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HomeMy WebLinkAbout2018-251-E Human Resources - Select Physical TherapyDocuSign Envelope ID: EAE3745D -23C6- 4352- A3D7- 9903DCB5D084 AGREEMENT THIS AGREEMENT is by and between Select Physical Therapy Holdings, Inc. and RchabClinies, Inc., a Delaware Corporation located at 4716 Gettysburg Rd, Mechanicsburg PA 17055 for and on behalf of its subsidiaries and affiliates, ( "Provider "), WorkSTEPS ®, Inc., a Texas corporation located at University Business Park, 3014 Alvin Dcvane, Suite 150, Austin, Texas, 78741 ( "WorkSTEPS"), and {Orange County, a local political subdivision of the State of North Carolina, located at 200 South Cameron Street, Post Office Box 8181, Hillsborough, North Carolina C "COMPANY "), collectively ( "THE PARTIES "). WHEREAS: COMPANY is desirous of implementing a functional employment testing program as a part of its work injury and disability management program, to, among other reasons, effectuate a reduction of on-the-job injuries by trying to determine if an applicant or employee can safely perform the essential functions of the job. WHEREAS: WorkSTEPS has developed functional employment testing protocols and procedures that COMPANY desires to utilize for its functional employment testing program, and WHEREAS: WorkSTEPS desires to assist COMPANY in implementing the WorkSTEPS functional employment- testing program, THERE FORE THE PARTIES HERETO DO HEREBY AGREE AS FOLLOWS: l . Scope of Services. The services and/or materials (hereinafter referred to collectively as "Services ") to be furnished under this Agreement are as follows: [functional employment testing of job descriptions identified by Company, as further described in Attachment A, Description of Services, which is attached hereto and incorporated by reference herein, except as to those parts that conflict with this Agreement. Job Analyses is the foundation of the COMPANY'S functional employment testing program. A job analyses is a measurement of the physical demands and requirements of the essential functions of a specific job. Accurate and current job analyses are the COMPANY'S responsibility. Job Specific Authorization Forms that document essential function requirements roust be executed by COMPANY'S representative and provided to WorkSTEPS before testing can begin. COMPANY managers should use professionals experienced in assisting with job analyses or other trained and certified ergonomic assessment specialists to assist in the preparation of job analyses and documentation of essential functions. The job analyses should be based on a close, careful examination of the specific job by an individual trained and competent in making the physical measurements of the essential functions of the specific job. The job analyses provides specific job content validity to COMPANY's functional employment testing program, which seeks to simulate the specific physical demands necessary to perform essential job functions. Accurate and up -to -date job analyses help ensure that employment decisions are based on objective, sound, individual, and job specific information. Likewise, accurate and up-to -date job analyses helps ensure that no individual or group of individuals is discriminated against. COMPANY agrees to enter into an agreement in the form attached hereto as Exhibit "1" with the provider that will perform the job analysis, which is attached and incorporated by reference into this Agreement, except as to those parts that conflict with this Agreement. If there is any conflict between the Exhibits and the all other documents and this Agreement, this Agreement shall take precedence over any other document. 2. Compensation for Services. Company agrees to pay at the rates specified for satisfactorily performed in accord with this Agreement. The amount to be paid by the Company shall not exceed fifteen thousand dollars, ($15,000.00). Payment shall be made within thirty (30) days of an invoice properly DocuSign Envelope ID: EAE3745D -23C6- 4352- A3D7- 9903DCB5D084 submitted to the Company. Should Provider fail to perform the duties under the terms of this Agreement, Company may, without fault or penalty, withhold any payment associated with the work to be performed until such time as said work is completed. Based on the functional employment test(s) and services that have been identified below the price for the test(s) and services shall be: ♦ Comprehensive Post Offer Functional Employment Test $125.00 1 Comprehensive Fit for Duty Test per employee $125.00 r Partial Test $75.00 t No Show Fee (24 hour cancellation required) $75.00 ♦ Job Analysis (per hour- maximum of 6 hours per job analyzed) $150.00 ♦ POET creation perjob title $500.00 r Validation of POET per hour $150.00 4 Work Conditioning initial 2 hours $150.00 r Work Conditioning -each additional hour $75.00 2. Terms. The term of this Agreement shall be for a term of one (1) year, from the effective date of this Agreement July 1, 2018 until June 30, 2014. 3. Termination, This Agreement may be terrninated by either Party hereto. The termination shall be effective five (5) business days after receipt of notice thereof. Receipt shall be deemed effective upon actual delivery to the noticed Party. Upon termination, COMPANY shall be responsible to pay for any employment tests that have actually been performed prior to the termination. 4. Ownership. All data and information generated by the WorkSTEPS Functional Employment Testing Program for Company shall be the property of WorkSTEPS and Company. WorkSTEPS shall use best efforts to keep such data or information in a legally compliant manner pursuant to all state or federal laws affecting such data or information. COMPANY may keep copies of data or information for use in its normal course of business, but COMPANY hereby agrees that should it have possession of any WorkSTEPS materials, forms, procedures, protocols, or information, that such shall be deemed proprietary and confidential and kept strictly confidential. COMPANY shall use best efforts to see that such is not utilized for any purpose that would reasonably be deemed in competition with WorkSTEPS, 5. Confidentiality. WorkSTEPS shall keep all information or materials received by COMPANY strictly confidential, and shall not divulge any such information or materials without the express written consent of COMPANY. 6. Third Party Claims. In the event of any third party claims associated with the services provided under this Agreement, the party receiving notice of the claim shall immediately inform the other party of such claim. WorkSTEPS° and COMPANY shall timely make available to each other such information and assistance as reasonably requested in connection with the defense of any potential claim or action. 7. Release of Data. Notwithstanding any prohibition contained within this Section, WorkSTEPS or COMPANY may release data or information as contemplated herein should a state or federal court of law require it. WorkSTEPS may also release data or information received from the testing of COMPANY's employees for any legitimate business purpose, provided that (i) any personal information is kept confidential, and (ii) that all state and federal laws regarding such data or information are strictly followed. 8. Proprietary Marks. COMPANY acknowledges that is has been advised that WorkSTEPS believes the WorkSTEPS name, and its marks and proprietary software, protocols and testing process are federally trademarked and copyrighted. COMPANY agrees that WorkSTEPS proprietary software, protocols, processes, procedures, including modifications thereto, are, and shall be considered "proprietary" and "confidential information." WorkSTEPS confidential and proprietary information will be provided to COMPANY for the sole purpose of having the WorkSTEPS Provider provide functional employment DocuSign Envelope ID: EAE3745D -23C6- 4352- A3D7- 9903DCB5D084 testing services to the COMPANY. COMPANY acknowledges, agrees and confirms that COMPAN'Y's disclosure or misappropriation of WorkSTEPS proprietary information could cause irreparable injury to WorkSTEPS, and COMPANY hereby expressly agrees that it will not use the confidential and proprietary information provided to COMPANY, except for the express purposes described in this Agreement. 9. Protected Health Information. WorkSTEPS may receive from Company health information that is protected under applicable state and/or federal law, including without limitation, protected health information ("PHI ") as defined in the regulations at 45 C.F.R. Parts 160 and 164 (the "Privacy Standards ") promulgated pursuant to the Health Insurance Portability and ACCauntability Act of 1996 "HIPAA "). WorkSTEPS agrees not to use or disclose (or permit the use or disclosure of) PHI in a manner that would violate the requirements of the Privacy Standards if the PJ-H were used or disclosed by Company in the same manner. WorkSTEPS shall use appropriate safeguards to prevent the use or disclosure of PHI other than as expressly permitted under this Agreement. Use of PH1. WorkSTEPS will use PHI solely for Company's benefit and only (i) for the purpose of performing services for Company and (ii) as necessary for the proper management and administration of the Company or to carry out its legal responsibilities, provided that such uses are permitted under federal and state law. Company shall retain all rights in the PHI not granted herein. Disclosure of PHI. WorkSTI -TS may disclose PHI as necessary to perform its obligations under this Agreement and as permitted by law, provided that WorkSTEPS shall in such case: (a) obtain reasonable assurances from any person to whom the information is disclosed that it will be held confidential and further used and disclosed only as required by law or for the purpose for which it was disclosed to the person or entity; (b) agree to immediately notify Company of any instances of which it is aware that PHI is being used or disclosed for a purpose that is not otherwise provided for in this Agreement or for a purpose not expressly permitted by the Privacy Standards; and (c) ensure that all disclosures of PIII are subject to the principle of "minimum and necessary use and disclosure," i.e., only the minimum PHI that is necessary to accomplish the intended purpose may be disclosed. If WorkSTEPS discloses PHI received from Company, or created or received by WorkSTEPS on behalf of Company, to agents, including a subcontractor (collectively, "Recipients "), WorkSTEPS shall require Recipients to agree in writing to the same restrictions and conditions that apply to the WorkSTEPS under this Agreement. 10. Remedies. THE PARTIES agree that (i) the covenants and restrictions contained herein are of material consideration to this Agreement and are reasonable and necessary to protect and preserve the interest of both PARTIES; (ii) irreparable loss and damage will result from any breach hereof; (iii) monetary damages «vill not be sufficient to compensate a PARTY for any such default or breach by the other party; and (iv) in addition to all other remedies provided at law or in equity, a PARTY shall be entitled to seek and obtain temporary, preliminary and permanent injunctive relief in a court of law to prevent and restrain any breach or contemplated or threatened breach of and to specifically enforce the provisions of this Section, and neither PARTY will be obligated to post a bond or other security in seeking such relief or to provide proof of irreparable harm. Such remedies shall be in addition to and not in limitation of any injunctive relief or other rights or remedies to which a PARTY is or may be entitled at law or in equity or under this Agreement. 11. Exclusivity and Performance of Test. For as long as this Agreement is in effect, COMPANY shall not acquire the same or similar functional testing services from anyone other than WorkSTEPS or its' duly licensed providers. COMPANY acknowledges and understands that the tests are to be performed by medical providers that are independent contractors that have been licensed by WorkSTEPS to perform the tests identified. 12. Non - Solicitation of Employees and Use of Proprietary Network. COMPANY acknowledges that WorkSTEPS has invested considerable time and financial resource in the training, education, and certification of the professional staff necessary to deliver the services set forth on Attachment A to this Agreement. During the term of this Agreement, and for a period of one year after its termination, COMPANY agrees that it shall not actively or knowingly solicit or make an offer of employment to any of WorkSTEPS employees or WorkSTEPS licensed Providers associated with the delivery of these services to DocuSign Envelope ID: EAE3745D -23C6- 4352- A3D7- 9903DCB5D084 COMPANY nor shall COMPANY utilize the proprietary WorkSTEPS Network to perform any other competitive product to the WorkSTEPS Testing Program. 13. Use of Information after Termination. Without limiting the generality of this Section, TIfE PARTIES agree that after the termination or expiration of this Agreement, such PARTIES will not use the proprietary, confidential information of the other PARTY to provide the same or similar services to any person (unless and until such information ceases to be proprietary and confidential through no fault of the PARTY seeking to use the same), however, nothing in this Section shall prohibit Company or its affiliates, after termination of this Agreement, from providing a service to COMPANY similar to the services provided by Provider hereunder as long as neither COMPANY nor its affiliates uses the proprietary, confidential information of WorkSTEPS in so doing. 14. Employment Decision. COMPANY acknowledges and understands that this Agreement contemplates the functional employment testing of prospective employees and/or actual employees of COMPANY. That COMPANY, as employer of the individuals tested have a significant role, both before and after the test, including, but not limited to, selection of the essential functions of the applicable ,job, the writing of job descriptions, if any, in communicating with the individuals to be tested in a consistent manner, in making appropriate employment decisions based on test results and in properly processing and advising those individuals tested. 15. Independent Contractor. The Provider and WorkSTEPS shall operate as independent Contractors, and the Company shall not be responsible for any of their acts or omissions. Neither the Provider nor WorkSTEPS shall be treated as an employee with respect to the Services performed hereunder for either federal or state tax or unemployment or workers' compensation purposes. The Provider and WorkSTEPS understand that neither federal, state, or payroll tax of any kind shall be withheld or paid by the Company on behalf of the Provider or WorkSTEPS, or their employees. 16. WorkSTEPS and Provider represents and agrees that they are qualified to perform and are 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 Company. WorkSTEPS and Provider shall be responsible for all its' errors or omissions, in the performance or the Agreement. WorkSTEPS and Provider shall correct any and all its' errors, omissions, discrepancies, ambiguities, mistakes or conflicts at no additional cost to the Company. WorkSTEPS and Provider agree that they will 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 Company 17. Insurance. The Provider and WorkSTEPS shall obtain, at its sole expense, all insurance needed to adequately insure itself during the performance of these services as required by the Company's Risk Management Policy. 18. Indemnity. The Provider and WorkSTEPS agrees, without limitation, 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 or WorkSTEPS. 19. Adherence to Laws. COMPANY agrees to follow state and federal employment laws, regulations and practices including, but not limited to, appropriate procedures related to employment testing as set forth in the Americans' With Disabilities Act and any and all applicable laws. COMPANY further acknowledges that the Company, not the Provider or WorkSTEPS, is responsible for making employment decisions concerning any post employment candidates' or current employees' suitability for employment or continued employment and for making decisions concerning reasonable accommodations. 20. North Carolina Public Records Act. Provider and WorkS` FPS acknowledge that this Agreement, the Confidential Information and any documents, memorandum, data, reports, analyses, compilations, records, pricing and evaluation of all or any portion of the transactions contemplated by this Agreement DocuSign Envelope ID: EAE3745D -23C6- 4352- A3D7- 9903DCB5D084 may be deemed public records and subject to disclosure, in whole or in part, pursuant to the 'North Carolina Public Records Law. Company will provide WorkSTHTIS with prompt notice of any intended disclosures or requests for disclosure pursuant to the North Carolina Public Records Law and an appropriate opportunity to seek protection of the Confidential Information consistent with all applicable laws and regulations. Should a public records request be made for information WorkSTEPS claims is proprietary in nature, Company will, within a reasonable time, notify WorkSTEPS of such public records request. WorkSTEPS shall, within five (5) business days of said notification provide notice that it does or does not object to the Company disclosing the requested information pursuant to the subject public records request. If WorkSTEPS objects to the disclosure of the requested information, WorkSTEPS agrees that it shall be solely responsible for the defense of and the cost of defending any claim or complaint against the Company for its refusal to disclose Confidential Information. WorkSTEPS agrees that if any such complaint or claim is filed it will indemnify Company and will reimburse Company for any and all damages awarded against Company its refusal to disclose the requested information. WorkSTEPS agrees that it releases Company from all loss, liability, claims or expense, including attorney's fees, arising out of or related to the release or disclosure or failure by the Company to release or disclose Confidential Information. WorkSTEPS further agrees that it waives the right to file any court action for any such release, disclosure, or failure to release or disclose Confidential Information. 21. 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 intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. 22. Governing Law. 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. 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. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor identified, on the list created by the State Treasurer pursuant to G.S. 147 - 86.58. 23. Non- Appropriation. Provider and WorkSTEPS acknowledge that Company 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 Company's obligations under this Agreement, then this Agreement shall automatically expire without penalty to Company immediately upon written notice to Provider of the unavailability and non - appropriation of public funds. IN WITNESS WHEREOF, Orange County, WorkSTEPS and the Provider have signed this Agreement, effective as of the day first written above. THIS DAY OF 2018 E P Gt �OacuSigned by: L1 aaU4kr 382B33097218496... L:)Y. President Vitle: Peter Gallaher Printed Signature DocuSigned by: 0637994B755E477... Ay. County Manager I itle: Bonnie Hammersley 11nnted Signature DocuSign Envelope ID: EAE3745D -23C6- 4352- A3D7- 9903DCB5D084 DocuSigned by: �k 1F4E06�E07FE43A... !3'y'; VP National Contracting Title: David Engelhardt Printed Signature DocuSign Envelope ID: EAE3745D -23C6- 4352- A3D7- 9903DCB5D084 Exhibit 11111 Contract for Services For Job Analysis Bid Proposal Change County, NC. ( "Company ") understands that a job analysis must be completed in order to meet requirements for the Americans with Disabilities Act (ADA) so that Select Physical Therapy Holdings, Inc. and RehabClinics, Inc. for and on behalf of its subsidiaries and affiliates ( "Provider ") may perform post - offer and post employment testing pursuant to WorkSTEPS employment testing protocols. While the ADA does not require that a formal job analysis be conducted to determine the essential functions of a specific job position, the ADA does require an employer to prove that any exclusionary criteria obtained from a medical examination used to withdraw an offer of employment or terminate employment are "job related and justified by business necessity." (EEOC ADA 'Technical Assistance Manual II at 19 and VI at 2). Thus, the Provider must conduct a job analysis of the positions for which employment tests are performed to ensure that the employment test is measuring the candidate's or employee's ability to perform essential job functions. It is imperative that the Company provides accurate information to the Provider regarding the essential job functions for specific job positions. The EEOC provides a discussion relating to the identification of essential job functions in its Technical Assistance Manual. (EEOC ADA 'Technical Assistance Manual Il at 13-22). The Company acknowledges that the Company is responsible for familiarizing itself with this section of the ADA Technical Assistance Manual and providing the Provider accurate information concerning essential job functions. A separate job analysis must be performed for each position for which the Company desires to utilize employment testing. The job analysis may include filming, weighing, and measuring tasks for the selected major job positions for the Company. The Company understands that the evaluation usually takes between one (1) and six (6) hours to complete for each position and is billed at $150 per hour. The Company hereby authorizes Provider to provide said job analysis for each job position for which the Company will be requesting employment testing at the above referenced rate. I E D ocuSigned by: 6WAl (, Rmlkrt.Y'i� 0637994B755E477... —_- IV DocuSigned by: de � ��k 1F4E065E07FE43A... - - -- rroviner Kepreserlial(Vei I it +c 6/29/2018 Date 6/25/2018 Date DocuSign Envelope ID: EAE3745D -23C6- 4352- A3D7- 9903DCB5D084 "Attachment A" Description of Services Post Offer Testing to Include: Medical History — The job candidate is asked to complete a comprehensive medical history administered by an occupational healthcare professional that has been trained and certified in the WorkSTEPS Program. This history includes information gathering on previous injuries and/or surgeries, previous physical therapy /chiropractor visits, etc. The employee also signs a statement that falsification of the information he /she has provided could result in the withdrawal of the conditional job offer. Musculoskeletal Examination — A WorkSTEPS certified clinician completes this portion of the exam. The exam looks at all major joints and muscle groups. Thirty (30) baseline measurements are documented. The muscle groups are checked for strength as well as any atrophy. The shoulders, elbows, wrists, back, ankles, knees and hips are checked for signs of crepitus as well as ligament stability. In addition, the lumbar and the cervical spine is also checked. Flexion, extension, side bending and twisting are all measured. Visual inspection of the spine for signs of surgery is performed. Deep tendon reflexes of the biceps, triceps, patellar tendon and Achilles tendon are performed to further check for spinal cord proMenis. Shoulder range of .motion is checked and measured as well for movement in the internal and external national planes. The rotator cuff is also thoroughly checked. Static Grip - This portion of the tests measures grip strength and gathers baseline strength readings on the employee. Dynamic Lifting - This portion of the test gathers baseline, full motion, and strength readings. The employee is asked to lift a NIOSH box from 4 different positions. These 4 positions are lifting the box from floor to knuckle height, 12 inches off the floor to knuckle height, knuckle height to shoulder and shoulder to overhead. With each of these lifts, the employee is asked to lift the box. After the lift, they are asked if they can safely handle more weight. The employee is asked at the beginning to try and lift their maximum safe lift. The employee is shown and instructed on the proper lifting techniques for each of these Iifting positions. .lob Specific Tasks - This portion tests assesses the job candidate's ability to perform the essential functions of the job he /she is applying for. The essential functions for a job description are created through job analysis that is performed by a qualified vendor of the employer's choosing (this can be the WorkSTFPS Provider who will be providing testing service but is not required). The employer is obligated to participate in the job analysis process by approving and verifying that the essential functions have been properly identified and are accurate. Fit For Duty Testing As Part Of A Return To Work { IRTW') Program To Include: WorkSTI t'S will be conducting Fit- for -Duty (Post -Injury RTW) Tests on existing employees to include the following: • Any reported injury, illness, or condition that gives the employer reasonable belief that the employee's ability to perform essential jab functions will be impaired or create a direct threat to health and safety. • This category may also include testing at the request of the employer because, although there has been no formal injury or medical condition reported, the employer has observed current performance problems or has received reliable reports of performance problems indicating that the employee may not be able to perform essential job functions, or may pose a direct threat to the health and safety of the employee or others. DocuSign Envelope ID: EAE3745D -23C6- 4352- A3D7- 9903DCB5D084 ■ Even if the employee has fully "recovered" from injury or illness and no longer considers him or herself "injured", for documentation purposes the test should be identified as a "post- injury" fit for duty, or an injured worker, because that was the trigger for the test. • When testing an employee post-injury or illness the provider will: o Use the WorkSTEPS Fit for Duty Physical Capacity Consent Form o Use the WorkSTEPS Post injury Fit for Duty Medical History Interview o Not perform "routine" medical measures, including heart rate and blood pressure, that are not related to the injury or condition for which the employee is being seen, or that are not contributing to a job related fumctional deficit. o Not perform the standard "baseline" tests such as step test, Sorenson's or grip if they are not related to the injured area. o Perform only the dynamic lift postures that are considered qualifying criteria. o Perform any and all standard job specific tasks for the position, and expand to include any additional essential function tasks that could be impacted by their injury or condition. 16,0 ltiln t!. KALY�,t.t� 0379946755E477... L.ullipauy RuplG,mut lum JL dle DocuSignnefa edby: � � L�; 5.4kr 382693097218498... ►v vrko l nro rcepresentative /Title 6/29/2018 Date 6/25/2018 Date DocuSign Envelope ID: EAE3745D -23C6- 4352- A3D7- 9903DCB5D084 PATE (MMIDDiYYYYJ © CERTIFICATE OF LIABILITY INSURANCE 41212018 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 have ADDITIONAL INSURED provisions or 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 riiahts to the certificate holder in lieu of such endorsement(s). PRODUCER The Graham Company The Graham Building 1 Penn Square West Philadelphia PA 19102- INSURED SELEMED -01 -- - -- Select Physical Therapy Holdings, Inc. C/o Select Medical Corporation 4716 Old Gettysburg Road Mechanicsburg PA 17055 INSURERI§) AFFORDING COVERAGF NAIC ff =RA: Llbe Mutual Fire Ins. Co. _23035 -- 42404 =R A.- Libe Insurance Carpa_rafion MR C.- Columbia Casualty Company -RD: American Guarantee & Liability . -- _ - -- 31127 25247 :RE:. Allied World Assurance_Cumpany,_Ltd. {ROMICILEt? COVERAGES CERTIFICATE NUMBER: 1170875259 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. [NSR LTR TYPEaFiNSURANCE 111=SUBR POLICYNUMBER MMIIDIYYYY MMi� DIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACI -I OCCURRENCE $ CLAIMS -MADE n OCCUR PREMISES FaFoowrrenee $ MEO FXP (Any one person) $ PERSONAL $ RDV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 1:1 JECT PRO- LOG PRODUCTS - COMPIOPAGO $ $ OTHER: A AUTOMOBILE LIABILITY -1 AS2- 631- 5DM47•038 4/112018 4/7/209 Co-'al NF DSINGI.F.L.IMIT Ea acddenl $ 000 0 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPFRTYDAMAGE Per acclden $ HIRED NON-OWNF.O AUTOS ONLY AUTOS ONLY F UMBRELLA LIAB X OCCUR 0001445016 1213112017 12131/2018 EACH OCCURRENCE $25,006,000 X AGGREGATE $ 25,000,000 EXCESS LIAB CLAIMS -MADE BED I I RETENTION $ $ - B 0 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN WA7 -63D- 599047418 WC7 -630- 502047 -028 41112018 41112018 41112019 41112p19 X STATUTE FOR TH ANYPROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT $1,000,000 OFF ICE RfMEM 8ER EXCLUDED? ❑ N 1 A (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS belcw E.L. DISEASE - POLICY LIMn $1,000,000 C Excess General/Professlonal Llab. HMU 20662484s6 -i4 M112017 12I311201S See Helovi D Prapefty ZMM91783712 42!3112017 1213112018 See Beiew DFSCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 10t, Additional Remarks Schedule, may be attached it more space is required) EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE (CGL) -- $10M Each Occurrencel$10M Aggregate Limit EXCESS of $2M Self- Insured Retention; EXCESS PROFESSIONAL LIABILITY COVERAGE (PL) - $7M Each Clalml$7M Aggregate Limit Excess of $5M Self- Insured Retention; Both Coverages are subject to a $10M Policy Aggregate Limit. PROPERTY COVERAGE: $5,000,000 Limit for Unnamed /Unscheduled Locations; Specified Limits for Scheduled Locations. CERTIFICATE HOLDER CANCELLATION Select (Physical Therapy Holdings, Inc. dba Select Physical Therapy c/o Select Medical Corporation 4716 Old Gettysburg Road Mechanicsburg PA 17055 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE -i 0 9988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2096103) The ACORD name and logo are registered marks of ACORD