COMPLETED BOARD ORDER AND AME
N�23
Btfore the Board of Supervisors in and for the
County of Monterey, State of California
Agreement No. A-11010
Authorize the Purchasing Manager for Natividad
Medical Center NMC) t execute Amendment
No. 3 to the Agreement with Credit Consulting
Services Inc. for Bad Debt Collection Services at
NMC in an amount not t exceed $3,100,000 in
the aggregate and $700,00 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 Boar hereby;
Authorized the Pure lasing Manager for Natividad Medical Center NMC) to
execute Amendmen No. 3 to the Agreement with Credit Consulting Services Inc.
for Bad Debt Collec ion Services at NMC in an amount not to exceed $3,100,000
in the aggregate and $700,000 for the period July 1, 2011 to June 30, 2012.
PASSED AND ADOPTED on this 28th day of June, 2011, by the following vote, to wit:
AYES: Supervisors Cal agno, Salinas, and Parker
NOES: None
ABSENT: Supervisors Arir enta and Potter
1, Gail T. Borkowski, Clerk of he 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 5 for the meeting on June 28, 2011.
Dated: June 30, 2011 Gail T. Borkowski, Clerk of the Board of Supervisors
County of Monterey, State of California
By
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COMPLETED BOARD ORDER AND AME
N�Original Agreement No or PO#. A-11010)
The parties to Professional
of Natividad Medical Cent
their Agreement No. A-11
RENEWAL AMENDMENT NO.3
FOR PROFESSIONAL SERVICE AGREEMENT
BETWEEN Credit Consulting Services Inc. AND
THE NATIVIDAD MEDICAL CENTER
FOR
Bad Debt Collection SERVICES
Service Agreement, dated August 1, 2007 between the County of Monterey, on behalf
r NMC"), and Credit Consulting Services Inc. Contractor), hereby agree to renew
10) on the following amended terms and conditions:
1. Contractor will continue to provide NMC with the same scope of service as stated in the original Agreement
No. A-11010).
2. This Renewal Amendment shall become effective on July 1, 2011 and shall continue in full force and
extending the term date until June 30, 2012.
3. The total amount payable by County to Contractor under Agreement No. A-11010) shall not exceed the
total sum of 4,100,C09 for the full term of the Agreement and $700,000 for fiscal year 2011-2012.
4. All other terms aI Tiditions 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-11010).
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.
CONTRACTOR
Signature 1
Printed Name
Signature 2
Printed Name Debra nee
***INSTRUCTIONS: If CO CTOR is a corporation, including limited liability and non-profit corporations, the full legal name of the
corporation shall be set forth ab a together with the signatures of two specified officers. If CONTRACTOR is a partnership, the name of
the partnership shall be set forth bove together with the signature of a partner who has authority to execute this Agreement on behalf of
the partnership. If CONTRACTO is contracting in and individual capacity, the individual shall set forth the name of the business, if any
and shall personally sign the A ement.
Signature
Signature
Purchalg
NMC-CE
Manager
C
Approved as to Legal Form:
Charles J. McKee, County Counsel
Stacy saetta, Deputy
Attorneys for County and NMC
ITIG~~;f 0�ll~lnn`
Dated / / ll
Title
Dated
4 l1-i l
L
Title 15 et:
fu
Dated
Dated J L l
Dated: &4 2011
on ilex SJ~V-\\1
of Nlonlefe?/
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SIGNED BOARD REPORT AND SUPPO
W�MONTEREY COUNTY BOARD OF SUPERVISORS
MEETING: Jutl
e28,2011
AGENDA NO.:
SUBJECT: Authorize the Purchasing Manager for Natividad Medical Center NMC)
to lexecute Amendment #3 to the Agreement with Credit Consulting
Services Inc. for Bad Debt Collection Services at NMC in an amount not
to exceed $3,100,000 in the aggregate and $700,000 for the period July 1,
201;1 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 xecute Amendment #3 to the Agreement with Credit Consulting Services
Inc. for Bad Debt Collectioi Services at NMC in an amount not to exceed $3,100,000 in the
aggregate and $700,000 for! the period July 1, 2011 to June 30, 2012.
SUMMARY/DISCUSSION:
Credit Consulting Services provides collection services for Natividad's self-pay patients and bad
debt collections. CCS receives a daily data file of all self-pay patients from Natividad Meditech
system and is responsible tc send 3 collection notices to the patient within a 150 day time frame, if
no response, then the account is put into bad debt collections. Credit Consulting has been providing
this service to Natividad sinlCe 2007 and is a need to recover bad debt monies.
OTHER AGENCY INVOLVEMENT:
The Amendment has been r viewed 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 $700,000 and is included in the 2011/2012 Fiscal Year
Recommended Budget. Thi action will not require any additional General Fund subsidy.
Prepared by:
Vince Can, Business Office Director 755-4235
April 13, 2011
Harry Weis
Chief Executive Officer
Attachments: Amendments 1, 2, 3, Original Agreement, Board Order
Attachments are on file with the Clerk of the Board
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SIGNED BOARD REPORT AND SUPPO
W�Original Agreement No or PO#. A-11010)
RENEWAL AMENDMENT NO. 2
FOR PROFESSIONAL SERVICE AGREEMENT
BETWEEN Credit Consulting Services Inc. AND
THE NATIVIDAD MEDICAL CENTER
FOR
Bad Debt Collection SERVICES
The parties to Professional Service Agreement, dated August 1, 2007 between the County of Monterey,
on behalf of Natividad N edical Center NMC"), and Credit Consulting Services Inc. Contractor),
hereby agree to renew their Agreement No. A-11010) on the following amended teens and conditions:
1. Contractor will continue to provide NMC with the same scope of service as stated in the original
Agreement No. A-4 1010).
2. This Renewal Amendment shall become effective on July 1, 2010 and shall continue in full force
and extending the term date until June 30, 2011.
3. The total amount payable by County to Contractor under Agreement No. A-11010) shall not
exceed the total sum of $3,400,000 for the full term of the Agreement and $700,000 for fiscal year
2010-2011.
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-11010).
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.
CONTRACTOR
Signature
Dated
Printed Name
NATIVIDAD MEDICYALFUENTER
Signature
Signature
Approved as to Legal Form:
Charles J. McKee, County Counsel ff~~
By
tacy Saetta, Dep
Attorneys for County and NMC
Title NJ P,
Dated j"r-_ it?
Dated J
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SIGNED BOARD REPORT AND SUPPO
W�OriginalAgreement No orPO#. A-11010)
RENEWAL AMENDMENT NO.1
FOR PROFESSIONAL SERVICE AGREEMENT
BETWEEN Credit Consulting Services Inc. AND
THE NATIVIDAD MEDICAL CENTER
FOR
Bad Debt Collection SERVICES
The parties to Professional Service Agreement, dated August 1, 2007 between the County of Monterey,
on behalf of Natividad Medical Center NMC"), and Credit Consulting Services Inc. Contractor),
hereby agree to renew their Agreement No. A-11010) on the following amended terms and conditions:
1. Contractor will continue to provide NMC with the same scope of service as stated in the original
Agreement No. a-11010).
2. This Renewal Amendment shall become effective on July 1, 2009 and shall continue in full force
and extending 16 term date until June 30, 2010.
3. The total amount'jpayable by County to Contractor under AgreementNo. A-11010) shall not
exceed the total sjum of $2,700,000 for the full term of the Agreement and $700,000 for fiscal year
2009-2010.
4. All other terms aid 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-11010).
IN VMEREOF, 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 $.nd year set forth herein.
CONTRACTOR
Signature
Dated
Printed Name Title NJ V
NATIVIDAD MEDICAL CENTER
signahr~- /
Pychasitg Manager
F;$0~ C 1 Vl~iu~
Dated
Dated F i a l I� 1
Dated:
ditor- stroller Sr1` r11CGU* o Most o~
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SIGNED BOARD REPORT AND SUPPO
W�MONTEREY COUNTY BOARD OF SUPERVISORS
MEETING: August 28, 2007 AGENDA NO.:
SUBJECT: a) Authorize the Purchasing Manager for Monterey' County to enter into
Agreements with Credit Consulting Services, Inc, and Metro Republic
Commercial Services, Inc. for bad debt, collection services on a
contingency fee basis at Natividad. Medical Center NMC) in an amount
pot to exceed $2,000,000 for the term August 1, 2007 through June 30,
2009 or $1,000,000 for Fiscal Year 07/08; and
b) Waive County Insurance Endorsement requirements for Metro Republic
Commercial Services, Inc.
DEPARTMENT: Natiyidad Medical Center
RECOMMENDATION:
It is recommended that the Board of Supervisors;
a) Authorize the Purchasing Manager for Monterey County to enter into the Agreements with,
Credit Consulting Services, Inc. and Metro Republic Commercial Services, Inc. for-bad'.`
debt collection services on a contingency fee basis at Natividad Medical Center NMC).in
an amount not to exceed $2,000,000 for the term August 1, 2007 through June 30,'2009. or
$1,000,000 for Fiscal'. Year 07/08;' and
b) Waive County Insurance Endorsement requirements for Metro Republic Commercial
Services, Inc,
SUMI~RY/DIS-CUSS10
Natividad currently utilizes: a single bad debt vendor, NCO Financial Systems, Inc. Collections
average 3.7% of net placements and fees average 22.6% of collections. A new bad debt
management-strategy will-be implemented once the Agreements are approved which includes
utilizing two new vendors, Credit Consulting Services, Inc. a local vendor with strong experience
dealing with the same patients NMC serves, and Metro Republic Commercial Services, Inc.
These vendors provide reduced fees and an expectation of increased collections due to
competition, and improved monitoring by NMC. Both vendors have met the Countylnsurance
dollar amount evidence requirements; however, one vendor is unable to provide additional-:.
insured endorsements. NMC requests that both Agreements be approved understanding that Risk'
Management is unable to si4n one of the Agreements.
OTHER AGENCY INVOLVEMENT:
The Agreements have been.revi.ewed by County Counsel, the Auditor/ControllnIP;s.:.Ofce;
County Risk Management 1) and by the Natividad Medical Center Board of Trustees;
FINANCING:.
The cost for this Agreement is $2,000,000 for two years or $1,000,000 forPiscal Year 07/.08;;x11:
payments are contingency fe� based and included in the Natividad Medical CenterAdopted
Budget, This action will not require any additional General Fund subsidy.
Report Prepared by:
Sid Cato, Management Analyst William Foley
Date: July 18, 2007 Chief Executive Officer
Attachments: Agreements
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SIGNED BOARD REPORT AND SUPPO
W�0601.525; 0125.000
I~efore the Board of Supervisors in and for the,
County of Monterey, State of California
Agreement No.: A-11010
a. Authorize thejPurchasing Manager for Monterey County to enter into the
Agreements with Credit Consulting Services, Inc. and Metro Republic
Comm ercial.~ervices,Inc. forbad debt collection. services.ona
contingency fee basis at Natividad Medical Center NMC) in an amount not
to exceed $2,00,000 for the term August 1, 2007 through June 30, 2009 or
$1,000,000 fot Fiscal Year 07/08.
Waive County; Insurance Endorsement requirements for Metro Republic
Commercial Sbr�vices, Inc.
Upon motion of Supervisor Salinas, seconded by Supervisor Armenta, and carried by
those members presen;*t, effective August 28, 2007, the Board hereby;
a. Authorizes the Pui chasing Manager for Monterey County to enter into the.
Agreements with E~redit Consulting Services, Inc. and Metro Republic Commercial
Services, Inc for lad debt collection services on a contingency fee basis at Natividad
Medical-Center-( C)-it-an_amount not_to_excead_$2, 0-0,QQQfor_the-term
1 August 1, 2007 tlu~ouali June 0-2x09 or $1,0D0;000 for Fiscal Year 07/08.
PASSED AND ADOPTED this 28th day August 2007, by the following vote, to wit:
AYES: Supervisory Armenta, Calcagno, Salinas, and Potter
NOES: None
ABSENT: Supervisor Smith
I, Lew C. Bauman, Clerk iof the Board of Supervisors of the' County of Monterey, State of California,
hereby certify that the foreoing is a true-copy of an original order of said Board of Supervisors duly made
and entered in the minutes thereof of Minute Book 73 for the meeting on August 28, 2007
Dated: August 29, 2007 Lew C. Bauman, Clerk of the Board of Supervisors,
County Monteryly, Stq6,of California
B
Darlene Drain, Deputy
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SIGNED BOARD REPORT AND SUPPO
W�COUNTY OF MONTEREY AGREEMENT FOR PROFESSIONAL SERVICES
MORE THAN $100,000)*
This Professional Services Agreement Agreement") is made by and between the County of Mointere j', a
political subdivision of the Ste e of California hereinafter. County") and
Credit Consulting.Services.( CS)
hereinafter CONTRACTOR").
CONTRACTOR hereby agrees to perform, the service's described in Exhibit A' in conformity with the: terms of
this Agreement:. The services ar~ generally described as follows Provide Collection Services
In:consideratton of the. mu
follows:
as
al covenants: and conditionsset forth in this Agreement, the':p-gross agree,
1. SERVICES TO BE PRO''4 IDED. The County hereby engages CONTRACTOk'to perform,� acid
2, PAYMENTS BY COUNTY. County shall pay the CONTRACTOR in aocofdaiioe- withthe' payment
provisions'-: set'fortli in.Exliibit A; subject to the limitations s'et forth in this Agreement: total aiiiount
payable by County to CONTRAOTOR�under this Agreement shall not exceed the sutra of $ 1,1000,000.00':"' 3. TERM OF AGREEMENT. The term of this Agreement is from August l,'2007, to
July 30 2009 unless sooner terminated pursuant to the terms of this Agreement. This
Agreement is of no force or effect until signed by both CONTRACTOR and County and' with County signing
last,--and-CONTRACTOR nay_ t-camxxierrce-work befora-County_sign this Agreemen__
4. ADDITIONAL PRO VISIC`NS/EX1IIBITS. The.followiug attached exhibits are incorporated herein by
reference and constitute apart of this Agreement:
Exhibit A Scope of S~rvices/Payment Provisions
5. PERFORMANCE STANDARDS.
employees. of the County, or:imni daiate.'farriiiy of an employee of the County.
appropriately licensed to per#o~xn th yprk and cleliverj:the:sexvioes required uhtiez''tliisIp,.greei i'elit'and~'axe'.riot
subcontractors performing sexyics under this Agreement are; speciallq trained ej~'e'zeibed;~ctiiiiietent and
CONTRACTORrvarants that CONTRA.CTOR' and CONTRACT01t's:agents, employe
skillful manner and in compliant e with all applioable' laws and regulations: All work performed under' this
Agreement that is required by lave to be performed or supervised by licensed p&rsoinnel shall be'pei�foiined'iii
accordance with such licensing recjuii�ements,
5.02. CONTRACTOR, its gents,' employees,:'and subcontractors shall perform all work' in a safe and
*Approved by County Board of Supervisors on
Revised PSA Form More Than $100,000 1 of 8 Project ID:
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
AI103208-U03
DO104216-U03
C10-U03
BOARD-U03
REPORTS-U03
7/15/2011-U04
MARCELLAC-U04
16739-U05
7-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
3-U07
TO-U07
THE-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
6/17/2011-U011
AGREEMENT-U012
CREDIT-U012
CONSULTING-U012
SERVICES-U012
INC.-U012
BAD-U012
DEBT-U012
COLLECTION-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$3,100,000-U012
IN-U012
THE-U012
AGGREGATE-U012
$700,000-U012
THE-U012
PERIOD-U012
JULY-U012
1,-U012
2011-U012
TO-U012
JUNE-U012
30,-U012
2012.-U012
SIGNED BOARD REPORT AND SUPPO
W�5.03. CONTRACTOR shall furnish, at its own expense, all, materials, equipment, and personnel necessary
to carry out the terms of this A.greement, except as otherwise specified in this Agreement. CONTRACTOR
shall not use County premises;; property including equipment, instruments, or supplies) or personnel for any.
purpose other than in the perfor~ ance.of its obligations under this. Agreement,
6. PAYMENT CONDITION.
invoice to the County Auditor- ontroller for payment;" The County Auditor;Controllern shall, pay the amount
certified within 30 days of receiiing the certified invoice.
other amount as the County. a proves. in conformity with this Agreement, and, shall promptly submit sucho
6.01. CONTRACTOR shall submit to the Contract Administrator an invoice on a form: acceptable to'
Comity If not otherwise spe ified, the CONTRACTOR, may,, such invoice periodically or, at the,
completion of services, but in a y event, not later than 30 days after completion of services::The invoice sliail'
set forth the amounts claimed b CONTRACTOR for the previous period, together With-an itemized. basis for'
the amounts claimed,. and such other information pertinent to:the.invoice as the County-may require.: The
Contract Administrator or his or her designee, shall certify the invoice, either in the requested amount or in such
6.02. CONTRACTOR shall not receive reimbursement for travel expenses holes kPf: forth 1 fh,c
7: TERMINATION.
ee e t
7.01. During the term of is Agreement, the County may terminate the Agreement for any reason-by
giving written notice of terminat n to the CONTRACTOR at least thirty 30) days prior to the effective date of
termination-Such-notice-shall- forth the effective date of termination In the event of such termination, the
amount payable under this Agxee~nentshall be-reduced irrprop o-rtion-to-the services provided prior-to-the-date of
termination.
cost to the County shall be deduct d from any sum due the CONTRACTOR, under this Agreement:
7.02. The County may cane 1 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 an in the manner provided under this Agreement. If County terminates this
Agreement for good cause, the County may be relieved of the payment of any consideration to.
CONTRACTOR, and the County may proceed with the work in any manner which' County.deems proper The
8. INDEMNIFICATION. Co
hereinafter County"), its office
1,.ari'sing out.of, or in. connection-wi
or sub-contractors, excepts ig onl
cersonnel eimployed.by,tlie, Con
poq'sjble coverage fot the Cpun
e
ex
ses and li
uzi
ed`
b
l
t
p
n
ies nrac
a
i
i
defend and hold ha less t ie Cou
tractor shall indemnify, defend, and hold harml sS the. Coiinty.'.o Monterey:,:.
s, agents and employees from any claim, liability; loss,. injury, or:dax}nage�--:, i,T
h, performance of this Agreement by Contractor and/or, its agentsy employees
loss, injury or damage caused by the negligence or� will ui misconduct: of
It,is.the.intent o~the panties to this Agteetn At to provide the broadest
The C.ontractorshall reirnbti se the County%;, for a11, costs,;:atiQr eys' fees,
it i xespect; to. any litigation in winch the Coi tractox is obingat' d to=iiidernrxnfy
my under.this Agiecrnent
Evidence of Covera
Prior to commence ent of this Agreement, the Contractor shall provide, a. Certificate off
Insurance" certifying that coverage as required herein has been obtained. Individual endorsements
executed by the insurance carrier shall accompany the certificate. In addition, the Contractor upon
request shall provide certified copy of the policy or policies.
Revised PSA Form Over $100,000 2 of 8 Project ID
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
AI103208-U03
DO104216-U03
C10-U03
BOARD-U03
REPORTS-U03
7/15/2011-U04
MARCELLAC-U04
16739-U05
7-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
3-U07
TO-U07
THE-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
6/17/2011-U011
AGREEMENT-U012
CREDIT-U012
CONSULTING-U012
SERVICES-U012
INC.-U012
BAD-U012
DEBT-U012
COLLECTION-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$3,100,000-U012
IN-U012
THE-U012
AGGREGATE-U012
$700,000-U012
THE-U012
PERIOD-U012
JULY-U012
1,-U012
2011-U012
TO-U012
JUNE-U012
30,-U012
2012.-U012
SIGNED BOARD REPORT AND SUPPO
W�This verification of coverage shall be sent to the County's Contracts/1'urchasing 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 the County has approved
such insurance. This approval of insurance shall neither relieve nor decrease the liability, of the
Contractor.
9.02. Qualifying Insurer
non-owned, and hire vehicles, used in providing services under this Agreement, with a combined
single limit for Bodily Injury and Property Damage of not less than $500,000 per occurrence.
Lxemption/Modi~cation Justification attached; subject to approval).
County's Piohasin Manager,
Business autoniobil liability insurance, covering all motor vehicl-es,inaluduag-owvned-leased;
a combined. single limit for Bodily Injury and Property Damage of not less than $1,000,000 per.
occurrence.
Exemption/Modication Justification attached; subject to approval).
Commercial general liabili insurance, including but not limited to premises. and operations,
including coverage or Bodily Injury and Property Damage, Personal Injury, Contractual Liability.,
Broad form Property Damage, Independent Contractors, Products and Completed Operations, with
policies of insurano4 with the following minimum limits of liability:
9;03 Insurance Covera Requirements: Without limiting CONTRACTOR's duty to indemsoify,
CONTRACTOR shall maintain in effect throughout the term of this Agreement a policy or
Best's Key.Rating Guide: or� a company of e. qual,.:fmancial stability that is, approved by:the,1.,
All coverage's,. except surety, shall be issued by companies which.hold a current.policy holder's,;
alphabetic and fin` oral size category. rating. of not loss than A VII, according: to the aunent.
limits not less than; $:100Q,000 each person, $1,000',000 each accident. and:$1,000,000; eaohi
I
Workers' Compensation Insurance, if CONTRACTOR employs others in the performance of this
Agreement, in.adcor ance with' California Labor Code section 3700 and with Employer's Liability.'
Exexnpiiota/1Vlodi catign.(7u tification.attached; subject to approval).
those persons zutl?o zed by, a` license to engage n a business or. profession regu lated by the
Professional liability. insurance, if re.cluired-for t1ie`.pXofessional services beiia.g,;provided,
and 2,000,000:iii.ti% a gregate;.to co o liability; for.nialpractl e or errors of gni sszons tz ade<:
California,Business, nd rofessions,,,ode), 1 the amount Qf ia:ot less than $1,000,000 per, oIA}tm.,.
the course o f; loudeni} g professional service'4 If pi;af'egsioiial liability insurance i$ written ora;
expiration or earlier itermination of this Agreenieni, obtain extended repotting._eoyerage
coverage") with the ame liability, limits. Any such. tail coverage shall contiiiu for,,at least,t ree
claizlas-made basis, rather than ali occurrence basis, the CON TRACTOR;:-,shall;. upon a
years following thee*piration or earlier tetanhiation of this Agreement.
Exenaption/Modification Justification attached; subject to approval).
Revised PSA Form Over $100,000 3 of 8 Project ID
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
AI103208-U03
DO104216-U03
C10-U03
BOARD-U03
REPORTS-U03
7/15/2011-U04
MARCELLAC-U04
16739-U05
7-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
3-U07
TO-U07
THE-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
6/17/2011-U011
AGREEMENT-U012
CREDIT-U012
CONSULTING-U012
SERVICES-U012
INC.-U012
BAD-U012
DEBT-U012
COLLECTION-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$3,100,000-U012
IN-U012
THE-U012
AGGREGATE-U012
$700,000-U012
THE-U012
PERIOD-U012
JULY-U012
1,-U012
2011-U012
TO-U012
JUNE-U012
30,-U012
2012.-U012
SIGNED BOARD REPORT AND SUPPO
W �I
9.04. Other Insurance Requirements:
All insurance requited by this Agreement shall be with a company acceptable to the County and issued and
executed by. an admitted insurer authorized'to transact Insurance business'in the State of California:.Unless
otherwise specified by this k.greembnt, all such insurance shall be written on an occurrence basis; or,,if the
policy is not written on an occurrence basis, such policy with the coverage required herein shall continue in'...
effect for a period of three ylears following the date CONTRACTOR completes: its-performance of services
under this Agreement.
Each liability policy' Shall pprovide that the County shall be given notice-in writing at least,thirty days in'.
advance of and. ehdorse& r$duction in coverage or:limit; baricellati'ori; or intended non-renewal thereof
Each policy shall provide coverage for Contractor and additional insureds with respect to: claims arisitig.�
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 liabilit]i and automobile liability policies shall provide an. endorsement nanazn,g the
County of Monterey, its o{icers, agents, and employees as Additional Insurect with i esnect�,to liability.
arising. outbf the. CONTRAC'TOR'S work including ongoing and completed operations, and shall furthei
provide that, such insurance; is'primarryr� in.urance'to mny insurance' or self-insurance risaintained b th''
Court and'that the insurafi e' o the Additional Insureds shall' not' be called upon, to contribute to a. loss
covered by the CONTRAC OR"S insurance.-'The required en'dorseineht form. for Commercial General.
Liabiljty Additional Insured rjs ISO Form CG 201011-85 or CG 201010 01 in tandem with CG 20 3710
01 2000). The required end~rsenment form for Automobile Additional Insured endorsement is ISO Form
GA9 20-48-02 99
Prior to the execution of this Agreement by the County, CONTRACTOR shall file certificates of insurance
with the County's contract administrator and County's Contracts/Purchasing Division,, showing that. the
CONTRACTOR. has in effect the'irisurance required by this Agreement. The CONTRACTOR shall file a
new or amended certificate of insurance within five calendar days after any change is- made in any
insurance policy, which wound 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 fall force and effect:
CONTRACTOR shall at all times during the term of this Agreement maintain in force the insurance
t
co e
a
m
anr
ua c
adAltl eement d hall d tl
utde amid li Cowin 1 ertifi ate t
A
s
s
y,,:
y
c
r ge require un r' ns.~
gr
ns
en wi o
o...�
i
Y
t
County's Coi~traot-Administ ator;.andCounty's Contracts/Purchasing Division.,.; i oertaf'icate:is
tecei ed by.:the' expiration date; County shall h6ttfy CONTRACTOR aiid-CONZ'RACT,�OR shali,have�-fiye::
caleridar. vs osenid 111 he'certificgte, evidencing rid' lapse' in coverage' during, the. interim. Failurelby
s 1 greement, yrhicli' entitle Cu+, at iOntats
A p to riiauitain stteli iiasuiaij ceis a default gi thi
ONY CT
sale disc etiou tv teririiiiate tl greexnent'iriimediatelV
in'' t.
10. ECO1US AiND GON TDENTIALITY.
10.01; Confiilerifiality.' CONTRACTOR' acid its officers,'eniployees; agents;" and' subcontractors shall::,.--
comply with any arid all federia1,'staie, and local laws, which provide for the confjdentiality'of ecords-:end
other iiiforrnation. CONTRAiCTOR shall not disclose any confidential records or"other, confidential
information received fronr'tha County or prepared in connection with the performance of this Agreement,.
unless County specifically permits CONTRACTOR to disclose such records or information.
CONTRACTOR shall promptly transmit to County any and all requests for disclosure of any such
Revised PSA Fonn Over $100,000 4 of 8 Project ID
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
AI103208-U03
DO104216-U03
C10-U03
BOARD-U03
REPORTS-U03
7/15/2011-U04
MARCELLAC-U04
16739-U05
7-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
3-U07
TO-U07
THE-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
6/17/2011-U011
AGREEMENT-U012
CREDIT-U012
CONSULTING-U012
SERVICES-U012
INC.-U012
BAD-U012
DEBT-U012
COLLECTION-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$3,100,000-U012
IN-U012
THE-U012
AGGREGATE-U012
$700,000-U012
THE-U012
PERIOD-U012
JULY-U012
1,-U012
2011-U012
TO-U012
JUNE-U012
30,-U012
2012.-U012
SIGNED BOARD REPORT AND SUPPO
W
�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.
10.02. County Records. When this Agreement expire's or terminates, CONTRACTOR shall. return. to
County any County records Which CONTRACTOR used or received' from County to. perform services...
under this Agreement.
10.03. Maintenance of Records. CONTRACTOR shall prepare, maintain, and preserve all reports and
records that may be regini'ed by federal, state;' and'. County. rules and regulations related. to services.
e
nent:'CONTRACTOR shall maintain such records for a period of at least tlv,ee.
performed under�this.Agre
years after receipt of final; payment under this Agreement. If any litigation; claim, negotiation,. audit.
exception, or other action�rtlating to this Agreement is-pending at the end. of the three year period, then:.
CONTRACTOR shall retain said records until such-action is resolved.
10.04. Access to and Audit of Records. The County 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 85.46.7, if,this Agreement:
involves the experiditure of public funds in excess of $1 0,0.00-, the parties to this Agreement may be.subjeet,
at the request of the County or. as'p'art�of.any'auidit o�'the;.County,.to the examination and audit of the State
Auditor pertaining to. matterq connected with the performance.of'this Agreement.for a period of three years
after final payment under the Agreement:.
10.05. Royalties and Inventi County shall have a royalty-free, exclusive and irrevocable, license to
reproduce,publish-and_usend authorize-other-s-to-do-so,_a11 original~ompizt-programs, vrritig-s, sound
recordings, pictorial reproductions, drawings, and other works of similar nature produced in the course-of-
or under this Agreement. CONTRACTOR shall not publish any such material without the prior written
approval of County.
11. NON-DISCR] OINATION. During the' performance of this Agreement, CONTRACTOR, and its
subcontractors, shall not unlawfully discriminate against any person because of race, religious creed, color,
sex, national origin, ancestry, physical. disability, mental- disability, medical condition, marital status, age
h
s employment practices or in t
e furnishing or.
over 40), or sexual orientation, either in CONTRACTOR
services to recipients. CONTACTOR shall ensure that the evaluation and treatment of its employees,.and.
applicants for employment and all persons receiving and requesting services are free of such discrimination.
CONTRACTOR' acid any�subeontractor~shall, in the:.perfoniiance of this Agreer;ient,. fully comply with all-. r..
acrd local aw and'regulati'ons Which. prohibit discrimination The provision., of services
federal, state
primarily or exclusively to s cb target, populatioin as. may be designated, in this greement~ shall riot 1i
accrued to be'prol xbited discii nzinatiori:
1$ COMPLIANC 4'IY'I TE S OF STATE.-OR 3EDERA$~ GRANT. If:this.AgreementJhas been o
will be funded with monies received by. the County pursuant to a contract, with tlie,state,or federal
government in which the; County is the grantee, CONTRACTOR will comply with. All, the, provisions; of said
contract,' to the extent applioable to CONTRACTOR as a subgrantee under. said contract, and said;
provisions shall be deemed a part of this Agreement, as though fully set forth hereinUpon request, County,...,
will deliver a copy of said contract to CONTRACTOR; at no cost to. CONTRACTOR
13.1NDEPINDE, NT CONTRACTOR. In the performance 6 f work,- duties, and obligations under this
Agreement, CONTRACTOR is at all times acting and performing. as ail independent contractor and not as
an employee of the County, No offer or obligation of permanent employment with the County or particular
County department or agency s intended in any maimer, and CONTRACTOR shall not become entitled by
Revised PSA Pann over $100,000 5 of 8 Project ID
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
AI103208-U03
DO104216-U03
C10-U03
BOARD-U03
REPORTS-U03
7/15/2011-U04
MARCELLAC-U04
16739-U05
7-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
3-U07
TO-U07
THE-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
6/17/2011-U011
AGREEMENT-U012
CREDIT-U012
CONSULTING-U012
SERVICES-U012
INC.-U012
BAD-U012
DEBT-U012
COLLECTION-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$3,100,000-U012
IN-U012
THE-U012
AGGREGATE-U012
$700,000-U012
THE-U012
PERIOD-U012
JULY-U012
1,-U012
2011-U012
TO-U012
JUNE-U012
30,-U012
2012.-U012
SIGNED BOARD REPORT AND SUPPO
W
�virtue of this Agreement to receive from County 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 and obligated to pay directly all applicable-taxes, including:
federal and state income takes and social security, arising out of CONTRACTOR's performance of this
Agreement. In connection therewith, CONTRACTOR shall defend, indemnify, and hold County harmless.
from any and all- liability which County 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
pre-paid mail to the. County ahnd CONTRACTOR'S:contract administrators at the addresses listed below:
TO'R CO V`:
Name and T tle
Acldress
Name and Title
Address
Phone Phone
1=5 NLCSCELLANLOUS P~RO�IOlN~-
15.01, Conflict of Interest. kCONTRACTOR represents that it presently has no interest and agrees not to
acquire any interest during tlt.e 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 required to be
rendered under this Agreement.
15.02. Amendment. This-A regiment maybe amended or modified only by an instrunaerit izr writing sig ed;
by'the County and the CONT. CTOR::
15,03. Waiver. Any. waiver d any terms and'conditioiis of this Agreement must be in writing and signed
Q this. egirrre1mt
by, the otiiity and 1lib i CONi[RA CTOlZi A wai ve'r' of ariy of the terms and conditions
shallnnot lie eonstrued,a`s a~W VtY of~any. o'tl ertei'ns&or coriditi.gfis in this'Agreeinent
15:04;':ContCaOtor: The tern CONTR.A.CTOR" as:,used-in this.Agreemeut.includes_CONTRACCTOR s
otlicers, agents, and oniploye~s acting on t;UNTRA CTUK's belralt ira'the pertoz ace'ot this A greehiert'r`
15;05.,. Disputes, CONTRACTOR shall.coiitini.e,to per'forii? undei this:Agreernentduring,any dispute,
15.06. Assignment andSub'otrtractirig'`The shall- not assign, sell, ot.gtlierwise transfer, +
its interest or'obli'gations in' this. Agreement without Elie prior written consent gf_the County Nohe of t1r.e.
services covered by this'A eerirent- shall' lie subcbntracted Without the prior written approval of`the
County. Notwithstanding any such subcontract, CONTRACTOR shall continue to be liable, for the,
performance of all requiren erits of this Agreement:
Revised PSA Fom Over $100,000 6 of 8 Project ID
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
AI103208-U03
DO104216-U03
C10-U03
BOARD-U03
REPORTS-U03
7/15/2011-U04
MARCELLAC-U04
16739-U05
7-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
3-U07
TO-U07
THE-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
6/17/2011-U011
AGREEMENT-U012
CREDIT-U012
CONSULTING-U012
SERVICES-U012
INC.-U012
BAD-U012
DEBT-U012
COLLECTION-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$3,100,000-U012
IN-U012
THE-U012
AGGREGATE-U012
$700,000-U012
THE-U012
PERIOD-U012
JULY-U012
1,-U012
2011-U012
TO-U012
JUNE-U012
30,-U012
2012.-U012
SIGNED BOARD REPORT AND SUPPO
W
�15.07. Successors and Assigns. This Agreement and the rights, privileges, duties, and obligations of the
County 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.
15.08. Compliance with Applicable Law..The parties shall comply with all applicable federal, state, and.
local laws and regulations iii.performing this Agreement
15,,09. Headings, The headings are for convenience ponly'and shall not be used to interpret the tenxts. of this
Agreement
15.10. Time.is of tlZe Esser e, Time is of the essence'iil 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 County and CONTRACTOR
expressly reserve the right to contract with other entities for the same or similar services.
1 513 Construction of Agreement The County 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 am.endme~t to this Agreement
15.14. Counterparts. This qI Agreement may be executed in two or more counterparts, each of which shall be
deemed an original, but all o-owhich together shall constitute one and the same Agreement.
15
15
th
i
A
di
id
ti
A
i
l
hi
u
or
ny,
ua
execu
n
v
ng t
s Agreement on behalf of the County or the
CONTRACTOR represents and warrants hereby that he or she, has the requisite authority to enter into this
Agreement on behalf df such arty and bind the party to the terms and conditions of this Agreement.
15.16. Integration This Agreement, including the exhibits, represent the entire Agreement between the
County and the. CONTRACTOR with respect to the,subject matter of this Agreement and shall supersede.
all prior negotiations, repres$utations, or agreements, either written or oral, between the County and, the
CONTRACTOR as of the etrlective date of this Agreement, which is. the date' that the County, signs the'
Agreement.
15,17.; Interpratatiori. of Conflicting Provisions.: Izl':tJle event of any conflict or inconsistency, between.the:
provisions of this Agreement j and the Provisions of any exhibit or other attachnlent to this Agreement; the
This s
ace is left blank
i
t
tt
ll
p
g
eu
ona
y.
Revised PSA Porn Over $100,000
provisions-of'this- Agrcernent; hall. prevail and contro
7 of 8 Proj ect iD
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
AI103208-U03
DO104216-U03
C10-U03
BOARD-U03
REPORTS-U03
7/15/2011-U04
MARCELLAC-U04
16739-U05
7-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
3-U07
TO-U07
THE-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
6/17/2011-U011
AGREEMENT-U012
CREDIT-U012
CONSULTING-U012
SERVICES-U012
INC.-U012
BAD-U012
DEBT-U012
COLLECTION-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$3,100,000-U012
IN-U012
THE-U012
AGGREGATE-U012
$700,000-U012
THE-U012
PERIOD-U012
JULY-U012
1,-U012
2011-U012
TO-U012
JUNE-U012
30,-U012
2012.-U012
SIGNED BOARD REPORT AND SUPPO
W
�IN WITNBSS WHEREOF, County and CONTRACTOR have executed this Agreement as of the day and
year written below.
5.2007
Date:
O fisio
for/4 b.n oller
Board'Oider#'
Copy'of Baar&1Order thust eliiciii ea.
Oil behalf of the par.tnerslalp�:I1.C0pp" CTOR is contracting in an individual capacity, the mdrvrdppl shall set.,forl0 the Warne, of the
name of the partnership shall be set forrt4 above together with the signature of a partner who has, authority to, execptc,tbis Agrpemq it�
the corporation shall beset forth above together with the signatures of two specified officers. If.�CON713ACTOR is a,pa tpers1'ip, the c
President)*
Signature of Secretary, Asst. Secretary, CFO, or
Asst. Treasurer)*
*INSTRUCTIONS' If CONTRACTOR.ps.a corporation; including limited liability and non prott. coiporafionsrthe full legal rame,o f
business, rf any, and shall personally sign, the Agreement,
Approval requii'ed by the: following;
County Counsel
Risk Management
3Board of Supervisors, approved by board order
4Auditor/Controller, if changes are made to the standard payment provisions,
Revised PSA Ponn Over $100,000
e tmexii'-Ffbad if Apo
8 of 8
Project ID
Signe of Chair, President, or
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
AI103208-U03
DO104216-U03
C10-U03
BOARD-U03
REPORTS-U03
7/15/2011-U04
MARCELLAC-U04
16739-U05
7-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
3-U07
TO-U07
THE-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
6/17/2011-U011
AGREEMENT-U012
CREDIT-U012
CONSULTING-U012
SERVICES-U012
INC.-U012
BAD-U012
DEBT-U012
COLLECTION-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$3,100,000-U012
IN-U012
THE-U012
AGGREGATE-U012
$700,000-U012
THE-U012
PERIOD-U012
JULY-U012
1,-U012
2011-U012
TO-U012
JUNE-U012
30,-U012
2012.-U012
SIGNED BOARD REPORT AND SUPPO
W�COLLECTION AGREEMENT & HIPAA PROVISIONS
PROPRIETARY INFORMATION"
This agreement made and by and between County of Monterey Natividad Medical Center, hereinafter
xefen-ed to as Client" or; Provider", and Credit Consulting Services, Inc. a; collection agency
governed by state and federal collection laws, including the Federal Fair Debt Collection Practices-
Act, hereinafter referred to ap Company":
hereto in such course of dealing,
THEREFORE, in' c'pnsideration of the premises and of the mutual agreements of the;
WHEREAS, Client; desires Coinpany to undertake the collection of the Clietit's accounts
and other evidences of i Idebtedness accounts"), in the manner, and. under the, terms and
conditions hereinafter set forth;
WHEREAS, Client intends to assign accounts for collection to Company'putsuant'.to this
Agreement; and,
WHEREAS, the parties contemplate the future course of dealing as Client'and Company,
and desire to. set forth and define herein the mutual rights, obligations and liabilities of the parties'
1. Client warrants that each account assigned for collection is a valid and existing account
against the debtor and each account complies with all state and federal laws. Client further
warrants and represents that it is fully authorized and empowered to assign to Company all
accounts, an la 1 nigh s r. la int g tho,oh are sent ttstlle-Company-pursuant-t~thi
Agreement. Client also agrees to cease all collection efforts with its customer once the account is
assigned to Company.
2. Client acknowledges that Company has the authority on all assigned. accounts to
receive payment.in cash, check or money order. Client also acknowledges that Company is, given
the authority to endorse checks, drafts, money orders and other negotiable insirunaents, which
parties hereto, it.ns hereby agreed as follows:
may b e received in payment relating in any assigned account,
tohn ig`'defined at 45 CFR:�;164:S.�Qx
necessary:fot-t.i0.,Cotnpaty to use, arld'.disclose:Prot'ected'PIealth Infoi'nation:.('PF7I");sas
Health Insurance Portability and Accountability, Act
P.xoyisions
3. Use and DiscWure of Protected Health.'biforntation. The parties hereto,
agree that in, order. for. tha Company>to:.perBorm,:itsdutieis� unnder this:,.Agreernent,,::it,~x~s�1l
3,1 Permitted and Required Uses and Disclosures of PHI. The parties,...-.
hereto further agree that the Company may use or disclose PHI for any use or disclosure that.:is.
required by law.
function covered under the dpfmnition of Payment" contained in 45 CFR 164.501 The.parties
hereto agree that the Company may use and disclose PHI in order to carry out.�any.Payment
3.2 Use and Disclosure of Minimum Necessary Amount of PHI The
parties hereto desire to ens4re that the Provider discloses to the Company the minimum
CCS Calleotion Agreement HIPAA
1
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
AI103208-U03
DO104216-U03
C10-U03
BOARD-U03
REPORTS-U03
7/15/2011-U04
MARCELLAC-U04
16739-U05
7-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
3-U07
TO-U07
THE-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
6/17/2011-U011
AGREEMENT-U012
CREDIT-U012
CONSULTING-U012
SERVICES-U012
INC.-U012
BAD-U012
DEBT-U012
COLLECTION-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$3,100,000-U012
IN-U012
THE-U012
AGGREGATE-U012
$700,000-U012
THE-U012
PERIOD-U012
JULY-U012
1,-U012
2011-U012
TO-U012
JUNE-U012
30,-U012
2012.-U012
SIGNED BOARD REPORT AND SUPPO
W�necessary amount of PHI necessary for the Company to perform its duties under this Agreement.
The parties hereto agree that the following information includes the minimum necessary in order
for the Company to perform its duties under this Agreement:
A)Name and address of patient and responsible party
B) Telephone number of patient and responsible party
C) Date and birth of patient and responsible party
D) Social Sectuity.� number of patient and responsible party
J) Upon the Company's receipt of a written request from patient.
ryquesting verification of the account information, the Provider shall
provide the Company with an itemization of the services and the
I) Payment history pertaining to the account, etc.;
emergency contact information
and'
G)Name, address, telephone, and contact for any healthcare provider,
health plan, insurance, or. other third party concerning the services
provided or payinentsource for the obligation
H) Name, address, and telephone.: number of nearest living relative or,
E) Driver's*License of patiei t and responsible party
F) Employment Name, address, and telephone number of patient
responsible party
date(s) such service(s) were rendered to the patient and which pertain
to e-acc(junt receivable refereed to the- ompany_pursuant to this-
Agreement;
K) Upon. the Company's request, identifying information as necessary
and such other information relating to the obligation, payments,
service, to enforce the right to receive payment from any insurance
comnpany or plan, or in any judicial, non judicial, administrative, or
other. proceeding or nation; or to. irespohd, to allegations of the patient,
person, or governmental entity that attempts to collect the account was
improper.
4 Terrnincztzgn bp) Pr pvicler For� Breach. Notwithstanding' any other� provi sign, f r. tile�
termination of this Agreement, the Provider may terminate this Agreement.:if��the�. Provider
determines, that::the;. Compatly has l reached amaterial: tterln. of this Agreerrrent;. 4,5. Q.,F.Ri.~,..
x_69,504 e 2) zrr:.t eve oL, a; i ate
m)) e; n,�t, r~ ria breac of theCompany s duties an
responsibilities contained in Sections 6,1 throUgh, and:including 6.12 of thi.s Agreement;,_
Piovidei�,may immediately tern te-this.Agreement upon written notice to the Company In tl~e�,:.
event of a claimed materiall reach of any other provision of this Agreement by the Comnpainy, he.
Provider. shall give the Company written notice of the alleged material breach The. Company,
shall have ten: 10)::days- from the. date of any, writteii�notice. of breach to cure. the alleged breach
In the event the Company Cures the alleged breach within the ten 10), day...time: period this:
Agreement shall remain in frill force and effect, In the event that the Comp an,y failsto cure the
alleged breach within the ten;(10) day tirrie period, this Agreement shall terminate.
5. Termination by tha Company for Breach. In the event of a claimed material breach of
any provision of this Agreement by the Provider, the Company shall give the Provider written
CCS Collection Agreommil IUPAA 2
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
AI103208-U03
DO104216-U03
C10-U03
BOARD-U03
REPORTS-U03
7/15/2011-U04
MARCELLAC-U04
16739-U05
7-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
3-U07
TO-U07
THE-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
6/17/2011-U011
AGREEMENT-U012
CREDIT-U012
CONSULTING-U012
SERVICES-U012
INC.-U012
BAD-U012
DEBT-U012
COLLECTION-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$3,100,000-U012
IN-U012
THE-U012
AGGREGATE-U012
$700,000-U012
THE-U012
PERIOD-U012
JULY-U012
1,-U012
2011-U012
TO-U012
JUNE-U012
30,-U012
2012.-U012
SIGNED BOARD REPORT AND SUPPO
W�notice of the alleged material breach. The Provider shall have ten 10) days from the date of any
written notice of breach to cure the alleged breach, In the event the Provider cures the alleged
breach within the ten 10) day time period, this Agreement shall remain in full force and effect.
In the event that the Provider fails to cure the alleged breach within the ten 10) day time, period,
this Agreement shall termjnate.'
6. Duties' and;Responsbilities Concerning PHI
6.1 Restrictions on Use and Disclosure ofPFII The Compaa3y shall not use or.
further disclose airy PHI other than as permitted or required by this Agreement, or as required by.
law;
Provider;
to the Provider�for'amendment.and shall incorporate any such amendments' into the P.HI.iri.:.
accordance with:.4,5CF, 1;64.526. Within ten,(10)� days after receipt:of a,request;;from an
individual for an amendment to any PHI, the Company shall forward such request to the.
the Provider, Within ten l10) days after receipt of a request from an individual for access to PHI
in the possession of:the Company, the Company shall forward such request to the Provider;
6.6 Amendments to PHI. Within ten 10) days after receipt of a request from
the Provider for, an amendment to any PHI, the Company shall make the requested PHI. available
with-45-CF t 1-64.5-24. Jitl-in_ten_(1 Q) y_s aft~r__re~ipt of a request from the Provider for j
access to PHI in the possession of the Company, the Company-shall make such-PHI-available to
6.5 Access to PHI. The Company shall make available PHI in accordance
conditions that apply to the Company with respect to such PHI;
created or received by the Qbmpany on behalf of the Provider agrees to the same restrictions and
ensure that an agents;. including. any subcontractors, to whom it provides PI3I-received from; or
6.4 Protection of PHI by Agents and Subcontractors: The Company shall
the. Company becomes aware;
6.3 12.epprting of Unauthorized. se or Disclosure ofPliT The Company shall
report to the Provider any use or disclosure of PHI not provided for by this Agreement of which
prevent the use or disclosure of PHI other than as provided for in this Agreement;
6.2 Safeguarding' of PHI. T6 Company shall use appropriate safeguards to`.4
diselosure$ of pHI regatdrzl$;t1 mdrvrdual clurtng the;slr 6) years-p~�rot.to;;tl date.on.Whleh;tYre;
Provider; that tbe.,Pr.o dd.o 1ias zepeive,d, a recluest,froin an individual., for an. accountng:
Accounting, Within ten.; 10) days after receipt of notice from the
disolosures.of PHI to.the_ii diyidual iz3 accordanoeLwith 45.C FP 164.528;
is in tire Company's possesson,and is required for the Provider to provide an accounting of
aecoutrting was:requested; tlre_Coriipany:shall nialc available to the.�Providg.r sucl iufor aafl6d as:;
compliance with Subpart B of Part 164 of Title 45 of the Code of Federal Regulations; and,
created or received by the,.Corxrpar y:on behalf Q.f the Provider available to the Secretary of the.
Department of. Health gird Human services fo. r purposes of determining the Provider's
internal practices, books, midxecords� relatiirg*to the use and' disclosure of P.H1: received fromn,.o
6.8 Inte~a al Practices, Books,: and Records` The Company shall make. its.
6.9 Duties with. Regard to PHI Upon Termination of this Agreement. At
termination of this Agreement, if feasible, the Company shall return or destroy all PHI received
CCS Collection Agreement HIPAA
3
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
AI103208-U03
DO104216-U03
C10-U03
BOARD-U03
REPORTS-U03
7/15/2011-U04
MARCELLAC-U04
16739-U05
7-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
3-U07
TO-U07
THE-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
6/17/2011-U011
AGREEMENT-U012
CREDIT-U012
CONSULTING-U012
SERVICES-U012
INC.-U012
BAD-U012
DEBT-U012
COLLECTION-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$3,100,000-U012
IN-U012
THE-U012
AGGREGATE-U012
$700,000-U012
THE-U012
PERIOD-U012
JULY-U012
1,-U012
2011-U012
TO-U012
JUNE-U012
30,-U012
2012.-U012
SIGNED BOARD REPORT AND SUPPO
W�from or created or received by the Company on behalf of the Provider that the Company still
maintains in any form and retain no copies of such PHI. If such return or destruction.is not
feasible, the Company shall extend the protections of this Agreement to the PHI and limit further
uses and disclosures of the PHI to those purposes that make the return or destruction of the PHI
not feasible.
6.14 No Restrictions. The Provider shall not place any account with the
Company if the Provider has agreed to any individual's request to restrict the use or disclosure of
PHI connected with- such account pursuant to 45 CFR 164.522.
6.12 Amer7.dmerit of PHI. In the event That an individual has requested an
6.10 Prej aration and Delivery of Accountings. It shall be the sole
responsibility of the Provider to prepare and deliver,any accounting requested pursuant to 45
CFR 164.528;
6.11 Decisions Concerning Access to PHI. In the event that an individual has
requested access to PHI4irectly from the Company, and the Company lras, forwarded such
request to the Provider in ccordan'ce* with Section 6.5 of this Agreement,., it shall. be the sole
responsibility of the.Provider to determine whether to grant at deny such access; and,.
ofthe Providerto.determine wb ther,to allow or disallow such amendment
amendment to PHI directly from the Company, and.the Company has forwarded such request to
the Provider in accordance with Section 6.6 of this Agreement, it shall be thelsole responsibility
6,13'... Consents and Authorizations. Prior to disclosing any PHI to the.:
by Provider or regulation; pursuant to 45 CFR 164,506 and 45 CFR 164.508 respectively,
sufficient to permit the disclosure of PHI from the Provider to the Company, and to permit the
Company,'. the Provider shall obtain all required consents and' authorizations, if any are required
Company to perform its duties pursuant to the terms of this Agreement;
Ii Client fails fo rcivide'siich iriformatron 10 days;' Con?[pany, Wray elect to.:deerzi: the
bl
l
Client shall pxbvid~ such'infbrinatioh;-,data, and doduineiits as reason` ablyneces.saxy�to Goinpaaay.
AndDios ecutioti;of any. htlg.tion or other proceeding for.the.euforcement.o.f, an assigncd-Cie. 1t,
debt, to respond to rigi.uries'from a debtor on an assigned' debt,.evaluatior~. of collection op'tioi s
CONDUCT OF COMPANY
7. Collection Efforts;' Company will use collectidi efforts that it deems to be reasonable,
and consistent. with all applicable laws, and the general reputation of the Client and.Compai y
As reasonably. requested by Company, including for the purposes of veri:cation. of an; assigned.:
ecta
e
assr.gried acU 1w utrcol
couunencirig:.axiy such 1iti6tibn.'C61npany.agrees to advance all necessary, legal. cost, Who
Company collects an acoount, in whole of in part, Company may first deduct any: aiid all, legal
cost advanced before disbursing any amounts to Client or Company. If Client advances legal
cost, Company will first disburse any and all legal cost advanced before making any
disbursements to Company,
account assigned wider, this agreement. Coinp ily Hill; obtain Client's approval p1iox'...to
whether litigation or other` ei1foraemerit proceediings should: be commenced or coni;inueo for. any.
8, Liiigations and Enforcernent. Company, as the assignee, shall make the decision
CCS Collection Agreement ffi?AA
4
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
AI103208-U03
DO104216-U03
C10-U03
BOARD-U03
REPORTS-U03
7/15/2011-U04
MARCELLAC-U04
16739-U05
7-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
3-U07
TO-U07
THE-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
6/17/2011-U011
AGREEMENT-U012
CREDIT-U012
CONSULTING-U012
SERVICES-U012
INC.-U012
BAD-U012
DEBT-U012
COLLECTION-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$3,100,000-U012
IN-U012
THE-U012
AGGREGATE-U012
$700,000-U012
THE-U012
PERIOD-U012
JULY-U012
1,-U012
2011-U012
TO-U012
JUNE-U012
30,-U012
2012.-U012
SIGNED BOARD REPORT AND SUPPO
W�9. Forwarding Assigned Accounts. Client recognizes debtor may reside in a
state with restrictive laws and regulations, Company may forward any of Client's claims to
another collection agency', in order to comply with such laws and regulations or- to improve the
chance of recovery, Such other collection agency shall have the authority to exercise all ordinary
and reasonable collection fforts as permitted by law.
10. Credit Reporting. Client agrees each account assigned to Company may be placed
in.its sole discretion, issue, any,such'.corrections or deletions of information reported to credit
reporting agencies.
deleted from a credit file due to the:Client's errot�.� Company may, as it determines appropriate
original date of assignment. Client reserves the right to have. Company direct that. an item be
as a derogatory item for the times and in the manner allowed under the Federal and applicable.
State Fair Credit Reporting Acts. Company will report unpaid accounts after.60 days from the
with a credit reporting agency by.Company for inclusion in the individual credit.file and.reported
Agreement.as if the accouni.was.�paid� in full.:...
Company, without Client doiisent so long as client receives the amounts due under. this
Company may settle or compromise accounts, with all reductions to be made frorn monies due
the full amount as originally assigned by Client. withQut the, expressed consent. of Client:
Company shall not accept as settlement in full, on any account assigned, any amount less than
11. Settlement of4s~ i n d Accounts. Except as- provided in this paragraph,.'
further credit repot tirig'. Corrbpany agrees to return any'Medicare accounts. deemed, uncolleotable�
by the Consumer Reporting Agencies, and it shall be Clients responsibility to conduct any such
cancellation, Company aha1~{ issue instructions to have previously reported information;. deleted
Client may also require Coriipany to return specific accounts, which Client identifies within one
month after assignment wad assigned in error, and for which Client has not been paid since
assignment. If Olient'�is�paiel within six-months of anaccount- cancelled as�being assigned due to
error, Client shall immediately notify Company of the payment, and within 10 days after
receiving such payment, pay Company an amount equal to its share of such monies as if the
account had not been cancelled. Company may offset such amount from a disbursement to be
made to Client for monies' collected on other Client assigned accounts. In the event of a,
l fng`a ion has commenced b o arry,-or=the Companyhas-obtained a Jjrzdgmerrt on the account.
12. Reassignment of Accounts. Client. may require Company to return a specific
account or accounts for which there have' not been any monies collected within the seven
calendar month period, unless there is a payment plan between the debtor and Company,
aft er` 120 days per client.redtle'stfi'ee.ofoh'arge:.
bankruptcy notices, and any and all- cornmuinications friiii the debtor or any third party, Client
also agrees to direct all cornniunication from debtors to Company. Client shall notify Company
remltting�p'ayment arid remittance staternenfto'Client
14. Client Direct. Pay?tents: Client agrees tt promptly report to Company all payments,
or payment locatlozi. Clienlt')�'ill. pay coinpaiiy its collection fees'vvithin thirty.days,offCoinpany'
on an'y. money,collected'onaa�tlie accouiit is assigri,ad;i'or collecti-oii regardless. of paymerit'source
i�enmittance statement of each;account collected, Client recognizes Company is due a commission
month,, coupled with a remittance check, All monies due the' client shall be remitted mn frill:,witl~. a s
given to- the Chet t1'not Iatef`th.an the 5th"of the'.moritlf follov ing'the close M f; tbel reV ous
Ernst aecoui~t, Compiiny wi 4 ieizrit payi ients.'dii�ectly from the trust- account:' lA port shall pe
13: Di bu~serise t ooriies Callecterl
fl(7 Company will deposit all payrnents.:intQ, a:.
CCS Collaclimi Agrcomcnl H1PAA
5
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
AI103208-U03
DO104216-U03
C10-U03
BOARD-U03
REPORTS-U03
7/15/2011-U04
MARCELLAC-U04
16739-U05
7-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
3-U07
TO-U07
THE-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
6/17/2011-U011
AGREEMENT-U012
CREDIT-U012
CONSULTING-U012
SERVICES-U012
INC.-U012
BAD-U012
DEBT-U012
COLLECTION-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$3,100,000-U012
IN-U012
THE-U012
AGGREGATE-U012
$700,000-U012
THE-U012
PERIOD-U012
JULY-U012
1,-U012
2011-U012
TO-U012
JUNE-U012
30,-U012
2012.-U012
SIGNED BOARD REPORT AND SUPPO
W�the following information for each Direct Payment: A) The amount of the payment; B) The naive
of the debtor; and, C),The debtor's account number,
15. Interests Assigned In addition to the principal amount of the debt assigned,--.
Client assigns all rights, Whether contractual or statutory, relating to the assigned. account(s),
including without limitatlo!n, the right to interest, fees, costs, bad check charges, attorneys' fees,
and other financial obligations to the Company. Company shall retain all interest owing after the
time of assignment, and all pre-assignment interest, which was not listed in the balance due on
the account by'the Client at the time of assignment:.Pursuiant to the assignment, Company shall.
have the right to commence suit as it deteimifes' necessary and appropriate in the collection of
the assigned a c c o u n t
16. Fees ancjIntere{sts in Monies Collected. For. all accounts assigned; Company
is assigned fourteen percent 14%) of all Principal Sums Principal Sums" is. the dollar amount
of the account as assigned) by the client during the first 30 days of assignment, including: the.
interest and. other, costs as then computed by the Client) collected from wh.atever,.source or any items returned as a credited item on accounts referred from this date hereon forward, and
eighteenp.ercent 18%) aftej'.30.days of assignment, On accounts where legal;aetion.is instituted
or it becomes necessary to forward the account to an. agency outside the geographic' area,.
Company is.assigned thirty-five-percent 35%) of all, Principal. Sums In the. e:vent.the. Coinpany"
files any action. or proceeding against the Client for the recovery of any monies due from.the...
Client to the Company pursuant to this Agreement, Client shall pay Company. all costs incurred:
by the Company in prosecuting such action, including, without limitation; reasonable attorneys'
fees. Any accounts where payments or insurance are identified within the first five days of
assignment the account will be canceled and returned at no cost.
The Client's duties and obligations under Paragraphs through and including 16,18 and 19
of this Agreement shall contininue subsequent to termination, for any reason,. of this Agreement
with respect to-payments received upon which the: Company remains entitled to receive pursuant
to this Agreement.
17, T,ertn ofAgreemeii, The initial tenn of this Agreement shall be fora period of
two years, with the option to extend this Agreement for an additional two additional one-year year.
periods, Either; party shall havethe right to terminate this agreement in writing on:'a:�sixty 60).
day notice Should either party elect to terminate this agreement, Company will return all
aC oUuts except�;thosein active.Status,ifpayment�plati,;litigatio i.and judgri2ez~t.,. 1t tear xnat olr;gf
agreement Cprnpany:sliall remit every thirty days all monies. due Client ono, nel::basis;.cn etaizi:
ell ironies due Company,
18 Client C4riduGt T i anion Tf Ahe debtor' files a xes onsive leacixai r c'ros
g
l?. P...- g,.
cbiulilaint, counter dlainii, oi othdr, affirmstive� cla ii-;foic:dar ages�oir other!reief:based Qrz
conduct of Client; Client shall paytall:.of Connpmiy-,3ega1 fees and cost inouared relating,.to,,the
claims. or rights. assert6d� in Such responsive pleading, crops.,ebmpliant, counterclaim, or other:;.
affirmative claim.: nor� da3iia es, Client will- be notiffed:,o such, affu ative, clainx;to::,ixiake
appropriate.atrangen n,ts::.be ore: Company. undertal~es: any d.efens.o. Clien-,=pha1l' be responsible
for entering its' appearance and defending such affirmative damage claims based o a the conduct.':.
of Client asserted by. a debtor;
19, Indeinnificatiora.~. Client: agrees to indemnify, defend, and hold harmless Company,
its officers, management, members, employees, and agents from damages, claims, or liability
arising out of or related to Client's conduct or airy information provided to Company by Client.
CCS Cotleetipv Agreement I3II'AA
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
AI103208-U03
DO104216-U03
C10-U03
BOARD-U03
REPORTS-U03
7/15/2011-U04
MARCELLAC-U04
16739-U05
7-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
3-U07
TO-U07
THE-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
6/17/2011-U011
AGREEMENT-U012
CREDIT-U012
CONSULTING-U012
SERVICES-U012
INC.-U012
BAD-U012
DEBT-U012
COLLECTION-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$3,100,000-U012
IN-U012
THE-U012
AGGREGATE-U012
$700,000-U012
THE-U012
PERIOD-U012
JULY-U012
1,-U012
2011-U012
TO-U012
JUNE-U012
30,-U012
2012.-U012
SIGNED BOARD REPORT AND SUPPO
W�Client acknowledges that Company shall rely upon the. information as provided by Client for
accounts assigned pursuant to this Agreement in perfornirig its collection activities, including
reporting information to Consumer Reporting Agencies, commencing litigation, and enforcing a
judgment and Company is iqot obligated to independently investigate infonnation provided: by
Client. Company agrees to indeniziify, *defend, and,:-hold harmless Client, its officers,.
m.anagein:ent, and employees from damages, claims,'liabilities arising solely out of Company's
collection activities on an account assigned pursuant to this Agreement:. The liability of.
Company to Client, if any, with respect to this Agreement-shall in any event, be limited to the
total compensation for tho, services provided heteuuder for the month in which. Client' suffered a
loss or damage; Any such, ooinpensatiot shall-not inclu.de'any liability for any loss of anticipated
profits or consequential. or indirect damages, whether foreseeable or unforeseeable,. whether or
not resulting from the. passive or active negligence or other acts of Company or its officers,
management, members, er>iiployees or agents.`
20. Limitations. Notwithstanding any other' provisions of law, all claims, disputes;
corrections or other alleged errors by' Company concerning the monies disbursed to Client for:
amounts' collected on assigned accounts must be made, and any judicial or non judicial
proceeding commenced, Within four hundred��and eighty-five 485) days: of. the disbursement:
having been mailed to Client. Each disbursement to Client shall be deemed a, separate. and
independent potential cIaiil:i`:for whichthd.�four htindred'-a d eighty-five 485).day period shall
separately apply, arid s ich eriod shall''iotbe'extendedby any subsequent disbursements..
21.' Choice of Law. This Agreement shall be construed and interpreted in accordance
with and governed by the laws of the State of California, The Company and the Provider hereby
expressly agree that any action to interpret, construe, or enforce this Agreement shall be brought
tate-of' California,
22. Fees and Costs. If either party resorts to legal action to enforce or interpret any
provision of this Agreenaeht, the prevailing party shall be entitled to recover. the costs M. d
expenses of the action, incli. ding without limitation, reasonable attorneys' fees.
23 Entire Agreement This Agreement represents the entire agreement of the parties and,
supersedes all"other'oral o;.'cvritten agreements,.tuadeistandings, statements, or representations.'.
between them regarding the�subject:matter'h reof;.:exceptfor:previous agreed compensation on:
previously assigned accounts. Each of the parties hereto have relied solely on their own
judgment and ifnpwledge rid; been: provided, the pppQrttuiityto seep. the, advice of theix own
respectivelegal counsel' in entering into, is Agreexxient::. N.p modification; axsiezldment, or
alteration of this Agreement shall be valid' t less.in. writing: acid signed by. each: of the parties
hereto.
24;:':Cour~tet zai�ts, T1rij�s:� Agreement'�.iinay: be':executed by the. parties;:.hereto...in,
duplicate:couiiterpaXtS;;eacY of which.shall�b.e,dsetttec'an,original, when atta.ol}ed,.togethen,shall:;,:�
fond one: document,. Signatures on,this� Agreement: may:rbe oonitm ni'oated- by. facsunile:'I::
transmission. ab,d shall be'l binding. upon: the., parties' transmitting the same by. facsimile
iransmissiom.:.Cotulterpar s with. original.signatttr'es. shall:'beprovided to theothei party;:yr thin r
fifteen 15) days ofthe: bpplicable facsimile transmission; provided, however;: that. the failure.to
provide the original counterpart shall have no effect. on the validity or the binding nature of the
Agreement.
25, Confidentiality. The parties agree to keep all of the terms of this Agreement
strictly confidential, including without limitation, the Compensation terms contained in this
CCS Colleclian Agreement HIPAA
7
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
AI103208-U03
DO104216-U03
C10-U03
BOARD-U03
REPORTS-U03
7/15/2011-U04
MARCELLAC-U04
16739-U05
7-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
3-U07
TO-U07
THE-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
6/17/2011-U011
AGREEMENT-U012
CREDIT-U012
CONSULTING-U012
SERVICES-U012
INC.-U012
BAD-U012
DEBT-U012
COLLECTION-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$3,100,000-U012
IN-U012
THE-U012
AGGREGATE-U012
$700,000-U012
THE-U012
PERIOD-U012
JULY-U012
1,-U012
2011-U012
TO-U012
JUNE-U012
30,-U012
2012.-U012
SIGNED BOARD REPORT AND SUPPO
W�Agreement, The parties further agree to maintain the confidentiality of any confidential
information and/or trade secrets that they may learn about each other throughout the course of
this Agreement; including without limitation, the terms of any contracts that the other party may
have with any third parties,
1 41
County of Monterey. Nat~.vidad'Medica],, Center
1441 Constitution-Blvd.
Salinas, CA:9.~906
Telephoner 831-:755-4235, s.csiinile: 831-75.4-4760
Email c.ar cQ:monterey:_pa:us.;.
Contact:
Rodney Meeks, Vice President, Business Development
Crer t Cons ltitr Services, Vic-
201 John Street, Suite E, Salinas, CA 93901
Telephone: 831-424-0606 / 800-679-6888, Facsimile: 831-424-3732
CCS Collection Agreement HJPAA
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
AI103208-U03
DO104216-U03
C10-U03
BOARD-U03
REPORTS-U03
7/15/2011-U04
MARCELLAC-U04
16739-U05
7-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
3-U07
TO-U07
THE-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
6/17/2011-U011
AGREEMENT-U012
CREDIT-U012
CONSULTING-U012
SERVICES-U012
INC.-U012
BAD-U012
DEBT-U012
COLLECTION-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$3,100,000-U012
IN-U012
THE-U012
AGGREGATE-U012
$700,000-U012
THE-U012
PERIOD-U012
JULY-U012
1,-U012
2011-U012
TO-U012
JUNE-U012
30,-U012
2012.-U012
SIGNED BOARD REPORT AND SUPPO
W�Ate,
CERTIFICATE OF LIABILITY INSURANCE DA O)MM DDDIYYYY)
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 CONTACT
NAME:
AOn Risk insurance services west, inc. 831) 422-4856
831) 422-9631 wc
No
a
inc. Of Cen CA
fka Aon Risk services rc
Exl):
Na)a
20 Last Al i sal
Suite 205 E-MAIL
Salinas CA 93901 USA PRODUCER 10494403
CUSTOMER ID A:
INSURER(S) AFFORDING COVERAGE NAIC k
INSURED INSURERA; Hartford Casualty Insurance Co 29424
Credit Consulting Services,Inc
Box 5879
P INSURER B: State compensation Ins Fund of CA 35076
O.
Salinas CA 93912 USA INSURER C:
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 570041844725
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF I SURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIR MENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERT IN, 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. Limits shown are as requested
LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMPOLICY tf-F
DDIYYYY POLICY
MMIOD LIMITS
A GENERAL LIABILITY S15BANY1982 1110112011 EACH OCCURRENCE S1,000,000
Commercial Pkg/umbrella DAMAGE N $300
000
COMMERCIAL GENERAL LIABILITY occurrence
PREMISES Ea
CLAIMS-MADE 1-71
OCCUR MED EXP Any one Person) $10,000
PERSONAL &ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMPIOP AGG S2,000,000
X POUCY E T LOC
A AUT OMOBILE LIABILITY 51UEC105817
Bu
in
v
A
t
C I1/ 2 1 COMBINED SINGLE LIMIT
JEn Ccidenl $1, 000, 000
X ANYAUTO s
ess
u
erage
o
o BODILY INJURY Per person)
ALL OWNED AUTOS BODILY INJURY Per acciden0
SCHEDULED AUTOS PROPERTY DAMAGE
Per accident)
HIRED AUTOS
NON OWNED AUTOS
UMBRELLA LWAS OCCUR EACH OCCURRENCE
EXCESS LIAR CLAIMS MADE AGGREGATE
DEDUCTIBLE
RETENTION
B WORKERS COMPENSATION AND 56286910 1110112010 11/01 2011 STATU- 0TH-
X TOR
EMPLOYERS' LIABILITY
i
k Y
TO LIMITS ER
ANY PROPRIETOR I PARTNER I EXECUTIVE Y I N NN
OFF)CERRAEMBER EXCLUDED? I I
NIA Wor
ers Compensat
on
E.L EACH ACCIDENT
S1,000,000
Manduory in NH) J
If
e
de
ibe
nde E.L. DISEASE-EA EMPLOYEE $1,000,000
y
scr
r
s,
u
DESCRIPTION OF OPERATIONS below
E.L. DISEASE-POLICY LIMIT
S1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES Attacli ACORO 101, Additional Remarks Schedule, if mare space is required)
Re: Contract for collections. County of Monterey, its agents, officers and employees are named as Additional insured on the
general liability policy per form 550008 attached and on the automobile policy per form attached, A 10 day notice of
cancellation for non payment of premium applies.
CERTIFICATE HOLDER
County of Monterey
Contracts Purchasing Dept.
168 W. Alisal St., 3rd Flr.
Salinas CA 93901 USA
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
Qd
1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 2009/09) The ACORD name and logo are registered marks of ACORD
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
AI103208-U03
DO104216-U03
C10-U03
BOARD-U03
REPORTS-U03
7/15/2011-U04
MARCELLAC-U04
16739-U05
7-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
3-U07
TO-U07
THE-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
6/17/2011-U011
AGREEMENT-U012
CREDIT-U012
CONSULTING-U012
SERVICES-U012
INC.-U012
BAD-U012
DEBT-U012
COLLECTION-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$3,100,000-U012
IN-U012
THE-U012
AGGREGATE-U012
$700,000-U012
THE-U012
PERIOD-U012
JULY-U012
1,-U012
2011-U012
TO-U012
JUNE-U012
30,-U012
2012.-U012
SIGNED BOARD REPORT AND SUPPO
W�POLICY NUMBER: 51 SBA NY1982
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED STATE/POLITICAL SUBDIVISION
COUNTY OF MONTEREY, ITS AGENTS, OFFICERS AND EMPLOYEES
CONTRACTS PURCHASING DEPARTMENT
168 W. ALISAL ST. 3RD FLOOR
SALINAS, CA 93901
COVERAGE IS PRIMARY & NON-CONTRIBUTORY PER THE BUSINESS LIABILITY
COVERAGE FORM SS0008
Form IH 12 0011 85 T 8EO. NO. 0 0 2; Printed in U.S.A. Page 0 01
Process Date: 09 /3 0 / 10 Expiration Date: 11 / 01 / 11
PRODUCER COPY
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SIGNED BOARD REPORT AND SUPPO
W�POLICY NUMBER: 51 UEC In581.7 COMMERCIAL AUTO
CHANGE NUMBER: 002A CA 20 48 02 99
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
DESIGNATED INSURED
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
GARAGE COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
TRUCKERS COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified
by this endorsement.
This endorsement identifies person(s) or organization(s) who are insureds" under the Who Is An Insured Provision of
the Coverage Fon'n. This endotsement does not alter coverage provided in the Coverage Form.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated
below.
Endorsement effective
Named Insured Col`ig d by
Authorized Representative)
SCHEDULE
Name of Person(s) or Organization(s):
COUNTY OF MONTEREY, ITS AGENTS,
OFFICERS AND EMPLOYEES
168 W. ALISAL ST., 3RD FLOOR,
SALINAS, CA 93901
If no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to the endorsement.)
Each person or organization shown in the Schedule is an insured" for Liability Coverage, but only to the extent that
person or organization qualifies as an insured" under the Who Is An Insured Provision contained in Section II of the
Coverage Form.
CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998
Page 1 of I
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AS99967-U03
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C10-U03
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MARCELLAC-U04
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SIGNED BOARD REPORT AND SUPPO
W�YEAR Withholding Exemption Certificate CALIFORNIA FORM
20 1C7 This form can only be used to certify exemption from nonresident withholding under California
PP
Tr
Recfinn 1RRR~This form cannot he used for eremotinn from wane withholdind
File this form with your withholding agent. Withholding agent's name
Please type or print) Natividad Medical Center
Vendor/Payee's name
Credit Consulting Services, Inc. 9 4 1 5
Vendor/Payee's address number and street) APT no.
201 John St., Ste. E
City
Salinas
State
CA
Vendor/Payee's Social security number
SOS. no. JZ California carp. no. FEIN
ZIP Code
93901
8 6 9 6
Private Mailbox no.
Vendo
83
590
Note:
Failure to furnish your
identification number will
make this certificate void.
r/Payee's daytime telephone no.
1 424-0606
I certify that for the reasons checked below, the entity or individual named on this form is exempt from the California income tax
withholding requirement on payment(s) made to the entity or individual. Read the following carefully and check the box that applies
to the vendor/payee:
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
inform the withholding agent. See instructions for Form 590, General Information D, for the definition of a resident.
7 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 to do business in California. The corporation will withhold on payments of Califor-
nia source income to nonresidents when required. If this corporation ceases to have a permanent place of business in
California or ceases to be qualified to do business in California, I will promptly inform the withholding agent. See instruc-
tions for Form 590, General Information E, for the definition of permanent place of business.
Partnerships:
The above-named partnership has a permanent place of business in California at the address shown above or is registered
with the California Secretary of State, and is subject to the laws of California. The partnership will file a California tax return
and will withhold on foreign and domestic nonresident partners when required. If the partnership ceases to do any of the
above, I will promptly inform the withholding agent. Note: For withholding purposes, a Limited Liability Partnership is treated
like any other partnership.
71 Limited Liability Companies LLC):
The above-named LLC has a permanent place of business in California at the address shown above or is registered with
the California Secretary of State, and is subject to the laws of California. The LLC will file a California tax return and will
withhold on foreign and domestic nonresident members when required. If the LLC ceases to do any of the above, I will
promptly inform the withholding agent.
Tax-Exempt Entities:
The above-named entity is exempt from tax under California or federal law. 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 inform
the withholding agent.
Insurance Companies, 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 Irrevocable Trusts:
At least one trustee of the above-named irrevocable 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 nonresi-
dent at any time, I will promptly inform 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.
CERTIFICATE: Please complete and sign below.
Under penalties of perjury, I hereby certify that the information provided herein is, to the best of my knowledge, true and correct. If
conditions change, I will promptly inform the withholding agent.
Vendor/Payee's name and title type or print) Rodney Meeks, Vice President
1
Date 3/15/2011
For Privacy Act Notice, get farm FTB 1131 individuals only). 59002103 Form 590 c2 REV. 2002)
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SIGNED BOARD REPORT AND SUPPO
W�CREDIT CONSULTING SERVICES, INC.
March 17, 2011
Sid Cato
Management Analyst/Corltracts
Natividad Medical Center
1441 Constitution Blvd.
Salinas, CA 93906
RE: Natividad/Credit Consulting Services Amendment
Dear Sid:
We are excited that Natividad Medical Center has elected to extend our services for another year.
Enclosed please find 3 signed original amendments and a completed 590 form. A copy of our general
liability insurance naming the County of Monterey as an additional insured will be emailed to you by
Joan Ouye of AON Risk Insurance Services. Her telephone number is 831-775-4786.
Sincerely,
Rodney Meeks
Vice President, Business Development
201 John Street, Suite E Salinas. CA 93901-3345
Phone: 831-424-0606 800-679-6888 Fax: 831-424-3732
www.creditconsultingservices.com
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