HomeMy WebLinkAbout2022-615-E-Health-UNC Family Medicine-Medical Director Services1
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NORTH CAROLINA FY 22-23
SERVICES AGREEMENT UNC FAMILY MEDICINE
ORANGE COUNTY
This Services Agreement (hereinafter “Agreement”), made and entered into this first day of
July, 2022, (“Effective Date”) by and between Orange County, North Carolina a body politic and
corporate of the State of North Carolina (hereinafter, the "County") on behalf of the Orange County
Health Department (hereinafter, “OCHD”) and The University of North Carolina at Chapel Hill
(hereinafter referred to as "Provider" or "University") on behalf of its Department of Family
Medicine in the School of Medicine, (hereinafter, the "Department").
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 the County for Medical
Director Services, including the professional “General Consultation” and “Clinical
Services” identified in Section 3, Basic Services, below.
ii) This Agreement also includes clinical supervision for licensed clinical social
workers.
iii) 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.
iv) Time is of the essence with respect to this Agreement.
v) 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
performance of these services. Provider is solely responsible for the professional
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quality, accuracy and timely completion and/or submission of all work related to
the Basic Services.
ii) 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.
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) Provider agrees that Provider, its employees, agents and its subcontractors, if any,
shall be required to comply with all federal, state and local antidiscrimination laws,
regulations and policies that relate to the performance of Provider’s services under
this Agreement.
vi) If activities related to the performance of this Agreement require specific licenses,
certifications, or related credentials Provider represents that it and/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.
3. Basic Services
a. Basic Services. The Services to be rendered pursuant to this Agreement are as follows:
i) General Consultation Medical Services. Medical Director Services provided by the
Department in accordance with appropriate medical standards, accepted methods
and procedures and shall include the following General Consultation Services:
1) Provide consultation, medical expertise, and technical assistance to the
OCHD Health Director and OCHD Personal Health Services Director to
support and advise the department’s medical/clinical programs and services.
2) Represent the OCHD, as deemed appropriate by the Health Director, with
community relations, including but not limited to, print media, TV and radio.
Serve as the OCHD liaison to the medical community at-large, including
hospitals and physician practices regarding public health issues.
3) Provide medical oversight and supervision to the Advanced Practice
Practitioners (3.5 FTE) employed by OCHD as required by the NC Board of
Medical Examiners. To the maximum practicable extent, OCHD shall include
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the medical director in the hiring process of APPs. As the hiring authority for
the Health Department, the health director shall consult the medical director
prior to any final hiring decisions. Should the medical director’s schedule not
permit participation and/or consultation, the health director shall consult with
the Chair of Family Medicine in the medical director’s absence or
unavailability. The health director and medical director or Chair of Family
Medicine shall mutually agree on the final hiring decision of an APP. If such
mutual agreement is not achieved, then this agreement shall terminate and any
payment due as of the date of termination shall be paid as provided in this
agreement.
4) Develop medical policies and protocols, in consultation with the Personal
Health Services Director, which conform to standards set by the North
Carolina Department of Health and Human Services (DHHS), and the U.S.
Department of Health and Human Services.
5) Sign protocols and standing orders that will allow professional working with
OCHD to utilize the optimum range of procedures/medical treatment legally
allowed by their Licensure Boards.
6) Provide 24/7 on-call consultation services for OCHD Communicable Disease
Programs.
7) Attend OCHD Leadership Team or Board of Health meetings as requested by
the Health Director.
8) Provide medical direction to the Communicable Disease Program via
meetings, TB Management and Outbreak Management.
9) Provide medical direction to school health programs in both school systems
in Orange County and medical consultation to both school and OCHD staff
working in or with school health programs.
10) Attend and complete required trainings to include but not limited to the NC
Department of Public Health (DPH) Annual Tuberculosis Symposium, Title
X Training, NC DPH Annual STD Update, etc.
11) Other miscellaneous duties as provided for in the agreement.
12) Discharge the above described responsibilities through and with prior
knowledge of OCHD Health Director.
ii. Clinical Services. The Medical Director Services provided by the Department shall
include Clinical Services in compliance with State and Federal guidelines,
program rules and all OCHD clinical practice guidelines and standards for all
Outpatient Clinics conducted by OCHD, including without limitation the following
OCHD Outpatient Clinics: Family Planning (FP), Prenatal Care (PNC), Child
Health (CH), Adolescent Health (ADOL), Tuberculosis (TB), Sexually
Transmitted Disease (STD), General Communicable Disease Control (GEN), Adult
Health Preventive Services (AH/HP), Primary Care (PC), and Refugee Health
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(RH). The Clinical Services provided by the Department shall include the
following:
1) Collaboration with OCHD to develop and approve protocols for Outpatient
Clinics. For the mutual benefit of the Department, OCHD, and its prenatal
patients, prenatal patients will be managed according to OCHD established
protocols. These protocols will be reviewed annually and will be developed
in a manner that attempts to be consistent with protocols used at UNC
Department of OB/GYN and Family Medicine outlying clinics.
2) Primary medical supervision of the Advanced Practice Practitioners (APPs)
who are employees of OCHD to include ongoing monitoring and evaluation
of the medical acts performed by the APPs. Meeting with APPs at least once
every six months to identify and document clinical problems, progress toward
improving outcomes and recommendations for changes in treatment plans.
Documentation of clinical issues discussed and actions taken will be signed,
dated, retained by the APP and physician and be available for review.
3) During the first six months of practice, meet with new APPs monthly to
discuss practice-relevant clinical issues and quality improvement measures.
Documentation of clinical issues discussed and actions taken will be signed,
dated, and retained by the APP and physician and be available for review.
4) Weekly case conference meetings with clinical staff at each site according to
an agreed upon schedule to discuss high-risk patient care, treatment changes,
and clinical operation issues.
5) Overall responsibility for medical residents and medical students working in
clinics. This includes orientation, supervision of practice and assurance of
compliance with OCHD program and documentation requirements. Advance
notice of medical resident and student placement will be made to the Personal
Health Director. Medical students are limited to those involved in special
projects with the Medical Director. All medical residents and students must
be in compliance with OCHD immunization requirements and maintain
documentation of such on file at UNC.
6) Provision of routine medical services during scheduled on-site times at
OCHD Outpatient Clinics, including documentation of Clinical Services,
follow-up on all labs, patient calls and medication refills for all Medical
Director Sessions provided per established OCHD protocols.
7) Medical consultation to OCHD APPs as needed when the Medical Director
is not on-site at OCHD outpatient clinics.
8) Continuing education consultation for OCHD APPs and other OCHD staff to
include regular informal consultation and periodic formal sessions as
appropriate.
9) After-hours medical consultation for patients of OCHD. UNC Health Care’s
HealthLink program provides initial triage of after-hours calls for all patients
with the exception of Prenatal Patients. The Department will provide Medical
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Director Consultation and supervision to OCHD clinicians (4 APPs) that
provide after-hours medical consultation (on a rotating basis) for OCHD
clients referred by HealthLink. The Medical Director shall also provide after-
hours medical consultation for HealthLink referred OCHD clients on a
rotating basis such that each of the 5 clinicians shall provide such after-hours
medical consultation 1 week every 4-5 weeks.
10) Discharge the above described responsibilities through and with the prior
knowledge of OCHD Health Director.
iii. Designation of a Medical Director. The Department shall provide, at a minimum,
the equivalent of .80 Full Time Equivalent (FTE) personnel to carry out the Medical
Director Services described in this agreement, including the General Consultation
and Clinical Services identified above.
1) Services shall be provided primarily by the “Medical Director” or a “back-up
Department physician.” The Medical Director shall be board certified in
Family Medicine or an equivalent certification. The Medical Director will
report activities and services performed for OCHD as requested by OCHD
Health Director.
2) The Chair of the Department shall, concurrent with the execution of this
agreement, designate the name of the Medical Director, and the names of up
to five Department physicians who will rotate as back-up Department
physicians, to be “available” to provide the General Consultation and Clinical
Services identified in this agreement, see Attachment A, Designation of a
Medical Director, which is hereby incorporated by reference.
3) The Department and OCHD shall indicate their mutual agreement to the
designation of the Medical Director and designated back-up Department
physicians available to be scheduled in the absence of the Medical Director
by signing the "Designation of Medical Director" which is attached to this
Agreement as Exhibit A and hereby incorporated by reference. Any changes
in these designations will be mutually agreed to by the Chair of the
Department and OCHD Health Director. In the event that the Medical
Director or any designated back-up Department physician becomes unwilling
or unable to perform the duties required by this Agreement, the Department
and OCHD shall attempt to mutually agree upon replacement(s). If such
mutual agreement is not achieved, then this Agreement shall terminate and
any payment due as of the date of termination shall be paid as provided below
in this Agreement.
4) Coverage. The Medical Director or designated back-up Department
physician shall provide a total of sixteen (16) hours per week of the foregoing
Clinical Services on-site at OCHD Outpatient Clinics or other sites as
provided therefore. Days and times and the identity of the person or persons
scheduled to be on-site to provide this coverage on behalf of the Department
will be mutually agreed to by the Department and OCHD. Although the
Department is not required to provide the attendance of a Medical Director or
back-up Department physician on the premises of OCHD outpatient facilities
or other sites provided therefore at other times, access should be made
available during other days and times as stipulated in this Agreement.
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5) Back-Up Coverage. Substitute coverage by a back-up Department physician
is expected during vacations and other anticipated absences of the Medical
Director or back-up Department physician originally scheduled to be
available. The Medical Director or designated back-up Department physician
shall be responsible for notifying OCHD of schedule changes. If attendance
as scheduled of the Medical Director or designated back-up Department
physician is impossible due to unremediable circumstances, phone coverage
of a designated back-up Department physician must be provided. In addition
to the foregoing described days and hours, at the request of OCHD Health
Director, the Medical Director or designated back-up Department physician
will provide on-site medical supervision at OCHD Outpatient Clinics or other
sites as necessary during communicable disease incidents or other public
health-related emergencies.
6) Substitutions in the scheduling of the Medical Director or designated back-up
Department physician will be the responsibility of the Department in
consultation with OCHD Health Director. Vacation leave, continuing
education, and other assignments requiring temporary back-up coverage will
be mutually agreed upon by the Chair of the Department and OCHD Health
Director.
iv. The Department will assure that the Medical Director and designated back-up
Department physicians are in, and maintain, compliance with OSHA guidelines
regarding bloodborne pathogens including Hepatitis B and TB status as well as
documentation of immunization against measles, mumps, rubella and varicella. In
the event of a bloodborne pathogen exposure, the Department will be responsible
for providing follow-up according to its policies and procedures governing
exposure incidents.
v. The Department will maintain current registration and licensure of the Medical
Director and designated back-up Department physicians and shall provide copies
to OCHD as appendices to the Designation of Medical Director attachment to this
Contract.
vi. Monthly one-on-one clinical supervision by a Mental Health Clinical Supervisor to
OCHD Licensed Clinical Social Workers (“LCSW”) providing behavioral health
and mental health services to OCHD clients, in order to enhance and support best
clinical skills and recommendations for the development of an integrated
behavioral health program. The Mental Health Clinical Supervisor shall provide
professional support, guidance, and review of LCSW practice and services to
clients with issues related to mental health, substance abuse and behavioral health.
4. Duration of Services
a. Term. The term of this Agreement shall be from July 1, 2022 to June 30, 2023, and shall
be renewable annually thereafter upon written notification executed by both parties.
b. Scheduling of Services.
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i) The Provider shall schedule and perform his activities in a timely manner.
ii) OCHD Outpatient Clinics are operational during the normal business hours of 8:00
A.M. to 5:00 P.M., Monday through Friday. On Wednesday, the clinics operate
from 10 AM – 5 PM. In addition, one weekday per site (Tuesday - Hillsborough;
Thursday - Chapel Hill) the Outpatient Clinics operate on a flexible evening
schedule (i.e. 9:30 AM – 6:30 PM) to provide greater access to care. Outpatient
Clinics may run beyond their scheduled time. In addition to the above-described
activities during the after-hours program, the Department is responsible for medical
activities conducted in the Outpatient Clinics in accordance with this agreement
during the entirety of the hours specified in this paragraph.
iii) Should the County determine that the Provider is behind schedule, it may require
the Provider to expedite and accelerate his efforts, including providing additional
resources and working overtime, as necessary, to perform his services in
accordance with the approved project schedule at no additional cost to the County.
iv) The Commencement Date for the Provider's Basic Services shall be July 1, 2022.
5. Compensation
a. Compensation for Basic Services. Compensation for Basic Services shall include all
compensation due the Provider from the County for all services under this Agreement
except for any authorized Reimbursable Expenses which are defined herein. The
maximum amount payable for Basic Services shall not exceed One Hundred Eight One
Thousand One Hundred Twenty Six and 40/100 Dollars ($181,126.40). In addition,
County shall pay Provider a 5.5% administration fee, which shall not exceed Nine
Thousand Nine Hundred Sixty One and 95/100 Dollars ($9,961.95). The maximum
amount payable under this contract for both Basic Services and the administration fee
shall not exceed One Hundred Ninety One Thousand Eighty Eight and 35/100 Dollars
($191,088.35) and shall be payable in equally monthly installments of Fifteen Thousand
Nine Hundred Twenty Four and 02/100 Dollars ($15,924.02).
b. The University shall invoice OCHD on a monthly basis with the first invoice being dated
July 1, 2022.
c. Payment for Basic Services shall become due and payable within thirty (30) days of
University properly invoicing the County. Any adjustments to the invoice shall be taken
into account in the next invoice or as soon thereafter as reasonably practicable.
d. 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 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.
e. 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.
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6. Responsibilities of the County
a. Cooperation and Coordination. The County has designated, the Health Director, to act
as the County's representative with respect to the Project and shall have the authority to
render decisions within guidelines established by the County Manager and/or the County
Board of Commissioners and shall be available during working hours as often as may be
reasonably required to render decisions and to furnish information.
b. OCHD agrees to furnish all supplies, equipment, office space and a computer as needed
by the Medical Director; to include the Medical Director in all appropriate conferences,
meetings, correspondence and publications necessary to appropriately discharge the
Medical Director's duties within budgetary constraints.
c. OCHD represents and warrants that it will provide such collaborative practice agreements
(“CPA(s)”) as may be necessary to comply with North Carolina laws related to the
medical oversight and supervision services provided hereunder.
7. Insurance
a. General Requirements. The University will be responsible for the negligence of its
employee and agents working under this Agreement to this extent of the North Carolina
Tort Claims Act. Further, the University shall provide adequate professional liability self-
insurance for the University and its personnel who provide services described in this
Agreement. The insurance limits will be stated in a Conformation of Insurance submitted
at the time this Agreement is commenced. The professional liability insurance shall cover
personal injury by the persons designated as Medical Director under this Agreement in
the amount of at least $1 million, per occurrence, $2 million aggregate.
b. Evidence of Insurance. Evidence of such insurance shall be furnished to the County,
together with evidence that each policy provides the County with not less than thirty (30)
days prior written notice of any cancellation, non-renewal or reduction of coverage.
8. Indemnity
a. Indemnity. The University will be responsible for the negligence of its employees and
agents to the extent of the North Carolina Tort Claims Act. 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.
10. Termination
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a. Termination for Convenience of the County. This Agreement may be terminated without
cause by the County and for its convenience upon ninety (90) days’ prior written notice
to the Provider.
b. Termination by Either Party. This Agreement or its renewals may be terminated at any
time without penalty by either party provided that the agreement is terminated either:
i) Upon failure of the parties to agree on a replacement Medical Director or
replacement designated back-up Department physician pursuant to paragraph 6 of
this agreement; or
ii) Upon delivery of written notice of termination furnished to the other party at least
ninety (90) days prior to termination.
c. 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 ninety (90) days' prior
written notice of its intent to terminate this Agreement for cause.
d. 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.
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.
e. 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.
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.
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,
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on the list created by the State Treasurer pursuant to G.S. 147-86.81.
c. Anti-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 anti-discrimination laws, policies, rules, regulations and the UNC-DH Anti-
Discrimination Policies. 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.
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. 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. Nondiscrimination. OCHD hereby agrees with the University that, in their educational
and/or employment practices, OCHD and the University will comply with such state and
federal non-discrimination laws as may be applicable to it in the performance of this
Agreement.
g. Conduct of Service. The Department shall abide by pertinent rules and regulations of
OCHD, Orange County, and the North Carolina Department of Health and Human
Services in the conduct of service.
h. Confidentiality. The University, the Department and OCHD shall comply with such
confidentiality laws as may be applicable in the performance of this Agreement and
acknowledge that in receiving, storing, processing or otherwise dealing with any
confidential information, they will safeguard and not further disclose the information
except as permitted by the Health Insurance Portability and Accountability Act of 1996,
Public Law 104-191, as amended.
i. 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.
j. 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
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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 and/or mandated
functions, by state and/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.
k. 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: Kimberlee Quatrone UNC Dept. of Family Medicine
300 West Tryon Street Attn: Margaret Helton
Hillsborough, NC 27278 590 Manning Drive
Chapel Hill, NC 27599
l. Signatures. This agreement may be executed in any number of counterparts, each of which
when executed and delivered shall constitute a duplicate original, but all counterparts
together shall constitute a single agreement. Counterparts of this Agreement, together
with any amendments or modifications, may be executed electronically. All electronic
signatures affixed hereto have the same legal force and effect as any wet or ink signatures
affixed hereto. All electronic signatures evidence the intent of the Parties to comply with
Article 11A and Article 40 of North Carolina General Statute Chapter 66.
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.
[SIGNATURE ON FOLLOWING PAGE]
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ORANGE COUNTY: PROVIDER:
By:
Bonnie Hammersley, County Manager
By:
Josephine Tetteh
Director, Office of Professional Service
Contracts and Affiliations
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal
Control Act:
Date:
Gary Donaldson, Finance Director
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11/29/2022
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ATTACHMENT A
Designation of Medical Director
Attachment to Contract between the Department of Family Medicine, University of North Carolina, School of Medicine and the Orange County Health Department for July 1, 2022 through June 30, 2023.
The following physicians are designated by the Department of Family Medicine to fulfill the terms of the attached contract:
Erica Pettigrew, MD Medical Director
Martha Carlough, MD Physician
Ashley Rietz, MD Physician
Morgan McEachern, MD Physician
Modjulie Moore, MD Physician
Sylvia Becker-Dreps MD Physician
Copies of current registration and licensure for these physicians are attached.
Signed:
Margaret Helton, MD, Chair
Department of Family Medicine Date
Agreed:
Quintana Stewart, Health Director
Orange County Health Department Date
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11/28/2022
Revised 06/21
ORANGE COUNTY—DEPARTMENT USE ONLY
______________________________________________________________________________
Party/Vendor Name: UNC Family Medicine Party/Vendor Contact Person: Andrew Olsson Contact Phone: 984-
974-4880 Party/Vendor Address: PO Box 168 City Chapel Hill State: NC Zip: 27514 Department: Health Amount:
$191,088.35 Purpose: Medical Director Services Budget Code(s): 10414020-630000-
71400/71403/71406/71409/71414/71416 Vendor # 21243 (N/A if new vendor) Vendor is a BOCC consultant?
Yes No Contract Type: (Check one) New Renewal Amendment Effective Date 7-1-22 Approved
by Board Yes No Agenda Date: 6-21-22 --- For Section XIV. c. contracts only, Approved by Board in Current
FY Budget Yes No
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:
Department Director’s Signature ________________________________________ Date: ________
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: Waiting on UNC signatures. Mandated services.
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 sufficiency of insurance standards, specifications, and requirements:
Office of the Risk Management Officer___________________________________ Date: _________
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer ____________________________________ Date: _________
Legal Services
This agreement is approved as to legal form and sufficiency:
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:_________
DocuSign Envelope ID: 7B7892E5-236C-41E4-ABE3-1D6C8E0B195C
11/28/2022
11/28/2022
11/29/2022
11/30/2022
CERTIFICATE OF COVERAGE
FOR
THE STATE OF NORTH CAROLINA
(For information purposes Only)
Certificate Holder: Public Officers & Employee Liability Insurance Commission
of North Carolina and the General Statutes of North Carolina, Chapter
143, Articles 31 to 31D, Sections §143-291 to § 143-300.
http://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_143/Article_31.html
http://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_143/Article_31A.html
Period: February 01, 2022 until February 01, 2023
Coverage: A)
B)
Tort Claims against Departments, Agencies, and Employees
Excess Liability for State Employees
Ambridge Partners, LLC – Policy # PK1035822;
Kinsale Insurance Company – Policy #0100154762-1
Limits A)
B)
$1,000,000 for Tort claims against the State
$2,000,000 per employee/$10,000,000 aggregate for claims
against state employees
Description: The State of North Carolina and its employees, officers, agents, as
covered by the Defense of State Employees as per NCGS § 143 300.2.
Administrator: Department Insurance - Risk Management Division
Public Officers & Employees Liability Insurance Commission
1202 Mail Service Center, Raleigh, NC 27699-1202
Note: This Certificate is for informational purposes only and does not alter any
provision of the Tort Claims or Defense of State Employees General
Statutes of the State.
Verified By:
Bryan Heckle, CIC, CPCU, CRM
Deputy Commissioner of Risk Management
POELIC Certificate
DocuSign Envelope ID: 7B7892E5-236C-41E4-ABE3-1D6C8E0B195C