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HomeMy WebLinkAbout102461 POUDRE VALLEY HOSPITAL - CONTRACT - RFP - 8037 PFA EMERGENCY MEDICAL SERVICE PROVIDERAmendment #4 - 8037 PFA Emergency Medical Services Page 1 of 3 Amendment #04 to the Service Agreement between Poudre Fire Authority and Poudre Valley Health Care, Inc. d/b/a Poudre Valley Hospital This Fourth Amendment (“Amendment #04”) is entered into by and between The Poudre Fire Authority (“PFA”) and Poudre Valley Health Care, Inc. d/b/a Poudre Valley Hospital (the “Service Provider”). WHEREAS, PFA and the Service Provider mutually entered into a Services Agreement (8037 PFA Emergency Medical Services), effective June 1, 2015; and WHEREAS, the parties agreed to certain amendments and extensions of the Services Agreement by executing Amendment #01 on July 14, 2016; Amendment #02 on July 14, 2016; and Amendment #03 on July 26, 2017 (together with the Services Agreement, the “Agreement”); and WHEREAS, the parties wish to make additional changes to the Agreement to incorporate Remediation-Equivalence (R-E) pursuant to the terms of this Amendment #04; and WHEREAS, both parties agree to the changes. NOW, THEREFORE, in consideration of the foregoing recitals and the mutual promises herein contained, the parties agree as follows: 1. Term. Pursuant to Section 2 of the Agreement, the term of the Agreement is hereby extended for an additional one-year period, commencing June 1, 2018 and extending to May 31, 2019. 2. Exhibit A, Scope of Services, Definitions. Section 1.0, Definitions, in Exhibit A, Scope of Services, as attached to the Agreement, is hereby amended by adding the following definition: “Remediation-Equivalence” (R-E) is the process of allowing an equivalency to be applied by the Contractor in lieu of liquidated damages being assessed, as further described in Section 7.0. 3. Exhibit A, Scope of Services, Liquidated Damages. Section 7.0, Liquidated Damages, in Exhibit A, Scope of Services, as attached to the Agreement, is hereby amended by adding the following Paragraph G: G. Remediation-Equivalence (R-E): 1. An equivalency shall be applied by the Contractor in lieu of liquidated damages being assessed under any of the following conditions: a. Contractor is not compliant with Section 2.2(B) during the time period of the applicable R-E being requested. b. Contractor is compliant with Section 2.4 during the time period of the applicable R-E being requested. c. NLCERA system improvements (operational or clinical) are identified and implemented within specified time frames by the Contractor in affected zones. d. An R-E plan pertaining to the last full month of NLCERA or WFPD EMS response data must be submitted to PFA EMS Contract Coordinator prior to the second Tuesday of the next month with the following components: DocuSign Envelope ID: E150C14E-0C9D-4DD3-B8F6-A5CCE79F37C0 Amendment #4 - 8037 PFA Emergency Medical Services Page 2 of 3 i. Clearly defined non-compliant NLCERA zone(s); ii. Metrics used to address NLCERA zone deficits and solutions as identified in subparagraph 1.C. above; iii. Plan of system improvements to be implemented - Contractor will follow a performance improvement methodology, such as that provided by the Institute for Healthcare Improvement (IHI) and use their tools as appropriate; iv. Evaluation of effectiveness – Tools and methods to establish successful improvements or desired changes as a result of the implementation; and v. Reassessment plan and reporting parameters. 2. PFA will use current R-E evaluation tool to score the proposed R-E and to work with Contractor for development of R-E proposal revisions prior to approval. 4. Exhibit A, Scope of Services, Quality Control and Performance Improvement. Section 5.0, Quality Control and Performance Improvement, in Exhibit A, Scope of Services, as attached to the Agreement, is hereby amended by revising Paragraph C as follows (with revised language identified in italics): C. Contractor shall establish and carry out its own comprehensive performance improvement (PI) program and should not be limited to clinical functions. The Contractor’s PI program shall interface and work collaboratively with the PFA’s programs. Contractor’s PI program may include Remediation-Equivalence toward performance improvements by the Contractor. Contractor shall prepare an annual PI program plan delineating specific initiatives and outcomes. Contractor shall provide monthly updates for all PI initiatives. 4. No Other Amendments. The parties agree that all other terms and conditions of the Agreement shall remain unchanged and in full force unless modified by a subsequent amendment. [SIGNATURE PAGE FOLLOWS] DocuSign Envelope ID: E150C14E-0C9D-4DD3-B8F6-A5CCE79F37C0 Amendment #4 - 8037 PFA Emergency Medical Services Page 3 of 3 IN WITNESS WHEREOF, the parties have executed this Amendment #04 as of the last date of signature below. POUDRE FIRE AUTHORITY By: Gerry Horak PFA Board Chair DATE: ATTEST: PFA Secretary APPROVED AS TO FORM: POUDRE VALLEY HEALTH CARE, INC. d/b/a POUDRE VALLEY HOSPITAL By: Printed: Title: CORPORATE PRESIDENT OR VICE PRESIDENT Date: DocuSign Envelope ID: E150C14E-0C9D-4DD3-B8F6-A5CCE79F37C0 Assistant City Attorney ll 5/29/2018 Kevin Unger 5/29/2018 President/CEO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME: CONTACT (A/C, No): FAX E-MAIL ADDRESS: PRODUCER (A/C, No, Ext): PHONE INSURED COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ PROPERTY DAMAGE $ BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOS ONLY AUTOS NON-OWNED OWNED SCHEDULED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME: CONTACT (A/C, No): FAX E-MAIL ADDRESS: PRODUCER (A/C, No, Ext): PHONE INSURED COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ PROPERTY DAMAGE $ BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOS ONLY AUTOS NON-OWNED OWNED SCHEDULED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CANCELLATION ACORD 28 (2016/03) © 2003-2015 ACORD CORPORATION. All rights reserved. YES NO YES NO Subject to Different Provisions: If YES, LIMIT: DED: Subject to Different Provisions: NAMED STORM INCL If YES, LIMIT: DED: If YES, LIMIT: If YES, LIMIT: If YES, LIMIT: If YES, LIMIT: If YES, LIMIT: If YES, LIMIT: RENTAL VALUE N/A FUNGUS EXCLUSION (If "YES", specify organization's form used) LIMITED FUNGUS COVERAGE $ EARTH MOVEMENT (If Applicable) WIND / HAIL INCL ORDINANCE OR LAW EQUIPMENT BREAKDOWN (If Applicable) COINSURANCE AGREED VALUE REPLACEMENT COST DED: IS DOMESTIC TERRORISM EXCLUDED? IS THERE A TERRORISM-SPECIFIC EXCLUSION? TERRORISM COVERAGE Attach Disclosure Notice / DEC BLANKET COVERAGE YES NO COVERAGE INFORMATION FLOOD (If Applicable) PERMISSION TO WAIVE SUBROGATION IN FAVOR OF MORTGAGE HOLDER PRIOR TO LOSS If YES, % DED: COMMERCIAL PROPERTY COVERAGE AMOUNT OF INSURANCE: DED: PERILS INSURED BASIC BROAD SPECIAL - Demolition Costs - Incr. Cost of Construction - Coverage for loss to undamaged portion of bldg DED: DED: DED: DED: DED: If YES, indicate value(s) reported on property identified above: $ BUSINESS INCOME If YES, LIMIT: Actual Loss Sustained; # of months: If YES, LIMIT: AUTHORIZED REPRESENTATIVE ADDITIONAL INTEREST NAME AND ADDRESS CONTRACT OF SALE LENDER SERVICING AGENT NAME AND ADDRESS MORTGAGEE LENDER'S LOSS PAYABLE LOCATION / DESCRIPTION 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 EVIDENCE OF PROPERTY INSURANCE 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. (ACORD 101 may be attached if more space is required) BUILDING OR BUSINESS PERSONAL PROPERTY THIS EVIDENCE OF COMMERCIAL PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST. ADDITIONAL NAMED INSURED(S) NAMED INSURED AND ADDRESS CODE: AGENCY CUSTOMER ID #: SUB CODE: E-MAIL ADDRESS: (A/C, No, Ext): PHONE FAX (A/C, No): PRODUCER NAME, CONTACT PERSON AND ADDRESS EFFECTIVE DATE EXPIRATION DATE THIS REPLACES PRIOR EVIDENCE DATED: TERMINATED IF CHECKED CONTINUED UNTIL IF MULTIPLE COMPANIES, COMPLETE SEPARATE FORM FOR EACH COMPANY NAME AND ADDRESS NAIC NO: POLICY TYPE LOAN NUMBER POLICY NUMBER EVIDENCE OF COMMERCIAL PROPERTY INSURANCE DATE (MM/DD/YYYY) The ACORD name and logo are registered marks of ACORD PROPERTY INFORMATION LOSS PAYEE 10/3/2017 678-651-2202 (ATL) Stephanie Gordon XL Insurance Beecher Carlson Insurance Services 6 Concourse Parkway, Suite 2300 Atlanta, GA 30328 www.beechercarlson.com 678-539-4890 sgordon@beechercarlson.com All Risk Property US00035664PR17A 10/1/2017 10/1/2018 ✓ 1,000,000,000 25,000 ✓ ✓ ✓ 12 ✓ 1,000,000,000 ✓ ✓ ✓ ✓ 250,000 ✓ ✓ ✓ ✓ ✓ Included 25,000 ✓ Included 25,000 ✓ Included 25,000 ✓ Included 25,000 ✓ $50,000,000 100,000 ✓ $50,000,000 100,000 ✓ Sharon D. Brainard Poudre Valley Health Care, Inc. dba Poudre Valley Health System and Poudre Valley Hospital 2315 E. Harmony Rd., Suite 200 Fort Collins CO 80528 Poudre Fire Authority Purchasing Department PO Box 580 Fort Collins CO 80522 38198836 | 17-18 EOP - Master | (ATL) Stephanie Gordon | 10/3/2017 5:01:06 PM (EDT) | Page 1 of 1 DocuSign Envelope ID: E150C14E-0C9D-4DD3-B8F6-A5CCE79F37C0 (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT ER OTH- STATUTE PER (MM/DD/YYYY) LIMITS POLICY EXP (MM/DD/YYYY) POLICY EFF LTR TYPE OF INSURANCE POLICY NUMBER INSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB EACH OCCURRENCE $ AGGREGATE $ $ OCCUR CLAIMS-MADE DED RETENTION $ PRODUCTS - COMP/OP AGG $ GENERAL AGGREGATE $ PERSONAL & ADV INJURY $ MED EXP (Any one person) $ EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 9/27/2017 Beecher Carlson Insurance Services 6 Concourse Parkway, Suite 2300 Atlanta, GA 30328 678-651-2202 678-539-4890 www.beechercarlson.com Sharon D. Brainard (ATL) Stephanie Gordon sgordon@beechercarlson.com Poudre Valley Health Care, Inc. dba Poudre Valley Health System 2315 E. Harmony Rd., Suite 200 Fort Collins CO 80528 38038386 Liability only. Poudre Fire Authority PO Box 580 Fort Collins CO 80522 Poudre Fire Authority and the City of Fort Collins, its officers and employees are listed as additional insured with respect to Automobile A TJ-CAP-4251B599-TIL-17 10/1/2017 10/1/2018 $1,000,000 ✓ C TC2K-UB-1761B963-17-Ded 10/1/2017 10/1/2018 TRJ-UB-9F337692-17-Retro 1,000,000 1,000,000 1,000,000 Travelers Property Casualty Co of Amer 25674 Travelers Indemnity Company 25658 38038386 | 17-18 AU, WC | (ATL) Stephanie Gordon | 9/27/2017 4:42:23 PM (EDT) | Page 1 of 1 DocuSign Envelope ID: E150C14E-0C9D-4DD3-B8F6-A5CCE79F37C0 (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT ER OTH- STATUTE PER (MM/DD/YYYY) LIMITS POLICY EXP (MM/DD/YYYY) POLICY EFF LTR TYPE OF INSURANCE POLICY NUMBER INSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB EACH OCCURRENCE $ AGGREGATE $ $ OCCUR CLAIMS-MADE DED RETENTION $ PRODUCTS - COMP/OP AGG $ GENERAL AGGREGATE $ PERSONAL & ADV INJURY $ MED EXP (Any one person) $ EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 9/27/2017 Beecher Carlson Insurance Services, LLC 321 North Clark Street, 5th Floor Chicago, IL 60654 (PROV) Jerilynn Leahy Poudre Valley Health Care, Inc. d/b/a Poudre Valley Health System and Poudre Valley Hospital 2315 E. Harmony Rd., Suite 200 Fort Collins CO 80528 38015133 Please Note: Primary Medical Professional Liability - $1,000,000/$3,000,000 Umbrella/Excess Liability, including Medical Professional and General Liability $15,000,000/$15,000,000 Poudre Fire Authority Purchasing Department PO BOX 580 Fort Collins CO 80522 Poudre Fire Authority and the City of Fort Collins, its officers and employees are listed as additional insured with respect to General Liability. General Liability - $1,000,000/$3,000,000 Cyber Liability - Insured by Beazley - Policy # PH1600049 Effective 10/1/2017 to 10/1/2018 Limits of Liability: $7,500,000 A HCC0013228 10/1/2017 10/1/2018 1,000,000 500,000 ✓ 5,000 ✓ ✓ 1,000,000 3,000,000 ✓ ✓ 1,000,000 C ✓ ✓ HPC 0184343-02 10/1/2017 10/1/2018 15,000,000 ✓ 15,000,000 A Health Care Professional Liability HCC0013228 10/1/2017 10/1/2018 Per Claim: $1,000,000 Aggregate: $3,000,000 COPIC Insurance Company 11860 Steadfast Insurance Company 26387 38015133 | 17-18 GL PL, AU UMB WC (Poudre | (PROV) Denise Simmons | 9/27/2017 10:20:52 AM (EDT) | Page 1 of 1 DocuSign Envelope ID: E150C14E-0C9D-4DD3-B8F6-A5CCE79F37C0