HomeMy WebLinkAbout2021-339-Health-Logistics Health Inc-Facility Use Agreement DocuSign Envelope ID:3972E6CB-2728-4F85-9405-C3827B138ABF
ORANGE COUNTY GOVERNMENT
STATEMENT OF AGREEMENT FOR
THE USE OF COUNTY FACILITIES FOR COVID-19 TESTING AND VACCINATIONS
The Orange County Government, by and through its Orange County Health Department
(hereinafter, "Orange County") is dedicated to ensuring the appropriate and efficient distribution
of COVID-19 tests and vaccinations throughout Orange County. Logistics Health Inc.
(hereinafter, "Provider") has been contracted by the State of North Carolina to distribute COVID-
19 tests and vaccinations in North Carolina. Orange County has agreed to permit Provider to
perform testing and vaccination distribution services at the Orange County facilities identified in
this Agreement, and Provider wishes to cooperate with Orange County for such purposes.
The parties hereto mutually desire to reach an understanding that will result in making the
aforesaid Orange County facilities available to Provider for the aforesaid use. Now, therefore, it
is mutually agreed between the parties as follows:
1. Orange County agrees that it will permit the use of its physical facilities located at 300 West
Tryon Street, Hillsborough, North Carolina (hereinafter, the "Whitted Building") and at 2501
Homestead Road, Chapel Hill, North Carolina (hereinafter, the "Southern Human Services
Building") by Provider as vaccination distribution sites. Orange County further agrees that it
will permit use of the Southern Human Services Building by Provider as a COVID-19 testing
site. Orange County and Provider shall work together in good faith to establish the specific
dates and times during which Provider will provide testing and vaccination distribution
services throughout the term of this Agreement.
2. The term of this Agreement shall be June 2, 2021 until September 30, 2021. Thereafter, this
Agreement may be extended on a monthly basis by duly executed written amendment.
3. Provider shall conduct its activities at the Whitted Building and the Southern Human
Services Building in accordance with the terms of State of North Carolina Contract#30-
21232 and in accordance with applicable federal, state and local laws and regulations.
4. Provider will have primary responsibility for operation of the testing and vaccination
distribution sites and will designate an official, the Site Manager, to manage the testing and
vaccination distribution activities. Orange County will designate an individual, the Facility
Coordinator, to coordinate with the Site Manager regarding use of the facility by Provider.
Orange County and the Provider should remain in contact during operation of the facilities.
5. Provider is an independent contractor. 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.
6. 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
DocuSign Envelope ID:3972E6CB-2728-4F85-9405-C3827B138ABF
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 for all injuries or damages occurring to persons or
property in conjunction with the use of County buildings, grounds and parks.
7. 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.
8. Orange County and the Provider will complete a walk-through of the facility before it is
opened for use, noting any previous damages or issues. Before the Provider vacates the
facility, Orange County and the Provider will compete a walk-through of the facility to make
note of any damages caused as a result of Provider's operation of the facility that were not
previously present.
9. The Provider may post signs identifying the testing and vaccination distribution sites in
locations approved by the Facility Coordinator and will remove such signs when the
vaccination distribution site is closed. The Provider will not issue press releases or other
publicity concerning the testing and vaccination distribution sites without the express written
consent of the Facility Coordinator. The Provider will refer all media questions about the
testing and vaccination distribution sites to the Facility Coordinator.
10. 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).
The County's Risk Manager has further determined additional insurance coverage is
required, and such additional insurance shall consist of Professional Liability Insurance
(1 M/5M). Provider shall not commence work until such insurance is in effect and certification
thereof has been received by the County's Risk Manager. County shall be named as
additional insured on Provider's General Liability policy.
Signatures to the Agreement:
Orange County Government Logistics Health Inc.
DocuSigned by: DocuSigned by: �y,
Bonnie Hammersely, County Manager Brian Hafner, COO
6/4/2021 6/2/2021
Date Date
DocuSign Envelope ID:3972E6CB-2728-4F85-9405-C3827B138ABF
ORANGE COUNTY—DEPARTMENT USE ONLY
Party/Vendor Name: Logistics Health Inc. Party/Vendor Contact Person: Clifford Guest Contact Phone: 860-978-
1830 Party/Vendor Address: 328 Front Street South City La Crosse State: WI Zip: 54601 Department: Health
Amount: $00 Purpose: Facility Use Agreement Budget Code(s): N/A Vendor # N/A (N/A if new vendor)
Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one)New ® Renewal ❑ Amendment ❑
Effective Date 6-2-21 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:
DocuSigned by:
it ALtA Department Director's Signature sh" yf Date: 6/2/2021
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 sufficienc q L"Atwstandards,specifications,and requirements:
gusx (hvvdb 6/3/2021
Office of the Risk Management Officer 7FDCF9176800498 Date:
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act: DocuSigned by:
Office of the Chief Financial Officer el-taDate: 6/4/2021
Legal Services
This agreement is approved as t 00mc td sufficiency:
Qkk t, Aurit, Tmo 6/4/2021
Office of the County Attorney Date:
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
DocuSign Envelope ID:3972E6CB-2728-4F85-9405-C3827B138ABF
ATE
A�" CERTIFICATE OF LIABILITY INSURANCE D05/28/2021DIYYYv)
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 Enterprise Risk Financing&Insurance
Marsh USA Inc. NAME: p 9
333 South 7th Street,Suite 1400 AICNNo Ext: 952 936-1172 FAX No),
Minneapolis,MN 55402-2400 E-MAIL .comuh
Attn:Healthcare.AccountsCSS@marsh.com Fax:212-948-1307 ADDRESS: eis @ 9
INSURER(S)AFFORDING COVERAGE NAIC#
CN101631729--Cyber-20-22 INSURER A:Old Republic Insurance Company 24147
INSURED INSURER B:
LOGISTICS HEALTH,INC.
328 FRONT STREET SOUTH INSURER C
LACROSSE,WI 54601 INSURER D
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER: CHI-009853064-01 REVISION NUMBER: 1
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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DDIYYYY
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
DAMAGE TO CLAIMS-MADE1:1 OCCUR PREMISES
('a
a RENTED
) $
MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY❑ PRO-
POLICY ❑ LOC PRODUCTS-COMP/OP AGG $
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
Ea accident
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
L $
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
A CYBER LIABILITY MWZZ315407 05/01/2020 05/01/2022 EACH CLAIM 10,000,000
AGGREGATE 10,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
RE:STATE OF NORTH CAROLINA VACCINATION AGREEMENT
CERTIFICATE HOLDER CANCELLATION
ORANGE COUNTY GOVERNMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
ATTN:RISK MANAGER THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ORANGE COUNTY,NC,PO BOX 8181 ACCORDANCE WITH THE POLICY PROVISIONS.
HILLSBOROUGH,NC 27281-8181
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Manashi Mukherjee _lVi av�ao .h1J�K L
@ 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
DocuSign Envelope ID:3972E6CB-2728-4F85-9405-C3827B138ABF
ATE
A�" CERTIFICATE OF LIABILITY INSURANCE D05/28/2021DIYYYv)
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 Enterprise Risk Financing&Insurance
Marsh USA Inc. NAME: p 9
333 South 7th Street,Suite 1400 AICNNo Ext: 952 936-1172 FAX No),
Minneapolis,MN 55402-2400 E-MAIL .comuh
Attn:Healthcare.AccountsCSS@marsh.com Fax:212-948-1307 ADDRESS: eis @ 9
INSURER(S)AFFORDING COVERAGE NAIC#
CN101631729-ALL-GAWUP-21-22 INSURER A:Old Republic Insurance Company 24147
INSURED INSURER B:N/A N/A
LOGISTICS HEALTH,INC.
328 FRONT STREET SOUTH INSURER C:Travelers Property Casualty Company of America 25674
LACROSSE,WI 54601 INSURER D:
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER: CHI-009853058-01 REVISION NUMBER: 1
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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DDIYYYY
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
AMAGE TO TED
A CLAIMS-MADE � OCCUR MWZY315405 05/01/2020 05/01/2022 PREM SES(Ea occurrence) $ 1,000,000
MED EXP(Any one person) $ 2,500
PERSONAL&ADV INJURY $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
X POLICY❑ PRO-
JECT ❑ LOC PRODUCTS-COMP/OP AGG $ 4,000,000
OTHER: $
AUTOMOBILE LIABILITY COEaMBINED accident SINGLE LIMIT $ 5,000,000
A X ANY AUTO MWTB315404 05/01/2020 05/01/2022 BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
L $
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
C WORKERS COMPENSATION UB-6R864629-21-NC-T(AOS) 05/01/2021 05/01/2022 X PER OTH-
AND EMPLOYERS'LIABILITY STATUTE ER
C Y/N UB-6R80648A-21-NC-R(MA&WI) 05/0112021 05/01/2022 2,000,000
ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
C OFFICER/MEMBER EXCLUDED? N/'4 HWXJ-UB-472M4779-21 XWC OH 05/01/2021 05/01/2022
(Mandatory in NH) ( ) E.L.DISEASE-EA EMPLOYEE $ 2,000,000
If yes,describe under (SIR$2M-XWC OH) E.L.DISEASE-POLICY LIMIT $ 2,000,000
DESCRIPTION OF OPERATIONS below
A Managed Care Professional Liab MWZZ315406 05/01/2020 05/01/2022 Each Claim 10,000,000
Retro Date:1/1/77 Annual Aggregate 10,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
RE:STATE OF NORTH CAROLINA VACCINATION AGREEMENT/ADDITIONAL INSURED:ORANGE COUNTY GOVERMENT
THE GENERAL LIABILITY POLICY INCLUDES A BLANKET ADDITIONAL INSURED ENDORSEMENT FOR PERSONS OR ORGANIZATIONS WHERE THE NAMED INSURED IS OBLIGATED TO PROVIDE
SUCH STATUS BY WRITTEN CONTRACT OR AGREEMENT,ONLY TO THE MINIMUM EXTENT REQUIRED AND SUBJECT TO POLICY TERMS AND CONDITIONS.
CERTIFICATE HOLDER CANCELLATION
ORANGE COUNTY GOVERNMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
ATTN:RISK MANAGER THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ORANGE COUNTY,NC,PO BOX 8181 ACCORDANCE WITH THE POLICY PROVISIONS.
HILLSBOROUGH,NC 27281-8181
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Manashi Mukherjee _lVi av�ao .h1J�K L
@ 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD