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Home My WebLink AboutCORRESPONDENCE - AGREEMENT MISC - NORTH RANGE BEHAVIORAL HEALTH (3)Financial Services Purchasing Division 215 North Mason Street 2nd Floor PO Box 580 Fort Collins, CO 80522 970.221,6775 970.221.6707 - fax fcgo v. com/purchasing November 3, 2011 North Range Behavioral Health Attn: Mr. Larry Pottorff, LCSW 1300 North 17th Avenue Greeley, CO 80631 RE: Renewal, North Range Behavioral Health Substance Abuse Professional Services Agreement Dear Mr. Pottorff: The City of Fort Collins wishes to extend the agreement term for the above captioned proposal per the existing terms and conditions and the following: The term will be extended for one (1) additional year, January 1, 2011 through December 31, 2011. The City of Fort Collins agrees to pay Ninety Seven Thousand Nine Hundred Sixty Six Dollars ($97,966.00) for the 2011 renewal term which includes up to One Thousand (1,000) confirmed Fort Collins residents and/or Fort Collins Police Services referrals. North Range Behavioral Health's (NRBH) goal is to respond to all requests within a reasonable time -frame (normally ninety (90) minutes to two (2) hours). NRBH agrees to inform Poudre Valley Hospital (PVH) of the anticipated pick up time, after the referral form has been faxed to NRBH and NRBH has accepted the client, for any client(s) being referred -for substance abuse professional services. If NRBH is unable to pick up the client at the time given, and will be delayed more than thirty (30) minutes, NRBH agrees to notify PVH of the reason(s) for the delay and the new anticipated pick up time. In case of a dispute, the following procedures will be used in addressing any immediate issues/concerns arising from the implementation of this Agreement: a) During normal working hours, PVH will contact Amanda Springer, CSS Program Director at 970-347-2352 (office) or 970-397-0158 (cell). b) After hours, PVH will contact: Amanda Springer, CSS Program Director at 970-397-0158 (cell); or Kendall Alexander, Administrative Director, at 970-412-2051 (cell). If the renewal is acceptable to your firm, please sign this letter in the space provided include a current copy of insurance naming the City as an additional insured and return all documents to the City of Fort Collins, Purchasing Division, P. O. Box 580, Fort Collins, CO 80522, within the next fifteen days. Rev 07/08 If this extension is not agreeable with your firm, we ask that you send us a written notice stating that you do not wish to renew the contract and state the reason for non -renewal. Please contact John D. Stephen, CPPO, LEED AP, Senior Buyer at (970) 221-6777 if you have any questions regarding this matter. Sincerely, J es B. O'NeiI�PPO, FNIGP D�ector of Purchasing and Risk Management Gt/• li 3 /o Signature Lar D. Pottorff, .ExVrth a Director ate (Please indica your desire to renewangeBehavioral Health by signing this letter and returning it to Purchasing Division within the next fifteen days.) JBO:jkb Rev 07/08 ® CERTIFICATE OF LIABILITY INSURANCE OP ID DP ACORJ� NORTHI2 DATE(MM!ODIYYYY) 05/23/10 PRooucER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rich & Cartmill Ins of CO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE of Colorado LLC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 8213 19. 20th Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Greeley CO 80634 Phone:970-356-8030 Fax:970-356-8032 _...._ INSURERS AFFORDING COVERAGE ..._..... —_.. _.._... ........_.__...... ... NAIC# __..........___._...... ............._.. : INSURED INSURER Az ACE American Ins Cc 22667 INSURER8: Pinnacol Assurance .... .......... INsuRERc: Ace -Property & Casualty North Range Behavioral Health 1300 N. 17th Avenue INSURER D: Greeley CO 80631 .............. ... __... _ .._...._...-----... I INSURER E: rntreDn r`CC THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NO-1IMTHSTANDING 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS Ry11)U'--.._.__—___................. ....._.._.. _.__... _..._ P�Iny—p-'T TIVC•b�ST.TC PRA PO LTR )NSR TYPE OF INSURANCE LICY NUMBER DATE (MMIDDNYYY DATE MM/DDIWYY LIMITS GENERAL LIABILITY I EACH OCCURRENCE i $ 1,000,000 P, X i X i COMMERCIAL GENERAL LIABILITY II f SVRD37799361001 07/01/10 07/01/11 PREMISES(Ea oocurence)e CLAIMS MADE I. X I OCCUR! ( i i MED EXP (Any one person} y S 10 , 000 i i I i PERSONAL S ADV INJURY I S 1, 00_0 , 0 00 I I GENERAL AGGREGATE 5 3 000 000 ' GENT AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMPIOP AGG is 3, 0 00, 0 00 �X _i POLICY Jt O —j LOC 1 I Em Ben. I 1,000,000 A I AUTOMOBILE X LIABILITY ANY AUTO CALH08614611001 ! I 07/01/10 I I 07/01/11 I COMBINED SINGLE LIMIT $ 1 000 000 i (Ea ac.-ide"I) r r ALL OWNED AUTOS SCHEDULED AUTOS !I 1 BODILY INJURY ( (Per person) BODILY INJURY I $ (Per accident) I I BARED AUTOS I NON -OWNED AUTOS I PROPERTY DAMAGE i $ (Per accident I ' GARAGE LIABILITY I AUTO ONLY - EA ACCIDENT $ i I ' ANY AUTO .. I i : OTHER THAN E" AL S _... AUTO ONLY AGG ! S i i EXCESS! UMBRELLA LIABILITY I ! EACH OCCURRENCE i : 2 , 000, 000 C ix Qa:uR — CLAIMS MADE XOOG25503740001 f 07/01/10; 07/01/11 AGGREGATE I$2,040,000 DEDUCTIBLE (' X (RETENTION $10,000 ! I.$ I WORKERS COMPENSATION I AND EMPLOYERS' LIABILITY yI N, 4044331 i I X ITOR'i LIMITS l 1 F1i , , / . . . ...... ....._.—_.—_.._ __'-- Q7/0�/�0 07/01, 11 i E.L. EACHA.CCIDENT $ 100000 B i ANY PROPRIETOR/PARTNERIEX.ECUTIVg--I OFMCEPLIMEMEEP. EXCLUDED? L.� (MyyandM.ry In NH) i E:L. DISEASE: CA EMPLOYEEi $ 100000 SPECIALes,SPROVISIONS balo+. j E.LDISEASE - POLICY LIMIT 1 $ 00000 OTHER I A iProfessional Liab IOGLG2550382A001 07/01/10 07/01/11i Aggregate $5,000,000 Ea incide $3,000,000 DESCRIPTION OF OPERATIONS J LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS City of Fort Collins, Colorado, a Municipal Corporation, is listed as additional insured as their interest may appear. CERTIFICATE HOLDER CANCELLATION CITFOR City of Fort Collins, Colorado A Municipal Corporation 300 LaPorte Ave PO Box 580 Fort Collins CO 80522 AcnRn 99 rvnnvinli SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. TUTHORIZED REPRESENTATIVE lichael J Schmitt CIC n 19BB-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD