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HomeMy WebLinkAbout102641 POUDRE VALLEY HOSPITAL - CONTRACT - RFP - 8037 PFA EMERGENCY MEDICAL SERVICE PROVIDER (3)Amendment #1 – Agreement for Dispatch Services Page 1 of 3 Amendment #01 to the Agreement For Dispatch Services between The City of Fort Collins and Poudre Valley Health Care, Inc. d/b/a Poudre Valley Hospital This First Amendment (“Amendment #01”) is entered into by and between The City of Fort Collins, Colorado (“City”) and Poudre Valley Health Care, Inc. d/b/a Poudre Valley Hospital (the “Service Provider”). WHEREAS, the City and the Service Provider mutually entered into an Agreement for Dispatch Services on May 5, 2015 (“Agreement”); and WHEREAS, the parties wish to update Schedule 1, Dispatch Services Reimbursement Calculation Methodology and renew the Agreement for one (1) additional year; and WHEREAS, both parties agree to the revised Schedule 1 and renewal. NOW, THEREFORE, in consideration of the foregoing recitals and the mutual promises herein contained, the parties agree as follows: 1. Term. Pursuant to Section 1 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. Schedule 1, Dispatch Services Reimbursement Calculation Methodology. The attached Schedule 1 supersedes and replaces the original Schedule 1 in its entirety. 3. 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: 3117421D-4606-4349-9E92-E99032312AE5 Amendment #1 – Agreement for Dispatch Services Page 2 of 3 IN WITNESS WHEREOF, the parties have executed this Amendment #01 as of the last date of signature below. CITY OF FORT COLLINS By: Gerry Paul, Purchasing Director DATE: ATTEST: 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: 3117421D-4606-4349-9E92-E99032312AE5 5/24/2018 Assistant City Attorney ll City Clerk 5/29/2018 President/CEO Kevin Unger Amendment #1 – Agreement for Dispatch Services Page 3 of 3 Schedule 1 Dispatch Services Reimbursement Calculation Methodology Fort Collins 911 will provide dispatching services on a twenty-four (24) hour per day basis. Radio bases, mobile units and portable dispatching units will be owned and maintained by the Service Provider. FORMULA FOR COSTS IS: • 1 FTE Emergency Services Dispatcher position – Estimated 2018 cost is $76,877 (includes benefits). • A percentage of Fort Collins 911 year ending expenditures based on the number of calls generated by the Service Provider. Any call opened, dispatched or closed by Fort Collins 911 will be included in this number. • Yearend expenditures shall include personnel and overtime costs and other operational costs, and any other dispatch related supplies and materials. This cost does not include the 1 FTE dispatcher salary and benefit figures as noted above. • A percentage of CAD yearly software maintenance costs; radio yearly maintenance costs, dispatch related phone line costs. • A percentage of costs of new or upgraded dispatched related systems such as CAD and/or applications to include software, hardware, implementation services and any other related service required for the system(s). • Any additional equipment costs incurred by Fort Collins 911 to provide dispatching services to the Service Provider such as; o One Dispatch workstation/furniture equipment o One Radio console/workstation o One Radio consolette for back up communications FOR EXAMPLE: Yearly expenditures for 2018 totaled $2,791,252.74 Percentage of ambulance calls opened, dispatched or closed by Fort Collins 911 through Computer Aided Dispatch (CAD) system = 13.25% 13.25 % OF TOTAL EXPENDITURES = $ 369,840.98 $ 369,840.98 Annual expenditures excluding equipment maintenance $ 32,112.83 Equipment maintenance (radio, Tiburon CAD maintenance, & analog back-up phones) $ 168,817.00 New/upgraded CAD system and related expenses $ 76,877.00 Emergency Services Dispatcher Position 1 FTE $647,647.81- TOTAL AMBULANCE CONTRACT COSTS DocuSign Envelope ID: 3117421D-4606-4349-9E92-E99032312AE5 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: 3117421D-4606-4349-9E92-E99032312AE5 (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: 3117421D-4606-4349-9E92-E99032312AE5 (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: 3117421D-4606-4349-9E92-E99032312AE5