HomeMy WebLinkAbout2019-476-E DSS - MediSolutions contract amendment DocuSign Envelope ID:3B617C6F-5AC0-46E6-B1CC-3E58D8A37545 Contract#68-2039
Medisolutions, Inc.
Contract Amendment
Orange County Department of Social Services
Fiscal Year Begins July 1, 2018 Ends June 30, 2019
Contract#68-2039
Amendment#1
SECTION I
Agency: Orange County Department of Social Services
Program: In-Home Aide Services
Effective Period of the Contract: July 1, 2018-June 30, 2019
This Contract Amendment amends the contract between the Orange County Department of Social Services(the"County")and
Medisolutions, Inc. (the"Contractor"). As provided for under the terms of the contract, The County and Contractor agree to
amend the provisions) indicated in Section 11 below.
SECTION II
Justification/Change to Contract:
3. Effective Period. This Agreement shall be effective July 1, 2018 through September 30, 2019.
SECTION III
All other terms and conditions set forth in the original contract shall remain in effect for the duration of the contract. The
contract specified above is amended by this Contract Amendment effective May 20, 2019.
Contractor County
Meg OocuSigned by: Ora1r,
DocuSigned by:
By' OC86E1OAE89C478.. By: 3ES1B12B364B4 .
Title: ceo Title: Deputy County Manager
Date:
7/18/2019 Date: 7/19/2019
This agreement has been preaudited in the manner required by the Local Government Budget and Fiscal Control Act.
Attest: DocuSigned by:
Orange County NCp
County: Signature:
704E51S1ACC1409.
Title:
Finance Director Date: 7/19/2019
Contract-Amendment(07/08) Page 1 of 1
DocuSiggn Envelope ID:3B617C6F-5AC0-46E6-B1CC-3E58D8A37545
DDcuSign Envelapa ID:3E4B4B91-8AA8-4IUB-8584-11AAEUCt3t;03
DATE IMWDD/YYYYI
AC(:?& CERTIFICATE OF LIABILITY INSURANCE 7/2412 0 1 8
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($),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT; If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)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 rights to the certificate holder In Ileu of such endorsements.
PRODUCER NAME: Ronald Morgan
Morgan&Associates LLC-GA e,No EA : 7708617509 a ko: 1-866-713.6171
PO Box 456 ADDRESS; dtnorgan®maginsurance,com
INSURER(S)AFFORDING COVERAGE NAIC9
Kennesaw GA 30156 INSURER A� SVANSTON INS CO 35378
ENSURED INSURER B:
Medisoultlon INSURER C
100 N Church ST INSURER D
INSURER E
Btirlington NC 27217 INSURER F;
COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR OTHER DCCUMENT WITH RESPECTTO 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,
PULTCY FIFF POLICY LAP
NS LTRTYPE OF INSURANCE INaDALPLIL I Dr POLICY NUMBER _ MM7DO YYY] MMIDDfYYYY LIMRS•
�( COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
X CLAIMS-MADE FI OCCUR PREMISES Wa occurrence] S 100,000
MEO EXP(Any one person) $ 5,000
A NP343324 07/15/2018 07/15/2019 PERSONAL&AOV INJURY $ 1,000,000
GFN%AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE S 2,000,000
}� POLICY JCRC El LDC PRODUCTS-COMPfOP AGO $ 1,000,000
OTHER: S exual and Phydoal Abus S 1,000,000
cam
AUTOMOBILE LIABILITY Ea aocldenl S
ANY AUTO BODILY INJURY[Per person] S
OWNED SCHEDULED BODILY INJURY(Per amlderiO $
AUTOS ONLY AUTOS
HIRED NON-OWNED [Per accldant $
AUTOS ONLY AUTOS ONLY
$
UMBRELLA LIAR HOCCUR EACH OCCURRENCE: S
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DEO RETENTION$ _ S
WORKERS COMPENSATION ISTWTUTE I I ER
AND EMPLOYERS'LIABILITY Y f N
NY PROPRIETORIPARTNERIEXECUTIVE❑ NIA A L.L.EACH ACCIDENT $
FFICERIMEMBER EXCLUDED? E,L,DISEASE-EA EMPLOYEE
S
Mandatary is NH]
yyea,dmcdba under
ESCRIPTION OF OPERATIONS below E.L.DISEASE.POLICY LIMIT ;
A Sexual Misconduct/Molestation/Abuse NP343324 07/15/2018 07/15/2019 $1,000,000
DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (ACORD 101,AddijIanal Remarks SeliaduIo,may ba RNa(:had I[mom apace is required]
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Orange County Goverment ACCORDANCE WITH THE POLICY PROVISIONS.
P.O.Box 8181 AUTHORIZED REPRESENTATIVE
0on64J Morgan.
11E11sbornugU,NC 27278
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