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Home My WebLink About20161895.tiffCONTRACT AGREEMENT AMENDMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND MOUNT SAINT VINCENT HOME (Core) This Agreement Amendment, made and entered into C& day o 2016 by and between the Board of Weld County Commissioners, on behalf of the Weld Co ty Department of Human Services, hereinafter referred to as the "Department", and Mount Saint Vincent Home, hereinafter referred to as the "Contractor". WHEREAS the parties entered into an Agreement for Day Treatment Services, (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2014-2816. approved on September 15, 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. 2015-1611(2), approved on June 1, 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. 2016-1895 ec:atliet,d,&1-1s-D /41Oa 7 ,O20- 020 - �G IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ,Cam[ COUNTY: ATTEST: ■,(_ J v• 'Il BOARD OF COUNTY COMMISSIONERS Weld C , my Clerk to the Board WELD COUNTY, COLORADO By: Deputy CI Mike Freeman, Chair JUN 2 0 2016 CONTRACTOR: Mount Saint Vincent Home 4159 Lowell Boulevard Denver, Colorado 80211 (303) 458-7220, x259 By: Date: Megan 0-ali/X/ tk, LCSW Associate Clinical Director AC R1® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 12/03/2015 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 MARSH USA INC. 540 W. MADISON CHICAGO, IL 60661 Vincnt CONTACT NAME: PHONE FAX Extl: INC, No1� E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC N INSURER A : SCL Health Trust INSURED Mount St. Vincent Home, Inc. 4159 Lowell Blvd. Denver, CO 80211 INSURER 8 : INSURER C ; INSURER o ; INSURER E : INSURER F : CERTIFICATE NUMBER: CHI.006481796-01 :3 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 LTR TYPE OF INSURANCE ADDL INSD SUBRI WVD I POUCY NUMBER POUCY EFF (MMIDD/YYYY) POUCY EXP (MM/DD/YYYY) OMITS A X COMMERCIAL GENERAL X CLAIMS-MADE7 LIABILITY OCCUR ISCL Health Trust 10/01/2015 10/01/2016 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ N/A MED EXP (Any one person] $ N/A GEN'L PERSONAL & ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: p� POLICY ` _ ACT [] LOC OTHER: GENERAL AGGREGATE S 3,000,000 X PRODUCTS - COMP/OP AGG $ 3,000,000 $ AUTOMOBILE ' ' _ j LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS -- SCHEDULED AUTOS NON -OWNED ''' i AUTOS I I COMBINED SINGLE LIMIT _LEa accident) $ BODILY INJURY (Per person) $ BODILY INJURY Per accident # ) $ PROPERTY DAMAGE (Per accident) $ $ s UMBRELLA LIAB OCCUR CLAIMS -MADE 1 EACH OCCURRENCE $ EXCESS LIAR _ _ �F AGGREGATE $ DED I RETENTION $ I I I WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE- OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes. describe under DESCRIPTION OF OPERATIONS i YIN' NIA'; I PER OTH- STATUTE I ER__, _-__ E L EACH ACCIDENT $ --�_ f ,I be E.L. DISEASE - EA EMPLOYEE$ $ E. L. DISEASE - POLICY LIMIT A Professional Liability (Claims Made / Shared Limits) SCL Health Trust 10/01/2015 10/01/2016 Each Incident Aggregate 1,000,000 3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) ERTIFICATE HOLDER CAN Mount Saint Vincent Home 4159 Lowell Blvd, Denver, CO 80211 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 Kathleen Tulipana ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AWRD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 12/10/2015 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 MARSH USA INC. 540 W. MADISON Chicago, IL 60661 Attn: Healthcare.AccauntSCSS@marsh.com Vincnt INSURED Mount St. Vincent Home, Inc. 4159 Lowell Blvd. Denver, CO 80211 CONTACT NAME: PHONE-.~._ .—..— I FAX ,A/C, No. Ertl_ saA1C, Not: EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Phoenix Insurance Company INSURER B : Safety National Casualty Corp. INSURER C: 125623 ;15105 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: CHI -006442572.05 REVISION NUMBER:2 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 LTR AODL'SUBR TYPE OF INSURANCE I INSDI.yyVD POUCY NUMBER POLICY EFF POLICY EXP ,(MMIDD/YYYY1 IMMIDD/YYYY) LIMITS I COMMERCIAL GENERAL UABIUTY OCCUR 1 ' , { 1 T EACH OCCURRENCE $ • CLAIMS -MADE ! DAMAGE TO RENTED PREMISES IEa occurrence) $ ) MED EXP (Any one person) S PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: 1 ( P PRODUCTS - COMP/OP AGG $ $ A AUTOMOBILE UABILITY r----1 I fP8107588R769PHX15 '10/01/2015 110/0112016 I I COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ANY AUTO ( ; I BODILY INJURY (Per person) $ s X 1 ALL OWNED I__ AUTOS I )r -c- HIRED AUTOS 1__ SCHEDULED AUTOS NON -OWNED AUTOS " ( BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LAB I OCCUR I I 1 1 I I #01/01/2017 I EACH OCCURRENCE $ EXCESS UAB— CLAIMS -MADE AGGREGATE $ DED 1 RETENTION $ $ B 8 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS Y / N' N / A SP4054141 (SIR $750,000) PRP4052294 (Guaranteed Cost WC Non Self Insured States ) !01/01/2016 i j01/01/201601/01/2017 X I STATUTE OTH ER E.L EACH ACCIDENT E.L DISEASE • EA EMPLOYEE $ 1,000,000 N $ 1,000,000 1,000.000 below ! E.L. DISEASE - POLICY LIMIT I $ DESCRIPTION OF OPERATIONS / LOCATIONS ! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION Weld County Department of Human Services ATTN: Judy A. Griego, Director P.O. 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 POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee .�Lnv4.oc.t,.: 4,114,...t�-KA, u ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACO CERTIFICATE OF LIABILITY INSURANCE DATE (MM UD,YYYYI 12/R3;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 pollcy(ies) must be endorsed if SUBROGATION IS WAIVED, sub) act to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer tights to the certificate holder In lieu of such endorsement(s). PRODUCER ?Arai Nerve ommit Stavtces Cayman L:d Governors Square, Bldg 4 F kxr 2 23 Lie Tree Bay Avenue PO Box, 1051 and Cayman KY 11102 INSURED Mani SI Vncent Home Inc 4150 Lowell Blvd Denver CO ©0211 CONTACT NAME: PHONE MirAFill: AADDRESS: INSURE R(S) AFFORDING COVERAGE INSURER A : Leaven Insurance Co Ltd INSURER B:, INSURER C : RD: INSURER E: INSURER F: IFAX I COVERAGES CERTIFICATE NUMBER: CHI -00649195O01 REVISION NUMBER:3 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. ---'A66L POLICY EFF POUCYEXP TYPE LTR OF INSURANCEi POLICY NUMBER ....----LMMDD/YYYY LMMD/YYYY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7, OCCUR AG pour( OTHER_,_.. AUTOMOBILE LIABILITY ANY AUTO AL.L OWNED J' SOILDI/LED AUTOS _ I AUTOS NON -OWNED HIRED AUTOS` AUTOS X I UMBRELLA LIAB OCCUR 1 EXCESS LIAB X CLAIMS -MADE lPENSATION RS' LIABILITY YIN; DRlPARTNER(EXECUTIVE ER EXCLUDED RIP DON OF OPERATIONS ' LOCATIONS: VEHICLES IACORD 101. Additional RemarMs Schedule. may be attached i1 more space re required) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP ACG I CERTIFICATE HOLDER CANCELLATION Mount Saint Vincent Hone 4159 I aaetrilvd Denver CO 90211 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AU IHORIZED REPRESENTAFIV 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Hello