The URL can be used to link to this page

Browse Search

Home My WebLink About20162035.tiffCONTRACT AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND RICK L. MAY, PSY.D., P.C. DBA TREATMENT & EVALUATION SERVICES (Core) This Agreement Amendment, made and entered into & / day of 2016, by and between the Board of Weld County Commissioners, on behalf of the Weld aunty Department of Human Services, hereinafter referred to as the "Department", and Rick L. May, Psy.D. DBA Treatment & Evaluation Services, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Sexual Abuse Treatment (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2014-3047, approved on October 6, 2014. WHEREAS the parties hereby agree to amend the term of the Original Agreement in accordance with the terms of the Original Agreement, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: • The Original Agreement ended on May 31, 2015. • The Original Agreement was amended for an additional term of June 1, 2015 -May 31, 2016. This Agreement Amendment is identified by the Weld County Clerk to the Board of County Commissioners as document No. 2015-1850(2), approved on June 24, 2015. • The Amendment(s), together with the Original Agreement, constitutes the entire understanding between the parties. The following change is hereby made to the Contract Documents: 1. Term This agreement shall become effective on September 22, 2014, upon proper execution of this Agreement and shall expire May 31, 2017, unless sooner terminated as provided herein. 2. None • All other terms and conditions of the Original Agreement remain unchanged. 2016-2035 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST dirAvt) v• ;ei BOARD OF COUNTY COMMISSIONERS Weld aunty Clerk to the Board WELD COUNTY, COLORADO By: Mike Freeman, Chair JUN 2 7 2016 Rick L. May, Psy D. DBA Treatment & Evaluation Services 2629 Redwing Road, Suite 270 Fort Collins, Colorado 80528 (970) 231 9611 By: Date: A 66 Rick L May, Psy.D Director do/6. -oZ o ACORD. PRODUCER Pirnacol Assurance 75O1 E Lowry Blvd Denver, CO 8O23O-7OO6 INSURED Rick L. May, Psyd, PC 13693 E !lift Avenue, Suite 22O Aurora, CO 80014 CERTIFICATE OF LIABILITY INSURANCE DATE IMWOUYYYYY) 06107/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW INSURERSAFFORDING COVERAGE INSURER A Plnnacol Assurance INSURER II INSURER C L__FASURER 0 INSURER E COVERAGES NAZC# I 41f90 THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDNG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AU. THE TERMS, EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES- LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. iNSR ADOL I TR A *SAD TYPE OF INSURANCE GENERAL LIABILITY �`f �COUW ERCIAL GENERA. UAL TY i CLAUMS MADE ❑ OCCUR GENT AGGREGATE ULSTAPPUERS PEN I PGUCT 11 PROJECT: LOC NORSERS OODPENSATION MID MIIPLAYER'S LINDUTY AIY PROPRIETOReANTNERCEECULWE OFFCEWMEMaER EXCLUDED? 11 yes. Naar darcybo melAr SPECIAL PROVISIONS beim POLICY ?LLAMA -r- POLICY EFL LC I'VE I POLICY ENV:RATION ' OA'E(4140OferrY'I 1 QATE[MMfDO/YYYY) I • 3423413 TIDIER 04/011016 DESCRIPTION OF OPERATIOIEU.00ATIONSAIENICLE$IEXCLUSIONS A00RD SY ENOORSERENT/SPECIAL PROVISIONS CERTIFICATE HOLDER 1710109 Weld County Department of Human Services i PO Box A Greeley. CO 80632 ACORD 25(2001/08) 04/0112017 DAIS EACN OCCURRENCE DAMAGE TO RENTED PREMISES MED DPW., oMP potion} PERSONAL / AIN INJURY ',GENERAL AGGREGATE _ PRODUCTS • COMP*" ADC COAe1NEO 51101,E LURT aES AKY-) wove INJURY PPP arson? BODILY WADI? IPtfAmderl1 PROPERTY DAMAGE 'M APD*MI 1 ALTO ONLY - EA ACCgERT OTMER TITAN EA ACC TO°FAT A EACH OCCURRENCE WC STATTA f omen TORT W TS 1 EL EACH AC0DENT S100,000 E L DISEASE - EA EMPLOYEE S 1 oo.oUG EL DISEASE - PODGY LIMIT _MOAN_ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE { THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO NOTIFY tO DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO NOTIFY SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Casey Bertram Underwriter ACORD CORPORATION 1988 ACORD" CERTIFICATE OF LIABILITY INSURANCE kin.-.----- DATE DIUNDDIYYYY) 06/07/2016 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 POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PROOUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(es) must be endorsed. If SUBROGATION IS WANED, subject to the tams and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certMcats holder in lieu of such endorsement(s). PRODUCER Summit Insurance Professionals, LLC PO Box 1939 Granby, CO 80446-1939 BILL HERBERT, CC PlosI; , 303.745-2155 I_N„4, 303-484-5121 AWsII, Bill@SummitinsurancePos.co ueIIREwsI AFFORDING COVERAGE Nasc S INSURER A : FOREMOST 16535 INSURED Rick L. May, PSY,D., P.C. 13693 E. (tiff Ave., Suite 220 Aurora CO 80014 =UWR s : PINNACOL ASSURANCE 41190 INSURER C: ENCOMPASS INSURER O: INSURERS: INSURER c. CERTIFICATE 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCCEEDpPAApIIDuLSYDCLAIMS. VAR LTR TYPE CF INSURANCE moonlit MD MD PNU OLICY MM GUMS IMBY D UNITS A X rialurriesm oENERAL uaaIuvr X X PP535121780 07/10/15 07/10/16 EACH occuRRENce $ 1,000,000 CLA1Ms#NOE X OCCUR DAMAGE TO RENTED PEEMISES Ma ommenoet $ 1,000,000 MEDEXP!Any ono patio,) i $ 10,000 PERSONAL a AM IMJ RY $ 1,000,000 1 GENL X AGGREGATE LIMIT APPLIES PER POLICY n IT& LOC OTHER: GENERAL AGGREGATE 5 2,000,000 PRODUCTS - COMP/OP AGG S 2,000,000 S C '—',wYAUTo A AUTOMOBILE X UAB1UTY ALL OWNED AUTOSHIRED urns rye X scHrum N°Nt)WNE° 282096744 PPS3512178O 05/11/16 07/10/15 COMBINED SINGLE LIMITMA tionilwua 5 500,000 05/11/17 Boolirl07,0,m.on► $ 07/10/16 BODILY INJURY IPA, .GCitleM) S PROPERTY DAMAGE Per =Mann 5 Non -Owned liability S 1,000,000 UMBRELLA LIAR sxcsss UAe — OCCUR CCAIMS.MADE EACH OCCURRENCE $ AGGREGATE S DED I I RETENTIONS 5 8 AMD EMPLOYERS' LIABILITY ANY PROPRIETORPARTNERADCECUTNE OFRCERIMEMBER EXCLUDED? (MsrtdMery In NN) DESCRIPTION OF OPERATIONS Won Y � N I A X 3423413 04/01/16 04/01/17 x I sTAT I TER E.L. EACH ACCIDENT 3 100,000 E.L. GI -CEASE • EA EMPLOYEE $ 100,E E.L. r icCAsp -POLICY LIMIT S 500,000 DESCRIPTION OF OPCFA11ONI I I.00ATIOMS I VEWCLES t11CORD 151, Additional RMmerie SNodulr, may be Mend H mote spout is reputed) MEDICAL OFFICE: PSYCHOLOGIST ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY: Weld County Department of Human Services. WAIVER OF SUBROGATION IN RESPECTS TO WORKERS' COMPENSATION INSURANCE IN FAVOR OF: Weld County Dept of Human Services, per a written contract. TION •••••••• +, •'., • Weld County Department of Human Services PO Box A Greeley, CO 80632 SHOULD ANY Of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE (WitAIA4AA C 1986-2014 ACORD CORPORATION. All rights reserved. ACORD 23 (2014/01) The ACORD name and logo are registered marks of ACORD PINN ACOL ASSURANCE INSURED: Rick L May, Psyd. PC 13693 E (tiff Avenue, Suite 220 Aurora, CO 80014 ENDORSEMENT: Waiver Of Subrogation ?501 E Lowry Blvd Denver, CO 6023O7006 Phone. (303} 361-4000 : (800) 873-7242 Fax (303) 361-5000 (888) 329-2251 WVAV pn}nacnt corn NCCI # WC0C0313 Policy # 3423413 AGENT: Summit Insurance Professionals, LLC P. O. Box 1939 Granby, CO 80446 (303) 745-2155 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE Weld County Department of Human Services PO Box A Greeley, CO 80632 Effective Date: June 7, 2016 Expires on April 1, 2017 Pinnacot Assurance has issued this endorsement June 7, 2016. Casey Bertram Underwriter P,nr.rnzl Assurance' i v E lowry &W ' Oenver CO t1C23u Page I u' 3 PINNAWE8 • PrA.A j{tt1; `t "b, 3773411 Judrina 2(1120(1: l;'ftt11 CERTIFICATE HOLDER COPY Weld County Department of Human Services PO Box A Greeley, CO 80632 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. Hello