HomeMy WebLinkAboutPSA Compass Direct HealthcarePROFESSIONAL SERVICES AGREEMENT
_ This Agreement is made by and between Kittitas County (hereinafter "the County',)and Compass Direct Healthcare (hereinafter "Contracto/'). T-he County and Contractor
agree as follows:
General Conditions; Exhibit A (Scope of Work); Exhibit B (Compensation);
Exhibit C (Proof of lnsurance).
copies of which are attached hereto and incorporated herein by this reference as fulry as if
set forth herein.
d&rh
The term of this Agreement shall commence andcontinue until completion of the project.party may terminate this Agreement by givingAny
thirty (30) days' notice in writing either personally delivered or mailed postage-prepaid
certified mail, retum receipt requested,to the party's last known address forthe purposes
giving notice under this paragraph.
by
of
Contractor acknowledges and by signing this Agreement agrees that thelndemnification provisions set forth in Paragraphs 7 (lndeperident Contraito4, 9 (Taxes),15 (Defense and lndemnity Agreement), 21 (Pat6nUCbpyright lnfringement) and 21(Confidentiality), are totally and fully part of this Agreement-and hav6 been mutually
negotiated by the parties.
Professional Services Agreement (rev. Ogt24t211 g)
Page I of 17
lN WITNESS WHEREOF, the parties have executed this Agreement this ? day
ot Utt"t,2o2o.
APPROVED:
Compass Direct Healthcare
107 E. Mountain ViewAve.
BOARD OF COUNTY COMMISSIONERS
KITTITAS COUNTY,INGTON
Ellensburg, WA
t{/
Chairma 4lzt luzo
c
of
Commissioner
Attest:
oi ihe
to Form:lililill\
Contractor Address:
107 E. Mountain View Ave.
Ellensburg, WA 98926
Project Gontact:
Profossionaf Services Agreement (rev, 09 l24l 201 8)
Page2ol17
Deputy P Attorney
Gounty's Address
Kittitas County
205 West Sth Avenue, Suite 108
Ellensburg, WA 98926
By w zr31"\
Project Contact:
GENERAL CONDITIONS
1. Scone of Contractorrs Services:
Contractor agrees to provide to the County services and any materials set forth in the project
narrative identified in Exhibit "A" during the Agreement period. No material, labor, orfacilities
will be fumished by the County, unless otherwise provided for in the Agreement.
2. Performance of Work:
Contractor shall perform work in accordance with, and shall comply with, all of the provisions
of this Agreement. All work shall comply with applicable codes and ordinances.
3. Schedule of Performance:
Unless directed otherwise by the County, Contractor shall perform the work in accordance
with any schedules made a part of this Agreement.
4. Definitions:4.1 "Additional lnsureds" means the County, its successors and assigns, and
the respective directors, officers, employees, agents and representatives of
the County and its successors and assigns.4.2 "Support" means the following: Contractofs directors, officers, employees,
agents and representatives; and sub-Contractors of any tier; the respective
directors, officers, employees, agents and representatives of these sub-
Contractors of any tier; and any other person or entity acting under the
direction or control of, or on behalf of, Contractor or any Contracto/s sub-
Contractors of any tier in connection with or incident to the performance of the
Work or this Agreement.4.3 The "Work" means all of the duties listed in Exhibit A and the performance of
all other obligations, under this Agreement by Contractor or its Support.
5. Acgountino and Pavment for Contractor:$ervices:
Payment to the Contractor for services rendered under this Agreement shall be as set forth
in Exhibit "B". Where Exhibit "B" requires payments by the County, payment shall be based
upon billings, supported unless otherwise provided in Exhibit "8", by documentation of units
of work actually performed and amounts eamed, including where apprcpriate, the actual
number of days worked each month, total number of hours for the month, and the total dollar
payment requested. Unless specifically stated in Exhibit "8" or approved in writing in
advance by the Kittitas County Board of Commissioners, the County will not reimburssthe
Contractor for any costs or expenses incurred by the Contractor in performance of this
Agreement.
Where required, the County shall, upon receipt of appropriate documentation, compensate
the Contractor, no more often than monthly, through the County voucher system, for the
Contractods service pursuant to the fee schedule set forth in Exhibit "8".
Professional Services Agree ment {rev . 0g 124 I 201 B)
Page 3 of 17
6. Assisnmentand Subcontracting:
No portion of this Agreement may be assigned or subcontracted to any other individual, firm
or entity without the express and prior written approval of the County.
7. lndependent Contractor:
The Contracto/s services shall be fumished by the Contractor as an independent Gontractor
and nothing herein contained shall be construed to create a relationship of employer-
employee or master-servant, but all payments made hereunder and all services performed
shall be made and performed pursuant to this Agreement by the Contractor as an
independent Contractor.
The Contractor acknowledges that the entire compensation for this Agreement is specified
in Exhibit "B" and the Contractor is not entitled to any County benefits including, but not
limited to: vacation pay, holiday pay, sick leave pay, medical, dental, or other insurance
benefits, or any other rights or privileges afforded to Kittitas County employees.
Contractor will defend, indemniff and hold harmless the County, its Additional lnsureds,
officers, agents or employees from any loss or expense, including but not limited to
settlemerits, judgnrei-rts, seioffs, attomeys' fees or costs incuri'ed bii i'eason of claims oi^
demands because of breach of the provisions of this paragraph.
8. Nq-guara"nle-e-plExnplsvmen!:
The"perfurmance of all-orpartof thisAgreement*bythe"€ontractsr-shall"not'oper'aleto'vest
any employment rights whatsoever and shall not be deemed to guarantee any employment
of the Contractor or any employee of the Contractor or any sub-Contractor or any employee
of any sub-Contractor by the County at the present time or in the future.
9. Taxes:
The Contractor understands and acknowledges that the County will not withhold Federal or
State income taxes. Where required by State or Federal law, the Contractor authorizes the
County to make withholding for any taxes other than income taxes (i.e. Medicare). All
compensation received by the Contractor will be reported to the lnternal Revenue Service
at the end of the calendar year in accordance with the applicable IRS regulations. lt is the
responsibility of the Contractor to make the necessary estimated tax payments throughout
the year, if any, and the Contractor is solely liable for any tax obligation arising from the
ContractoCs performance of this Agreement. The Contractor hereby agrees to indemnify
the County against any demand to pay taxes arising from the Contracto/s failure to pay
taxes on compensation eamed pursuant to this Agreement.
The County will pay sales and use taxes imposed on goods or services acquired hereunder
as required by law. The Contractor must pay all other taxes including, but not limited to:
Business and Occupation Tax, taxes based on the Contractor's gross or net income, or
personal property to which the County does not hold title. The County is exempt from
Federal Excise Tax.
Professional Services Agreement (rev. 0912412018)
Page 4 of 17
10. Regulations and Requirement:
This Agreement shall be subject to all laws, rules and regulations of the United States of
America, and State of Washington, and political subdivisions of the State of Washington,
and to any other prcvisions set forth herein or in the attached exhibits.
11. Right to Review:
This contract is subjectto review byany FederalorState auditor. The Countyoritsdesignee
shall have the right to review and monitor the financial and service components of this
program by whatever means are deemed expedient by the County. Such review may occur
with or without notice, and may include, but is not limited to, on-site inspection by County
agents or employees, inspection of all records or other materials which the County deems
pertinent to the Agreement and its performance, and any and all communications with or
evaluation by service recipients under this Agreement. The Contractor shall preserve and
maintain all financial records and records relating to the performance of work under this
Agreement for 6 years after contract termination, and shall make them available for such
review, within Kittitas County, State of Washington, upon request.
12. Modifications:
12.1 Either party may request changes in the Agreement. Any and all agreed
modifications shall be in writing, signed by each of the parties.
12.2 The County may, at anytime, bywritten notice thereof to Contractor("Change
Notice") makes changes in the Work within the general scope of this
Agreement, including, but not limited to: (a) changes in, revisions to,
substitutions for, additions to or deletions of any Work; (b) changes in
schedule; and (c) acceleration, deceleration or suspension of performance of
any Work.
12.3 lf any change in the Work causes an increase or decrease on Contractofs
cost ol or the time required for, performance of the Work, an equitabte
adjustment in the compensation to Contractor and in the schedule for the
performance of the Work shall be made to reflect such an increase or
decrease.
12.4 Notwithstanding any dispute or delay in arriving at a mutually acceptable
equitable adjustment, Contractor shall proceed in accordance with all Change
Notices. Contractor must, within thirty (30) days after receipt of any change
Notice that does not set forth any acceptable adjustment, submit to the County
a written statement setting forth any adjustment claimed.
12.5 lf any change results in a decrease in the Work performed, Contractor shall
be entitled to compensation associated with changing the Work, such as
Professional Services Agreement (rev. O9l24l2O1B)
Page 5 of 17
revising design already completed, revising calculations already performed,
and revising documents.
13. Termination for Default:
lf the Contractor defaults by failing to perform any of the obligations of the Agreement or
becomes insolvent or is declared bankrupt or commits any act of bankruptcy or insolvency
or makes an assignment for the benefit of creditors, the County may, by depositing written
notice to the Contractor in the U.S. mail, postage prepaid, terminate the Agreement, and at
the County's option, obtain performance of the work elsewhere. lf the Agreement is
terminated for default, the Contractor shall not be entitled to receive any further payments
under the Agreement until all work called for has bccn fully pcrformed. Any extra cost or
damage to the County resulting from such default(s) shall be deducted from any money due
or coming due to the Contractor. The Contractor shall bear any extra expenses incurred by
the County in completing the work, and all damage sustained, or which may be sustained
by the County by reason of such default.
lf a notice of termination for default has been issued and it is later determined for any reason
that the Contractor was not in default, the rights and obligations of the partles shall be the
saine as if the notice of tei'mination had been issued pui'suant to the Ternnination fo:" Public
Convenience paragraph hereof.
14. Termination for Public Convenience:
The*Gounty-may- terminate"*the -Agreernent"in-whole-sr -in--par't"-whenever the -eounty
determines, in its sole discretion that such termination is in the best interests of the County.
Whenever the Agreement is terminated in accordance with this paragraph, the Contractor
shall be entitled to payment for actual work performed at unit contract prices for completed
items of work. ln the event of such termination, an equitable adjustment shall be made in
the compensation payable to Contractor.
An equitable adjustment in the contract price for partially completed items of work will be
made, but such adjustment shall not include provision for loss of anticipated profit on deleted
or uncompleted work. Termination of this Agreement by the County at any time during the
term, whether for default or convenience, shall not constitute a breach of contract by the
County.
15. Defense & lndemnitvAqreement:
The Contractor agrees to and shall defend, indemnify and hold harmless the County, its
Additional lnsureds, appointed and elective officers, agents and employees, from and
against all loss or expense, including but not limited to judgments, settlements, attorney's
fees and costs by reason of any and all claims and demands upon the County, its Additional
lnsureds, its elected or appointed officials, agents, or employees for damages because of
personal or bodily injury, including death at any time resulting therefrum, sustained by any
person or persons and on account of damage to property including loss of use thereof,
whether such injury to persons or damage to prcperty is due to the negligence of the
Professional Services Agreement (r ev . A9 124 1201 8)
Page 6 of 17
Contractor, its sub-Contractors, its elected officers, emptoyees or their agents, except only
such injury or damage as shall have been occasioned by the sole negligence of the County,
its Additional lnsureds, appointed or elected officials, agents, or employees. lt is further
provided that no liability shall attach to the County by reason of entering into this contract,
except as expressly provided herein.
16, Indu-strial lnsurance Waiver:
With respect to the performance of this Agreement and as to claims against the County, its
Additional lnsureds, officers, agents and employees, the Contractor expressly waives its
immunity under Title 51 of the Revised Code of Washington, the lndustrial lnsurance Act,
for injuries to its employees and agrees that the obligations to indemnifiT, defend and hold
harmless provided in this agreement extend to any claim brought by or on behalf of any
employee of the Contractor. This waiver is mutually negotiated by the parties to this
Agreement.
17. Venue and Choice of Law:
ln the event that any litigation should arise concerning the construction or interpretation of
any of the terms of this Agreement, the venue of such action of litigation shall be in the
Superior Court of the State of Washington in and for the County of Kiftitas. This Agreement
shall be governed by the law of the State of Washington.
18. Withholdinq Payment:
ln the event the Contractor has failed to perform any obligation to be performed by the
Contractor under this Agreement within the time set forth in this Agreement, then the County
may, upon written notice, withhold all monies due and payable to Contractor, without
penalty, until such failure to perform is cured or otherwise adjudicated.
19. Future No n of Funds:
lf sufficient funds are not appropriated or allocated for payment under this Agreement for
any future fiscal period, the County will not be obligated to make payments for services or
amounts incuned after the end of the current fiscal period. No penalty or expense shall
accrue to the County in the event this provision applies.
20. .So.ntractor Commitments, Warranties and Representations:
The contractor represents and warrants to the county as foilows:20.1 The Contractor is duly incorporated, validly existing and in good standing
under the laws of the State of Washington, and has all requisite corporate
power and authority to enter into and to perform its obligations under this
Agreement.
20.2 The Contractor has the authority to execute this Agreement, to make the
representations and warranties set forth in it and to perform the
obligations of the Contractor under this Agreement in accordance with its
terms.
Professional Services Agreement (rev . 09 124 I 201 8)
Page 7 of 17
20.3
20.4
20.5
20.6
This Agreement has been validly executed by an authorized
representative of the Contractor and constitutes a valid and legally
binding and enforceable obligation of Contractor.
The Contractor has or will obtain prior to the commencement date such
licenses, permits and other authorizations from federal, state and other
governmental authorities, as are necessary for the performance of its
obligations under this Agreement.
The Contractor is not in violation of any applicable law, ordinance or
regulation the consequence of which will or may materially affect
Contractor's ability to perform its obligations under this Agreement. The
Contractor is not subject to any order or judgment of any court, tribunal or
governmental agency which materially and adversely affects its
operations or assets in the State of Washington, or its ability to perform
its obligations under this Agreement.
None of the representations or warranties in this Agreement, and none of
the documents, statements, certificates or schedules turnished or to be
furnished by Contractor pursuant hereto or in connection with the
performance of the obligations contemplated under this Agreement,
contains oi'wiii contain any unti"ue statement of a material ,ract oi'omits oi"
will omit to state a material fact necessary to make the statements of fact
contained therein not misleading.
2'L' PatenV8owriqht" lnfrinqemer'lt:
Contractor will defend and indemnify the County from any claimed action, cause or demand
brought against the County; to the extent such action is based on the claim that information
supplied by the Contractor infringes any patent or copyright. The Contractor will pay those
costs and damages attributable to any such claims that are finally awarded against the
County in any action. Such defense and paymenis are conditioned upon the foilowing:
21.1 Contractor shall be notified promptly in writing by County of any notice of such
claim.
21.2 Contractor shall have the right, hereunder, at its option and expense, to obtain
for the County the right to continue using the information, in the event such
claim of infringement is made, provided no reduction in performance or loss
results to the County.
22. Disputeq:
22.1 General
Differences between the Contractor and the County, arising under and by
virtue of the Agreement Documents shall be brought to the attention of the
County at the earliest possible time in order that such matters may be settled
or other appropriate action promptly taken. Except for such objections as are
made of record in the rnanner hereinafter specified and within the time limits
stated, the records, orders, instructions, and decisions of the Kittitas Goun$
Commissioners shall be final and conclusive.
Professional Servicee Ag reement (rev . 09 124 I 2O1 8l
Page 8 of 17
22.2 Notice of Potentiqj Claims
The Contractor shall not be entitled to additional compensation which
otherwise may be payable, or to extension of time for (1) any act or failure to
act by the County, or (2) the happening of any event or occurrence, unless
the Contractor has given the County a written Notice of Potential Claim within
ten (10) days of the commencement of the act, failure, or event giving rise to
the claim, and before final payment by the County. The written Notice of
Potential Claim shall set forth the reasons for which the Contractor believes
additional compensation or extension of time is due, the nature of the cost
involved, and insofaras possible, the amount of the potential claim. Contractor
shall keep full and complete daily records of the work performed, labor and
material used, and all costs and additionaltime claimed to be additional.
22.3. Detailed Claim
The Contractor shall not be entitled to claim any such additional
compensation, or extension of time, unless within thirty (30) days of the
completion of the portion of the work from which the claim arose, and before
final payment by the County, the Contractor has given the County a detailed
written statement of each element of cost or other compensation requested
and of all elements of additional time required, and copies of any supporting
documents evidencing the amount or extension of time claimed to be due.
23. Ownership of ltems Produced:
All writings, programs, data, public records or other materials prepared by the Gontractor
and/or its consultants or sub-Contractors, in connection with performance of this Agreement
shall be the sole and absolute prcperty of the County.
24. Confidentialitv:
The Contractor, its employees, sub-Contractors, and their employees shall maintain the
confidentiality of all information provided by the County or acquired by the Contractor in
performance of this Agreement, except upon the priorwriften consent of the Kittitas County
Prosecuting Attorney or an order entered by a court after having acquired jurisdiction over
the County. Contractor shall immediately give to the County notice of any judicial
proceedings seeking disclosure of such information. Contractor shall indemnify and hold
harmless the County, its Additional Insureds, officials, agents or employees from all loss or
expense, including, but not limited to settlements, judgments, setoffs, attomeys'fees and
costs resulting from Contracto/s breach of this provision.
To the extent that any information obtained by the Contractor is required to be shared with
or provided to others by the terms of the Statement of the Work, this provision is not
breached by such acts.
25. Notice:
Professional Se rvices Agreemenl (r ev . 09 124 120'1 8)
Page 9 of 17
Except as set forth elsewhere in the Agreement, for all purposes under this Agreement,
except service of process, notice shall be given by the Contractor to the department head
of the department for whom services are rendered, and to the Kittitas County
Commissioners, 205 W Sth Ave, Suite 108, Ellensbulg, WA 98926. Notice to the Contractor
for all purposes under this Agreement shall be given to the address reflected on the
signature page. Notice may be given by delivery or by depositing in the U.S. Mail, first class,
postage prepaid.
26. $everabilitv:
lf any term or condition of this Agreement or the application thereof to any person(s) or
circurnstances is held invalid, such invalidity shall not affect other terms, conditions or
applications which can be given effect without the invalid term, condition or application. To
this end, the terms and conditions of this Agreement are declared severable.
27. Miscellaneous:
27.1 The County's failure or delay to insist upon strict performancd of any of thd
provisions of this Agreement or to exercise any rights or remedies under this
Agreement shall not be construed as a waiveror relinquishment to any extent
-l rL_oi its right to asseri or reiy upon any such provisions, i'ights oi'i'emedies in that
or any other instance; rather the same shall be and remain in full force and
effect.
27.2 This Agreement embodies the entire Agreement between the County and
Oontractor;-and' supersedes'any-and"all "prior-agreements; 'regarding the
Work. No change, amendment or modification of any provisions of this
Agreement shall be valid unless set forth in a written instrument signed by the
party to be bound thereby.
27.3 The rights and remedies of the County set forth in any prcvision of this
Agreement are in addition io and do not in any way limit any other rights of
remedies afforded to the County by any other provisions of this Agreement,
by any of Contracto/s Support or by law.
27.4 The headings of sections and paragraphs of this Agreement are for
convenience of reference only and are not intended to restrict, affect or be
of any weight in the interpretation or construction of the provisions of such
sections or paragraphs,
28. Waiver:
Waiver of any breach or condition of this Agreement shall not be deemed a waiver of any
prior or subsequent breach. No terms or conditions of this Agreement shall be held to be
waived, modified ordeleted except by an instrument, in writing, signed bythe parties hereto.
29. Survival:
The provisions of paragraphs 7, 9, 1 1, 13, 14, 1 5, 16, 17, 1 8, 1 9, 20, 21, 22, 23, 24, 28, 30,
31, and 32 shall survive, notwithstanding the termination or invalidity of this Agreement for
any reason.
Professional Ecrviccs Agrccmcnt (rcv . 08 124 120 1 8l
Page 10 of 17
30. Nondiscrimination:
30.1
30.2
30.3
30.4
The County is an equal opportunity employer.
Nondiscrimination in Emplovment
ln the performance of this Agreement, the Contractor will not
discriminate against any employee or applicant for employment on the
grounds of race, creed, color, national origin, sex, sexual orientation,
marital status, age or the presence of any sensory, mental or
physical handicap; provided that the prohibition against discrimination
in employment because of handicap shall not apply if the particular
disability prevents the proper performance of the particular worker
involved. The contractor shall ensure that applicants are employed,
and that employees are treated during employment without
discrimination because of their race, creed, color, national origin, sex,
sexual orientation, marital status, age or the presence of any sensory,
mental or physical handicap. such action shall include, but not be
limited to: employment, upgrading, demotion or transfers, recruitment or
recruitment advertising, layoff or termination, rates of pay or other
forms of compensation, and programs for training including
apprenticeships, The Contractor shall take such action with respect to
this Agreement as may be required to ensure full compliance with
local, state and federal laws prohibiting discrimination in employment.
Nondiscrimination in Services
The Contractor will not discriminate against any recipient of any services
or benefits provided for in this Agreement on the grounds of race,
creed, color, national origin, sex, sexual orientation, marital status, age or
the presence of any sensory, mental or physical handicap.
lf any assignment and/or subcontracting has been authorized by the
county, said assignment or subcontract shall include appropriate
safeguards against discrimination. The contractor shall take such
action as may be required to ensure full compliance with the
provisions in the immediately preceding paragraphs herein.
31. Prevailins Wagg:
Contractor shall pay the prevailing rate of wages to all workers, laborers, or mechanics
employed in the performance of any part of the Work in accordance with RCW 99.12
and the rules and regulations of the Department of Labor and lndustries. The schedule
of prevailing wages rates for the locality or localities of the Work is determined by the
Professional Services Agree ment (rev . 0g I 24 I 20 1 B)
Page 11 of17
lndustrial Statistician of the Department of Labor and lndustries. lt is the Contractor's
responsibility to verify the applicable prevailing wage rate. lt is understood that the
Contractor is responsible for obtaining and completing all required government forms
and submitting same to the proper authorities.
Disputes regarding prevailing wage rates shall be referred for arbitration to the Director
of the Department of Labor and lndustries. The arbitration decision shall be final and
conclusive and binding on all parties involved in the dispute as provided for by RCW
39.12.060.
32, Debarment Certification:
The Contractor certifies that it:
32J ls not presently debarred, suspended, proposed for debarment, declared
ineligible or voluntarily excluded from covered transactions by any Federal
g,z.2 fl"*"mffilnil SntiliJ:r"ar period precedins the execution of this cohtract
with Kittitas County, been convicted of or had a civiljudgment rendered
against them for commission of fraud or a criminal offense in connection
with oiitainirrg, attemptirrg iu crbtaii-r, or perfornring a public oi'private
agreement or transaction, violation of Federal or State antitrust statutes or
commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, tax evasion, receiving
stolen-property; makingrfalse claims; orobstructisn of-iustiee;
32.3 ls not presently indicted for or otherwise criminally or civilly charged by a
governmental entity (Federal, State, or local) with commission of any of
the offenses enumerated in paragraph 32.2 of this section.
32.4 Has not within a three-year period preceding the preceding the execution
of this contract with Kittitas County had one or more pubiic transactions
(Federal, State, or local) terminated for cause of default.
Professiona I Services Agreernent (r ev . 09 124 l2O1 8)
Page 12 of 17
EXHIBIT "A"
SCOPE OF WORK
ln addition to providing all material and labor, the Contractor shall perform the following:
To conduct pre-employment medical screening for employment for the Kittitas County
Sheriffs Office. The component parts of the medical screening are broken down in
Exhibit B.
Contractor will maintain appropriate security standards and practices with regard to
applicant medical records regardless of the form of the records, consistent with all
applicable Federal, State, and Local laws and administrative regulations, including
HIPAA standards and Business Associate Agreements,
Professional Services Agreement (rev. 0912412018)
Page 13 of 17
EXHIBIT ''8"
COMPENSATION
As full compensation for satisfactory performance of the work, the County shall pay
Contractor compensation not to exceed:
s 29s.00
Professional Services Agreement (rev. 09/241201 8)
Page 14 of 17
Description Code Price
Physical Exam 99203 $ rrs.oo
Range oi Motton ino chargei 9t tsu $
XR Chest, l View 71045 5 go.oo
XR Spine Thoracolumbar 2+ Views 72084 $ gs,oo
PPD - Tuberculosis Screen 86s80 S rs.oo
Urinalysis VMicro 8L001 S ro.oo
FecalOccult Blood 82270 $ s.oo
Lab - CBC 005009 $ s.oo
Lab . LP 3037s5 S s.oo
Lab - CMP 5UJl5b ) 5.UU
Lab - TSH w/Reflex 004259,349829 S ro.oo
Venipuncture (no charge)36415 $
Brcothing Capacity Tcst (PFT, Pre Only)94010 S zs.oo
EKG 93000 s 2s.00
Pure Tone Audiometry (Hearing Test)92552 $ ro.oo
EXHIBIT'C"
PROOF OF INSURANCE
The Contractor shall secure and maintain in effect at all times during performance of the
Work such insurance as will protect Contractor, its Support and the Additional lnsureds
from all claims, losses, harm, costs, liabilities, damages and expenses arising out of
personal injury (including death) or property damage that may result from performance of
the work or this Agreement, whether such performance is by Contractor or any of its
Support.
All insurance shall be issued by companies admitted to do business in the State of
Washington and have a rating of A-, Class Vll or better in the most recently published
edition of Best's Reports unless othenruise approved by the County. lf an insurer is not
admitted, all insurance policies and procedures for issuing the insurance policies must
complywith Chapter48.15 RCW and284-15 WAC.
The Contractor shall provide proof of insurance for:
[l Comn]ercial General Liabilitv lnsur.a.neg
Coverage limits not less than:. $5,000,000 per occurrence. $1,000,000 per occurrence liquor liability. $1,000,000 products & completed operations aggregate. $1,000,000 personal and advertising injury, each offenseo Certificate Holder - Kittitas Countyo The Certificate must name the County as additional insured. Sixty (60) days written notice to the County of cancellation of the insurance
policy
f] CommercialAutomobile Liabilitv lnsurance (if ANY use of vehicle in performance)
Automobile Liability for owned, non-owned, hired, and leased vehicles (MCS g0
endorsement and a CA gg46 endorsement must be attached if 'poltutants' are to be
transported)r Coverage limits not less than:. $1,000,000 combined single limit. Thirtv (30) days written notice to the County of cancellation
of the insurance policy.
Professional Servi ces Agree ment (r ev . 09 I 241 20 1 8)
Page 15 of 17
Additional Coverage May Be Required:
Workers' Compensation
Workers' Compensation in amounts required by law
I Stop Gap/Emolovers. Liabilitv
Coverage limits not less than:. $1,000,000 each accident. $1,000,000 dlsease - pollcy llmit. $1,000,000 disease - each employee. ThirtV (30) days written notice to the County of cancellation
of the insurance policy.
fl Professional Liability
The Contractor and/or its Subcontractor and/or its consultant providing
professional services shall provide evidence of Professional Liability lnsurance
covering prof'essionaierrors anci omissions. Such poiicy must provicie the foiiowing
minimum limits:. $1,000,000 per claim
' $2,000,000 annual aggregater lf iiTsuruince^is"-un a-e1?firR$made furru- lfs-relroactlve*date;"and-that of all
subsequent renewals, shall be no later than the effective date of this
Agreement.
I Potlution Liability
The Contractor shall provide a Pollution Liability policy, providing coverage for
claims involving bodily injury, property damage (including loss of use of tangible
property that has not been physically injured), cleanup costs, remediation, disposal
or other handling of pollutants, including costs and expenses incured in the
investigation, defense, or settlement of claims arising out of:r Contractor's operations related to this project; andlorr Remediation, abatement, repair, maintenance or other work with lead-based
paint or materials containing asbestos; and/orr Transportation of hazardous materials away from any site related to this project
Such Pollution Liability policy shall provide the following minimum coverage:r $ Per claimr $ annual aggregate
I Property Damase
Professional Services Agreement (rev . 09 I 24 120 1 8l
Page 16 of 17
The Contractor shall provide a policy that covers damage to Kittitas County
facilities, including buildings, equipment, grounds, etc. Such policy shall provide
the following minimum coverage:e $ per occurrence
f Umbrella Coverao,e
Umbrella policies shall provide coverage at least as broad as specified for
underlying coverages (CGL, Auto, Employer's Liability) and cover those insured in
the underlying policies, including additional insured.r Amount required for this Agreement: g
Contractor shall furnish the County a Certificate of Insurance to include the Policy
Endorsements/Exclusions as evidence that policies providing insurance required by this
Agreement are in full force and effect. Contractor hereby waives all rights of recourse,
including any right to which another may be subrogated, against Kittitas County for
personal injury, including death, and property damage. Contractor's insurance policies
required above shall be primary insurance and shall be non-contributing with any
other insurance maintained by Kittitas County.
The Contractor shall assume full responsibility for all loss or damage from any cause
whatsoever to any tools, Contractor's employee-owned tools, machinery, equipment, or
motor vehicles owned or rented by the Contractor, or the Contractor's agents, suppliers
or contractors as well as to any temporary structures, scaffolding and protective fences.
The Contractor shall have sole responsibility for ensuring the insurance coverage and
limits required are obtained by subcontractors,
NOTE: No contract shall form until and unless a copy of the Gertificate of
lnsurance with Endorsements/Exclusions, properly completed and in the amount
required, is attached hereto.
Failure of the Contractor to fully comply with the above insurance requirements during
the term of the Agreement shall be considered a material breach of contract and cause
for immediate termination of the Agreement at the County's discretion. Alternatively, the
County may procure and maintain, at the Contracto/s sole expense, insurance to the
extent deemed proper up to the amount of the required coverage(s). The County may
offset the cost of such insurance against payment due to the Contractor under this
Agreement.
Professional Services Agreement (rev . 0g I 24 120 1 8)
Page 17 of 17
L
F^J1 Phy;l5,inns Insurance
PO Box 84453
Seattle, WA 98124-5753
(206) 343-7300
(800) 962-1399
www.phyins.com
CONFIRMATION OF INSURANCE COVERAGE
PROFESSIONAL LIABILITY INSURANCE POLICY
CLAIMS.MADE
Named lnsured:
Mailing Address:
Byron L Haney, MD
107 E Mountain View Ave Ste 1
Ellensburg, WA 98926
Policy Number: 178152000
POLICY PERIOD: January 1,2020 to January 1,2021
al 12:01 a.m. local time at the address shown above
RETROACTIVE DATE: September 3, 1990
This document will confirm that Physicians lnsurance A Mutual Company (the
Company) provides professional liability insurance to Byron L Haney, MD, subject
to the Company's minimum liability limits of $1,000,000 each medical incident and
$5,000,000 aggregate.
The certificate of insurance is issued as a matter of information only and confers
no rights upon the certificate holder. This confirmation does not amend, extend or
othenvise alter the terms, conditions or limits of the insurance afforded by the
policy. lf the Policy, or coverage for any person, is canceled for any reason or if the
terms of the policy are changed, we will notify the Named lnsured only.
This confirmation was issued on April 13,2020
To our lnsureds: This confirmation of coverage is provided for your use for hospital privilege requirements,
HMOs, PPOs, etc. You are authorized to photocopy and distribute as needed without further permission
from or notification to the Company.
cor-Pr.080712
21 178152
{ } Phy;Jginns I nsu rance
PO Box 84453
Seattle, WA 98124-5753
(206) 343-7300
(800) 962-1399
www.phyins.com
Named lnsured:
Paramedical Employee
Mailing Address:
CONFIRMATION OF INSURANCE COVERAGE
PROFESSIONAL LIABILITY INSURANCE POLICY
CLAIMS.MADE
Elkhorn Valley Corp dba Family Health Care of
Ellensburg
Aaron David Long, ARNP
107 E Mountain Vw Ave Ste 1
Ellensburg, WA 98926
Policy Number: 002258000
ReferenceNumber: 376778
POLICY PERIOD: January 1,2020 to January 1,2021
al l2:O1 a.m. local time at the address shown above
RETROACTIVE DATE: September 1,2012
This document will confirm that Physicians lnsurance A Mutual Company (the
Company) provides professional liability insurance to Aaron David Long, ARNP,
subject to the Company's minimum liability limits of $1,000,000 each medical
incident and $5,000,000 aggregate.
The certificate of insurance is issued as a matter of information only and confers
no rights upon the certificate holder. This confirmation does not amend, extend or
othenvise alter the terms, conditions or limits of the insurance afforded by the
policy. lf the Policy, or coverage for any person, is canceled for any reason or if the
terms of the policy are changed, we will notify the Named lnsured only.
This confirmation was issued on April 13,2020
To our lnsureds: This confirmation of coverage is provided for your use for hospital privilege requirements,
HMOs, PPOs, etc. You are authorized to photocopy and distribute as needed without further permission
from or notification to the Company.
cor-Pr.080712
72 376778
,J'lt Phy;Jginns lnsuranceL
F
PO Box 84453
Seattle, WA 98124-5753
(206) 343-7300
(800) 962-1399
www.phyins.com
CONFIRMATION OF INSURANCE COVERAGE
PROFESSIONAL LIABILITY INSURANCE POLICY
CLAIMS-MADE
Named lnsured:
Mailing Address
Richard D Vaughan, MD
107 E Mountain Vw Ave Ste 1
Ellensburg, WA 98926
Policy Number: 300002600
POLICY PERIOD: January 1,2020 to January 1,2021
al 12:01 a.m. local time at the address shown above
RETROACTIVE DATE: May 1,2014
This document will confirm that Physicians lnsurance A Mutual Company (the
Company) provides professional liability insurance to Richard D Vaughan, MD,
subject to the Company's minimum liability limits of $1,000,000 each medical
incident and $5,000,000 aggregate.
The certificate of insurance is issued as a matter of information only and confers
no rights upon the certificate holder. This confirmation does not amend, extend or
otherwise alter the terms, conditions or limits of the insurance afforded by the
policy. lf the Policy, or coverage for any person, is canceled for any reason or if the
terms of the policy are changed, we will notify the Named lnsured only.
This confirmation was issued on April 13,2020.
To our lnsureds: This confirmation of coverage is provided for your use for hospital privilege requirements,
HMOs, PPOs, etc. You are authorized to photocopy and distribute as needed without further permission
from or notification to the Company.
cor-Pr.080712
12 119487
Kittitas County
Review Form
Grants & Contract Agreement
Today's Date
April13,2020
Agenda Date.tl-t- 7c>
Fund/Department
30 / Sheriff
Contract/Grant Information
Financial Information
B Information
Pass Throu Information
Prosecutor Review
Contract /Grant Direct Healthcare
Period Begin Date: 0410912020 Period End Date: 04109/2021
Total Grant/Contract Amount
Grant/Contract Number: SH20-01 1
This agreement is between Kittitas County and Compass Direct Healthcare for
to conduct re-e ent medical screerrirr for em ent for the Kittitas Co Sheriff s Office
Contract/Grant Summary
the
Total Amount State Funds $0 Federal Funds $0
Percentage County Funds Matchins Funds $0 CFDA# na
In-Kind $
Explain
Is Equipment being purchased? NO Who uipment? na
New Personnel being hired? NO Contact HR hiring - r'eporting requirements - na
Future impacts or liability to Kittitas County
Budget Amendment Needed?
New Division Created? NO
Yesf] attach budget form No $ Why not - Already budgeted
Revenue Code NA
Expense Code 0013Oxxx4I13
Agency to Pass T'hrough NA
Amount to Pass Throueh $o
Sub-Contract Approved Date
Grant/Contract Review Page 1
Has the Prosecutor reviewed this agreement?Yesfk No CAMAS# 48620
Coun De rtments Im
Submitted
Auditor Facilities Maintenance
Information Services Human Resource
Prosecutor Treasurer
Signature: (h.u fn*e.1A,Date:}4/13120
Department: Sh6riff
Assi ent of Trackin Information
Auditor's Office
Human Resource
Prosecutor's Office * zrgl}"2
Who Signed the grant application I
Reviewer Date
Grant/Contract Review Page 2