HomeMy WebLinkAbout20250018.tiffResolution
Approve Professional Service Agreement and Addendum for Cancer Screening
and Tuberculosis Imaging Services for Women's Wellness Connection Program,
and authorize Chair to sign — Radiology Imaging Associates, P.C.
Whereas, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
Whereas, the Board has been presented with a Professional Service Agreement and
Addendum for Cancer Screening and Tuberculosis Imaging Services for the Women's
Wellness Connection Program between the County of Weld, State of Colorado, by and
through the Board of County Commissioners of Weld County, on behalf of the Department
of Public Health and Environment, and Radiology Imaging Associates, P.C., commencing
January 1, 2025, and ending December 31, 2025, with further terms and conditions being
as stated in said agreement and addendum, and
Whereas, after review, the Board deems it advisable to approve said agreement and
addendum, copies of which are attached hereto and incorporated herein by reference.
Now, therefore, be it resolved by the Board of County Commissioners of Weld County,
Colorado, that the Professional Service Agreement and Addendum for Cancer Screening
and Tuberculosis Imaging Services for the Women's Wellness Connection Program
between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Public Health and
Environment, and Radiology Imaging Associates, P.C., be, and hereby are, approved.
Be it further resolved by the Board that the Chair be, and hereby is, authorized to sign
said agreement and addendum.
The Board of County Commissioners of Weld County, Colorado, adopted the above
and foregoing Resolution, on motion duly made and seconded, by the following vote on
the 6th day of January, A.D., 2025, nunc pro tunc January 1, 2025:
Perry L. Buck, Chair: Aye
Scott K. James, Pro-Tem: Aye
Jason S. Maxey: Aye
Lynette Peppler: Aye
Kevin D. Ross: Aye
Approved as to Form:
Bruce Barker, County Attorney
Attest:
Esther E. Gesick, Clerk to the Board
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2025-0018
HL0058
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BOARD OF COUNTY COMMISSIONERS
PASS -AROUND REVIEW
PASS -AROUND TITLE: WOMEN'S WELLNESS CONNECTION AND TB IMAGING SERVICES
DEPARTMENT: PUBLIC HEALTH AND ENVIRONMENT DATE: DECEMBER 12, 2024
PERSON REQUESTING: JASON CHESSHER, EXECTUIVE DIRECTOR
SHAUN MAY, PHS DIVISION DIRECTOR
Brief description of the problem/issue:
This contract establishes a partnership between the Weld County Department of Public Health and
Environment and Radiology Imaging Associates P.C. to provide timely and comprehensive imaging services
for clients in the Women's Wellness Connection (WWC) and Tuberculosis (TB) Prevention programs. The
collaboration supports early detection, accurate diagnosis, and appropriate treatment referrals for breast and
cervical cancer among uninsured and underinsured women, as well as for suspected TB patients in our
community.
The contract covers the radiology portion of the imaging services essential for program goals, including
mammograms, X-rays, ultrasounds, and MRI (if applicable), as well as chest X-rays for TB diagnosis and
monitoring. It also includes interpretation and reading of imaging results by qualified radiologists to ensure
accurate and timely reporting. Separate contracts address surgical biopsy procedures and pathology services.
What options exist for the Board?
1. Approve the contract to ensure timely and comprehensive imaging services for WWC and TB
Prevention programs.
2. Request modifications to the contract before approval.
3. Decline to approve the contract.
Consequences:
If Approved: Eligible clients will have access to critical imaging services, facilitating early
detection and diagnosis of breast, cervical, and TB -related conditions, and enabling timely
treatment and referrals.
If Not Approved: Delayed access to imaging services could hinder program effectiveness,
potentially resulting in poorer health outcomes for vulnerable populations. Additionally, failure to
satisfy deliverables outlined in the grant programs could jeopardize current and future grant
funding for the Women's Wellness Connection and Tuberculosis Prevention programs.
Impacts:
This contract will improve access to vital imaging services for individuals with limited or no access to
healthcare, supporting early detection and timely diagnosis for breast, cervical, and TB -related
conditions, and enhancing program effectiveness.
Costs (Current Fiscal Year / Ongoing or Subsequent Fiscal Years):
Annual costs are expected to align with program utilization rates and approved budget allocations.
Activities will be conducted by current staff; no additional FTE is being requested.
Recommendation: I recommend approval to place this contract with Radiology Imaging Associates P.C. on a
future BOCC agenda for formal consideration.
2025-0018
Li<Sn
Support Recommendation Schedule
Place on BOCC Agenda Work Session Other/Comments:
Perry L. Buck, Pro-Tem
Mike Freeman
Scott K. James
Kevin D. Ross , Chair
Lori Saine
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PROFESSIONAL SERVICE AGREEMENT BETWEEN WELD COUNTY AND
RADIOLOGY IMAGING ASSOCIATES P.C.
THIS AGREEMENT is made and entered into this 1st day of January 2025, by
and between the Board of Weld County Commissioners, on behalf of WELD COUNTY
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT, hereinafter referred to as
"County," and RADIOLOGY IMAGING ASSOCIATES P.C., hereinafter referred to as
"Contractor".
WHEREAS, County desires to retain Contractor to perform services as required
by County and set forth in the attached Exhibits; and
WHEREAS, Contractor is willing and has the specific ability, qualifications, and
time to perform the required services according to the terms of this Agreement; and
WHEREAS, Contractor is authorized to do business in the State of Colorado and
has the time, skill, expertise, and experience necessary to provide the services as set
forth below.
NOW, THEREFORE, in consideration of the mutual promises and covenants
contained herein, the parties hereto agree as follows:
1. Introduction. The terms of this Agreement am contained in the terms recited in this
document and in the attached Exhibits, each of which forms an integral part of this
Agreement and are incorporated herein. The parties each acknowledge and agree
that this Agreement, including the attached Exhibits, define the performance
obligations of Contractor and Contractor's willingness and ability to meet those
requirements (the "Work"). If a conflict occurs between this Agreement and any
Exhibit or other attached document, the terms of this Agreement shall control, and
the remaining order of precedence shall be based upon order of attachment.
2. Service or Work. Contractor agrees to diligently provide all services, labor,
personnel, and materials necessary to perform and complete the Work described
in the attached Exhibits.
Exhibit A consists of an Addendum for Professional Services Contract
Exhibit B consists of a Banner Universal Voucher.
3. Term. The term of this Agreement begins upon the date of the mutual execution of
this Agreement and shall continue for one-year. Both parties to this Agreement
understand and agree that the laws of the State of Colorado prohibit County from
entering into Agreements which bind County for periods longer than one year. This
Agreement may be extended upon mutual written agreement sixty (60) days before
the termination of the agreement.
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4. Termination; Breach; Cure. County may terminate this Agreement for its own
convenience upon thirty (30) days written notice to Contractor. Both parties shall
have the right to terminate this agreement, without cause, by giving at least ninety
(90) days written notice. Either Party may immediately terminate this Agreement
upon material breach of the other party; however, the breaching party shall have
fifteen (15) days after receiving such notice to cure such breach.. County shall be
entitled to the use of all material generated pursuant to this Agreement upon
termination. Upon termination of this Agreement by County, Contractor shall have
no claim of any kind whatsoever against the County by reason of such termination
or by reason of any act incidental thereto, except for compensation for professional
services performed.
5. Extension or Amendment. Any amendments or modifications to this agreement
shall be in writing signed by both parties sixty days before the termination of the
agreement. No additional services or work performed by Contractor shall be the
basis for additional compensation unless and until Contractor has obtained written
authorization and acknowledgement by County for such additional services.
Accordingly, no claim that the County has been unjustly enriched by any additional
services, whether or not there is in fact any such unjust enrichment, shall be the
basis of any increase in the compensation payable hereunder. In the event that
written authorization and acknowledgment by the County for such additional
services is not timely executed and issued in strict accordance with this Agreement,
Contractor's rights with respect to such additional services shall be deemed waived
and such failure shall result in non-payment for such additional services or work
performed. In the event the County shall require changes in the scope, character,
or complexity of the work to be performed, and said changes cause an increase or
decrease in the time required or the costs to the Contractor for performance, an
equitable adjustment in fees and completion time shall be negotiated between the
parties and this Agreement shall be modified accordingly by Change Order. Any
claims by the Contractor for adjustment hereunder must be made in writing prior to
performance of any work covered in the anticipated Change Order, unless
approved and documented otherwise by the County Representative. Any change in
work made without such prior Change Order shall be deemed covered in the
compensation and time provisions of this Agreement, unless approved and
documented otherwise by the County Representative.
6. Compensation. Upon Contractor's successful completion of the Work, and
County's acceptance of the same, County agrees to pay Contractor an amount as
set forth in the Exhibits. If, at any time during the term or after termination or
expiration of this Agreement, County reasonably determines that any payment made
by County to Contractor was improper because the service for which payment was
made did not perform as set forth in this Agreement, then upon written notice of such
determination and request for reimbursement from County, Contractor shall forthwith
return such payment(s) to County. Upon termination or expiration of this Agreement,
unexpended funds advanced by County, if any, shall forthwith be returned to County.
County will not withhold any taxes from monies paid to the Contractor hereunder and
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Contractor agrees to be solely responsible for the accurate reporting and payment of
any taxes related to payments made pursuant to the terms of this Agreement.
Unless expressly enumerated in the attached Exhibits,
7. Independent Contractor. Contractor agrees that it is an independent contractor and
that Contractor's officers, agents or employees will not become employees of
County, nor entitled to any employee benefits (including unemployment insurance
or workers' compensation benefits) from County as a result of the execution of this
Agreement. Contractor shall be solely responsible for its acts and those of its
agents and employees for all acts performed pursuant to this Agreement.
8. Subcontractors. Contractor acknowledges that County has entered into this
Agreement in reliance upon the particular reputation and expertise of Contractor.
Contractor shall not enter into any subcontractor agreements for the completion of
the Work without County's prior written consent, which may be withheld in County's
sole discretion. County shall have the right in its reasonable discretion to approve
all personnel assigned to the Work during the performance of this Agreement and
no personnel to whom County has an objection, in its reasonable discretion, shall
be assigned to the Work. Contractor shall require each subcontractor, as approved
by
County and to the extent of the Work to be performed by the subcontractor, to be
bound to Contractor by the terms of this Agreement, and to assume toward
Contractor all the obligations and responsibilities which Contractor, by this
Agreement, assumes toward County. County shall have the right (but not the
obligation) to enforce the provisions of this Agreement against any subcontractor
hired by Contractor and Contractor shall cooperate in such process. The Contractor
shall be responsible for the acts and omissions of its agents, employees, and
subcontractors.
9. Ownership. All work and information obtained by Contractor under this Agreement
or individual work order shall become or remain (as applicable), the property of
County. In addition, all reports, documents, data, plans, drawings, records and
computer files generated by Contractor in relation to this Agreement and all reports,
test results and all other tangible materials obtained and/or produced in connection
with the performance of this Agreement, whether or not such materials are in
completed form, shall at all times be considered the property of the County.
Contractor shall not make use of such material for purposes other than in
connection with this Agreement without prior written approval of County.
10. Confidentiality. Confidential information of the Contractor should be transmitted
separately from non -confidential information, clearly denoting in red on the relevant
document at the top the word, "CONFIDENTIAL." However, Contractor is advised
that as a public entity, Weld County must comply with the provisions of the
Colorado Open Records Act (CORA), C.R.S. 24-72-201, et seq., with regard to
public records, and cannot guarantee the confidentiality of all documents.
Contractor agrees to keep confidential all of County's confidential information.
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Contractor agrees not to sell, assign, distribute, or disclose any such confidential
information to any other person or entity without seeking written permission from
the County. Contractor agrees to advise its employees, agents, and consultants, of
the confidential and proprietary nature of this confidential information and of the
restrictions imposed by this Agreement.
11. Warranty. Contractor warrants that the Work performed under this Agreement will
be performed in a manner consistent with the standards governing such services
and the provisions of this Agreement. Contractor further represents and warrants
that all Work shall be performed by qualified personnel in a professional manner,
consistent with industry standards, and that all services will conform to applicable
specifications.
12.Acceptance of Services Not a Waiver. Upon completion of the Work, Contractor
shall submit to County originals of all test results, reports, etc., generated during
completion of this work. Acceptance by County of reports and incidental material(s)
furnished under this Agreement shall not in any way relieve Contractor of
responsibility for the quality and accuracy of the project. In no event shall any
action by County hereunder constitute or be construed to be a waiver by County of
any breach of this Agreement or default which may then exist on the part of
Contractor, and County's action or inaction when any such breach or default exists
shall not impair or prejudice any right or remedy available to County with respect to
such breach or default. No assent expressed or implied, to any breach of any one
or more covenants, provisions or conditions of the Agreement shall be deemed or
taken to be a waiver of any other breach. Acceptance by the County of, or
payment for, the Work completed under this Agreement shall not be construed as a
waiver of any of the County's rights under this Agreement or under the law
generally.
13. insurance. Contractor must secure, before the commencement of the Work, the
following insurance covering all operations, goods, and services provided pursuant to
this Agreement, and shall keep the required insurance coverage in force at all times
during the term of the Agreement, or any extension thereof, and during any warranty
period. For all coverages, Contractor's insurer shall waive subrogation rights against
County.
Types of Insurance.
Workers' Compensation /Employer's Liability Insurance as required by state
statute, covering all of the Contractor's employees acting within the course and
scope of their employment. The policy shall contain a waiver of subrogation against
the County. This requirement shall not apply when a Contractor or subcontractor is
exempt under Colorado Workers' Compensation Act., AND when such Contractor or
subcontractor executes the appropriate sole proprietor waiver form.
Commercial General Liability Insurance including public liability and property damage,
covering all operations required by the Work. Such policy shall include minimum limits as
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follows: $1,000,000 each occurrence; $1,000,000 general aggregate; $1,000,000
Personal injury $5,000; Medical payment per person.
Automobile Liability Insurance: Contractor shall maintain limits of $1,000,000 for
bodily injury per person, $1,000,000 for bodily injury for each accident, and $1,000,000
for property damage applicable to all vehicles operating both on County property and
elsewhere, for vehicles owned, hired, and non -owned vehicles used in the
performance of this Contract.
Professional Liability (Errors and Omissions Liability). The policy shall cover
professional misconduct or lack of ordinary skill for those positions defined in the
Scope of Services of this contract. Contractor shall maintain limits for all claims
covering wrongful acts, errors and/or omissions, including design errors, if
applicable, for damage sustained by reason of or in the course of operations under
this Contract resulting from professional services. In the event that the professional
liability insurance required by this Contract is written on a claims -made basis,
Contractor warrants that any retroactive date under the policy shall precede the
effective date of this Contract; and that either continuous coverage will be
maintained, or an extended discovery period will be exercised for a period of two (2)
years beginning at the time work under this Contract is completed. Minimum Limits:
$1,000,000 Per Loss; $2,000,000 Aggregate.
Proof of Insurance. Upon County's request, Contractor shall provide to County a
certificate of insurance, a policy, or other proof of insurance as determined in
County's sole discretion. County may require Contractor to provide a certificate of
insurance naming Weld County, Colorado, its elected officials, and its employees as
an additional named insured.
Subcontractor Insurance. Contractor hereby warrants that all subcontractors
providing services under this Agreement have or will have the above -described
insurance prior to their commencement of the Work, or otherwise that they are
covered by the Contractor's policies to the minimum limits as required herein.
Contractor agrees to provide proof of insurance for all such subcontractors upon
request by the County.
No limitation of Liability. The insurance coverages specified in this Agreement are
the minimum requirements, and these requirements do not decrease or limit the
liability of Contractor. The County in no way warrants that the minimum limits
contained herein are sufficient to protect the Contractor from liabilities that might
arise out of the performance of the Work under by the Contractor, its agents,
representatives, employees, or subcontractors. The Contractor shall assess its own
risks and if it deems appropriate and/or prudent, maintain higher limits and/or
broader coverages. The Contractor is not relieved of any liability or other obligations
assumed or pursuant to the Contract by reason of its failure to obtain or maintain
insurance in sufficient amounts, duration, or types. The Contractor shall maintain, at
its own expense, any additional kinds or amounts of insurance that it may deem
necessary to cover its obligations and liabilities under this Agreement.
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Certification of Compliance with Insurance Requirements. The Contractor stipulates
that it has met the insurance requirements identified herein. The Contractor shall be
responsible for the professional quality, technical accuracy, and quantity of all
services provided, the timely delivery of said services, and the coordination of all
services rendered by the Contractor and shall, without additional compensation,
promptly remedy and correct any errors, omissions, or other deficiencies.
14. Indemnity. The Contractor shall defend, indemnify and hold harmless County, its
officers, agents, and employees, from and against any and all injury, loss, damage,
liability, suits, actions, claims, or willful acts or omissions of any type or character
arising out of the Work done in fulfillment of the terms of this Agreement or on
account of any act, claim or amount arising or recovered under workers'
compensation law or arising out of the failure of the Contractor to conform to any
statutes, ordinances, regulation, judicial decision, or other law or court decree. The
Contractor shall be fully responsible and liable for any and all injuries or damage
received or sustained by any person, persons, or property on account of its
performance under this Agreement or its failure to comply with the provisions of the
Agreement. It is agreed that the Contractor will be responsible for primary loss
investigation, defense, and judgment costs where this contract of indemnity applies.
In consideration of the award of this contract, the Contractor agrees to waive all
rights of subrogation against the County its associated and/or affiliated entities,
successors, or assigns, its elected officials, trustees, employees, agents, and
volunteers for losses arising from the work performed by the Contractor for the
County. A failure to comply with this provision shall result in County's right to
immediately terminate this Agreement.
15. Non -Assignment. Contractor may not assign or transfer this Agreement or any
interest therein or claim thereunder, without the prior written approval of County. Any
attempts by Contractor to assign or transfer its rights hereunder without such prior
approval by County shall, at the option of County, automatically terminate this
Agreement and all rights of Contractor hereunder. Such consent may be granted or
denied at the sole and absolute discretion of County.
16. Examination of Records. To the extent required by law, the Contractor agrees
that a duly authorized representative of County, including the County Auditor, shall
have access to and the right to examine and audit any books, documents, papers
and records of Contractor, involving all matters and/or transactions related to this
Agreement. Contractor agrees to maintain these documents for three years from
the date of the last payment received.
17. Interruptions. Neither party to this Agreement shall be liable to the other for delays
in delivery or failure to deliver or otherwise to perform any obligation under this
Agreement, where such failure is due to any cause beyond its reasonable control,
including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or
Governmental actions.
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18. Notices. County may designate, prior to commencement of Work, its project
representative ("County Representative") who shall make, within the scope of his or
her authority, all necessary and proper decisions with reference to the project. All
requests for contract interpretations, change orders, and other clarification or
instruction shall be directed to County Representative. All notices or other
communications made by one party to the other concerning the terms and conditions
of this contract shall be deemed delivered under the following circumstances:
a) personal service by a reputable courier service requiring signature for receipt;
or
b) five (5) days following delivery to the United States Postal Service, postage
prepaid addressed to a party at the address set forth in this contract; or
c) electronic transmission via email at the address set forth below, where a
receipt or acknowledgment is required and received by the sending party; or
Either party may change its notice address(es) by written notice to the other. Notice
may be sent to:
TO CONTRACTOR:
Name: Radiology Imaging Associates, P.C.
Address: 10800 E Geddes Ave, Suite 300
Address: Englewood, Colorado 80112
E-mail: Shellie.nowicki@riaco.com
Phone: 303-761-9190
TO COUNTY:
Name: Cynthia Horn
Position: Chief Nursing Officer
Address: 1555 N. 17th Avenue
Address: Greeley, Colorado 80631
E-mail: chom@weld.gov
Phone: 970-400-2433
19. Compliance with Law. Contractor shall strictly comply with all applicable federal
and State laws, rules and regulations in effect or hereafter established, including
without limitation, laws applicable to discrimination and unfair employment
practices.
20. Non -Exclusive Agreement. This Agreement is nonexclusive, and County
may engage or use other Contractors or persons to perform services of the
same or similar nature.
21. Entire Agreement/Modifications. This Agreement including the Exhibits attached
hereto and incorporated herein, contains the entire agreement between the parties
with respect to the subject matter contained in this Agreement. This instrument
supersedes all prior negotiations, representations, and understandings or
agreements with respect to the subject matter contained in this Agreement. This
Agreement may be changed or supplemented only by a written instrument signed
by both parties.
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22. Fund Availability. Financial obligations of the County payable after the current
fiscal year are contingent upon funds for that purpose being appropriated,
budgeted and otherwise made available. Execution of this Agreement by County
does not create an obligation on the part of County to expend funds not otherwise
appropriated in each succeeding year.
23. Employee Financial Interest/Conflict of Interest — C.R.S. §§24-18-201 et seq.
and §24-50-507. The signatories to this Agreement state that to their knowledge,
no employee of Weld County has any personal or beneficial interest whatsoever in
the service or property which is the subject matter of this Agreement.
24. Survival of Termination. The obligations of the parties under this Agreement that
by their nature would continue beyond expiration or termination of this Agreement
(including, without limitation, the warranties, indemnification obligations,
confidentiality and record keeping requirements) shall survive any such expiration or
termination.
25. Severability. If any term or condition of this Agreement shall be held to be invalid,
illegal, or unenforceable by a court of competent jurisdiction, this Agreement shall be
construed and enforced without such provision, to the extent that this Agreement is
then capable of execution within the original intent of the parties.
26. Governmental Immunity. No term or condition of this Agreement shall be
construed or interpreted as a waiver, express or implied, of any of the immunities,
rights, benefits, protections or other provisions, of the Colorado Governmental
Immunity Act §§24-10-101 et seq., as applicable now or hereafter amended.
27. No Third -Party Beneficiary. It is expressly understood and agreed that the
enforcement of the terms and conditions of this Agreement, and all rights of
action relating to such enforcement, shall be strictly reserved to the undersigned
parties and nothing in this Agreement shall give or allow any claim or right of
action whatsoever by any other person not included in this Agreement. It is the
express intention of the undersigned parties that any entity other than the
undersigned parties receiving services or benefits under this Agreement shall be
an incidental beneficiary only.
28. Board of County Commissioners of Weld County Approval. This Agreement
shall not be valid until it has been approved by the Board of County
Commissioners of Weld County, Colorado or its designee.
29. Choice of Law/Jurisdiction. Colorado law, and rules and regulations established
pursuant thereto, shall be applied in the interpretation, execution, and enforcement
of this Agreement. Any provision included or incorporated herein by reference which
conflicts with said laws, rules and/or regulations shall be null and void. In the event
of a legal dispute between the parties, Contractor agrees that the Weld County
District Court shall have exclusive jurisdiction to resolve said dispute.
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30. No Employment of Unauthorized Aliens - Contractor certifies, warrants, and
agrees that it does not knowingly employ or contract with an unauthorized alien
who will perform work under this Agreement (see 8 U.S.C.A. §1324a and (h)(3)),
nor enter into a contract with a subcontractor that employs or contracts with an
unauthorized alien to perform work under this Agreement. Upon request,
contractor shall deliver to the County a written notarized affirmation that it has
examined the legal work status of an employee and shall otherwise comply with all
other requirements of federal or state law, including employment verification
requirements contained within state or federal grants or awards funding public
contracts.
Contractor agrees to comply with any reasonable request from the Colorado
Department of Labor and Employment in the course of any investigation.
If Contractor fails to comply with any requirement of this provision, County may
terminate this Agreement for breach, and if so terminated, Contractor shall be liable
for actual and consequential damages.
31.Attorney's Fees/Legal Costs. In the event of a dispute between County and
Contractor concerning this Agreement, the parties agree that each party shall be
responsible for the payment of attorney fees and/or legal costs incurred by or on
its own behalf.
32. Binding Arbitration Prohibited. Weld County does not agree to binding arbitration
by any extra -judicial body or person. Any provision to the contrary in this Agreement
or incorporated herein by reference shall be null and void.
Acknowledgment. County and Contractor acknowledge that each has read this
Agreement, understands it and agrees to be bound by its terms. Both parties further
agree that this Agreement, with the attached Exhibits, is the complete and exclusive
statement of agreement between the parties and supersedes all proposals or prior
agreements, oral or written, and any other communications between the parties relating
to the subject matter of this Agreement.
CONTRACTOR:
By:
Brendan Essary
RIA President
O
12/12/24
Date of Signature
9
WELD CO TY:
ATTEST: el. ,J
Weld,County Clerk to the Board WELD COUNTY, COLORADO
BY: hlillant14040 5fl
Deputy Clerk to the Boar
BOARD OF COUNTY COMMISSIONERS
Perry L. B dk, Chair JAN 0 6 2025
10
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EXHIBIT A
Addendum for Professional Services Contract
Women's cancer screening and TB services
Weld County Public Health agrees to:
• Identify dients that are eligible for given programs (WWC and TB).
Issue and provide Order to "CONTRACTOR" identifying the eligible client for
professional services (typically a chest X-ray, screening mammogram, diagnostic
and breast biopsy).
• Provide the diagnostic imaging order signed by client provider.
• Conduct any required tracking or follow-up care.
• Agrees will remit payment only for services authorized and defined on the order
and will reimburse at the 100% CY Medicare rate for service as provided by
CDPHE-WWC program each year. A copy will be provided to the
"CONTRACTOR" each year as it is received from CDPHE. Unlisted or non -valued
codes by Medicare will reimburse at 50% of billed charges as long as it is an
authorized service per the order.
Payment will be made to "CONTRACTOR" up to 45 days after receipt of billed
claim on form 1500.
CONTRACTOR agrees to:
Directly bill "COUNTY" for eligible dients receiving eligible services which were
approved by "COUNTY" on the order.
Agrees to accept the reimbursement provided by the "COUNTY" as directed by each
state program of approved Medicare allowable rate.
Agrees to accept the reimbursement provided by "COUNTY" as payment in full, dient
should not receive any portion of the bill.
Send radiology or lab reports to the referring "COUNTY" within 7 business days.
Send billed daims for eligible services performed to Weld County Department of
Public Health and Environment, 1555 Norlh 17"' Ave, Greeley, CO 80631O8
electronically (secure email) to: health-ap(asweld.gov
Radiology Imaging Associates, P.C.
Weld County Commissioners
-0597929 Welunty, Colorado
Sittfiature
Brendan Essary
6
Print Name
RIA President
Title
12/12/24
Signature date
Signature /
Perry L Buck, Chair SAN 0 6 2025
Printed Name �
Weld County Attest: W4rAtit.) '°�' ' `1 .4 E'""i
Weld ounty lerk to the Board
By:
Deputy Clerk to the Boa
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EXHIBIT B
Radiology Service Voucher
This voucher is for the following patient who has been confirmed as eligible for:
Este cupon es para las personas que son confirmadas elegible para:
o Women's Wellness Connection Program o TB Program
Patient: Please present this voucher, as well as any other paperwork given to you, as you arrive for your
radiology appointment to ensure proper billing. Your appointment is scheduled at:
Al llegar a su cita por favor presente este cupon y otros documentos necesarios entregados a usted, para asegurar la
facturacion apropiada. Su cita es programada en:
❑ Summit View Medical Commons
2001 70th Avenue, Greeley, CO 80634
(970) 810-6070
❑ North Colorado Medical Center
1801 16th Street, Greeley, CO 80631
(970) 810-4121
Appointment date/time: Patient's Date of Birth:
Fecha de la cita Fecha de nacimiento
Patient's name:
Nombre del paciente
Covered service for this visit:
Servicio cubierto para esta vita
*All other services will require prior authorization.
Todos otros servicios se requieren autorizacion previa.
NOTE: This voucher expires 60 days after date of issue.
Issue date: Authorized Signature:
Service Provider: please bill Weld County as an insurance for the above listed service only:
Weld County Department of Public Health
Attn: Contract Billing
1555 North 17th Avenue, Greeley, CO 80631
If you have any questions or need to reschedule, please call (970) 304-6420.
Si usted tiene alguna pregunta o tiene que cancelar la cita, por favor llame (970) 304-6420.
ontract Form
Entity Information
Entity Name* Entity ID*
RADIOLOGY IMAGING ASSOCIATES @00021450
PC
Contract Name *
WOMEN'S WELLNESS CONNECTION AND TB IMAGING
SERVICES
Contract Status
CTB REVIEW
Q New Entity?
Contract ID
8966
Contract Lead *
BFRITZ
Contract Lead Email
bfritz@weld.gov;Health-
Contracts@weld.gov
Contract Description*
WOMEN'S WELLNESS CONNECTION AND TB IMAGING SERVICES
Contract Description 2
Contract Type*
AGREEMENT
Amount*
$0.00
Renewable*
NO
Automatic Renewal
Grant
IGA
Department
HEALTH
Department Email
CM-Health@weld.gov
Department Head Email
CM-Health-
DeptHead@weld.gov
County Attorney
GENERAL COUNTY
ATTORNEY EMAIL
County Attorney Email
CM-
COUNTYATTORNEY@WEL
D.GOV
If this is a renewal enter previous Contract ID
If this is part of a MSA enter MSA Contract ID
Requested BOCC Agenda
Date*
01/06/2025
Parent Contract ID
Requires Board Approval
YES
Department Project #
Due Date
01/02/2025
Will a work session with BOCC be required?*
NO
Does Contract require Purchasing Dept. to be
included?
Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts
are not in OnBase
Contract Dates
Effective Date
Termination Notice Period
Contact Information
Review Date*
11/01/2025
Committed Delivery Date
Renewal Date
Expiration Date*
12/31/2025
Contact Info
Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2
Purchasing
Purchasing Approver Purchasing Approved Date
Approval Process
Department Head Finance Approver Legal Counsel
JASON CHESSHER CHERYL PATTELLI BYRON HOWELL
DH Approved Date Finance Approved Date Legal Counsel Approved Date
12/18/2024 12/18/2024 12/18/2024
Final Approval
BOCC Approved Tyler Ref #
AG 010625
BOCC Signed Date Originator
BFRITZ
BOCC Agenda Date
01/06/2025
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