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File #: 11-763    Name:
Type: Minutes Status: Passed
File created: 6/28/2011 In control: Board of Supervisors
On agenda: 6/28/2011 Final action: 6/28/2011
Title: Authorize the Purchasing Manager for Natividad Medical Center (NMC) to execute Amendment No. 1 to the Authorize the Purchasing Manager for Natividad Medical Center (NMC) to execute Amendment No. 1 to the
Attachments: 1. Completed Board Order and Amendment, 2. Signed Board Report and Supporting Docs

 

 

 

 

 

 

COMPLETED BOARD ORDER AND AME

=�17

Before the Board of Supervisors in and for the

County of Monterey, State of California

Agreement No. A-11709

Authorize the Purchasing Manager for Natividad Medical

Center NMC) to execute Amendment #1 to the Agreement

A-11709 with Supplemental Health Care Services for

Ancillary and Respiratory Registry Staffing Services at NMC

in an amount not to exceed $250,000 in the aggregate and

$125,000 for the period July 1, 2011 to June 30, 2012...........

Upon motion of Supervisor Salinas, seconded by Supervisor Calcagno, and carried by those

members present, the Board hereby;

Authorized the Purchasing Manager for Natividad Medical Center NMC) to

execute Amendment #1 to the Agreement # A-11709) with Supplemental Health

Care Services for Ancillary and Respiratory Registry Staffing Services at NMC in

an amount not to exceed $250,000 in the aggregate and $125,000 for the period

July 1, 2011 to June 30, 2012.

PASSED AND ADOPTED on this 28`h day of June, 2011, by the following vote, to wit:

AYES: Supervisors Calcagno, Salinas, and Parker

NOES: None

ABSENT: Supervisors Armenta and Potter

I, Gail T. Borkowski, Clerk of the Board of Supervisors of the County of Monterey, State of California, hereby

certify that the foregoing is a true copy of an original order of said Board of Supervisors duly made and entered in the

minutes thereof of Minute Book 75 for the meeting on June 28, 2011.

Dated: June 29, 2011 Gail T. Borkowski, Clerk of the Board of Supervisors

County of Monterey, State of California

By

Deputy

 

 

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COMPLETED BOARD ORDER AND AME

=�Original Agreement No or PO#. A-1 1709)

RENEWAL AMENDMENT NO. 1

FOR PROFESSIONAL SERVICE AGREEMENT

BETWEEN Supplemental Health Care Services AND

THE NATIVIDAD MEDICAL CENTER

FOR

Ancillary and Respiratory Registry Staffine Services

The parties to Professional Service Agreement, dated June 1, 2010 between the County of Monterey, on

behalf of Natividad Medical Center NMC"), and Supplemental Health Care Services Contractor),

hereby agree to renew their Agreement No. A-11709) on the following terms and conditions:

1. Contractor will continue to provide NMC with the same scope of service as stated in the original

Agreement No. A-11709).

2. This Amendment shall become effective on July 1, 2011 and shall continue in full force until June

30, 2012.

3. The total amount payable by County to Contractor under Agreement No. A-11709) shall not

exceed the tot 1 sum of $250,000 for the full term of the Agreement and $125,000 for fiscal year

p'-

4. All other terms and conditions of the Agreement shall continue in full force and effect.

5. A copy of this Amendment shall be attached to the original Agreement No. A-11709).

IN WITNESS WHEREOF, the parties hereto are in agreement with this Amendment and

Professional Service Agreement on the basis set forth in this document and have executed this

amendment on the day and year set forth herein.

NATIVIDAD MEDICAL CENTER

Signature

Purchasing Manager

Dated

Signature Dated t  t I

NMC  CEO

Approved as to Legal Form:

Charles J. McKee, County Counsel

tacy Saetta, Depu

Attorneys for County and NMC

 

 

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SIGNED BOARD REPORT AND SUPPO

@�MONTEREY COUNTY BOARD OF SUPERVISORS

MEETING: June 28, 2011 AGENDA NO.:

SUBJECT: Authorize the Purchasing Manager for Natividad Medical Center NMC)

to execute Amendment #I to the Agreement # A- 11709) with

Supplemental Health Care Services for Ancillary and Respiratory

Registry Staffing Services at NMC in an amount not to exceed $250,000

in the aggregate and $125,000 for the period July 1, 2011 to June 30,

2012.

DEPARTMENT: Natividad Medical Center

RECOMMENDATION:

It is recommended that the Board of Supervisors authorize the Purchasing Manager for Natividad

Medical Center NMC) to execute Amendment #I to the Agreement # A- 11709) with Supplemental

Health Care Services for Ancillary and Respiratory Registry Staffing Services at NMC in an amount

not to exceed $250,000 in the aggregate and $125,000 for the period July 1, 2011 to June 30, 2012.

SUMMARY/DISCUSSION:

Natividad Medical Center NMC) contracts with outside staffing agencies that provide the hospital

with Respiratory Therapists, Occupational and Physical Therapists when the hospital is unable to

recruit licensed personnel for these positions, and also to cover short term absences of existing staff.

The affected departments are also currently working on cross training efforts to provide coverage to

support these service lines.

These positions are essential in order for NMC to meet clinical needs, and to comply with

regulations as established by The Joint Commission; a regulatory agency that sets standards of care

for hospitals and ancillary clinical services. This action will allow NMC to continue to provide

appropriate staffing to cover the Cardiopulmonary, and Occupational/Physical Therapy

Departments; until the time where permanent replacements are determined.

Actual dollars spent as of June 8, 2011 are $31,010, out of the $125,000 budgeted for the period of

July 1, 2010 to June 30, 2011. A contingency amount of $125,000 is based on historic actual usage

and needed reserve in order to maintain a method of payment for the period of July 1, 2011 to June

30, 2012.

OTHER AGENCY INVOLVEMENT:

The Amendment has been reviewed and approved by County Counsel, the Auditor/Controller's

office and the Natividad Medical Center Board of Trustees.

FINANCING:

The cost for this Amendment is $125,000 and is included in the 2011/2012 Fiscal Year

Recommended Budget. This action will not require any additional General Fund subsidy.

Prepared by:

John Nevill, Director of Cardiopulmonary 755-4366

April 4, 2011

Harry Weis

Chief Executive Officer

Attachments: Amendments #1, Original Agreement, Board Order

Attachments are on file with the Clerk of the Board

 

 

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SIGNED BOARD REPORT AND SUPPO

@�MONTEREY COUNTY BOARD OF SUPERVISORS

MEETING: June 8, 2010

AGENDA NO.:

SUBJECT: Authorize the Purchasing Manager for Natividad Medical Center NMC)

to execute an Agreement with Supplemental Health Care Services for

Temporary Staffing Services at NMC in an amount not to exceed

$125,000 for the period June 1, 2010 to June 30, 2011,

DEPARTMENT: Natividad Medical Center

RECOMMENDATION:

It is recommended the Board of Supervisors authorize the Purchasing Manager for Natividad

Medical Center NMC) to execute an Agreement with Supplemental Health Care Services for

Temporary Staffing Services at NMC in an amount not to exceed $125,000 for the period June 1,

2010 to June 30, 2011.

SUMMARY/DISCUSSION:

Natividad Medical Center NMC) contracts with outside staffing agencies that provide the hospital

with Respiratory Therapists when the hospital is unable to recruit licensed personnel for these

positions, and also to cover short term absences of existing staff. The Cardiopulmonary Department

at NMC provides services 24 hours per day, 7 days per week for inpatients and Monday through

Friday 8:00 A.M. to 4:30 P.M. for outpatients.

Respiratory Therapists work with the hospital's Physician and Nursing staff to provide diagnostic as

well as clinical services to assist Respiratory and Cardiac compromised patients. Services provide

include assessment and treatment of adult, pediatric and neonatal patients. Additional hospital

departments Outpatient and Occupational Therapy and Pharmacy) are also included in the

Agreement in case of emergency need of licensed and qualified temporary services.

OTHER AGENCY INVOLVEMENT:

The Agreement has been reviewed and approved by County Counsel, the Auditor/Controller's

office, and the Natividad Medical Center Board of Trustees' Finance Committee.

FINANCING:

The cost for this Agreement is $125,000; $8,000 is included in the Fiscal Year 20 9-2-01-0-Approved

B-udget-and-$-l 17,000 is approved-in the Fiscal Year 2010/2011 Recommended Budget. This action

will not require any additional General Fund subsidy.

Prepared by:

John Nevill Harry Weis

Cardiopulmonary Manager Chief Executive Officer

May_1-0,204-0

Attaclunents: Agreement, Board Order

 

 

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SIGNED BOARD REPORT AND SUPPO

@�7

20

Before the Board of Supervisors in and for the

County of Monterey, State of California

Agreement No: A  11709

Authorize the Purchasing Manager for Natividad

Medical Center NMC) to execute an Agreement with

Supplemental Health Care Services for Temporary

Staffing Services at NMC in an amount not to exceed

$125,000 for the period June 1, 2010 to June 30, 2011.

Upon motion of Supervisor Armenta, seconded by Supervisor Parker, and carried by those

members present, the Board hereby:

Authorized the Purchasing Manager for Natividad Medical Center NMC) to execute an

Agreement with Supplemental Health Care Services for Temporary Staffing Services at NMC in

an amount not to exceed $125,000 for the period June 1, 2010 to June 30, 2011.

PASSED AND ADOPTED this 8`h day of June, 2010, by the following vote, to wit:

AYES: Supervisors Armenta, Calcagno, Salinas, Parker, Potter

NOES: None

ABSENT: None

I, Gail T. Borkowski, Clerk of the Board of Supervisors of the County of Monterey, State of California, hereby

certify that the foregoing is a true copy of an original order of said Board of Supervisors duly made and entered in

the minutes thereof of Minute Book 75 for the meeting on June 8, 2010.

Dated: June 11, 2010 Gail T. Borkowski, Clerk of the Board of Supervisors

County of Monterey, State of California

By l

Deputy

 

 

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SIGNED BOARD REPORT AND SUPPO

@�A Notivi ad MEDICALCENTER

COUNTY OF MONTEREY AGREEMENT FOR PROFESSIONAL SERVICES

MORE THAN $100,000)

This Professional Services Agreement hereinafter Agreement") is made by and between Natividad

Medical Center NMC"), a general acute care teaching hospital wholly owned and operated by the County

of Monterey, which is a political subdivision of the State of California and Supplemental Health Care

hereinafter CONTRACTOR").

In consideration of the mutual covenants and conditions set forth in this Agreement, the parties agree as

follows:

I  SERVICES TO BE PROVIDED. NMC hereby engages CONTRACTOR to perform, and

CONTRACTOR hereby agrees to perform, the services described in Exhibit A in conformity with the

terms of the Agreement. The services are generally described as follows: Provide Temporary

Staffing including but not limited to Therapy PT, OT, SLP, COTA, PTAs) Radiology, Pharmacy

2. PAYMENTS BY NMC. NMC shall pay the CONTRACTOR in accordance with the payment

provisions set forth in Exhibit A, subject to the limitations set forth in this Agreement. The total amount

payable by NMC to CONTRACTOR under this Agreement shall not exceed the sum of $125,000

3. TERMS OF AGREEMENT The term of this Agreement is from JJun 1, 2010 to Jun 30, 2011

unless sooner terminated pursuant to the terms of this Agreement. This Agreement is of no force or

effect until signed by both CONTRACTOR and NMC and with NMC signing last and CONTRACTOR

may not commence work before NMC signs this Agreement.

4. ADDITIONAL PROVISIONS/EXHIBITS. The following attached exhibits are incorporated herein

by reference and constitute a part of this Agreement:

Exhibit A Scope of Services/Payment Provisions

5. PERFORMANCE STANDARDS.

5.1. CONTRACTOR warrants that CONTRACTOR and Contractor's agents, employees, and

subcontractors performing services under this Agreement are specially trained, experienced,

competent,-and_appropriately licensed to_perform the_work_and delh er_tlie_ser ices required under

this Agreement and are not employees of NMC, or immediate family of an employee of NMC.

5.2. CONTRACTOR, its agents, employees, and subcontractors shall perform all work in a safe and

skillful manner and in compliance with all applicable laws and regulations. All work performed

under this Agreement that is required by law to be performed or supervised by licensed personnel

shall be performed in accordance with such licensing requirements.

5.3. CONTRACTOR shall furnish, at its own expense, all materials, equipment, and personnel

necessary to carry out the terms of this Agreement, except as other wise specified in this

Agreement. CONTRACTOR shall not use NMC premises, property inc uding equipment,

Revised NMC PSA Form over $100,000

Page 1 of 8

 

 

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SIGNED BOARD REPORT AND SUPPO

@�instruments, or supplies) or personnel for any purpose other than in the performance of its

obligations under this Agreement.

6. PAYMENT CONDITIONS.

6.1. CONTRACTOR shall submit to the Contract Administrator an invoice on a form acceptable to

NMC. If not otherwise specified, the CONTRACTOR may submit such invoice periodically or at

the completion of services, but in any event, not later than thirty 30) days after completion of

services. The invoice shall set forth the amounts claimed by CONTRACTOR for the previous

period, together with an itemized basis for Administrator or his or her designee shall certify the

invoice, either in the requested amount or in such other amount as NMC approves in conformity

with this Agreement, and shall promptly submit such invoice to the County Auditor-Controller for

payment. The County Auditor-Controller shall pay the amount certified within thirty 30) days of

receiving the certified invoice.

6.2. CONTRACTOR shall not receive reimbursement for travel expenses unless set forth in this

Agreement; and then only in accordance with any applicable County policies.

7. TERMINATION.

7.1. During the term of this Agreement, NMC may terminate the Agreement for any reason by giving

written notice of termination to the CONTRACTOR at least thirty 30) days prior to the effective

date of termination. Such notice shall set forth the effective date of termination. In the event of such

termination, the amount payable under this Agreement shall be reduced in proportion to the services

provided prior to the date of termination.

7.2. NMC may cancel and terminate this Agreement for good cause effective immediately upon written

notice to Contractor. Good cause" includes the failure of CONTRACTOR to perform the required

services at the time and in the manner provided under this Agreement. If NMC terminates this

Agreement for good cause, NMC may be relieved of the payment of any consideration to

Contractor, and NMC may proceed with the work in any manner, which NMC deems proper. The

cost to NMC shall be deducted from any sum due the CONTRACTOR under this Agreement.

8. INDEMNIFICATION: CONTRACTOR shall indemnify, defend and hold harmless, NMC and the

County of Monterey hereinafter County"), it officers, agents and employees from any and all claims,

liability, losses, whatsoever including damages to property and injuries to or death of persons, court

costs, and reasonable attorneys' fees) occurring or resulting to any and all persons, firms or corporations

furnishing or supplying work, services, materials, or supplies in connection with the performance of this

Agreement, and-from any and all claims, liabilities and-losse occurring or resultmg to any person, firm,

or corporation for damage, injury, or death arising out of or connected with the Contractor's

performance of this Agreement, unless such claims, liabilities, or looses arise out of the sole negligence

or willful misconduct of NMC. Contractor's performance" includes Contractor's action or inaction and

the action or inaction of Contractor's officers, employees, agents and subcontractors.

9. INSURANCE.

9.1. Evidence of Coverage:

Prior to commencement of this Agreement, the CONTRACTOR shall provide a Certificate of

Insurance" certifying that coverage as required herein has been obtained. Individual endorsements

Revised NMC PSA Form over $100,000 Page 2 of 8

 

 

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2011-U012

TO-U012

JUNE-U012

30,-U012

2012.-U012

 

 

SIGNED BOARD REPORT AND SUPPO

@�executed by the insurance carrier shall accompany the certificate. In addition, the CONTRACTOR

upon request shall provide a certified copy of the policy or policies.

This verification of coverage shall be sent to NMC's Contracts/Purchasing Department, unless

otherwise directed. The CONTRACTOR shall not receive a Notice to Proceed" with the work

under this Agreement until it has obtained all insurance required and NMC has approved such

insurance. This approval of insurance shall neither relieve nor decrease the liability of the

Contractor.

9.2. Qualifying Insurers: All coverage's except surety, shall be issued by companies which hold a

current policy holder's alphabetic and financial size category rating of not less that A-VII,

according to the current Best's Key Rating Guide or a company of equal financial stability that is

approved by NMC's Contracts/Purchasing Director.

9.3. Insurance Coverage Requirements: Without limiting Contractor's duty to indemnify,

CONTRACTOR shall maintain in effect throughout the term of this Agreement a policy or policies

of insurance with the following minimum limits of liability:

Commercial general liability insurance, including but not limited to premises and operations,

including coverage for Bodily Injury and Property Damage, Personal Injury, Contractual Liability,

Broad form Property Damage, Independent Contractors, Products and Completed Operations, with a

combined single limit for Bodily Injury and Property Damage of not less than $1,000,000 per

occurrence.

Exemption/Modification Justification attached; subject to approval).

Business automobile liability insurance, covering all motor vehicles, including owned, leased, non-

owned, and hired vehicles, used in providing services under this Agreement, with a combined single

limit for Bodily Injury and Property Damage of not less than $1,000,000 per occurrence.

Exemption/Modification Justification attached; subject to approval).

Workers' Compensation Insurance, If CONTRACTOR employs other in the performance of this

Agreement, in accordance with California Labor Code section 3700 and with Employer's Liability

limits not less than $1,000,000 each person, $1,000,000 each accident and $1,000,000 each disease.

F]' Exemption/Modification Justification attached; subject to approval).

Professional-liability insiTranct-if reFquir-ed-forth- rofas o-n serv ceg-b i provided-; e, those

persons authorized by a license to engage in a business or profession regulated by the California

Business and Professions Code), in the amount of not less than $1,000,000 per claim and $2,000,000

in the aggregate, to cover liability for malpractice or errors or omissions made in the course of

rendering professional services. If professional liability insurance is written on a claims-made"

basis rather than an occurrence basis, the CONTRACTOR shall, upon the expiration or earlier

termination of this Agreement, obtain extended reporting coverage tail coverage") with the same

liability limits. Any such tail coverage shall continue for at least three years following the expiration

or earlier termination of this Agreement.

F Exemption/Modification Justification attached; subject to approval).

Revised NMC PSA Form over $100,000

Page 3 of 8

 

 

BIB]

 

40740-U01

SIGNED-U02

BOARD-U02

REPORT-U02

SUPPORTING-U02

DOCS-U02

LI21329-U03

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FO96184-U03

FO99828-U03

MG99940-U03

AS99966-U03

AS99967-U03

AI103232-U03

DO104188-U03

C10-U03

BOARD-U03

REPORTS-U03

7/15/2011-U04

MARCELLAC-U04

16745-U05

1-U06

AUTHORIZE-U07

THE-U07

PURCHASING-U07

MANAGER-U07

NATIVIDAD-U07

MEDICAL-U07

CENTER-U07

NMC)-U07

TO-U07

EXECUTE-U07

AMENDMENT-U07

NO.-U07

1-U07

TO-U07

THE-U07

960-NMC-U08

RUIZ-IGNACIO-U09

MAEGAN-U09

RUIZ-IGNACIOM-U10

6/17/2011-U011

AGREEMENT-U012

A-11709)-U012

SUPPLEMENTAL-U012

HEALTH-U012

CARE-U012

SERVICES-U012

ANCILLARY-U012

RESPIRATORY-U012

REGISTRY-U012

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SERVICES-U012

AT-U012

NMC-U012

IN-U012

AN-U012

AMOUNT-U012

TO-U012

EXCEED-U012

$250,000-U012

IN-U012

THE-U012

AGGREGATE-U012

$125,000-U012

THE-U012

PERIOD-U012

JULY-U012

1,-U012

2011-U012

TO-U012

JUNE-U012

30,-U012

2012.-U012

 

 

SIGNED BOARD REPORT AND SUPPO

@�9.4. Other Insurance Requirements:

All insurance required by this Agreement shall be with a company acceptable to NMC and issued

and executed by an admitted insurer authorized to transact insurance business in the State of

California. Unless otherwise specified by this Agreement, all such insurance shall be written on an

occurrence basis, or, if the policy is not written on an occurrence basis, such policy with the

coverage required herein shall continue in effect for a period of three years following the date

CONTRACTOR completes its performance of services under this Agreement.

Each liability policy shall provide that NMC shall be given notice in writing at least thirty days in

advance of any endorsed reduction in coverage or limit, cancellation, or intended non-renewal

thereof. Each policy shall provide coverage for CONTRACTOR and additional insured with respect

to claims arising from each subcontractor, if any, performing work under this Agreement, or be

accompanied by a certificate of insurance from each subcontractor showing each subcontractor has

identical insurance coverage to the above requirements.

Commercial general liability and automobile liability policies shall provide an endorsement naming

the County of Monterey, its officers, agents, and employees as Additional insureds with respect to

liability arising out of the Contractor's work, including ongoing and completed operations, and shall

further provide that such insurance is primary insurance to any insurance or self-insurance

maintained by the County and that the insurance of the Additional Insureds shall not be called upon to

contribute to a loss covered by the Contractor's insurance. The required endorsement from for

Commercial General Liability Additional Insured is ISO Form CG 20 10 1 1-85 or CG 20 10 10 01

in tandem with CG 20 37 10 01 2000). The required endorsement from for Automobile Additional

Insured Endorsement is ISO Form CA 20 48 02 99.

Prior to the execution of this Agreement by NMC, CONTRACTOR shall file certificates of

insurance with NMC's Contracts/Purchasing Department, showing that the CONTRACTOR has in

effect the insurance required by this Agreement. The CONTRACTOR shall file a new or amended

certificate of insurance within five 5) calendar days after any change is made in any insurance

policy, which would alter the information on the certificate then on file. Acceptance or approval of

insurance shall in no way modify or change the indemnification clause in this Agreement, which

shall continue in full force and effect.

CONTRACTOR shall at all times during the term of this Agreement maintain in force the insurance

coverage required under this Agreement and shall send, without demand by NMC, annual

certificates to NMC's Contracts/Purchasing Department. If the certificate is not received by the

expiration date, NMC sha11 nori CONTRACTOI d-CONTRACTOR shall-have five calends

days to send in the certificate, evidencing no lapse in coverage during the interim. Failure by

CONTRACTOR to maintain such insurance is a default of this Agreement, which entitles NMC, at

its sole discretion, to terminate the Agreement immediately.

10. RECORDS AND CONFIDENTIALITY.

10.1. Confidentiality, CONTRACTOR and its officers, employees, agents and subcontractors shall

comply with any and all federal, state, and local laws, which provide for the confidentiality of

records and other information. CONTRACTOR shall not disclose any confidential records or other

confidential information received from NMC or prepared in connection with the performance of this

Revised NMC PSA Form over $100,000 Page 4 of 8

 

 

BIB]

 

40740-U01

SIGNED-U02

BOARD-U02

REPORT-U02

SUPPORTING-U02

DOCS-U02

LI21329-U03

FO96183-U03

FO96184-U03

FO99828-U03

MG99940-U03

AS99966-U03

AS99967-U03

AI103232-U03

DO104188-U03

C10-U03

BOARD-U03

REPORTS-U03

7/15/2011-U04

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16745-U05

1-U06

AUTHORIZE-U07

THE-U07

PURCHASING-U07

MANAGER-U07

NATIVIDAD-U07

MEDICAL-U07

CENTER-U07

NMC)-U07

TO-U07

EXECUTE-U07

AMENDMENT-U07

NO.-U07

1-U07

TO-U07

THE-U07

960-NMC-U08

RUIZ-IGNACIO-U09

MAEGAN-U09

RUIZ-IGNACIOM-U10

6/17/2011-U011

AGREEMENT-U012

A-11709)-U012

SUPPLEMENTAL-U012

HEALTH-U012

CARE-U012

SERVICES-U012

ANCILLARY-U012

RESPIRATORY-U012

REGISTRY-U012

STAFFING-U012

SERVICES-U012

AT-U012

NMC-U012

IN-U012

AN-U012

AMOUNT-U012

TO-U012

EXCEED-U012

$250,000-U012

IN-U012

THE-U012

AGGREGATE-U012

$125,000-U012

THE-U012

PERIOD-U012

JULY-U012

1,-U012

2011-U012

TO-U012

JUNE-U012

30,-U012

2012.-U012

 

 

SIGNED BOARD REPORT AND SUPPO

@�Agreement, unless NMC specifically permits CONTRACTOR to disclose such records or

information. CONTRACTOR shall promptly transmit to NMC any and all requests for disclosure of

any such confidential records or information. CONTRACTOR shall not use any confidential

information gained by CONTRACTOR in the performance of this Agreement except for the sole

purpose of carrying out Contractor's obligations under this Agreement.

10.2. NMC Records. When this Agreement expires or terminates, CONTRACTOR shall return to NMC

and NMC records which CONTRACTOR used or received from NMC to perform services under

this Agreement.

10.3. Maintenance of Records. CONTRACTOR shall prepare, maintain, and preserve all reports and

records that may be required by federal state, and County rules and regulations related to services

performed under this Agreement. CONTRACTOR shall maintain such records for a period of at

least three years after receipt of final payment under this Agreement. If any litigation, claim,

negotiation, audit exception, or other action relating to this Agreement is pending at the end of the

three year period, then CONTRACTOR shall retain said records until such action is resolved.

10.4. Access to and Audit of Records. NMC shall have the right to examine, monitor and audit all

records, documents, conditions, and activities of the CONTRACTOR and its subcontractors

related to services provided under this Agreement. Pursuant to Government Code section 8546.7,

if this Agreement involves the expenditure of public funds in excess or $10,000, the parties to this

Agreement may be subject, at the request of NMC or as part of any audit of NMC, to the

examination and audit of the State Auditor pertaining to matters connected with the performance

of this Agreement for a period of three years after final payment under the Agreement.

10.5. Royalties and Inventions. NMC shall have a royalty-free, exclusive and irrevocable license to

reproduce, publish, and use, and authorize other to do so, all original computer programs, writings,

sound recordings, pictorial reproductions, drawings, and other works of similar nature produced in

the course of or under this Agreement. CONTRACTOR shall not publish any such material

without the prior written approval of NMC.

11. NON-DISCRIMINATION. During the performance of this Agreement, Contractor, and its

subcontractors, shall not unlawfully discriminate against any person because of race, religious creed,

color, sex, national origin, ancestry, physical disability, mental disability, medical condition, marital

status, age over 40), or sexual orientation, either in Contractor's employment practices or in the

furnishing of services to recipients. CONTRACTOR shall ensure that the evaluation and treatment of its

employees and applicants for employment and all persons receiving and requesting services are free of

such discrimination. CONTRACTOR and any subcontractor shall, in the performance of this

Agre~merit,~futl~omply^vvith 11-fede al ate; anzl-local-IaZVS~~rdreg it tuns which prohibit

discrimination. The provision of services primarily or exclusively to such target population as may be

designated in this Agreement shall not be deemed to be prohibited discrimination.

12. COMPLIANCE WITH TERMS OF STATE OR FEDERAL GRANT. If this Agreement has been or

will be funded with monies received by NMC pursuant to a contract with the state or federal government

in which NMC is the grantee, CONTRACTOR will comply with all the provisions of said contract, and

said provisions shall be deemed a part of this Agreement, as though fully set forth herein. Upon request,

NMC will deliver a copy of said contract to Contractor, at no cost to Contractor.

Revised NMC PSA Form over $100,000 Page 5 of 8

 

 

BIB]

 

40740-U01

SIGNED-U02

BOARD-U02

REPORT-U02

SUPPORTING-U02

DOCS-U02

LI21329-U03

FO96183-U03

FO96184-U03

FO99828-U03

MG99940-U03

AS99966-U03

AS99967-U03

AI103232-U03

DO104188-U03

C10-U03

BOARD-U03

REPORTS-U03

7/15/2011-U04

MARCELLAC-U04

16745-U05

1-U06

AUTHORIZE-U07

THE-U07

PURCHASING-U07

MANAGER-U07

NATIVIDAD-U07

MEDICAL-U07

CENTER-U07

NMC)-U07

TO-U07

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AMENDMENT-U07

NO.-U07

1-U07

TO-U07

THE-U07

960-NMC-U08

RUIZ-IGNACIO-U09

MAEGAN-U09

RUIZ-IGNACIOM-U10

6/17/2011-U011

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A-11709)-U012

SUPPLEMENTAL-U012

HEALTH-U012

CARE-U012

SERVICES-U012

ANCILLARY-U012

RESPIRATORY-U012

REGISTRY-U012

STAFFING-U012

SERVICES-U012

AT-U012

NMC-U012

IN-U012

AN-U012

AMOUNT-U012

TO-U012

EXCEED-U012

$250,000-U012

IN-U012

THE-U012

AGGREGATE-U012

$125,000-U012

THE-U012

PERIOD-U012

JULY-U012

1,-U012

2011-U012

TO-U012

JUNE-U012

30,-U012

2012.-U012

 

 

SIGNED BOARD REPORT AND SUPPO

@                     �13, INDEPENDENT CONTRACTOR. In the performance of work, duties, and obligations under this

Agreement, CONTRACTOR is at all times acting and performing as an independent CONTRACTOR

and not as an employee of NMC. No offer or obligation of permanent employment with NMC or

particular County department or agency is intended in any manner, and CONTRACTOR shall not

become entitled by virtue of this Agreement to receive from NMC any form of employee benefits

including but not limited to sick leave, vacation, retirement benefits, workers' compensation coverage,

insurance or disability benefits. CONTRACTOR shall be solely liable for an obligated to pay directly all

applicable taxes, including federal and state income taxes and social security, arising out of Contractor's

performance of this Agreement. In connection therewith, CONTRACTOR shall defend, indemnify, and

hold NMC and the County of Monterey harmless from any and all liability, which NMC may incur

because of Contractor's failure to pay such taxes.

14. NOTICES. Notices required under this Agreement shall be delivered personally or by first-class,

postage per-paid mail to NMC and Contractor's contract administrators at the addresses listed below.

FOR NATIVIDAD MEDICAL CENTER:

Contracts/Purchasing Manager

Name and Title

FOR CONTRACTOR:

1441 Constitution Blvd. Salinas, CA. 93906

Address

831.755.4111

Phone

15. MISCELLANEOUS PROVISIONS.

 

Address

15.1. Conflict of Interest. CONTRACTOR represents that it presently has no interest and agrees not to

acquire any interest during the term of this Agreement, which would directly, or indirectly

conflict in any manner or to any degree with the full and complete performance of the professional

services requirec moo be rendered under this Agreemen

15.2. Amendment. This Agreement may be amended or modified only by an instrument in writing

signed by NMC and the Contractor.

15.3. Waiver  Any waiver of any terms and conditions of this Agreement must be in writing and signed

by NMC and the Contractor. A waiver of any of the terms and conditions of this Agreement shall

not be construed as a waiver of any other terms or conditions in this Agreement.

15.4. Contractor. The term Contractor" as used in this Agreement includes Contractor's officers,

agents, and employees acting on Contractor's behalf in the performance of this Agreement.

Revised NMC PSA Form over $100,000

Page 6 of 8

 

 

BIB]

 

40740-U01

SIGNED-U02

BOARD-U02

REPORT-U02

SUPPORTING-U02

DOCS-U02

LI21329-U03

FO96183-U03

FO96184-U03

FO99828-U03

MG99940-U03

AS99966-U03

AS99967-U03

AI103232-U03

DO104188-U03

C10-U03

BOARD-U03

REPORTS-U03

7/15/2011-U04

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16745-U05

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PERIOD-U012

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30,-U012

2012.-U012

 

 

SIGNED BOARD REPORT AND SUPPO

@

�15.5. Disputes. CONTRACTOR shall continue to perform under this Agreement during any dispute.

15.6. Assignment and Subcontracting. The CONTRACTOR shall not assign, sell, or otherwise transfer

its interest or obligations in this Agreement without the prior written consent of NMC. None of the

services covered by this Agreement shall be subcontracted without the prior written approval of

NMC. Notwithstanding any such subcontract, CONTRACTOR shall continue to be liable for the

performance of all requirements of this Agreement.

15.7. Successors and Assigns. This Agreement and the rights, privileges, duties, and obligations of NMC

and CONTRACTOR under this Agreement, to the extent assignable or delegable, shall be binding

upon and inure to the benefit of the parties and their respective successors, permitted assigns, and

heirs.

15.8. Compliance with Applicable Law. The parties shall comply with all applicable federal, state, and

local laws and regulations in performing this Agreement.

15.9. Headings. The headings are for convenience only and shall not be used to interpret the terms of

this Agreement.

15.10. Time is of the Essence. Time is of the essence in each and all of the provisions of this Agreement

15.11. Governing Law. This Agreement shall be governed by and interpreted under the laws of the State

of California.

15.12. Non-exclusive Agreement. This Agreement is non-exclusive and both NMC and

CONTRACTOR expressly reserve the right to contract with other entities for the same or similar

services.

15.13. Construction of Agreement  NMC and CONTRACTOR agree that each party has fully

participated in the review and revision of this Agreement and that any rule of construction to the

effect that ambiguities are to be resolved against the drafting party shall not apply in the

interpretation of this Agreement or any amendment to this Agreement.

15.14. Counterparts  This Agreement may be executed in two or more counterparts, each of which shall

be deemed an original, but all of which together shall constitute one and the same Agreement.

15.15. Integration. This Agreement, including the exhibits, represents the entire Agreement between

NMCand-th-e-C-O RAC-TOR with-respect-to the-subject-matter-cfthis Agre-ement-and-shall

supersede all prior negotiations. Representations, or agreements, either written or oral, between

NMC and CONTRACTOR as of the effective date of this Agreement, which is the date that

NMC signs the Agreement.

15.16. Interpretation of Conflicting Provisions  In the event of any conflict or inconsistency between the

provisions of this Agreement and the Provisions of any exhibit or other attachment to this

Agreement, the provisions of this Agreement shall prevail and control.

Revised NMC PSA Form over $100,000 Page 7 of 8

 

 

BIB]

 

40740-U01

SIGNED-U02

BOARD-U02

REPORT-U02

SUPPORTING-U02

DOCS-U02

LI21329-U03

FO96183-U03

FO96184-U03

FO99828-U03

MG99940-U03

AS99966-U03

AS99967-U03

AI103232-U03

DO104188-U03

C10-U03

BOARD-U03

REPORTS-U03

7/15/2011-U04

MARCELLAC-U04

16745-U05

1-U06

AUTHORIZE-U07

THE-U07

PURCHASING-U07

MANAGER-U07

NATIVIDAD-U07

MEDICAL-U07

CENTER-U07

NMC)-U07

TO-U07

EXECUTE-U07

AMENDMENT-U07

NO.-U07

1-U07

TO-U07

THE-U07

960-NMC-U08

RUIZ-IGNACIO-U09

MAEGAN-U09

RUIZ-IGNACIOM-U10

6/17/2011-U011

AGREEMENT-U012

A-11709)-U012

SUPPLEMENTAL-U012

HEALTH-U012

CARE-U012

SERVICES-U012

ANCILLARY-U012

RESPIRATORY-U012

REGISTRY-U012

STAFFING-U012

SERVICES-U012

AT-U012

NMC-U012

IN-U012

AN-U012

AMOUNT-U012

TO-U012

EXCEED-U012

$250,000-U012

IN-U012

THE-U012

AGGREGATE-U012

$125,000-U012

THE-U012

PERIOD-U012

JULY-U012

1,-U012

2011-U012

TO-U012

JUNE-U012

30,-U012

2012.-U012

 

 

SIGNED BOARD REPORT AND SUPPO

@
�NATIVIDAD MEDICAL CENTER

By:

NMC Contracts/Purchasing Agent

Date:

Department Head if applicable)

Date:

By: Z~n  J G

St y Saetta, D puty County Counsel

Date: 6Wk

By:

Auditor/Contfoiler

Date: 5 11 1t)

CONTRACTOR

Contractor's Business Name***

gnature df Chair, Presidentkor Vice-President

Name and Title

Date: &21 v /l U

By:

CFO, Treasurer or Asst. Treasurer

ignature of Secretary, Asst cret

Name and Title

Date: / V

***INSTRUCTIONS: If CONTRACTOR is a

corporation, including limited liability and

non-profit corporations, the full legal name

of the corporation shall be set forth above

together with the signatures of two

specified officers. If CONTRACTOR is a

partnership, the name of the partnership

shall be set forth above together with the

signature of a partner who has authority to

execute this Agreement on behalf of the

partnership. If CONTRACTOR is

contracting in and individual capacity, the

individual shall set forth the name of the

business. if any and shall personally sign

the Agreement.

Revised NMC PSA Form over $100,000

Page 8 of 8

 

 

BIB]

 

40740-U01

SIGNED-U02

BOARD-U02

REPORT-U02

SUPPORTING-U02

DOCS-U02

LI21329-U03

FO96183-U03

FO96184-U03

FO99828-U03

MG99940-U03

AS99966-U03

AS99967-U03

AI103232-U03

DO104188-U03

C10-U03

BOARD-U03

REPORTS-U03

7/15/2011-U04

MARCELLAC-U04

16745-U05

1-U06

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THE-U07

PURCHASING-U07

MANAGER-U07

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MEDICAL-U07

CENTER-U07

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TO-U07

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AMENDMENT-U07

NO.-U07

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THE-U07

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HEALTH-U012

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RESPIRATORY-U012

REGISTRY-U012

STAFFING-U012

SERVICES-U012

AT-U012

NMC-U012

IN-U012

AN-U012

AMOUNT-U012

TO-U012

EXCEED-U012

$250,000-U012

IN-U012

THE-U012

AGGREGATE-U012

$125,000-U012

THE-U012

PERIOD-U012

JULY-U012

1,-U012

2011-U012

TO-U012

JUNE-U012

30,-U012

2012.-U012

 

 

SIGNED BOARD REPORT AND SUPPO

@

�Schedule A

Natividad Hospital

Client 2011 Bill Rates

 Regular 

 Registry/Per

Diem Regular

Weekend

Base Travel*

Specialty Hours Hours Hours

Occupational Therapist & Physical Therapist $68.00 $68.00 $70/hour*

Speech Language Pathologist $73.00 $70.00 $72/hour*

Occupational Therapist Assistant & Physical  

Therapist Assistant $56.00 $57.00 $59/hour*

 $62,00-  $67/hour*

Respiratory Therapist $67.00/hour 

  

*Travel Rates: Negotiated on a case by case basis pending request/geographic location. Rate is agreed and

confirmed in writing prior to assignment.

Billable Mileage or Transportation Costs: In the event that Client requires Company Health Care Personnel to

travel between facilities during any work day, mileage between facilities will be billed to Client at a rate of

$ per mile.

Billable Housing Costs: No Billable Housing Costs; rates are inclusive.

Billable Employment Conversion Permanent Placement) Costs: Any Company Health Care Personnel, whose

profile has been submitted to Client by Company, may not be employed at Client either directly or through another

Agency for one year following the termination of the assignment for any reason. However, any Company health Care

Personnel may become an employee of the client with the payment of a placement fee and a 30 day notice of perm

hire at the Client facility. If the employee has worked less than 520 hours, Client agrees to pay a Ten Thousand

$10,000) fee for said hire. If the employee has worked 520  1040 hours and Client desires to make Company health

Care Personnel a direct employee, Client agrees to pay an Eight Thousand Dollar $8,000) fee. In the event that after

employee has worked 1040 hours of service client wishes to hire employee directly a Four Thousand $4,000) fee will

be due.

Billable Shift or Assignment Cancellation Terms: A Thirty 30) day notice is required for cancellation of all travel

assignments. Two 2) week notice for cancellation of 30 day or ongoing assignments and a Forty  eight 48) hour

cancellation of PRN shifts is required; otherwise a four 4, 6, or 8) hour minimum billing for Shifts will be assessed

depending on confirmation of 6, 8, or 10 hour confirmed assignment.

Other Billable Costs or Terms:

 Overtime rate  equal to time and one half on hours worked as required by the highest of federal or state law.

 Holiday rate  equal to time and one half on hours worked as required by the highest of federal or state law.

*All rates include payroll costs, employee benefits, malpracticelliability insurance, and travel expenses if

required and not agreed upon with confirmation of assignment.

Signature Date

 

 

BIB]

 

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1,-U012

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TO-U012

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30,-U012

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SIGNED BOARD REPORT AND SUPPO

@

�Schedule A

Natividad Hospital

Client 2010 Bill Rates

 Regular  

 Registry/P

er Diem Regular

Weekend Base

Travel*

Call Back/Holiday

Specialty Hours Hours Hours Hours

Occupational Therapist & Physical Therapist $67.00 $68.00 $70/hour* Time and %2 Base Rate

Speech Language Pathologist $73.00 $70.00 $72/hour* Time and %2 Base Rate

Occupational Therapist Assistant & Physical   

Therapist Assistant $56.00 $57.00 $59/hour* Time and %2 Base Rate

 $62,00-  $66/hour* Time and % Base Rate

Respiratory Therapist 66.00/hour  

   

*Travel Rates: Negotiated on a case by case basis pending request/geographic location. Rate is agreed and

confirmed in writing prior to assignment.

Billable Mileage or Transportation Costs: In the event that Client requires Company Health Care Personnel to

travel between facilities during any work day, mileage between facilities will be billed to Client at a rate of

$ per mile.

Billable Housing Costs: No Billable Housing Costs; rates are inclusive.

Billable Employment Conversion Permanent Placement) Costs: Any Company Health Care Personnel, whose

profile has been submitted to Client by Company, may not be employed at Client either directly or through another

Agency for one year following the termination of the assignment for any reason, However, any Company health Care

Personnel may become an employee of the client with the payment of a placement fee and a 30 day notice of perm

hire at the Client facility. If the employee has worked less than 520 hours, Client agrees to pay a Ten Thousand

$10,000) fee for said hire. If the employee has worked 520- 1040 hours and Client desires to make Company health

Care Personnel a direct employee, Client agrees to pay an Eight Thousand Dollar $8,000) fee, In the event that after

employee has worked 1040 hours of service client wishes to hire employee directly a Four Thousand $4,000) fee will

be due.

Billable Shift or Assignment Cancellation Terms: A Thirty 30) day notice is required for cancellation of all travel

assignments.-Two-(2) week notice-for-cancell ation-of-30-day-or-ongoing-assignments-and-a-Forty=eight(48)-hour

cancellation of PRN shifts is required; otherwise a four 4, 6, or 8) hour minimum billing for Shifts will be assessed

depending on confirmation of 6, 8, or 10 hour confirmed assignment.

Other Billable Costs or Terms:

 Overtime rate  equal to time and one half on hours worked as required by the highest of federal or state law.

 Holiday rate  equal to time and one half on hours worked as required by the highest of federal or state law.

*All rates include payroll costs, employee benefits, malpractice/llability insurance, and travel expenses if

required and not agreed upon with confirmation of assignment

 

 

BIB]

 

40740-U01

SIGNED-U02

BOARD-U02

REPORT-U02

SUPPORTING-U02

DOCS-U02

LI21329-U03

FO96183-U03

FO96184-U03

FO99828-U03

MG99940-U03

AS99966-U03

AS99967-U03

AI103232-U03

DO104188-U03

C10-U03

BOARD-U03

REPORTS-U03

7/15/2011-U04

MARCELLAC-U04

16745-U05

1-U06

AUTHORIZE-U07

THE-U07

PURCHASING-U07

MANAGER-U07

NATIVIDAD-U07

MEDICAL-U07

CENTER-U07

NMC)-U07

TO-U07

EXECUTE-U07

AMENDMENT-U07

NO.-U07

1-U07

TO-U07

THE-U07

960-NMC-U08

RUIZ-IGNACIO-U09

MAEGAN-U09

RUIZ-IGNACIOM-U10

6/17/2011-U011

AGREEMENT-U012

A-11709)-U012

SUPPLEMENTAL-U012

HEALTH-U012

CARE-U012

SERVICES-U012

ANCILLARY-U012

RESPIRATORY-U012

REGISTRY-U012

STAFFING-U012

SERVICES-U012

AT-U012

NMC-U012

IN-U012

AN-U012

AMOUNT-U012

TO-U012

EXCEED-U012

$250,000-U012

IN-U012

THE-U012

AGGREGATE-U012

$125,000-U012

THE-U012

PERIOD-U012

JULY-U012

1,-U012

2011-U012

TO-U012

JUNE-U012

30,-U012

2012.-U012

 

 

SIGNED BOARD REPORT AND SUPPO

@�A~ & CERTIFICATE OF LIABILITY INSURANCE DATE MM/DDNYYY)

 10/1/2010

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).

PRODUCER

Commercial Lines  206) 892-9200 CONTACT

NAME:

 PHONE IFAX

I

A Li

#

D0

408 o E t  A/C No:

nc.  C

 O

Wells Fargo Insurance Services USA,

c

8 MA L

 ADDRESS:

601 Union Street, Suite 1300 PRODUCER SHCSERVIC

 CUSTOMER ID #:

Seattle, WA 98101-1371 

 INSURERS AFFORDING COVERAGE NAIL #

INSURED INSURER A  Homeland Insurance Company of NY 34452

SHC Services, Inc.

INSURER B  National Union Fire Ins. Co. of Pittsburgh, PA

19445

1640 West Redstone Center Dr., Ste 200 INSURER C

Park City UT 84098 INSURER D

 INSURER E

 INSURER F

COVERAGES

CERTIFICATE NUMBER: 1862753

REVISION NUMBER: See below

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 AN Y CONTRACT OR OTHER DOCUMENT WITH RESPE CT 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 

ILTR I TYPE OF INSURANCE ADDL SUBRI

INSR WV POLICY NUMBER POLICY EFF POLICY EXP

MM/DD/YYYY MM/DDIYYYY LIMITS

1 GENERAL LIABILITY I

A MFL-0465-10

10/01/2010 10/01/2011 ILEACH OCCURRENCE $ 1,000,000

 

X   I DAMAGE TO RENTED

 COMMERCIAL GENERAL LIABILITY I  I PREMISES Ea occurrence $ 100,000

 CLAIMS-MADE J OCCUR    MED EXP Any one person) $ 5,000

     PERSONAL & ADV INJURY $ Included

     GENERAL AGGREGATE $ 3,000,000

EN'L AGGREGATE LIMIT APPLIES PER:

G   PRODUCTS  COMP/OP AGG $

PRO-

X    $

POLICY

LOC

POLICY   

B AUTOMOBILE LIABILITY 0934688 10/01/2010 10/01/2011 COMBINED SINGLE LIMIT

$ 1,000,000

   Ea accident)

ANY AUTO   BODILY INJURY Per person) $

ALL OWNED AUTOS    BODILY INJURY Per accident) $

 SCHEDULED AUTOS   

PROPERTY DAMAGE

 

$

X HIRED AUTOS    Per accident)

NON-OWNED AUTOS    1 $

     $

A L UMBRELLA LIABI OCCUR MFX-0138-10 10/01/2010 10/01/2011 EACH OCCURRENCE i s 7,000,000

I EXCESS LIAB CLAIMS-MADE    AGGREGATE $ 7,000,000

 DEDUCTIBLE     $

 

H H RETENTION $    I s

WORKERS COMPENSATION   I y I WC STATU-  OTH-1

Unr

i

JTS

R

 

B AND EMPLOYERS' LIABILITY Y/N I 069862301 10/01/2010 10/01/2011 L

M

E

 

 1

000

000

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?  N / A California   EL. EACH ACCIDENT

 

$

Mandatory in NH)    EL DISEASE  EA EMPLOYEE $ 1,000,000

If yes, describe under    

DESCRIPTION OF OPERATIONS below    E.L. DISEASE  POLICY LIMIT $ 1,000,000

A Medical Professional Liability MFL-0465-10 10/01/2010 10/01/2011 $1,000,000 OCC

   $3,000,000 AGG

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES Attach ACORD 101, Additional Remarks Schedule  if more space is required) 

Evidence of Insurance  

CERTIFICATE HOLDER

Natividad Medical Center

Attn: Sarah More, Staffing Coordinator

P.O. Box 81611

Salinas CA 93912-1611

CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE

1988-2009 ACORD CORPORATION. All rights reserved.

ACORD 25 2009/09) The ACORD name and logo are registered marks of ACORD

 

 

BIB]

 

40740-U01

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BOARD-U02

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AI103232-U03

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MARCELLAC-U04

16745-U05

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AUTHORIZE-U07

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SERVICES-U012

AT-U012

NMC-U012

IN-U012

AN-U012

AMOUNT-U012

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EXCEED-U012

$250,000-U012

IN-U012

THE-U012

AGGREGATE-U012

$125,000-U012

THE-U012

PERIOD-U012

JULY-U012

1,-U012

2011-U012

TO-U012

JUNE-U012

30,-U012

2012.-U012

 

 

SIGNED BOARD REPORT AND SUPPO

@�EXHIBIT B

INSURANCE JUSTIFICATION

Vendor/Contractor Name: Supplemental Healthcare Services SHC)

General Liability Auto Additional Insured Endorsements

Business Justification:

The vendor has provided proof of General Liability Insurance at the required amounts. Due

to the type of service provided by the vendor NMC request the Agreement be approved and

the requirement for General Liability Additional Insured Endorsement be waived.

Automobile Liability Additional Insured Endorsements

Business Justification:

The vendor has provided proof of Automobile Liability Insurance. NMC requests the

Agreement be approved and the requirement for the Additional Insured Endorsement for

Auto Insurance be waived.

Harry Weis

Chief Executive Officer

Date: 1(3JIta

 

 

BIB]

 

40740-U01

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BOARD-U02

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7/15/2011-U04

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16745-U05

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AMENDMENT-U07

NO.-U07

1-U07

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THE-U07

960-NMC-U08

RUIZ-IGNACIO-U09

MAEGAN-U09

RUIZ-IGNACIOM-U10

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AGREEMENT-U012

A-11709)-U012

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HEALTH-U012

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ANCILLARY-U012

RESPIRATORY-U012

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STAFFING-U012

SERVICES-U012

AT-U012

NMC-U012

IN-U012

AN-U012

AMOUNT-U012

TO-U012

EXCEED-U012

$250,000-U012

IN-U012

THE-U012

AGGREGATE-U012

$125,000-U012

THE-U012

PERIOD-U012

JULY-U012

1,-U012

2011-U012

TO-U012

JUNE-U012

30,-U012

2012.-U012

 

 

SIGNED BOARD REPORT AND SUPPO

@�YEAR Withholding Exemption Certificate

2011

This fore can only be used to certify exemption from nonresident withholding under California Revenue

and Taxation Code R&TC) Section 18662. Do not use this form for exemption from wage withholding.)

File this form with your withholding agent. Please type or print)

Withholding agent's name

Natividad Medical Center

Payee's name

SHC Services, Inc.

Address number and street, PO Box, or PMB no.)

1640 W. Redstone Center Drive

City

Park City

CALIFORNIA FORM

590

Payee's Li SSN or ITIN

1 SOS tile no. F J CA corp. no. f FEIN

1 6  1 2 1 6 7 9 6

State

U T

ZIP Code

Apt. no] Ste. no

2 0 0

8-4 0 9 8

Read the following carefully and check the box that applies to the payee.

I certify that for the reasons checked below, the payee named on this form is exempt from the California income tax withholding

requirement on payment(s) made to the entity or individual.

 Individuals  Certification of Residency:

I am a resident of California and I reside at the address shown above. If I become a nonresident at any time, I will promptly

notify the withholding agent. See instructions for General Information D, Who is a Resident, for the definition of a resident.

1Z Corporations:

The above-named corporation has a permanent place of business in California at the address shown above or is qualified

through the California Secretary of State SOS) to do business in California. The corporation will file a California tax return

and withhold on payments of California source income to nonresidents when required. If this corporation ceases to have

a permanent place of business in California or ceases to do any of the above, I will promptly notify the withholding agent.

See instructions for General Information F, What is a Permanent Place of Business, for the definition of permanent place of

business.

 Partnerships or limited liability companies LLC):

The above-named partnership or LLC has a permanent place of business in California at the address shown above or is

registered with the California SOS, and is subject to the laws of California. The partnership or LLC will file a California tax

return and will withhold on foreign and domestic nonresident partners or members when required. If the partnership or

LLC ceases to do any of the above, I will promptly inform the withholding agent. For withholding purposes, a limited liability

partnership LLP) is treated like any other partnership.

 Tax-Exempt Entities:

The above-named entity is exempt from tax under California Revenue and Taxation Code R&TC) Section 23701

insert letter) or Internal Revenue Code Section 501(c) insert number). The tax-exempt entity will withhold on payments

of California source income to nonresidents when required. If this entity ceases to be exempt from tax, I will promptly notify the

withholding agent. Individuals cannot be tax-exempt entities.

 Insurance Companies, Individual Retirement Arrangements IRAs), or Qualified Pension/Profit Sharing Plans:

The above-named entity is an insurance company, IRA, or a federally qualified pension or profit-sharing plan.

 California Trusts:

At least one trustee and one noncontingent beneficiary of the above-named trust is a California resident. The trust will file a

California fiduciary tax return and will withhold on foreign and domestic nonresident beneficiaries when required. If the trustee

becomes a nonresident at any time, I will promptly notify the withholding agent.

 Estates  Certification of Residency of Deceased Person:

I am the executor of the above-named person's estate. The decedent was a California resident at the time of death. The estate

will file a California fiduciary tax return and will withhold on foreign and domestic nonresident beneficiaries when required.

 Nonmilitary Spouse of a Military Servicemember:

I am a nonmilitary spouse of a military servicemember and I meet the Military Spouse Residency Relief Act MSRRA)

requirements. See instructions for General Information E, MSRRA.

CERTIFICATE: Please complete and sign below.

Under penalties of perjury, I hereby certify that the information provided in this document is, to the best of my knowledge, true and

correct. If conditions change, I will promptly notify the withholding agent.

Payee's name and title type or print) Steen Ure, CFO

Payee's signature

 Daytime telephone no._435-776-7213

Date 03/10/2011

For Privacy Notice, get form FTB 1131 7061113  Form 590 C2 2010

 

 

BIB]

 

40740-U01

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LI21329-U03

FO96183-U03

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AI103232-U03

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C10-U03

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7/15/2011-U04

MARCELLAC-U04

16745-U05

1-U06

AUTHORIZE-U07

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MANAGER-U07

NATIVIDAD-U07

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CENTER-U07

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TO-U07

EXECUTE-U07

AMENDMENT-U07

NO.-U07

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THE-U07

960-NMC-U08

RUIZ-IGNACIO-U09

MAEGAN-U09

RUIZ-IGNACIOM-U10

6/17/2011-U011

AGREEMENT-U012

A-11709)-U012

SUPPLEMENTAL-U012

HEALTH-U012

CARE-U012

SERVICES-U012

ANCILLARY-U012

RESPIRATORY-U012

REGISTRY-U012

STAFFING-U012

SERVICES-U012

AT-U012

NMC-U012

IN-U012

AN-U012

AMOUNT-U012

TO-U012

EXCEED-U012

$250,000-U012

IN-U012

THE-U012

AGGREGATE-U012

$125,000-U012

THE-U012

PERIOD-U012

JULY-U012

1,-U012

2011-U012

TO-U012

JUNE-U012

30,-U012

2012.-U012

 

 

SIGNED BOARD REPORT AND SUPPO

@�Supplemental rl' Health Care SM

WORKFORCE SOLUTIONS

March 20, 2011

Sid Cato

Management Analyst/Contracts

Natividad Medical Center

1441 Constitution Blvd.

Salinas, CA 93906

Dear Sid,

Attached is our renewal amendment. Please let me know if you need any additional information.

Thank you for your continuing support. We look forward to working with you more this year!

Thanks again!

Best,

Cindi S. Levin

Market Manager

333 Gellert Blvd., #150, Daly City, CA 94015

Ph: 650) 758-4700 Fax: 650) 758-4711

 

 

BIB]

 

40740-U01

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FO96183-U03

FO96184-U03

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AT-U012

NMC-U012

IN-U012

AN-U012

AMOUNT-U012

TO-U012

EXCEED-U012

$250,000-U012

IN-U012

THE-U012

AGGREGATE-U012

$125,000-U012

THE-U012

PERIOD-U012

JULY-U012

1,-U012

2011-U012

TO-U012

JUNE-U012

30,-U012

2012.-U012