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SH21-014 - Occupational Medicine Service Agreement
IndependentContractorOccupationalMedicineServicesRECEWEDOCCUPATIONALMEDICINESERVICESAGREEMENTBETWEENETTITAScouNTYSHERiFFKVHWorkplaceHealthMEDICINE("Clinic")AndKittitasCountySheriff'sOffice("Client")THISAGREEMENT,effectivethe1dayofÉgrn,2021,(the"EffectiveDate"),isbyandbetweenKVHWorkplaceHealth,havingitsprincipalplaceofbusinessat702EMountainViewAve.,Suite2,Ellensburg,Washington("Clinic"),andKittitasCountySheriffsOffice,havingitsprincipalplaceofbusinessat307W.UmptanumRd.,Ellensburg,Washington("Client").ClinicandClientmayindividuallybereferredtoasa"Party"orcollectivelyasthe"Parties."RECITALS1.Clinic'spurposeistoprovideoccupationalmedicineservicesforpersonswithintheKittitasCountycommunitythatClinicserves.2.ClientdesirestoobtainoccupationalmedicineservicesthatarereasonableandnecessaryforcertainemployeesofClient.3.ClienthasdetermineditisinthebestinterestsofitsemployeestocontractwithClinicforClinic'sservices.4.CliniciswillingtoprovidesuchservicespursuanttothetermsandconditionsofthisAgreement.NOW,THEREFORE,inordertoprovideforClinic'sprovisionofoccupationalmedicineservicesforClient'semployeeswhohavework-relatedhealthmatters(the"Patients"),thePartiesagreeasfollows:1.SERVICES.DuringthetermofthisAgreementandasprovidedbelow,ClinicwillmakeavailabletoClient'sPatients,asdeterminedappropriate,theoccupationalmedicineservicesasdescribedonExhibit"A"attachedtoandincorporatedinthisAgreement(the"Services").1.1CoordinationofServices.Client,oritsdesignee,willdeterminewhichofitsemployeesshouldbereferredtoClinicasPatientsforthepurposeofassessmentanddeterminationoftheappropriatecourseofcliniccare,andprovisionofServices.ClientwillcommunicatewithClinictoscheduleanappointment.Clientwilldesignateacontactstaffperson,ordesignee,forcommunicationsbetweenClientandClinicwithrespecttotheschedulingandprovisionofServicestobeprovided.ClientwillpayClinicforServicesrenderedasprovidedinSection4andExhibit"A"ofthisAgreement.IfaPatientrequiresServicesthatarecoveredbyorsubjecttoworkerscompensationinsurancepursuanttoaWashingtonState programand/orpursuanttoaself-insuredprogramorotherthirdpartyadministrativeprogram,totheextentcoverageforthecostoftheServicesisnotacceptedbyanysuchprogram,ClientwillpayClinicforServicesrenderedasprovidedinSection4andExhibit"A"ofthisAgreement.1.2ProvisionofServicesbyClinic.ClinicwillberesponsibleforarrangingthescheduleforprovisionoftheServicesatClinic'slocation,determiningtheappropriatecourseofcliniccarebyClinic,providingServices,documentingtheprovisionofServices,andbillingClient(and/oranyprogramasdescribedinParagraph1.1above)fortheServicesrendered.1.3Licensure/Certification.Clinicwillmaintainappropriatelicensureand/orcertificationasrequiredtoprovidetheServices.UponwrittenrequestofClient,ClinicshallprovidecurrentinformationwithrespecttotheServices,documentingappropriatelicensure,staffcredentials,includingWashingtonStatelicensureandMedicareandMedicaidlicensure/certificationwhenapplicable.ClinicandClienteachagreetonotifytheotherPartyupreasonableknowledgeofcircumstancesthatmaythreatenClinic'slicensure/certification.1.4Insurance.ClinicshallmaintainprofessionalliabilityinsurancefortheServicesrenderedpursuanttothisAgreementwithlimitsofatleast$1,000,000peroccurrenceand$3,000,000annualaggregate,whichinsuranceshallprovidecoverageforallactsoromissionsofClinicforthoseServicesattheClinicduringtheTerm.Clientshallberesponsibleforanyadditionaldesiredorrequiredcoverage.Clinicretainstherighttochooseanymethodofprofessionalliabilityprotectionincludingprovisionsforself-insuredretentionorpurchaseofinsurancepoliciesduringtheTerm.1.5RiskManagement.ClientshallimmediatelyreporttoClinicanyconcernsand/orcomplaintsofwhichClientbecomesawarewithrespecttotheprovisionofServicesbyClinic.2.STAFFING.TheClinicstaffwhowilldirectorprovideServicestoClient'sPatientsareemployeesorindependentcontractorsofClinic.ClinicshallberesponsibleforthecompensationtotheClinicstaffinvolvedintheprovisionoftheServices,andworker'scompensation,benefitsandwithholdings,asapplicable.ClientshallberesponsibleforthecompensationtoClient'semployeesorindependentcontractors,andworker'scompensation,benefitsandwithholdings,asapplicable.Clientshalldesignateanindividualtoactasitsauthorizedrepresentativeforpurposesofdecision-makingwithrespecttotheServices,asrequestedbyClinic.Noemployeeofeitherpartywillbeconsideredtobeanemployeeoftheotherpartyforanypurposewhatsoeveratanytime.3.TERMANDTERMINATION.2 3.1Term.ThisAgreementshallbeforatermofone(1)yearcommencingonEffectiveDateandshallcontinueforone(1)year,unlessterminatedsoonerasprovidedbythetermsofthisAgreement("InitialTerm").Unlessotherwiseterminated,thisAgreementshallautomaticallyrenewforsuccessiveone(1)yearterms("SubsequentTerm(s)),unlessaPartyprovideswrittennoticeofitsintenttopermittheAgreementtoexpire,whichwrittennoticemustbegivenatleast90daysbeforetheendofthethencurrentTerm.TheInitialTermandtheSubsequentTerms,ifapplicable,arereferredtoasthe"Term."3.2Terminationwith90-davNotice.SubjecttotherightsanddutiesimposedpursuanttothisSection3,thisAgreementmaybeterminatedatanytime,withoutcause,bygivingtheotherPartyatleastninety(90)days'advancewrittennotice,inwhicheventthisAgreementshallterminateonthefuturedatespecifiedinsuchnotice.3.3TerminationDuetoDefault.IntheeventofdefaultbyaPartyofanycovenantorobligationhereof,whichdefaultisnotcuredwithinfifteen(15)daysafterreceiptofwrittennoticefromthenon-defaultingPartydescribingsuchdefault(unlesssuchdefaultisnotreasonablycapableofbeingcured,ifcurable,withinsuch15daysthenifthedefaultingPartyfailstocommencethecuringofsuchdefaultwithinsuch15daysorthereafterfailstocompletesuchcurewithinareasonabletime),thenon-defaultingPartymayterminatethisAgreementuponthegivingofwrittennoticeofsuchtermination.3.4ImmediateTermination.ThisAgreementmaybeterminatedimmediatelyifanypaymentmadehereunderisdeterminedbyopinionofClinic'slegalcounsel,byacourtofcompetentjurisdictionorbyanappropriategovernmentalagencytobeillegalorinconsistentwithClinic'stax-exemptstatusorinviolationofthefederalAnti-KickbackStatuteorthefederalPhysicianSelf-ReferralStatute,aseachmaybeamendedfromtimetotime.ThisAgreementmayalsobeterminatedbyeitherPartyimmediatelyupontheexclusionorsuspensionoftheotherParty,oranyemployeeoftheotherParty,fromtheMedicare,Medicaid,oranysimilargovernmentprogram.3.5IntheeventthisAgreementshallterminatepriortotheendofitsInitialTerm,thePartiesshallnotenterintoanotheragreementwithoneanotheruntiltheexpirationoftheInitialTerm.UponterminationofthisAgreement,ClientshallpayClinicforallServicesperformedtothedateoftermination.4.COMPENSATION.Client(and/oranyprogramasdescribedinParagraph1.1ofthisAgreement)willcompensateClinicforServicesprovidedunderthisAgreementattherateagreeduponfortheparticularServices(asidentifiedinExhibit"A"),basedupontheactualServicesprovided.ClinicshallprovideClientwithinvoicesonamonthlybasisforServicesprovidedandcostsincurredandClientshallpaysuchinvoicewithinten(45)daysofthe3 invoicedate.AllfeesandcompensationreceivedorrealizedasaresultoftheServicesprovidedbyClinicunderthisAgreementshallbelongtoandbepaidanddeliveredtoClinic.ThePartiesagreetheabovetermshavebeennegotiatedatarm'slengthandthecompensationisconsistentwithfairmarketvaluethatdoesnottakeintoconsiderationthevolumeorvalueofanyreferralsorbusinessotherwisegeneratedorthatmaybegeneratedbetweenthePartiesforwhichpaymentmaybemadeinwholeorinpartunderMedicareoraStatehealthcareprogram.5.SPACE,EQUIPMENTANDASSISTANCE.Clinicwillmakereasonablynecessaryspace,equipment,andsuppliesavailableinorderforClinicstafftoprovidetheServices.ClientagreestomakeitsemployeesavailableasnecessaryandappropriatetocoordinatetheprovisionoftheServicesbyClinic.6.MEDICALREPORTINGREQUIREMENT.IntheeventtheServicesexceed$10,000.00duringthetermhereoforduringthecombinedtermhereofandanyprecedingorsucceedingAgreementorrenewalbetweentheParties,Clientagrees,with,toandforthebenefitof,theSecretaryofHealthandHumanServices("HHS")ortheComptrollerGeneraloftheUnitedStates,andtheirauthorizedrepresentativesincludingMedicarefiscalintermediaries,tograntaccessforaperiodofseven(7)yearsaftertheendofthecostreportingperiodinwhichsuchServicesarefurnishedpursuanttothisAgreementandtoanysimilarAgreementbetweenthePartiesandanyorganizationrelatedtoClientanditsbooks,documentsandrecordstoverifythecostsofthisAgreementinfurnishingtheServicesintheeventthattheimplementingregulationsissuedbyHHSaredeemedapplicabletothepartiesheretoandthisAgreement.ClinicagreestocooperatewithclienttotheextentnecessarywithregardtothemaintenanceofrecordsandtoallowClientsuchaccessasmayneededforanyauditoffiscalpracticesandcompliance,andforClienttoaddressit'sobligationsunderthePublicRecordsAct,RCW42.56.7.BINDINGEFFECT/ASSIGNMENT.ThisAgreementshallbebindingupon,andinuretothebenefitof,thePartiesandtheirrespectivesuccessorsandassigns.NeitherPartyshalldelegateorassignitsrightsordutiesunderthisAgreementwithoutthepriorwrittenconsentoftheotherParty.Anydelegationorassignment,withoutsuchconsent,shallnotrelievethetransferororassignorofitsdutiesorobligationsunderthisAgreement.ThisprovisionshallnotbeconstruedtopreventClinicfromengagingindependentcontractorstoperformcertainServices.8.GOVERNINGLAWANDVENUE.Allquestionsrelativetotheexecution,validity,interpretationandperformanceofthisAgreementshallbegovernedbythelawsoftheStateofWashington.ThePartiesagreethatanyactionrelatedtothisAgreementshallbeinstitutedandmaintainedasprovidedinSection13.ThePartiesagreethatvenueforanyactionshalllieinKittitasCounty,StateofWashington,andeachPartywaivestherighttochangeofvenue.4 9.WAIVERANDMODIFICATIONINEFFECTIVEUNLESSINWRITING.Nowaiver,alteration,ormodificationofanyoftheprovisionsofthisAgreementshallbebindingunlessinwritingandsignedbyadulyauthorizedrepresentativeofbothParties.10.COMPETITION.ClientrecognizesthatClinichasinvestedconsiderabletimeandmoneyindevelopingtheknowledgeandexperiencerelatedtotheServices.Clientfurtherrecognizesthefactthatstaffmgcosts,includingbutnotlimitedto,recruitment,insurance,fringebenefits,continuingeducation,andsalary,aremajorexpensestoClinic.Inconsiderationthereof,ClientagreesnottoemployorofferemploymenttoanypresentorformeremployeeorindependentcontractorofClinicwhomaybeinvolvedintheprovisionoftheServices,foraperiodofone(1)yearfromthedateofterminationofhisorheremploymentorcontractwithClinic.11.COMPLIANCE.EachPartyagreestocomplywithapplicablelaws,rulesandregulationswithrespecttotheServicesprovidedunderthisAgreement.l1.1HIPAA.Eachpartyagreestocomplywithallapplicablelaws,includingtheHealthInsurancePortabilityandAccountabilityActof1996,SubtitleF-AdministrativeSimplification,anditsimplementingregulationsastheycurrentlyexistandasfromtimetotimeamended("HIPAA")andWashingtonstatelawprotectingtheconfidentialityofhealthcareinformation,includingwithoutlimitationanyrequirementforawrittenreleaseofinformationfromClient'sPatient(s).ThepartiesfurtheragreetonegotiateingoodfaithanyadditionalagreementsoramendmentstothisAgreementthatarenecessarytoensurecompliancewithHIPAAorstatelaw.IfaftergoodfaithnegotiationsthepartiesarenotabletoagreetothetermsnecessarytocomplywithHIPAAorstatelaw,thisAgreementmaybeterminatedbyeitherpartyuponwrittennotice.11.2Thepartiesareawareoflawsprohibitingpracticesinvolvingkickbacks,rebates,paymentsforreferrals,privateinurementandtheunauthorizedpracticeofmedicine.EachpartyacknowledgesthatithasenteredintothisAgreementwithoutintenttoviolatesuchlawsandbelievesthatthisAgreementdoesnotviolatesuchlaws.EachpartyagreestoseektoenforcethisAgreementasitiswrittenandnottoassertthattherelationshipbetweenthepartiesisanythingotherthanabonafidecontractualrelationship.Ifanyfederalorstatelaworregulationisinterpretedbyjudicialdecision,regulatoryactionoraparty'slegalcounselinamannerthatindicatesthatthisAgreementmaybeinviolationofsuchlaworregulation,thepartiesshallworkingoodfaithtoamendthisAgreementasnecessarytocomplywithsuchlaworregulationtothemaximumextentpossible,anysuchamendmentshallpreservethefinancialtermsofthisAgreement.Ifthepartiesareunabletoreachagreementon·anamendmentthatpreservesthefinancialterms,thepartiesshallunwindthefinancialtermsandterminatethisAgreementwithinareasonabletime.12.RELATIONSHIPOFPARTIES.ClinicisanindependentcontractorintheprovisionoftheServicesunderthisAgreement.ThisAgreementdoesnotconstituteeitherPartytheagentor5 representativeoftheother,orcreateapartnershiporjointventurebetweentheParties,andneitherPartyshallhavethepowertoobligatetheotherinanymannerwhatsoever,exceptasexpresslyprovidedherein.ItisfurtherexpresslyagreedthatexceptwithrespecttotheobligationsspecificallysetforthinthisAgreement,ClientneitherhasnormayexerciseanycontrolovertheprofessionalmedicaljudgmentormethodsusedbyClinicintheperformanceoftheServices.13.ARBITRATION.ShouldadisputearisebetweenthePartiesastotheinterpretationormeaningwithregardtotheServicesprovidedpursuanttothisAgreement,thedisputeshallberesolvedbybindingarbitration.EitherPartymay,bywrittennoticetotheotherPartyatanytimeafteranimpassehasbeenreachedwithregardtoanydisputeastoServices,appointanarbitrator.IftheotherPartyisnotsatisfiedwiththechoiceofarbitrator,thensuchPartymay,bywrittennotice,within15businessdaysafterreceiptofsuchnoticebythefirstParty,appointanadditionalarbitrator.Indefaultofsuchadditionalappointmentofarbitratorbytheotherparty,thefirstarbitratorappointedshallbethesolearbitrator.Whentwoormorearbitratorshavebeenappointedasprovidedabove,theyshall,ifpossible,agreeuponanadditionalarbitratorasnecessarytoavoidadeadlock,bywrittennoticesignedbyeachoftheappointedarbitratorsandacopymailedtoeachParty.Within30daysaftertheappointmentofthearbitrator(s),thePartiesshallsubmitallfactsinwrittenororalform,andundertheprocedureprescribedbythearbitrator(s).Thereafter,thearbitrator(s)shallhave30daysinwhichtoreachadecisionuponthematterpresented.Thedecisionofthearbitrator(s)shallbebindinguponbothpartiesandshallbetheconclusive,finaldetermination.EachPartyshallbearitsowncostofarbitration,includingattorney'sfeesandfeesforthearbitratorappointedbysuchPartyandaproportionateshareofthefeesofanyarbitratorappointedbythearbitratorstoavoidadeadlock.Ifonlyonearbitratorisappointed,thePartiesshallsharethecostofsucharbitrator.TheprovisionsofthissectionshallnotbeapplicableintheeventClinicseekstolegallyenforcepaymentsdueunderthisAgreement.IntheeventClientdefaultswithrespecttopaymentofcompensationdueunderthisAgreement,ClinicshallhaveeveryrighttopursuelegalremediesforcollectioninacourtoflawinKittitasCounty,Washington,withoutfirsthavingtoresorttoarbitration.Intheeventsuchlegalactionisnecessarywithrespecttocollection,theprevailingPartyinsuchactionshallbeentitledtorecoverfromtheotherallreasonableattorney'sfees,costsandexpenses.14.INDEMNIFICATION.14.1Clientshallberesponsibleforthenegligentactsoromissionsofitself,itsemployees,directors,trustees,consultants,andagentswithinthescopeoftheirdutiesandagreestoindemnifyandholdharmlessanddefendClinic,itsdirectors,officers,employees,volunteers,andagentsfromandagainstclaims,suits,damages,fines,penalties,liabilitiesandexpenses(includingreasonableattorney'sfeesandcourtcosts)resultingfromor6 arisingoutofanynegligentactoromissionbyClientoranyofitsdirectors,officers,employees,agentsorvolunteerspertainingtotheServiceshereunder.14.2Clinicshallberesponsibleforthenegligentactsoromissionsofitself,itsemployees,directors,trustees,consultants,andagentswithinthescopeoftheirdutiesandagreestoindemnifyandholdharmlessanddefendClient,itsdirectors,officers,employees,volunteers,andagentsfromandagainstclaims,suits,damages,fines,penalties,liabilitiesandexpenses(includingreasonableattorney'sfeesandcourtcosts)resultingfromorarisingoutofanynegligentactoromissionbyClinicoranyofitsdirectors,officers,employees,agentsorvolunteerspertainingtotheServiceshereunder.14.3NoticeofClaim.ThepartyseekingindemnificationunderthisSection(the"IndemnifiedParty")shallprovidewrittennoticewithinthirty(30)daysafterthereceiptofanythirdpartyclaimcoveredhereundertothepartyfromwhomindemnificationissought(the"IndemnifyingParty").TheIndemnifyingPartyshallhavetherighttoassumeexclusivecontrolofthedefenseofsuchclaim,orattheoptionoftheIndemnifyingparty,tosettlesame.TheIndemnifiedPartyagreestocooperatereasonablywiththeIndemnifyingPartyinconnectionwiththeperformancebytheIndemnifyingPartyofitsobligationsunderthisSection,andfailuretodososhallterminatetheIndemnifyingParty'sobligations.15.SEVERABILITY.TheprovisionsofthisAgreementareseverable.IfanyoneormoreoftheprovisionsofthisAgreementareheldinvalidbyanycourtofcompetentjurisdictionorarevoidedornullifiedforanyreason,theremainingprovisionsandparagraphsshallcontinueinfullforceandeffectandshallbebindingonthepartiessoastocarryouttheintentandpurposesasnearlyaspossible;provided,however,thatanyfinaldeterminationofinvaliditywhicheliminatesorminimizestheconsiderationduetoeitherpartyhereundershallentitlesuchpartytoterminatethisAgreement.16.NOTICES.Allcorrespondenceandnoticesrequiredtobesenthereundershallbedeemedsufficientifinwritingandifpersonallydelivered,deliveredbyfacsimile,orifmailedbycertifiedmail,postagepre-paid,returnreceiptrequestedto:InthecaseofClient:InthecaseofClinic:Attention:CEOKittitasValleyHealthcare603S.ChestnutStreetEllensburg,WA98926Telephone:Telephone:509-962-7302Facsimile:Facsimile:509-962-7351Thedesignatedrepresentativeandaddressesmaybechangedasnecessarybygivingnoticeinthesamemanner.Noticeshallbedeemedeffectiveimmediatelyifdeliveredpersonallyorbyfacsimiledocumentedassuccessfullycompletedandeffective72hoursfollowing7 deliverybycertifiedmail.17.ENTIREAGREEMENT.ThisAgreementandExhibit"A"supersedeallprioragreementsandunderstandings,whetherwrittenororal,betweenthePartiesregardingthesubjecthereofandthisAgreementandExhibit"A"constitutetheentireunderstandingofthePartiesregardingthesubjecthereof.ThisAgreementandExhibit"A"mayonlybeamendedbyawrittenagreementsignedbybothParties.18.NOTHIRDPARTYRIGHTS.ThePartiesdonotintendthebenefitsofthisAgreementtoinuretoanythirdpersonnotasignatoryhereto.NothinginthisAgreementorthecourseofconductbyaPartyshallbeconstruedascreatinganyright,claimorcauseofactionagainsteitherPartybyanypersonorentitynotapartytothisAgreement.19.NOASSIGNMENT.Clientshallnotassign,delegate,orotherwisetransferanydutiesorobligationsunderthisAgreementwithoutthepriorwrittenconsentofClinic.AnyefforttodososhallbevoidandbecauseforimmediateterminationofthisAgreementbyClinic.20.NOWAIVER.NofailurebyeitherPartytoinsistuponthestrictperformanceofanyprovisionofthisAgreementshallbeconstruedasdeprivingthatPartyoftherighttoinsistonstrictperformanceofsuchprovisionorofanyotherprovisioninthefuture,andnowaivershallbedeemedtohavebeenmadeunlessexpresslyinwritingandsignedbytheotherParty.21.BINDINGEFFECT.ThisAgreementisbindingonthepartiesandontheirrespectiveexecutors,administrators,representative.successorsandassigns.22.CONSTRUCTIONOFAGREEMENT.Thepartiesagreethateachpartyandits/his/hercounselhaveparticipatedinthereviewandrevisionofthisagreementandthatanyruleofconstructiontotheeffectthatambiguitiesaretoberesolvedagainstthedraftingpartyshallnotapplyintheinterpretationofthisAgreementandanyAttachmentoramendment.23.COUNTERPARTS.ThisAgreementmaybeexecutedinoneormorecounterparts,eachofwhichshallbedeemedanoriginal,butallofwhichtogethershallconstituteoneandthesameinstrument,notwithstandingthefactthateachPartymaynothaveexecutedthesamecounterpart.INWITNESSWHEREOF,thepartieshaveexecutedthisinstrumenttobeeffectiveasoftheEffectiveDatefirstabovewritten.CLIENT:CLINIC:8 EXHIBIT"A"SEEATTACHED-KVHWorkplaceHealthServiceandPricingSheet.KVH/agrservicesoccupmedicine073117CLEAN9 KVH-KittitasValleyHealthcareW-KVHWorkplaceHealthGeneralInformationCompanyName:KittitasCountySheriff'sOfficePhysicalStreetAddress:307W.UmptanumRd.City,State,Zip:Ellensburg,WA98926MailingAddress(ifdifferentfromphysical):PrimaryContact:KimDawsonOfficePhone:509-962-7089ContactEmail:Kim.dawson@co.kittitas.wa.usOfficeFax:SecondaryContact(ifapplicable):SecondaryContactPhone:GuarantorInformationECheckifthesameasphysicaladdressCompanyName:StreetAddress(Mailing):City,State,Zip:Phone:Fax:ServicesPricingPhysicalExaminationOStandard:$100AudiogramOStandard:$55VenipunctureOStandard:$22Exec1PanelOStandard:$83Non-FederalDrugScreen,5panelOStandard:$45EKGOStandard:$75U/AwithmicroOStandard:$27StoolGuaiacOstandard:$40RangeofMotionOStandard:$45SpirometryOStandard:$60PAChestX-Ray(1view)OStandard:$100LSpineX-RayOStandard:$60TSpineX-RayOStandard:$60OptionalServicesHepBTiterOStandard:$60HepBInjections,each(seriesof3)OStandard:$103PSA(ifmedicallyindicated)Ostandard:$100Totalw/oOptionalServices$772 KVHKittitasValleyHealthcareYawrH«ncerrHofÁLabandMROLabCorpSpecialinstructionsForms/ReportingResults