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HomeMy WebLinkAbout2021-036-E Social Svc-Main Street Clinical Associates client services DocuSign Envelope ID:AA423ADA-1537-48C8-B878-6300C79ABB63 [Departmental Use Only] TITLE Main Street Clinical Associates, PA FY 2020-2021 NORTH CAROLINA SERVICES AGREEMENT NO RFP/RFQ ORANGE COUNTY This Services Agreement (hereinafter "Agreement"), made and entered into this 1st day of July, 2020, ("Effective Date") by and between Orange County, North Carolina a political subdivision of the State of North Carolina (hereinafter, the "County") and Main Street Clinical Associates, PA, (hereinafter,the "Provider"). WITNESSETH: That the County and Provider, for the consideration herein named, do hereby agree as follows: 1. Services a. Scope of Work. i) This Agreement is for services to be rendered by Provider to County with respect to (insert type of project): psychological evaluations, parental competency evaluations, interpretitive sessions, and/or court testimony ii) By executing this Agreement, the 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. iii) Time is of the essence with respect to this Agreement. iv) The services to be performed under this Agreement consist of Basic Services, as described and designated in Section 3 hereof. Compensation to the Provider for Basic Services under this Agreement shall be as set forth herein. 2. Responsibilities of the Provider a. Services to be provided. The Provider shall provide the County with all services required in Section 3 to satisfactorily complete the Project within the time limitations set forth herein and in accordance with the highest professional standards. b. Standard of Care. i) The Provider shall exercise reasonable care and diligence in performing services under this Agreement in accordance with the highest generally accepted standards of this type of Provider practice. throughout the United States and in accordance with applicable federal, state and local laws and regulations applicable to the Revised 07/20 1 DocuSign Envelope ID:AA423ADA-1537-48C8-B878-6300C79ABB63 performance of these services. Provider is solely responsible for the professional quality, accuracy and timely completion and submission of all work related to the Basic Services. ii) Provider shall be responsible for all errors or omissions of its agents, contractors, employees, or assigns 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. iii) The Provider shall not, except as otherwise provided for in this Agreement, subcontract the performance of any work under this Agreement without prior written permission of the County. No permission for subcontracting shall create, between the County and the subcontractor, any contract or any other relationship. iv) Provider is an independent contractor of County. Any and all employees of the Provider engaged by the Provider in the performance of any work or services required of the Provider under this Agreement, shall be considered employees or agents of the Provider only and not of the County, and any and all claims that may or might arise under any workers compensation or other law or contract on behalf of said employees while so engaged shall be the sole obligation and responsibility of the Provider. v) If activities related to the performance of this Agreement require specific licenses, certifications, or related credentials Provider represents that it or its employees, agents and subcontractors engaged in such activities possess such licenses, certifications, or credentials and that such licenses certifications, or credentials are current, active, and not in a state of suspension or revocation. vi) In determining the Basic Services to be provided, should any documents be referenced in this Agreement, the terms of this Agreement shall have priority in any conflict between the terms of referenced documents and the terms of this Agreement. vii) Should this Agreement involve project designs, the construction or creation of which is to be bid out or fulfilled by other contractors, and bidding or negotiation with contractors produce prices which, when added to the other elements of the approved total project cost, produce a cost that is in excess of the approved total project cost, the Provider shall participate with the County in negotiation and design adjustments to the extent such are necessary to obtain prices within the approved total project cost. All activity of the Provider with respect to these matters shall constitute Basic Services and shall be performed by the Provider without additional compensation. If negotiation and design adjustments fail to bring costs within the total project cost the County may reject all bids and Provider will redesign or reduce portions of the project in an effort to reduce the bid prices to within the total project cost and rebid the project. One such redesign is included within Basic Services. If this second letting for bids does not produce bids that are within the approved total project cost initially or after negotiations with the contractor the cost is not reduced to an amount within the total project cost, the Provider is not obligated to engage in further redesign. Revised 07/20 2 DocuSign Envelope ID:AA423ADA-1537-48C8-B878-6300C79ABB63 3. Basic Services a. Basic Services. The Services to be rendered pursuant to this Agreement are as follows (fully describe services to be provided): b. To provide psychological testing and evaluations, parental competency evaluations, and interpretive sessions to identified Orange County Social Service clients involved with the Child Welfare Division. These evaluations will be provided to clients as required by Court Order or as determined necessary by Orange County Social Service Child Welfare Division to assist with permanency planning and well-being needs. A final report will be prepared and provided to Orange County Social Service which becomes a part of the County's case file and cannot be released by the Contractor without the expressed, written permission of the County. Court testimony will be provided only if a Contractor receives a subpoena to appear in Court. c. Provider rates are as follows: psychological evaluations $80/hour, parental competency evaluations $80/hour, preparation for and time traveling to court $80/hour, court testimony and time spent in the court room $200/hour. The number of hours per client will be authorized by Orange County Department of Social Services Program Manager. d. Written evaluations should be provided to Orange County Social Services no later than 30 days after the last scheduled appointment with the client. 4. Duration of Services a. Term. The term of this Agreement shall be from July 1, 2020 to June 30, 2021. b. Scheduling of Services. i) The Provider shall schedule and perform its activities in a timely manner. ii) Should the County determine that the Provider is behind schedule, it may require the Provider to expedite and accelerate its efforts, including providing additional resources and working overtime, as necessary, to perform its services in accordance with the approved project schedule at no additional cost to the County. iii) The Commencement Date for the Provider's Basic Services shall be July 1, 2020. 5. Compensation a. Compensation for Basic Services. Compensation for Basic Services shall include all compensation due the Provider from the County for all services satisfactorily (as determined by the County) performed pursuant to this Agreement. The maximum amount payable for Basic Services shall not exceed Six.Thousand Dollars Dollars ($6,000). Payment for satisfactorily performed Basic Services shall become due and payable within thirty(30) days of Provider properly invoicing County. Payment shall be subject to provisions of Section 5(b). b. Disputes. In the event the amount stated on an invoice is disputed by the County, the County may withhold payment of all or a portion of the amount stated on an invoice until the parties resolve the dispute. Should Provider fail to perform its duties under the Revised 07/20 3 DocuSign Envelope ID:AA423ADA-1537-48C8-B878-6300C79ABB63 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. c. Additional Services. County shall not be responsible for costs related to any services in addition to the Basic Services performed by Provider unless County requests such additional services in writing and such additional services are evidenced by a written amendment to this Agreement. 6. Responsibilities of the County a. Cooperation and Coordination. The County has designated (Crystal Mitchell) to act as the County's representative with respect to the Project who shall have the authority to render decisions within guidelines established by the County Manager or the County Board of Commissioners and who shall be available during working hours as often as may be reasonably required to render decisions and to furnish information. 7. Insurance a. General Requirements. 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 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 consist of 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. 8. Indemnity a. Indemnity. To the extent authorized by North Carolina law the Provider agrees, without limitation, to defend, indemnify and hold harmless the County from all loss, liability, claims or expense, including attorney's fees, arising out of or related to the Project and arising from property damage or bodily injury including death 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. 9. Amendments to the Agreement a. Changes in Basic Services. Changes in the Basic Services and entitlement to additional compensation or a change in duration of this Agreement shall be made by a written Amendment to this Agreement executed by the County and the Provider. The Provider shall proceed to perform the Services required by the Amendment only after receiving a fully executed Amendment from the County. Revised 07/20 4 DocuSign Envelope ID:AA423ADA-1537-48C8-B878-6300C79ABB63 10. Termination a. Termination for Convenience of the County. This Agreement may be terminated without cause by the County and for its convenience upon seven (7) days' prior written notice to the Provider. b. Other Termination. The Provider may terminate this Agreement based upon the County's material breach of this Agreement;provided,the County has not taken all reasonable actions to remedy the breach. The Provider shall give the County seven(7) days'prior written notice of its intent to terminate this Agreement for cause. Either party may terminate this Agreement upon notice to the other party that obligations pursuant to this Agreement are made impractical due to declarations of emergency by Orange County or by North Carolina due to events directly impacting Orange County. Both parties shall remain responsible for all payment and performance due up to the receipt of such notice, but shall have no further obligation or responsibility beyond that date provided the terminating party has taken all reasonable steps to complete the performance of its obligations. c. Compensation After Termination. i) In the event of termination, the Provider shall be paid that portion of the fees and expenses that it has earned to the date of termination, less any costs or expenses incurred or anticipated to be incurred by the County due to errors or omissions of the Provider. Upon request of the County, the Provider shall submit to County all relevant documentation, including but not limited to, job cost records, to support its claims for final compensation. ii) Should this Agreement be terminated, the Provider shall deliver to the County within seven (7) days, at no additional cost, all deliverables including any electronic data or files relating to the Project. d. Waiver. The payment of any sums by the County under this Agreement or the failure of the County to require compliance by the Provider with any provisions of this Agreement or the waiver by the County of any breach of this Agreement shall not constitute a waiver of any claim for damages by the County for any breach of this Agreement or a waiver of any other required compliance with this Agreement. e. Suspension. County may suspend the Basic Services and this Agreement at any time for County's convenience and without penalty to County upon three (3) days' notice to Provider. Upon any suspension by County,Provider shall discontinue work on the Basic Services and shall not resume the Basic Services until notified to proceed by County. 11. Additional Provisions a. Limitation and Assignment. The County and the Provider each bind themselves, their successors, assigns and legal representatives to the terms of this Agreement. Neither the County nor the Provider shall assign or transfer its interest in this Agreement without the written consent of the other. Revised 07/20 5 DocuSign Envelope ID:AA423ADA-1537-48C8-B878-6300C79ABB63 b. 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. 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. c. Non-Discrimination. 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 non-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.oranfzecounty!ic.gov/departments/purchasing division/contracts.php.) Any violation of the Orange County Non-Discrimination Policy 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. d. Dispute Resolution. Any and all suits or actions to enforce, interpret or seek damages with respect to any provision of, or the performance or non-performance of, this Agreement shall be brought in the General Court of Justice of North Carolina sitting in Orange County,North Carolina. It is agreed by the parties that no other court shall have jurisdiction or venue with respect to such suits or actions. Binding arbitration may not be initiated by either Party, however, the Parties may agree to nonbinding mediation of any dispute prior to the bringing of such suit or action. e. Entire Agreement. This Agreement represents the entire and integrated agreement between the County and the Provider and supersedes all prior negotiations, representations or agreements, either written or oral. This Agreement may be amended only by written instrument signed by both parties. Modifications may be evidenced by facsimile signatures. f. Severability. 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. g. Ownership of Work Product. Should Provider's performance of this Agreement generate documents, items or things that are specific to this Project such documents, items or things shall become the property of the County and may be used on any other project without additional compensation to the Provider. The use of the documents, items or things by the County or by any person or entity for any purpose other than the Project as set forth in this Agreement shall be at the full risk of the County. Revised 07/20 6 DocuSign Envelope ID:AA423ADA-1537-48C8-B878-6300C79ABB63 h. 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. It is expressly agreed that County shall not activate this non-appropriation provision for its convenience or to circumvent the requirements of this Agreement, but only as an emergency fiscal measure during a substantial fiscal crisis. In the event of a change in the County's statutory authority, mandate or mandated functions, by state or federal legislative or regulatory action, which adversely affects County's authority to continue its obligations under this Agreement, then this Agreement shall automatically terminate without penalty to County upon written notice to Provider of such limitation or change in County's legal authority. i. Signatures. 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 11A and Article 40 of North Carolina General Statute Chapter 66. j. Notices. Any notice required by this Agreement shall be in writing and delivered by certified or registered mail, return receipt requested to the following: Orange County Provider's Name Attention:Nancy Coston Main Street Clinical Associates, PA- Karen Yoch P.O. Box 8181 3326 Durham-Chapel Hill Blvd., Building C-Suite 320 Hillsborough,NC 27278 Durham,NC 27707 (SIGNATURE PAGE TO FOLLOW] Revised 07/20 7 DocuSign Envelope ID:AA423ADA-1537-48C8-B878-6300C79ABB63 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: DocuSigned by: DocuSigned by: By. By Bonnie Hammersley Katy Harper,President Printed Name and Title Revised 07/20 8 DocuSign Envelope ID:AA423ADA-1537-48C8-B878-6300C79ABB63 ORANGE COUNTY—DEPARTMENT USE ONLY Party/Vendor Name: Main Street Clinical Associates, PA Party/Vendor Contact Person: Katy Harper Contact Phone: 919-286-3453 Party/Vendor Address: 3326 Durham-Chapel Hill Blvd.,Building C-Suite 320 City Durham State: NC Zip: 27707 Department: Social Services Amount: $6,000 Purpose: psychological evaluations/court testimony Budget Code(s): 10400220-761005/10405020-768000 Vendor# 16258 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 7/1/2020 Approved by Board Yes❑No❑ Agenda Date: This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project has not been initiated prior to execution of the agreement: D cbSfbin. Date:ocuSigned by: Department Director's Signature 1/22/2021 NOUit.G� Agreements for emergency services or repair are not subject to the above affirmation. If services related to this agreement have already begun or been completed please briefly describe the nature of the emergency condition that was addressed: Information Technologies (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Management This agreement is approved for sufficient �aasN�a y:standards,specifications,and requirements: Office of the Risk Management Office it � Date: 1 21 2021 Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: DocuSigned by: 7' Office of the Chief Financial Officer (� 0osa..lti Date: 1/26/2021 Legal Services This agreement is approved as ty4egaicftxmd=d sufficiency: Office of the County Attorney �' Date:1/26/2021 Clerk to the Board Received for record retention: All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync.gov The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: Revised 07/20 9 DocuSign Envelope ID:AA423ADA-1537-48C8-B878-6300C79ABB63 Psychological and Parental Competency Evaluations Psychological evaluations are performed to assess a client's current mental status, personality functioning, and to clarify diagnoses so that appropriate treatment and service recommendations can be made.When psychological evaluations are being Court ordered for parents who have come to the attention of the Court system due to allegations of abuse and neglect,the referring party generally requests information about a parent's ability to care for their child or children now and in the future and for recommendations regarding the services necessary to help the parent be able to do so. Psychologists commonly ask for as much information as is relevant to review to address the medical/mental health/substance abuse/legal issues that impact a client through completion of a referral form and copies of Court documents, social services'records regarding the individual parent and their children,previous psychological evaluations,mental health assessments, treatment summaries,hospital discharge summaries, social service case notes, criminal records, substance abuse evaluations, drug screens, and so forth. Following a review of these records and in consultation with the referring social worker,the psychologist schedules an appointment with the client. When I meet with a client,I ask him or her to sign a 3-page Informed Consent for Psychological Evaluation Form, and now, an Addendum related to Covid-19. Then I administer the particular psychological tests that will be most helpful in answering referral questions and understanding the particular individual I am evaluating. For example, I will administer tests regarding a client's intellectual functioning(e.g.,Reynolds Intellectual Assessment Scale)if there are concerns that the person cannot comprehend well and appears to be intellectually limited or disabled. I administered reading screening forms for clients who have learning problems and might not be able to accurately read the tests that I would administer so I can assure their literacy. I administer personality and other diagnostic tests(e.g., MMPI-2; MCMI-IV, Rorschach Inkblot Test,Rotter Incomplete Sentences Blank,Burns Depression Checklist,ADHD checklists,Burns Anxiety Inventory,Domestic Violence Checklist, PTSD questionnaires)to clarify diagnoses and issues relevant to understanding the client. I then must spend time scoring most of these tests to obtain valuable information derived from research and experience. If there are substance abuse issues,I administer substance abuse questionnaires regarding alcohol and drug abuse. The psychological evaluation is performed to assess a parent's capacity to parent and/or parenting issues and needs also includes tests such as the Parenting Stress Index-4, a Parenting Role Questionnaire, and specific questions regarding each of their children and the concerns and issues which brought them to the attention of social services. The psychological evaluation also includes a comprehensive interview during which the parent's family history, education, work,medical, legal, substance abuse,relationships (i.e., DocuSign Envelope ID:AA423ADA-1537-48C8-B878-6300C79ABB63 2 partners, children), substance use/abuse, and psychiatric symptoms and treatment history are reviewed. The interview and testing portion of the psychological evaluation for adult parents typically requires between 4-6 hours. Sometimes I am able to observe parents during a supervised visit with their child(ren)—a requirement for a formal Parenting Capacity Evaluation. Moreover, consultation with other providers is often necessary to obtain a thorough understanding of the child/adolescent or adult client.Phone calls to current treatment providers and evaluators,parent educators, case managers,psychiatrists and so forth are often needed, particularly for formal Parental Capacity Evaluations. Adolescents can usually be assessed within a 3-4 hour session. When adolescents are evaluated,the psychologist must also obtain previous records,including mental health treatment records, court and social services records,previous psychological evaluations, school records including testing, and so forth. Caretakers are typically asked to complete history forms and symptom checklists such as the Vanderbilt, as well as sitting down for interviews. The child/ adolescent client is also administered cognitive, academic and personality tests (e.g., RIAS, Millon Adolescent Clinical Inventory, Rorschach,High School Incomplete Sentences Blank, Thematic Apperception Test) and interviewed as well. This Provider documents the referral information at the beginning of the Psychological Evaluation,including the referral questions and issues. The report itself contains sections related to the client's history(see above), a section titled"Clinical Impressions"which pulls together all available information into a summary of the client's issues,personality traits,psychiatric symptoms, family of origin issues and the impact on his/her relationship with romantic partners and his/her children(e.g., attachment issues), and so forth. The final section is titled, "Conclusions and Recommendations,"in which the diagnoses are listed, along with appropriate treatment(e.g.,individual therapy, substance abuse treatment groups,residential treatment) and service recommendations (e.g.,parenting classes, anger management classes). Completion of Reports I make every effort possible to complete and deliver the evaluations within a two week period of time after the interview and testing session. I charge$80 per hour for time spent completing the evaluations and interpretive sessions. I recommend authorizing 20 hours for psychological evaluations and 30 hours for parental competency evaluations. I recommended authorizing 4 hours for interpretive sessions (which includes preparing for the session,travel to and from the agency, a one hour interpretive session with the client and social worker, and any extra time should unforeseen delays occur or if the session runs over). Interpretive Sessions Following completion of the Psychological Evaluation and/or Parenting Capacity Evaluation,this provider is often asked to offer interpretive sessions to clients, adult and adolescents (or their parents), to review the basis of my recommendations and to answer questions a client might have about the results. To prepare for the interpretive session, I must review the psychological evaluation, obtain an update of the client's current status,particularly if DocuSign Envelope ID:AA423ADA-1537-48C8-B878-6300C79ABB63 3 a good deal of time has passed, and then will meet with the client and his/her social worker (sometimes the client also asks for his/her attorney or therapist to attend)to review the test results, clinical impressions, and rationale for the recommendations made. These sessions generally last one hour and the preparation time varies depending on the client. Court Testimony This Provider is also subpoenaed to testify at Court to explain the psychological evaluations and/or parental competency evaluations to the Judge anywhere from several months to several years after the completion of the evaluations. The Court hearings in which I am subpoenaed are generally those in which decisions will be made regarding the termination of the parent's parental rights. To prepare for court, I must summarize and organize my often 20-30 page single-spaced report, so that I can be responsive to questions from the social service's attorney,the client's attorney,the other parent's attorney, along with the GAL attorney. Often I must spend time on the phone in consultation with the social services'attorney who has subpoenaed me a well. I charge$200/hour for court testimony, as well as all time spent in the court room, including for my actual court testimony. I will charge the$801hour for court preparation time and transportation to and from Court. Karin A.Yoch, Ph.D. Licensed Psychologist—#827 Main Street Clinical Associates, PA 3326 Durham-Chapel Hill Boulevard Building C, Suite 230 Durham,North Carolina 27707 (919)286-3453 (919)286-7033 (fax) (919) 599-0577 (cell) DocuSign Envelope ID:AA423ADA-1537-48C8-B878-6300C79ABB63 AC n ® DATE(MM/DD/WYY) CERTIFICATE OF LIABILITY INSURANCE 08/05/2020 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME:Trust Risk Management Services,Inc PHONE FAX Trust Risk Management Services,Inc.doing business in NC as Potomac A/C,No,Ext:877.637.9700 (A/c,No):877,251.5111 Risk Management Services, Inc. EMAIL 1791 Pas here Circle ADDRESS:info@trustrms.com y p INSURERS AFFORDING COVERAGE NAIC# Chicago,IL 60674 22667 INSURER A:ACE American Insurance Company INSURED INSURER B: Karin Yoch INSURER C: 3326 Durham Chapel Hill Blvd INSURER D: Bldg C,Suite 230 INSURER E: Durham, NC 27707 2600 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 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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDD/YYYY) (MM/DO/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED $ CLAIMS MADE OCCUR PREMISES(Ea occurrence) MED EXP(Any one person) $ PERSONAL&ADV INJURY $ M'OTHER: L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ JECTPRO- PRODUCTS—COMP/OPAGGPOLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per Person) $ ALL OWNED SCHEDULED $ AUTOS AUTOS BODILY INJURY(Per accident HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ Per accident OS UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION PER OTH- $ AND EMPLOYERS LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE❑ $ (Mandatory in NH) If yes,describe under $ E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS below Psychologist's Professional 88G22354991 06/01/2020 06/01/2021 Each Incident $1,000,000 A Liability Annual $3,000,000 Aggregate DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required): CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE Orange County Government DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 Hillsborough, NC,27275 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD