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HomeMy WebLinkAbout2019-477-E DSS - Personalized Patient contract amendment DocuSign Envelope ID: FBCC2048-2774-4750-9EA4-440DA53C487A Contract 968-2036 Personalized Patient Home Assistance,Inc. Contract Amendment Orange County Department of Social Services Fiscal Year Begins July 1, 2018 Ends June 30, 2019 Contract#68-2036 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 Personalized Patient Home Assistance, Inc. (the"Contractor"),As provided for under the terms of the contract, The County and Contractor agree to amend the provision(s) indicated in Section II 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 Per11)73BC2FODOAA94BE DocuSigned by: Ice, Inc. ❑rai1�r, ocusigned by: rb{�AA k. arVttnP btn cwuS ik�MA. By: By: 3ES1B12B364B4 . Title: Agency director 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 Centrol Act. Attest: Docusigned by: Orange County NCp County: Slg nature: 7oaE51s1 ACC14o9. Title: Finance Director Date: 7/19/2019 Contract-Amendment(07/08) Page 1 of 1 DocuSign Envelope ID: FBCC2048-2774-4750-9EA4-440DA53C487A DocuSign EnvelaPe ID:A=4620-D9170.4228-932F-1 D499E51F8796 CERTIFICATE OF LIABILITY INSURANCE DAr�:g�lr+lr�n�rt' acCUMA for a > THI5;CERVTIFIOATEIS ISSLIED:ASA MA%TTERiOF IN FORMATtIJN'OIJCY AIVD'C77NFER8 NO RIGHTS gPoN THE Q.ERTIFtGATE HIOLDER:THIS:GERT1F.l AFE pS7fi8•NDT: AFFIRMATIVELY.OR:NEGATIVELY'AM ENS,WENVO1t:ALTER•THE,GdVE AdEAFFORDED-BYTHEPbOdl ES9ELOW',THIS0ERTIFICATE•of INSURANdE` OES NCT'C'oKSTIM.1-8 AbONTRACT BETVVEEILI'THSISSLIING INSURER SNAQTHORIZED RE 0 RES ENTAT(VS.0 R 0.ROWCER AMt)1H12 CEKT'IFI-0ATE-Hf=ER, IMPORTM- T;If 1."000.lflq�te' Qider,i§40 A�DDITI'ON4 044P lEP."' ls.po�idy{fa;S�u��ie��ddaSe� k�yi1BRaCATkb�tl�WAl11�O,.�l�t�f e�'to�Eh�'f�irk I, and aplitlltl�tis:otthp¢6iGy;ceCtairi Roticles tFiyregtllle, n v�darsemeht; On Opp rlol FbrlfeC;IgYI#'s3�lle egIate'liCTe�;ln.11e� grldal'senlflntf�f� RRD[1l10ER CDNYAofiOVIES4I IP0IE�SIlRaN[3Epd pli3�Y HANOVEf#E �E5 :8°6uRP US�,.IiVc', p�i�l ; i►c:fl�,E ,1�a19jxrs� 1:�: � e. o�a[ essa r - llb-�. 24.5p' E-AIL ApD,R$SS:ohHati�fmofa{cflfl4uri-OP00m 1)�lSll$FR� i 0R 1l�If 1 pA �tilC;# ills lhi=[7 fttAOR A l�nited 5�etes t iah311ty 1nsLTtehoe Corsi 'eny.2¢$9� ❑,ordhea Farrin kori INSURES B: - �_— Paii;didilzed Paflents.Hota:A•sslstahed INSURER : 1,99Oo'nGoid Qf li�,StlREl�D;, _ OhapelHiII,jN-C2751G lf�lsllR R.E'• _ — _. _ -- - ---.- •-. - _.---- :1I�ISl1 ER Ft cO�EI3A�E$ eE.T •IOA.E N[I.M$ER1. f EVISI( . 'lslUh+l l THl$:as T(5 ER7iFY TF(AT'{HE P I1pIt=5 OF.�1�517AA1!l� LISTED,BELflV�ii?kVkB Ell I�StJED-7 5 Tfi i[l l])tEq: a�B,-OyE'F*THE POPQ; PE��IhItjIEATEQ, �10 fUNTJk9TALVd1hlZ3 R Y•RLSQ�IIR-E�uIENT,T Rb9 QRfsal�i'I�1TP V 8F7Wi'ORNTRA T-'0R CNEik RO.CI<1lN0�(VI71 REBPWIT,'f! •iN7IrO TH�a+R CERTI*GR'TE•MA]'HE i!SWtb 0R•3!IA PERTAIN,TIDE IN�1).RMCE S4FFQRDEp B]!fH�$411�1E$66b IRkO REIN•I S.Su W3 Gt TO.- .T{v TEWO'.•'I�JL��,4!$1fS1!1�°PfJ GON IrTj*q n# $l� H.E441OIE6,ILII11]TS-ySHGWNMRY:FAVE BEEN REOL)6kW BY-1`A1¢QL,A S;, Apo =SLBR; POLICY'E POUMY •-' CTi! l F eOF-fl7i tiRaTJd INGR; .�NVo. p¢�lf .HLI]y19p3 {bllhl(�Ut1 S4•Y.S IrfA fRl 1. 11Mt�C ERGH'OOGI�RFHCE' xi,{IO7ARp; OENER91.LIABILITY p� X :pOMMEgcIAL PP4fE 9'AL LIA%WTY• Ea,.WU,p e) iabiti�u ME4:PV{AhFA*0.FEersQhl: S.e 2,vft L�his NfiJ 511R - -----__ - - PFRsf3blAkd-AkJ@llt� _ t;floGnd7.�_� 6�NFRAI'ktl-511IF"•+�TE'^ SSDa9;Utl0: GE_IJ.L,i"sG�F�RTE!�Mir•RPPI-IES.PeR{ •.'�3RV.CL�C�gMP'ICiP�AG� �ncbl2e q � x PDIICk �� tvty gl e��SIMi�LE m IT � AUTOMOBIL'IELIABILITY' 0, CIlO, rEj .IN1R��PeC;Personf. � U7 Llh{nlf�'`IPai=aL€1daRll S. PAWe _ t�cFI�'�aRE�€NCE n u�nB �1.PiUMa. 9 A'013RE01E EXtEGS 1.199 f1AIlv{3 NIAGE DED R�TEL+lTl4N F yyyyp WORKERS O.OMPEHSASiON .T9 A29D EhiR4OYEW LIABILITY Y'1 N F-L::ERGf1•A0W0FXT : ANY P-.R0PRlEr*APARTNPAJJE ECQT1LE TshA: W.R. EWlAJDED7` ❑ EI.pI EPSE Et>x Li3Y W.R. ea ory ..��FrtrtUdd, CR FI t�z1F PERAT1aN&lrelui4 E:I, diMtE-RbUCY 116ft EAt H'IMAM, 1 oD;Utia Nil'e0iiealttic;a Prpfassloi'nal. A14465!�197A. MV2018 7I7i2UIA AI�uA.�na�r�oA�� a�;g4on9a „pA l,la¢Illfy o�L1t�Y19LE:EnCH��s �a ESpYI seta I7F_'t]RER T ONSI[dC TION I.V NICLES 16ed atiedhed Aeord i0i'Iurad2ltlnnel lTe IIItZ flm . HWE HEALTH AIM =CELL&I ION RAAIGE C3DLryT1`' S _ -----• SFL411�4M l:eF TFI Aflc?�(E oCtiP�4f�Cl ¢rCAI �LD e �gii F'0.$0x�1;$1• 00RATI6N—,'PATE7HOOF.NOTJdJ) It$A PFPMISWIN li'�Rt S��ITI�TFI�; Ii.IL�513'O�'®l9GH,7VC'2�,27� pbi��P#+31+isi�Hs. AUTHOR(ZEQ REPRESENTATIVIE AOaRl].2 :(20 IBIAS)L Col?]+rlgt[ .1 a8,&-;�d1.0',ACOFIDr. .RPO .'fIf.7N' .I .i Iits to5erved: Tfte.]A ,I]nams'an$I'odv are reglsleca matfcs Af k,10 RD, DocuSign Envelope ID: FBCC2048-2774-4750-9EA4-440DA53C487A DocuSign E6velope ID:A07C4620-DgFO-4228-9B2F-ID499E5F8796 AWNC Y QMERA Ail A TIONAL S PIDI .-RE R,,M-A OHEWULE re g�6+ot I HA ' '-N0VSR EX-Ct 109 Q3-n6ctd Or AO 1505WA, 'Chingel HilljINV,27516 NAIC CODE AMITIONAL REJOARK-5 tFR8 ADDITIONAL 0MARK$FORM IS.A�50PEDVLE Tb AC0RI)):0RM,. FORMINI'VMBEER; AP ORD TORKTITLEJ F*#h4d&,.Adv!04'WINuN,W!I'(MY 00e WsOW*19000 M04150 Poqi a-Kft.Ph 9 Person) Qwb.w0JQ ROMISP!ReNOTO YqwM-..0R0.Promlos) ProdUct'siCoMofeted'bpeiriilb'ns A gtqfekiadt4t-. included A11'ed Hi5dih AbUssVblestaf)d�Eadh.balm Liffik 'each CUM Omit Annual-Ag.wspt,ellmlt' beduclibi� tv Morks 6f APqRP DocuSign Envelope ID: FBCC2048-2774-4750-9EA4-440DA53C487A DocuSign Envelope ID:A07C4620-D9F0-4228-9B2F-117499E5F8796 =(MWYY)CERTIFICATE OF LIABILITY INSURANCE This CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES MOT 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 iNS1,11RER(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 pro visions or be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certaln polloles may require an endorsement, A statement on this certificate does not confer rights to the certificate holder in ileu of such endorsement[s], CONTACT Carla Dubuc PRODUCER NAME: P O E Fax t y BB8 AIC Not 28D-1597 Sanrord insurance CeRter Nv ExS �919j 775'7218 E-MAIL 1722 S HORNER BLVD ADDRESS: INSURERIS]AFFORDING COVERAGE NAIL# SANFORD NC 27330 INSURERA; National Liability and Fire INSURED INSURER B 1 Personalized Patients Home Assistance,0BA:Dorathea Farrington INSURER C 70g Concord Or INSURER D: INSURER E Chapal HIII NC 27516 INSURER F: COVERAGES CERTIFICATE NUMBER: CLIB7904847 REVISION NUMBER: THIS CE A D. NOTTWITH TAND N EQ G ANY RUIREMENT,TERM OR CONDIT T ION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO THE INSURED NAMED ABOVE FOR THE L ICY PERIOD N WHICH THIS CERTIFICATE MAY BE ISSUED 0R MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SVBJECTToALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. AIJUL PO ICY EFF POLICY EXP LIMITS IL7R L. TYPE OF INSURANCE ipgD y,N❑ POLICYNVMBER MM70D MMEDRMn COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S DAMAGE T7lM74TeT-- CLAIMS-MADE F OCCUR PREMISES Ea occurrence $ MED EXP(Any one Ps—') $ PERSONAL&AOV INJURY GENERALAGOREGATE S G EN'L AG GRFGATE LIMI T APP L I ES PER: PRO LOC PRODUCTS-COMPIOPACjQ $ POLICY❑JECT $ OTHER! £e COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY neddiBODILY BODILY LY INJURY(Per person) $ ANYAUTO OWNED SCHEDULED BODILY INJURY(P a a"ldent) S AUTOS ONLY AUTOS PROPERTY DAMAGE $ HIRED NGN•OWNEC Aar acc`danl AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAO OCCUR EACH OCCURRENCE $ S EXCESS LIRB CLAIMS-A1AOE AGGREGATE S DED RETENTION 3 WORKERS COMPENSAMON STATUTE ER AND EMPLOYERS'LIABILITY y I Ts E.L.EACH ACCIDENT $ 1 DO,fl00 A ANY PROPRIEiORIPARTNERIEXECUTiVE ❑ NIA A9WC987430 07/05/2019 07105I2019 100,Ona OFFICER MEMUER EXCLLIDED7 E,L,D35EASE-EA EMPLOYEE $ (Mandatory In NH) 500,000 II yes,describe under E. DISEASE-POLICY LIMIT $ DFSCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS!VEHIGLES(ACORD J01,Addlllonal Rernarkc Schedule,may be attached If more NP¢ce 19 required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE.EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE PDL{CY PROVISIONS, Orange CountY DSS PO Box 6181 AU THORRff2jEA REPRESENTATIVE HIIlsboraugh NC 27278 +J 4�4& ©1968-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD