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Home My WebLink About20161882.tiffi� L 7.6 CONTRACT AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND NORTH RANGE BEHAVIORAL HEALTH (Core) This Agreement Amendment, made and entered into O'Vr day o 2016, by and between the Board of Weld County Commissioners, on behalf of the Weld s�ounty Department of Human Services, hereinafter referred to as the "Department", and North Range Behavioral Health, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Functional Family Therapy, Mental Health Services, and Multisytemic Therapy (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2014-3107, approved on October 13, 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 renewed for the term of June 1, 2015 -May 31, 2016. The Agreement Amendment is identified by the Weld County Clerk to the Board of County Commissioners as document No. 2015-2205, approved on July 20, 2015. • The Amendment, 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 June 1, 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. 2016-1882 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. COUNTY: ATTEST: Weld C. . my Clerk to the B. and WELD COUNTY, COLORADO B dirAvt) '64. BOARD OF COUNTY COMMISSIONERS eputy CI k to the :;:fj%��► Mike Freeman, Chair JUN 2 0 2016 orth Range Behavioral Health 300 North 17th Avenue Greeley, Colorado 80634 (970) 347-2120 By: Date: rff, Executive Di r or p2,o/6,- /f0 NORTHI2 OP ID: DP A L RU CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/24/2015 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 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 Rich & Cartmill Ins of CO of Colorado LLC 8213 W. 20th Street Greeley, CO 80634 Michael J Schmitt CIC INSURED North Range Behavioral Health 1300 N 17th Avenue Greeley, CO 80631 ACT Michael J Schmitt CIC IA//C."I o, Este 970-356-8030 1(,ac NoL970-356-8032 E-MAIL ADDRESS: -- — k ---- INSURER(�AFFORDING COVERAGE F. NAIC INSURER A : Philadelphia Insurance Co 123850 INSURER B : Pinnacol Assurance INSURER C : Lloyds of London INSURER 0 INSURER E : ' --- ---------------_- ___-_ --------- ----- t INSURER F : COVERAGES CERTIFICATE NUMBER: • THIS IS TO CERTIFY THAT INDICATED NOTWITHSTANDING CERTIFICATE MAY BE ISSUED EXCLUSIONS AND CONDITIONS INSR LTR ' TYPE OF INSURANCE THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. A DDL I INSD SUM WWI POLICY EFF POLICY NUMBER (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X 1 COMMERCIAL GENERAL LIABILITY _ �, CLAIMS -MADE X J OCCUR X rtProfessional Liab X I PHPK1356673 07/01/2015 07/01/2016 EACH OCCURRENCE $ 1,000,000 DAMAGE TO PREMISES (Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 20,000 X HIPAA Inc/ GEN'L AGGREGATE LIMIT APPLIES PER. . I POLICY - I 'I1 r X_j LOC OTHER PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP/OP AGG �Emp i $ 3,000,000 1,000,000 Ben. $ AUTOMOBILE LIABILITY A X I ANY AUTO -' ALL OWNED _j AUTOS _ '— 1 HIRED AUTOS r 1 1 SCHEDULED AUTOS ,. -1 NON -OWNED AUTOS PHPK1356673 07/01/2015 07/01/2016 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY Per accident ( 1 $ PROPERTY DAMAGE _Per accident' $ $ F {UMBRELLA UAB A EXCESS LIAB DED ; X j RETENTIONS X I OCCUR t ; i PHUB504760 ' I 07/01/2015 07/01/2016 j EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE LAGGREGATE $ 2,000,000 10,000' $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY B ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED'/ (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS YIN N I A 4044331 07/01/2015 07/01/2016 wf PER i 0TH- Ai STATUTE , ; ER EL. EACH ACCIDENT $ _—.-- $ $ 100,000 —.— 100,000 500,000 _—_—_ E L_ DISEASE - EA EMPLOYEE E L DISEASE POLICY LIMIT be!ev C 'Privacy IUCS2669550.15 I I 07/01/2015 07/01/2016 I Each Aggregate 1,000,000 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) State of Colorado is listed as additional insured as pertains to the general liability policy, per written contract. CERTIFICATE HOLDER CANCELLATION WEL-HUM Weld County Department of Human Services 315 N 11th Ave Greeley, CO 80631 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Michael J Schmitt CIC ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Hello