepted by Freedom House. The amount of the fee will not vary based upon the amount of services provided by Freedom House to MDP as long as Freedom House provided at least one session to the individual. The MDP understands that Freedom House will pay all third party payors, including private insurance payors and governmental payors such as Medicaid. Freedom House will not consider the existence of a third party payor when deciding whether to accept a referral of a MDP client and will base such decisions on clinical information only. Due to the nature and purpose of MDP, Freedom House agrees that it will waive all amounts that would otherwise be the responsibility of the patient or the patient's family, including without limitation copays. The total amount of this Agreement shall not exceed $5,000 without written amendment, 4. Confidentiality. Except as otherwise subject to the North Carolina Public Records Law, no person will publish or disclose, use, or permit to be published, disclosed, or used, any confidential information pertaining to referrals or participants. Any information deemed confidential under state or federal law provided to or developed by any of the Parties in the performance of the duties described in this MOU shall be kept confidential and shall not be made available to any individual or organization without the approval of all Parties; however, the Parties shall make administrative, fiscal, program and participant records available as required by law for audit purposes to assist in the performance of state/federal responsibilities or grant requirements. Parties shall notify remaining Parties promptly of any unauthorized possession, use, knowledge or attempt thereof, of any other Parties data files or other confidential information and shall promptly furnish to that party full details of the unauthorized release of such confidential information and shall assist with the investigation or prevention of the further release of such information. 5. Duration of Services. This Agreement will continue until terminated by either party. Either party may terminate this Agreement at any time upon written notice to the other party. In the event of a termination, all individuals already accepted by Freedom House under referral by MDP will continue to be subject to this Agreement. 6. Amendments. Any amendment to this Agreement shall not be valid unless made in a writing signed by both parties. 2 DocuSign Envelope ID: B02A2B92-39F5-4594-9D3B-CB44B8448954 7. Indemnification. Provider will be responsible for its own negligence and the negligence of its employees. Provider shall indemnify and hold harmless the County from all loss, liability, claims of expense, including attorney's fees, arising out of or related to the services performed and arising from bodily injury, death, or property damage to any person or persons caused in whole, or in part, by the negligence or misconduct of the Provider 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 Provider to indemnify the County to the fullest extent permitted under North Carolina law. 8. Additional Provisions. The County, through MDP, and the Provider each bind themselves, their successors, assigns and legal representatives to the terms of this Agreement. Neither the County, through MDP, nor the Provider, shall assign or transfer its interest in this Agreement without the written consent of the other. 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. 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. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes and that they certify they have not been identified nor utilized the services of any subcontractor on the list created by the State Treasurer pursuant to G.S. § 147-86.58. 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. [SIGNATURE PAGE TO FOLLOW] 3 DocuSign Envelope ID: B02A2B92-39F5-4594-9D3B-CB44B8448954 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: PROVIDER: By: [ DocuSigned by: DocuSigned by: OUttt, Actwtwlt,V'Stt,t1 By: P0414ie. NU.SSt,t1 County Man p637994B755E477... Patricia Huss y,EmeetetimeiDirector Freedom House Recovery Center 104 New Stateside Dr. This instrument has been preaudited in the Chapel Hill,NC 27516 manner required by the Local Government (919) 942-2803 Budget and Fiscal Control Act DocuSigned by: el Orange Count a�efiFiin ial Officer Orange County Courthouse Caitlin Fenhagen, Criminal Justice Resource Director Criminal Justice Resource ,--DocuSigned by: Department bail& ruti 106 E. Margaret Lane Signature `--27D78E8EFC51493... Date 7/27/2017 Hillsborough,NC 27278 (919) 245-2303 Volunteers for Youth Kate Giduz, Youth Programs Administrator 205 Lloyd St., Suite 103 ,----DocuSigned by: Carrboro,NC 27510 igi _ (919) 967-4511 Signature _51A3E5689B954B9.. Date 7/27/2017 4 DocuSign Envelope ID: B02A2B92-39F5-4594-9D3B-CB44B8448954 AC J DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 7/17/2017 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 CONTACT : y Cr stal Ireland NAME Business Insurers of Carolinas (A/CNNo,Ext): (919)968-4611 FAX No): (919)968-8991 800 Eastowne Drive, Suite 208 aDRle55.cireland @business-insurers.com PO Box 2536 INSURER(S)AFFORDING COVERAGE NAIC# Chapel Hill NC 27515-2536 INSURERA:Riverport- Berkley National Ins Co INSURED INSURER B United Wisconsin Insurance Company 29157 Freedom House Recovery Center, Inc INSURER C: 104 New Stateside Drive INSURERD: INSURER E: Chapel hill NC 27516 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1771019046 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 1,000,000 A CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ X Professional Liability X 8527338-10 7/1/2017 7/1/2018 MED EXP(Any one person) $ 20,000 X Sexual & Physical Abuse PERSONAL&ADVINJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED AUTOS AUTOS X 8527338-10 7/1/2017 7/1/2018 BODILYINJURY(Peraccident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) $ Medical payments $ 5,000 X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ 8527338-10 7/1/2017 7/1/2018 $ WORKERS COMPENSATION X PER X OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A B E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? y (Mandatory in NH) 0400158723 5/16/2017 5/16/2018 E.L.DISEASE-EA EMPLOYEE$ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 A Employee Dishonesty 8527338-10 7/1/2017 7/1/2018 LIMIT 25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Orange County is also an additional insured with respect to General Liability and Automobile Liability, required by written contract. CERTIFICATE HOLDER CANCELLATION mallison @orangecountync.go SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE J Chappell/IREL01 � ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 r7mdm i