The URL can be used to link to this page

Home My WebLink About2018-636-E Health - Advanced Dental service agreement 17-18 DocuSign Envelope ID: FE073E3E-A914-41CA-9713-D88EF600F829 [Departmental Use Only] TITLE ADA Hygenist Referral FY 2017-2018 ORANGE COUNTY CONTRACT UNDER $1,000.00 NORTH CAROLINA THIS AGREEMENT, made and entered into this 28th day of December, 2017, ("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 Advanced Dental Associates, Inc. (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 and/or construction (hereinafter referred to collectively as "Services") to be furnished under this Agreement are as follows: Provide Orange County Dental Department referrals at a rate of$35/day of licensed dental hygienists that have, or are willing to obtain,malpractice insurance. The term of this agreement rendered shall be from January 1,2018 to February 28,2018. 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 Seven hundred dollars, ($700). 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 Revised 10/17 1 DocuSign Envelope ID: FE073E3E-A914-41CA-9713-D88EF600F829 Risk Transfer Policy and Orange County Minimum Insurance Coverage Requirements (each document is incorporated herein by reference and may be viewed at http://www.orangecountync.gov/departments/purchasing division/contracts.php). If County's Risk Manager determines additional insurance coverage is required such additional insurance shall be designated here N/A (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, 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 in carrying out Provider's duties and obligations related to the Services to be provided in this Agreement. 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 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. Modifications may be evidenced by telefacsimile signature. 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 I IA and Article 40 of North Carolina General Statute Chapter 66. 8. Governing Law and Priority_: Both parties agree that this Agreement shall be governed by the laws of the State of North Carolina and Orange County. 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.oran ec�ountync. og v/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 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. 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. 147-86.81. By executing this Agreement Provider affirms Provider is and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. In determining the basic services to be provided, should any documents be referenced in or attached to this Agreement, the terms herein shall have priority in any conflict between the terms of referenced documents and the terms of this Agreement. 9. Dispute Resolution: Neither party may initiate binding arbitration. Any disputes shall be resolved by nonbinding mediation. 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. Revised 10/17 2 DocuSign Envelope ID: FE073E3E-A914-41CA-9713-D88EF600F829 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. [SIGNATURE PAGE TO FOLLOW] Revised 10/17 3 DocuSign Envelope ID: FE073E3E-A914-41CA-9713-D88EF600F829 IN WITNESS WHEREOF, Orange County and the Provider have signed this Agreement, effective as of the day first written above. ♦1►TJ"lr !",r%YT1LTTt7 OR Doeusigned ay: PR(_- oacusigned ay: w1"a s Sitwolkf [Ativ"� ex By. 5F... By' 0275802B878D488... Department Director Title: owner/staffing consultant 200 S. Cameron St. Advanced Dental Associates, Inc. P.O. Box 8181 11312 US 15-501 North, Suite 107-139 Hillsborough,NC 27278 Chapel Hill,NC 27517 Revised 10/17 4 DocuSign Envelope ID: FE073E3E-A914-41CA-9713-D88EF600F829 EriErie Insurance Exchange Erik Insurance Exchange Member • Erie Insurance Group 100 Erie Ins.PI. • Erie.PA 1653g Ultrapack Plus Policy Declarations Renewal Certificate Mailing Name and Address for insured: Other Interest: ADVANCED DENTAL ASSOCIATES INC 11312 US 15-501 NORTH STE 107-139 ' CHAPEL HILL NC 27517 153636705 JJ1089 Named Insured's Full Name: Advanced Dental Associates Inc. Agent: Policy Period: Policy Number: JJ1095 THE SORGI INSURANCE AGENCY INC 06/02/2017 to 06/02/2018 Q971310636 Agent Address and Phone THE SORGI INSURANCE AGENCY INC Policy begins at 12:01 A.M. standard time on the 16 CONSULTANT PL STE 102 effective date and ends at 12.01 A.M. standard DURHAM NC 27707-6313 time on the expiration date. Standard time is 919-682-4814 determined at the stated address of the named insured. The insurance applies to those premises described below. This is subject to all applicable terms of the policy and attached forms and endorsements. Premium Summary Pay Plan Discount Applies Total Annual Policy Premium: $.348.00 (This is not a bill. Your invoice will follow in a separate mailing.) Property Protection -As Per Attached Supplemental Declarations Deductible (Property Protection Only) $500 Policy-Level Coverages Liability Protection Limits of Insurance Commercial General Liability Limits of Insurance Each Occurrence Limit $1,000,000 Damage to Premises Rented to You $1,000,000 Any One Premises Medical Expense limit $5,000 Any One Person Personal&Advertising Injury Limit Excluded General Aggregate Limit $2,000,000 Products/completed Operations Aggregate Limit $2,000,000 Processed On:03/19/2017 (See Reverse Side) DocuSign Envelope ID: FE073E3E-A914-41CA-9713-D88EF600F829 Insured Name: Advanced Dental Associates Inc. Policy Number: Q971310636 Policv Period: 06/0212017 to 0610212018 Page 3 of 55 Supplemental Declarations Location 1 f Building 1 Address: Cccupancy]Operations: 2 CROSSWINDS ESTATES DR Employment Agency PITTSBORO NC 27312-8450 County: Chatham Interest of Named Insured In Such Premises: Homeowner Coverage Deductible Amount of Insurance Property Protection 1. Buildings NIL 2. Business Personal Property and Personal Property of Others Property Deductible $10,100 Replacement Cost Theft Exclusion Applies: No 3. Income Protection&Extra Expense Actual Lass Sustained 12 Months Automatic Adjustment of Business Persona[Property and Personal Property of Others Coverage —1% Property and inland Marine-Optional Coverages: Sewer and Drain Backup $500 $5,000 Utility Properties-Direct Damage $5,000 Schedule of Static Forms Form Number Edition Date description 1 LIP P, 01110 ULTRAPACK PLUS POLICY PK0001 02117 * ULTRAPACK PLUS COMMERCIAL PROPERTY COVERAGE PART PKAX 01110 PRODUCTION OR PROCESS MACHINERY- DEDUCTIBLE PKAY 12114 SEWER AND DRAIN BACK-UP COVERAGE PKBB 07/16 * UTILITY PROPERTIES - DIRECT DAMAGE CL0209 11110 IMPORTANT NOTICE -LEAD LIABILITY EXCLUSION CL0214 11110 * IMPORTANT NOTICE- POLICY SERVICE FEES CL0218 12115 * IMP NOTICE TO PROP INS POLHLDR-NO FLOOD, EARTHQUAKE, MUDSLIDE, MUDFLOW, LANDSLIDE, WNDSTRM, HAIL COV PKGP 01110 AMENDMENT OF MOBILE EQUIPMENT DEFINITION PKRE 01110 NORTH CAROLINA AMENDATORY ENDORSEMENT CL0459 07/16 * IMPORTANT NOTICE TO POLICYHOLDERS- ULTRAPACK PLUS PROGRAM PK0003 07116 * ULTRAPACK PLUS EXTRA LIABILITY COVERAGES CGO001 04113 COMMERCIAL GENERAL LIABILITY COVERAGE FORM CGO099 11/85 CHANGES IN GENERAL LIABILITY FORMS FOR COMMERCIAL PACKAGE POLICIES CG2138 11185 EXCLUSION - PERSONAL AND ADVERTISING INJURY CG2147 12107 EMPLOYMENT-RELATED PRACTICES EXCLUSION CG2167 12104 FUNGI OR BACTERIA EXCLUSION UFB213 11112 * SUBSCRIBER'S AGREEMENT CG2170 04115 CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM CG2196 03105 SILICA OR SILICA-RELATED DUST EXCLUSION PKGN 12114 PUNITIVE DAMAGES COVERAGE Processed On:03119/2017 (See Reverse Side) DocuSign Envelope ID: FE073E3E-A914-41CA-9713-D88EF600F829 ERIE.INSURANCE ULTRAPACK PLUS Ch-0214(Ed. I I/10) IMPORTANT NOTICE - POLICY SERVICE FEES NORTH CAROLINA, WEST VIRGINIA Dear Policyholder: SERVICE FEES-For policies effective on and after March 1,2008, the following service Fees will be applicable to all payment plans. ■ Returned Payment Fee-A$25.00 charge will be applied to your account if your check or other payment is returned unpaid by your financial institution. If you have any questions concerning this Important Notice,please contact your ERIE Agent. Page 5 of 55