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Home My WebLink AboutCORRESPONDENCE - AGREEMENT MISC - NORTH RANGE BEHAVIORAL HEALTH (9)Official Purchasing Document Last updated 3/2018 AMENDMENT #05 AGREEMENT BETWEEN THE CITY OF FORT COLLINS, NORTH RANGE BEHAVORIAL HEALTH This Fifth Amendment (Amendment #05) is entered into by and between the CITY OF FORT COLLINS (the “City”) and NORTH RANGE BEHAVIOR HEALTH (the “Service Provider”). WHEREAS, the Service Provider and the City entered into an Agreement effective April 3, 2018 (the “Original Agreement”); and WHEREAS, the parties amended the Agreement (Amendment #01) effective July 1, 2018 to extend the contract period for an additional three months; and WHEREAS, the parties amended the Agreement (Amendment #02) effective October 1, 2018 to extend the contract period for an additional three months; and WHEREAS, the parties amended the Agreement (Amendment #03) effective January 1, 2019 to extend the contract period for an additional six months; and WHEREAS, the parties amended the Agreement (Amendment #04) effective July 1, 2019 to extend the contract period for an additional one year; and WHEREAS, Service Provider and the City desire to amend the Original Agreement to extend the services to be performed under the Original Agreement; and WHEREAS, the Parties wish to extend the term of the Original Agreement by one (1) additional year. NOW, THEREFORE, in consideration of the foregoing recitals and the mutual promises herein contained, the parties agree as follows: 1. Pursuant to paragraph 2 of the Original Agreement, Contract Period, the term is hereby extended for one additional year commencing July 1, 2020 until June 30, 2021. Except as expressly amended by this Amendment #05, all other terms and conditions of the Agreement shall remain unchanged and in full force and effect. In the event of a conflict between the terms of the Agreement and this Amendment #05, this Amendment #05 shall prevail. IN WITNESS WHEREOF, the parties have executed this Fifth Amendment the day and year shown. CITY OF FORT COLLINS: By: Gerry Paul Purchasing Director DATE: NORTH RANGE BEHAVIORAL HEALTH By: Printed: Title: CORPORATE PRESIDENT OR VICE PRESIDENT Date: DocuSign Envelope ID: C0C137EE-74D5-4B13-8D47-914503473905 7/6/2020 Larry Pottorff Executive Director 7/6/2020 7/10/2020 Professional Risk LLC 8213 W.20th St Greeley CO 80634 Dionne Perez (970)356-8030 (970)356-8032 dionne.perez@proriskllc.com North Range Behavioral Health 1300 N 17th Avenue Greeley CO 80631 Philadelphia Insurance Co 18058 Pinnacol Assurance 524210 Lloyds of London 20-21 Excess A X X X PROFESSIONAL LIABILITY X X PHPK2152685 7/1/2020 7/1/2021 1,000,000 1,000,000 20,000 1,000,000 3,000,000 3,000,000 Employee Benefits 1,000,000 A X X PHPK2152685 7/1/2020 7/1/2021 1,000,000 A X X X 10,000 PHUB728699 7/1/2020 7/1/2021 2,000,000 2,000,000 B Y 4044331 7/1/2020 7/1/2021 X 1,000,000 1,000,000 1,000,000 C PRIVACY ESJ0419736101 7/1/2020 7/1/2021 AGGREGATE $ 3,000,000 A HIPAA VIOLATION PSD1555400 7/1/2020 7/1/2021 LIMIT $ 50,000 City of Fort Collins, Colorado, a Municipal Corporation, is listed as additional insured as pertains to the General and Auto Liability policies, per written contract. City of Fort Collins, Colorado a Municipal Corporation PO Box 580 Fort Collins, CO 80522 Dionne Perez/DP The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) AUTHORIZED REPRESENTATIVE CANCELLATION CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) JECT LOC PRO- POLICY GEN'L AGGREGATE LIMIT APPLIES PER: CLAIMS-MADE OCCUR COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ DED RETENTION $ CLAIMS-MADE OCCUR $ AGGREGATE $ UMBRELLA LIAB EACH OCCURRENCE $ EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS PER STATUTE OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNED AUTOS AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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. INSD ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) OTHER: 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. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INSURED PHONE (A/C, No, Ext): PRODUCER ADDRESS: E-MAIL FAX (A/C, No): CONTACT NAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INS025 (201401)