Loading...
HomeMy WebLinkAboutDoc 387 - Svcs Agrmt - Pfeifer-Assoc❑Glr,, d! & 2 < Deschutes County Board of Commissioner ; 1300 NW Wall St., Suite 200, Bend, OR 97701-196, ) (541) 388-6570 - Fax (541) 385-3202 - www.deschutes.or AGENDA REQUEST & STAFF REPORT For Board Business Meeting of August 25, 2010 Please see directions for completing this document on the next page. DATE: August 10, 2010 FROM: Nancy England, Contract Specialist Phone: 322-7516 Health Services --Behavioral Health Division TITLE OF AGENDA ITEM: Consideration of Board Signature of Document #2010-387, renewing the contract between Pfeiffer and Associates, Deschutes County Health Services and Deschutes County Sheriffs Office. PUBLIC HEARING ON THIS DATE? No BACKGROUND AND POLICY IMPLICATIONS: Contractor, Pfeifer & Associates is responsible for providing a continuum of addiction treatment services to criminal offenders from the time they are incarcerated in the County jail and after they are released into the community. Services must be provided in the jail and Work Center, and may include continued treatment after release from custody. Each individual treatment plan is adapted t. the current status of the offender within the corrections system. The maximum compensation under this Contract is $180,000, divided equally between Deschutes County Health Services, Behavioral Health Division and Deschutes County Sheriff's Office. FISCAL IMPLICATIONS: Maximum compensation is $180,000. RECOMMENDATION & ACTION REQUESTED: Behavioral Health requests approval. ATTENDANCE: Nancy England, Contract Specialist DISTRIBUTION OF DOCUMENTS: Executed copies to: Nancy England, Contract Specialist, Health Services DESCHUTES COUNTY DOCUMENT SUMMARY (NOTE: This form is required to be submitted with ALL contracts and other agreements, regardless of whether the document is to be on a Board agenda or can be signed by the County Administrator or Department Director. If the document is to be on a Board agenda, the Agenda Request Form is also required. If this form is not included with the document, the document will be returned to the Department. Please submit documents to the Board Secretary for tracking purposes, and not directly to Legal Counsel, the County Administrator or the Commissioners. In addition to submitting this form with your documents, please submit this form electronically to the Board Secretary.) Please complete all sections above the Official Review line. Date: [ July 02, 2010 Department: Health Services, Behavioral Health Contractor/Supplier/Consultant Name: LPfeifer & Associates Contractor Contact: Sally Pfeifer] Contractor Phone #: 541-383-4293 1 Type of Document: Personal Services Contract Goods and/or Services: Consideration and signature of document number 2010-387, personal services contract between Pfeifer & Associates and Deschutes County Health Services and Deschutes County Sheriff's Office. Background & History: Contractor, Pfeifer & Associates is responsible for providing a continuum of addiction treatment services to criminal offenders from the time they are incarcerated in the County jail and after they are released into the community. Services must be provided in the jail, and Work Center and may include continued treatment after release from custody. Each individual treatment plan is adapted to the current status of the offender within the corrections system. The maximum compensation under this Contract is $180,000, divided equally between Deschutes County Health Services, Behavioral Health Division and Deschutes County Sheriff's Office. Agreement Starting Date: July 1, 2010 ] Ending Date: June 30, 2011 Annual Value or Total Payment: [ Maximum compensation is $180,000 ® Insurance Certificate Received (check box) Insurance Expiration Date: Check all that apply: RFP, Solicitation or Bid Process Informal quotes (<$150K) ® Exempt from RFP, Solicitation or Bid Process (specify — see DCC §2.37) II II November 21, 2010 7/2/2010 Funding Source: (Included in current budget? E Yes No If No, has budget amendment been submitted? ❑ Yes ❑ No Is this a Grant Agreement providing revenue to the County? ❑ Yes K/ No Special conditions attached to this grant: Deadlines for reporting to the grantor: If a new FTE will be hired with grant funds, confirm that Personnel has been notified that it is a grant -funded position so that this will be noted in the offer letter: ❑ Yes ❑ No Contact information for the person responsible for grant compliance: Name: Phone #: Departmental Contact and Title: Phone #: 541-322-7516 Department Director Approval: Nanc En • land, Contract S •ecialist 1.L.►0 Date Distribution of Document: Return both originals to Nancy England, Behavioral Health Department. Official Review: County Signature Required (check one): 0 BOCC Li Department Director (if <$25K) ❑ Administrator (if >$25K but <$150K; if >$150K. BOCC Order No. Date Legal Review Document Number 2010-387 REVIEWED LEGAL C UNSEL For Recording Stamp Only DESCHUTES COUNTY SERVICES CONTRACT CONTRACT NO. 2010-387 This Contract is made and entered into by and between Deschutes County Health Services, by and through the : heriff's Office and Behavioral Health Department, a political subdivision of the State of Oregon, 2577 NE Courtney Drive Bend, OR 97701, hereinafter referred to as "County'', and Pfeifer & Associates, 23 NW Greenwood Ave., Bend, OR 97701, Federal Tax ID# : 93-1254885, hereinafter referred to as "Contractor". The parties agree as follows: Effective Date and Termination Date. The effective date of this Contract shall be July 1, 2010 or the date, on whic i each party has signed this Contract, whichever is later. Unless extended or terminated earlier in accordance with its terms, :his Contract shall terminate when County accepts Contractor's completed performance or on June 30, 2011, whichever dE :e occurs last. Contract termination shall not extinguish or prejudice County's right to enforce this Contract with respect to any default by Contractor that has not been cured. This Agreement may be renewed or extended only upon written agreen ent of the parties. Statement of Work. Contractor shall perform the work described in Exhibit 1. Payment for Work. County agrees to pay Contractor in accordance with Exhibit 1. Contract Documents. This Contract includes Page 1-11 and Exhibits 1, 2, 3, 4, 5, 6 and 7. CONTRACTOR DATA AND SIGNATURE Contractor Address: 23 NW Greenwood Ave., Bend, OR 97701 Federal Tax ID# or Social Security #: 93-1254885 Is Contractor a nonresident alien? nYes n No Business Designation (check one): H" Corporation -for profit Sole Proprietorship n Partnership Fl Corporation -non-profit n Other, describe: LLC A Federal tax ID number or Social Security number is required to be provided by the Contractor and shall be usec for the administration of state, federal and local tax laws. Payment information shall be reported to the Internal Revenue Service under the name and Federal tax ID number or, if none, the Social Security number provided above. I have read this Contract including the attached Exhibits. I understand this Contract and agree to be bouni I by its terms. NOTE: Contractor shall also sign Exhibits 3 and 4 and, if applicable, Exhibit 6. Signature( Title Name (pleale print) Date • DESCHUTES COUNTY SIGNATURE Contracts with a maximum consideration of not greater than $25,000 are not valid and not binding on the Coui ty until signed by the appropriate Deschutes County Department Head. Additionally, Contracts with a maximum consic eration greater than $25,000 but less than $150,000 are not valid and not binding on the County until signed by the County Administrator or the Board of County Commissioners. Dated this of , 2010 Dated this of , 2010 Scott Johnson, Director David Kanner, County Administrator Page 1 of 11— Behavioral Health - Personal Services Contract No. 2010-387 STANDARD TERMS AND CONDITIONS 1. Time is of the Essence. Contractor agrees that time is of the essence in the performance of this Contract. 2. Compensation. Payment for all work performed under this Contract shall be made in the amounts and man ler set forth in Exhibit 1. a. Payments shall be made to Contractor following County's review and approval of billings and deliv gables submitted by Contractor. b. All Contractor billings are subject to the maximum compensation amount of this Contract. c. Contractor shall not submit billings for, and County shall not pay, any amount in excess of the m. ximum compensation amount of this Contract, including any reimbursable expenses, (See Exhibit 5). 1) If the maximum compensation amount is increased by amendment to this Contract, the amendment E hall be signed by both parties and fully executed before Contractor performs work subject to the amendment. 2) No payment shall be made for any services performed before the beginning date or after the expiration late of this Contract. d. This Contract shall not be amended after the expiration date. e. Unless otherwise specifically provided in Exhibit 5, Contractor shall submit monthly invoices for work peri )rmed. The invoices shall describe all work performed with particularity and by whom it was performed and shall temize and explain all expenses for which reimbursement is claimed. f. The invoices also shall include the total amount invoiced to date by Contractor prior to the current invoice. g. Prior to approval or payment of any billing, County may require and Contractor shall provide any informatioi which County deems necessary to verify work has been properly performed in accordance with the Contract. h. Contractor shall not expend funds on the delivery of a service in excess of the amount reasonable and nece sary to provide quality service. Funds may only be used for the delivery of the service or services set out in this pa agraph unless written permission is granted to use the funds for other services in accordance with this Contract. FL ids for Alcohol and Drug Abuse Services may not be used for: (1) inpatient hospital services; (2) cash payments to it tended recipients of health services; (3) to purchase or improve land, to purchase, construct or permanently improv( (other than minor remodeling) any building or other facility or to purchase major medical equipment; (4) to sati ;fy any requirement for expenditure of non-federal funds as a condition for receipt of federal funds (whether the feden I funds are to be paid under this Agreement; (5) to provide financial assistance to any entity other than a public or nc n -profit entity; (6) to carry out any program prohibited by section 245(b) of the Health Omnibus Programs Extensior Act of 1988 (codified at 42 USC 300ee(5); and (7) expend amounts in excess of allowable costs under federal OMB 1 ;ircular A-133. Contractor shall submit the final monthly expenditure report under this Contract no later than thirty (30) days ft Hawing the end of the fiscal year. Fiscal year shall be based on the period July 1 through June 30. j. Expenditures of Contractor may be charged to this Contract only if they: (1) are in payment for services pei formed under this Contract; (2) conform to applicable State and Federal regulations and statutes; (3) are in paymei t of an obligation incurred during the period of this Contract; and (4) are not in excess of 100% of program costs. Any County funds spent for purposes not authorized by this Contract shall be deducted from payments or refunded to Cc inty, at County's option. Payments by County in excess of authorized actual expenditures shall be deducted from pay nent or refunded to County no later than thirty (30) days after the expiration of this Contract. If Contractor fails to prc side an acceptable audit performed by a certified public accountant for federal funds received under this Contract, or if federal authorities demand the repayment of federal funds received under this Contract, County may recover all feden 11 funds paid under this Contract, unless a smaller amount is disallowed or demanded. If Department disallows or n quests repayment for any funds paid under this Contract due to Contractors' acts or omissions, Contractor sha make payment to the County of the amount disallowed or requested. In the event that the Department determir es that County is responsible for the repayment of any funds owed to the Department by Contractor, Contractor ac Tees to make such payment within ten days of notification by County or the Department of said determination by the Department. k. In the event that a statutorily required operating license or letter of approval is not extended or suspended, C aunty's obligation to provide reimbursement for services or program expenses hereunder related to services rendered without the necessary license or approval will cease on the date of termination of this Contract (whether in whole or in )art) or the date of expiration or suspension of the license or letter of approval, whichever date is earlier. Page 2 of 11— Behavioral Health - Personal Services Contract No. 2010-387 3. Delegation, Subcontracts and Assignment. Contractor shall not delegate or subcontract any of the work reqi ired by this Contract or assign or transfer any of its interest in this Contract, without the prior written consent of County. a. Any delegation, subcontract, assignment, or transfer without prior written consent of County shall conE :itute a material breach of this contract. b. Any such assignment or transfer, if approved, is subject to such conditions and provisions as the Cour ty may deem necessary. c. No approval by the County of any assignment or transfer of interest shall be deemed to create any oblig tion of the County to increase rates of payment or maximum Contract consideration. d. Prior written approval shall not be required for the purchase by the Contractor of articles, supplies and rvices which are incidental to the provision of services under this Contract that are necessary for the performance of the work. e. Any subcontracts that the County may authorize shall contain all requirements of this contract, and unless otherwise specified by the County the Contractor shall be responsible for the performance of the subcontrac tor. 4. No Third Party Beneficiaries. a. County and Contractor are the only parties to this Contract and are the only parties entitled to enforce its ter ns. b. Nothing in this Contract gives or provides any benefit or right, whether directly, indirectly, or otherwise, :o third persons unless such third persons are individually identified by name in this Contract and expressly descr bed as intended beneficiaries of this Contract. 5. Successors in Interest. The provisions of this Contract shall be binding upon and inure to the benefit of the parties and their successors and approved assigns, if any. 6. Early Termination. This Contract may be terminated as follows: a. Mutual Consent. County and Contractor, by mutual written agreement, may terminate this Contract at any ti ne. b. Party's Convenience. County or Contractor may terminate this Contract for any reason upon 30 calend it days written notice to the other party. c. For Cause. County may also terminate this Contract effective upon delivery of written notice to the Contrc :tor, or at such later date as may be established by the County, under any of the following conditions: 1) If funding from state or other sources is not obtained and continued at levels sufficient to allow for the purchase of the indicated quantity of services as required in this Contract. 2) This Contract may be modified to accommodate the change in available funds. 3) If state laws, regulations or guidelines are modified, changed or interpreted in such a way that the servi ;es are no longer allowable or appropriate for purchase under this Contract or are no longer eligible for the unding proposed for payments authorized by this Contract. 4) In the event sufficient funds shall not be appropriated for the payment of consideration required to )e paid under this Contract, and if County has no funds legally available for consideration from other sources. 5) If any license or certificate required by law or regulation to be held by the Contractor to provide the s rvices required by this Contract is for any reason denied, revoked, suspended, not renewed or changed in such a way that the Contractor no longer rneets requirements for such license or certificate. d. Contractor Default or Breach. The County, by written notice to the Contractor, may immediately termir ate the whole or any part of this Contract under any of the following conditions: 1) If the Contractor fails to provide services called for by this Contract within the time specified or any ex tension thereof. 2) If the Contractor fails to perform any of the other requirements of this Contract or so fails to pursue tl e work so as to endanger performance of this Contract in accordance with its terms, and after receipt of writtei notice from the County specifying such failure, the Contractor fails to correct such failure within 10 calendar lays or such other period as the County may authorize. 3) Contractor institutes or has instituted against it insolvency, receivership or bankruptcy proceedings, rm kes an assignment for the benefit of creditors, or ceases doing business on a regular basis. e. County Default or Breach. 1) Contractor may terminate this Contract in the event of a breach of this Contract by the County. Prior o such termination, the Contractor shall give to the County written notice of the breach and intent to terminate. 2) If the County has not entirely cured the breach within 10 calendar days of the date of the notice, tl en the Contractor may terminate this Contract at any time thereafter by giving notice of termination. Page 3 of 11— Behavioral Health - Personal Services Contract No. 2010-387 7. Payment on Early Termination. Upon termination pursuant to paragraph 6, payment shall be made as follows a. If terminated under subparagraphs 6 a. through c. of this Contract, the County shall pay Contractor fl 'r work performed prior to the termination date if such work was performed in accordance with the Contract. P ovided however, County shall not pay Contractor for any obligations or liabilities incurred by Contractor after Co 'tractor receives written notice of termination. b. If this Contract is terminated under subparagraph 6 d. of this Contract, County obligations shall be lir sited to payment for services provided in accordance with this Contract prior to the date of termination, less any dk mages suffered by the County. c. If terminated under subparagraph 6 e of this Contract by the Contractor due to a breach by the County, t ien the County shall pay the Contractor for work performed prior to the termination date if such work was perfoi med in accordance with the Contract: 1) with respect to services compensable on an hourly basis, for unpaid invoices, hours worked within ar y limits set forth in this Contract but not yet billed, authorized expenses incurred if payable according to this C ontract and interest within the limits set forth under ORS 293.462, and 2) with respect to deliverable -based Work, the sum designated for completing the deliverable multipliec by the percentage of Work completed and accepted by County, less previous amounts paid and any claim s) that County has against Contractor. 3) Subject to the limitations under paragraph 8 of this Contract. 8. Remedies. In the event of breach of this Contract the parties shall have the following remedies: a. Termination under subparagraphs 6 a. through c. of this Contract shall be without prejudice to any obliga ions or liabilities of either party already reasonably incurred prior to such termination. 1) Contractor may not incur obligations or liabilities after Contractor receives written notice of termination. 2) Additionally, neither party shall be liable for any indirect, incidental, consequential or special damage under this Contract or for any damages of any sort arising solely from the termination of this Contract in acc( rdance with its terms. b. If terminated under subparagraph 6 d. of this Contract by the County due to a breach by the Contractor, County may pursue any remedies available at law or in equity. 1) Such remedies may include, but are not limited to, termination of this contract, return of all or a portior of this Contract amount, payment of interest earned on this Contract amount, and declaration of ineligibility for the receipt of future contract awards. 2) Additionally, County may complete the work either by itself, by agreement with another Contractor, )r by a combination thereof. If the cost of completing the work exceeds the remaining unpaid balance of t re total compensation provided under this Contract, then the Contractor shall be liable to the County for the an ount of the reasonable excess. c. If amounts previously paid to Contractor exceed the amount due to Contractor under this Contract, Co' tractor shall repay any excess to County upon demand. d. Neither County nor Contractor shall be held responsible for delay or default caused by fire, civil unre=_ :, labor unrest, riot, acts of God, or war where such cause was beyond reasonable control of County or Cor tractor, respectively; however, Contractor shall make all reasonable efforts to remove or eliminate such a cause I 'f delay or default and shall, upon the cessation of the cause, diligently pursue performance of its obligations un ler this Contract. For any delay in performance as a result of the events described in this subparagraph, Contracl )r shall be entitled to additional reasonable time for performance that shall be set forth in an amendment to this Col tract. e. The passage of this Contract expiration date shall not extinguish or prejudice the County's or Contractor's right to enforce this Contract with respect to any default or defect in performance that has not been cured. f. County's remedies are cumulative to the extent the remedies are not inconsistent, and County may pun ue any remedy or remedies singly, collectively, successively or in any order whatsoever. g. Differences between a Contractor and County, or between contractors, will be resolved when possible at app opriate management levels, followed by consultation between boards, if necessary. County's Director will have iltimate responsibility for resolution of disagreements among subcontract agencies. 9. Contractor's Tender upon Termination. Upon receiving a notice of termination of this Contract, Contract )r shall immediately cease all activities under this Contract unless County expressly directs otherwise in such n itice of termination. a. Upon termination of this Contract, Contractor shall deliver to County all documents, information, works -in -p ogress and other property that are or would be deliverables had this Contract been completed. b. Upon County's request, Contractor shall surrender to anyone County designates, all documents, research, objects or other tangible things needed to complete the work. Page 4 of 11— Behavioral Health - Personal Services Contract No. 2010-387 10. Work Standard. a. Contractor shall be solely responsible for and shall have control over the means, methods, techniques, seq aences and procedures of performing the work, subject to the plans and specifications under this Contract and hall be solely responsible for the errors and omissions of its employees, subcontractors and agents. b. For goods and services to be provided under this contract, Contractor agrees to: 1) perform the work in a good, workmanlike, and timely manner using the schedule, materials, pla Is and specifications approved by County; 2) comply with all applicable legal requirements; 3) comply with all programs, directives, and instructions of County relating to safety, storage of equipr lent or materials; 4) take all precautions necessary to protect the safety of all persons at or near County or Contractor's citifies, including employees of Contractor, County and any other contractors or subcontractors and to prol :ct the work and all other property against damage. 11. Drugs and Alcohol. Contractor shall adhere to and enforce a zero tolerance policy for the use of alcohol nd the unlawful selling, possession or use of controlled substances while performing work under this Contract. 12. Insurance. Contractor shall provide reference herein. a. Prior to executing this Contract, the Contractor shall provide County the Certificates of Insurance, or cc Dies of Insurance policies and declarations, issued by an insurance company licensed to do business in the State of )regon as evidence of meeting insurance required under this paragraph. b. Contractor shall immediately notify County if any insurance coverage required by this Contract will be cance ed, not renewed, restricted or modified in any way. Contractor shall immediately notify County orally of the cancell ition or restriction and shall confirm the oral notification in writing within three days of notification by the insurance corr any of Contractor. c. Thirty -day cancellation notice endorsement is required on all policies. d. County reserves the right to require complete, certified copies of all required insurance policies at any time. e. The insurance coverages provided for herein must be endorsed as primary and non-contributory to any insur ince of Owner, its officers, employees or agents. insurance in accordance with Exhibit 2 attached hereto and incorpon ted by 13. Expense Reimbursement. If the consideration under this Contract provides for the reimbursement of Contra 3tor for expenses, in addition to Exhibit 5, Exhibit 1 shall state that Contractor is or is not entitled to reimbursement f )r such expenses. a. County shall only reimburse Contractor for expenses reasonably and necessarily incurred in the perform ince of this Contract. b. Expenses reimbursed shall be at the actual cost incurred; including any taxes paid, and shall not inch Je any mark-up unless the mark-up on expenses is specifically agreed to in this Contract. c. The cost of any subcontracted work approved in this Contract shall not be marked up. d. Contractor shall not bill County for any time expended to complete the documents necessary for reimburse nent of expenses or for payment under this Contract. e. The limitations applicable to reimbursable expenses are set forth in Exhibit "5," attached hereto and by re erence incorporated herein. 14. Criminal Background Investigations. Contractor understands that Contractor and Contractor's employe :s and agents are subject to periodic criminal background investigations by County and, if such investigations c isclose criminal activity not disclosed by Contractor, such non -disclosure shall constitute a material breach of this Contr act and County may terminate this Contract effective upon delivery of written notice to the Contractor, or at such later late as may be established by the County. 15. Confidentiality. Contractor shall maintain confidentiality of information obtained pursuant to this Contract as fol ows: a. Contractor shall not use, release or disclose any information concerning any employee, client, applicant or person doing business with the County for any purpose not directly connected with the administration of County's or the Contractor's responsibilities under this Contract except upon written consent of the County, and if applica )le, the employee, client, applicant or person. b. The Contractor shall ensure that its agents, employees, officers and subcontractors with access to Cou ity and Contractor records understand and comply with this confidentiality provision. Page 5 of 11— Behavioral Health - Personal Services Contract No. 2010-387 c. Contractor shall treat all information as to personal facts and circumstances obtained on Medicaid eligible individuals as privileged communication, shall hold such information confidential, and shall not disclos such information without the written consent of the individual, his or her attorney, the responsible parent of a min( r child, or the child's guardian, except as required by other terms of this Contract. d. Nothing prohibits the disclosure of information in summaries, statistical information, or other form that d, ies not identify particular individuals. e. Personally identifiable health information about applicants and Medicaid recipients will be subject to the transaction, security and privacy provisions of the Health Insurance Portability and Accountability Act ("HIPF A"). f. Contractor shall cooperate with County in the adoption of policies and procedures for maintaining the priv cy and security of records and for conducting transactions pursuant to HIPAA requirements. g. This Contract may be amended in writing in the future to incorporate additional requirements related to com Jliance with HIPAA. h. If Contractor receives or transmits protected health information, Contractor shall enter into a Business As ;ociate Agreement with County, which, if attached hereto, shall become a part of this Contract. 16. Reports. Contractor shall provide County with periodic reports at the frequency and with the information prescr bed by County. Further, at any time, County has the right to demand adequate assurances that the services prov Jed by Contractor shall be in accordance with the Contract. Such assurances provided by Contractor shall be suppc ted by documentation in Contractor's possession from third parties. a. Contractor agrees to prepare and furnish such reports and data as may be required by County and the Dep rtment, including but not limited, to financial reports documenting all expenditures of funds under this Agree- )ent in accordance with generally accepted accounting procedures, client records which contain client identification, j roblem assessment, treatment (including any training and/or care plan), appropriate medical information, and progres notes, including a service termination summary and current assessment or evaluation instrument as designate( in the administrative rules. It is understood that due to the limited nature of Contractor's services under this Contras not all of these documents will have been prepared by Contractor and therefore need not be furnished. Departmer t Client Process Monitoring System (CPMS) data, Community Mental Health Provider Report, and Termination Service Recording Form shall, if necessary, be completed in accordance with Department requirements and subrr fitted to Department through County. Contractor agrees to, and does hereby grant County and the Department the right to reproduce, use and disclose for County or Department purposes, all or any part of the reports, data, and t€ chnical information furnished to County under this Contract. Contractor shall make available to County, Department ; nd any client of Contractor as defined in Exhibit "A" of the contract referenced in Exhibit 1, paragraph 1 A., of this C )ntract, any and all written materials in alternate formats in compliance with Department's policies or administrative ru es. For purposes of the foregoing, "written materials" includes, without limitation, all work product and contracts relate, 1 to this Contract. b. Contractor shall prepare and furnish the following information to Department when a Service is delivered: 1) Client, Service and financial information as specified in the Service Description. 2) All additional information and reports that Department or County reasonably requests. 17. Access to Records. Contractor shall maintain fiscal records and all other records pertinent to this Contract. a. All fiscal records shall be maintained pursuant to generally accepted accounting standards, and other recor Is shall be maintained to the extent necessary to clearly reflect actions taken. 1) All records shall be retained and kept accessible for at least three years following the final paymer made under this Contract or all pending matters are dosed, whichever is later. 2) If an audit, litigation or other action involving this Contract is started before the end of the three year period, the records shall be retained until all issues arising out of the action are resolved or until the end of tr e three year period, whichever is later. b. County and its authorized representatives shall have the right to direct access to all of Contractor's books, documents, papers and records related to this Contract for the purpose of conducting audits and exam rations and making copies, excerpts and transcripts. 1) These records also include licensed software and any records in electronic form, including but not lir iited to computer hard drives, tape backups and other such storage devices. County shall reimburse Contra tor for Contractor's cost of preparing copies. 2) At Contractor's expense, the County, the Secretary of State's Office of the State of Oregon, the 'ederal Government, and their duly authorized representatives, shall have license to enter upon Contractor's pr =mises to access and inspect the books, documents, papers, computer software, electronic files and ani other records of the Contractor which are directly pertinent to this Contract. Page 6 of 11— Behavioral Health - Personal Services Contract No. 2010-387 3) If Contractor's dwelling is Contractor's place of business, Contractor may, at Contractor's expense, m ike the above records available at a location acceptable to the County. 18. Ownership of Work. All work of Contractor that results from this Contract (the "Work Product") is the e; clusive property of County. a. County and Contractor intend that such Work Product be deemed "work made for hire" of which County : hall be deemed author. b. If, for any reason, the Work Product is not deemed "work made for hire," Contractor hereby irrevocably as: igns to County all of its right, title, and interest in and to any and all of the Work Product, whether arising from cc )yright, patent, trademark, trade secret, or any other state or federal intellectual property law or doctrine. c. Contractor shall execute such further documents and instruments as County may reasonably request in ( rder to fully vest such rights in County. d. Contractor forever waives any and all rights relating to Work Product, including without limitation, any and E I rights arising under 17 USC § 106A or any other rights of identification of authorship or rights of approval, restri ;tion or limitation on use or subsequent modifications. e. County shall have no rights in any pre-existing work product of Contractor provided to County by Contracts r in the performance of this Contract except an irrevocable, non-exclusive, perpetual, royalty -free license to copy, r se and re -use any such work product for County use only. f. If this Contract is terminated prior to completion, and County is not in default, County, in addition to any othc r rights provided by this Contract, may require Contractor to transfer and deliver all partially completed work pr )ducts, reports or documentation that Contractor has specifically developed or specifically acquired for the perform ince of this Contract. g. In the event that Work Product is deemed Contractor's Intellectual Property and not "work made for hire," Co itractor hereby grants to County an irrevocable, non-exclusive, perpetual, royalty -free license to use, reproduce, )repare derivative works based upon, distribute copies of, perform and display the Contractor Intellectual Property, and to authorize others to do the same on County's behalf. h. In the event that Work Product is Third Party Intellectual Property, Contractor shall secure on the County's bel alf and in the name of the County, an irrevocable, non-exclusive, perpetual, royalty -free license to use, reproduce, ,repare derivative works based upon, distribute copies of, perform and display the Third Party Intellectual Property, and to authorize others to do the same on County's behalf. 19. County Code Provisions. Except as otherwise specifically provided, the provisions of Deschutes Count, Code, Section 2.37.150 are incorporated herein by reference. Such code section may be found at the followir g URL address: http://www.co.deschutes.or.us/dccode/Title2/html/Chapter2.37.htm. 20. Partnership. County is not, by virtue of this Contract, a partner or joint venturer with Contractor in connecti )n with activities carried out under this Contract, and shall have no obligation with respect to Contractor's debts or any other liabilities of each and every nature. 21. Indemnity and Hold Harmless. a. To the fullest extent authorized by law Contractor shall defend, save, hold harmless and indemnify the Cou ity and its officers, employees and agents from and against all claims, suits, actions, losses, damages, liabilities cc ;ts and expenses of any nature resulting from or arising out of, or relating to the activities of Contractor or its ( fficers, employees, contractors, or agents under this Contract, including without limitation any claims that the wi irk, the work product or any other tangible or intangible items delivered to County by Contractor that may be the su )ject of protection under any state or federal intellectual property law or doctrine, or the County's use thereof, infrini es any patent, copyright, trade secret, trademark, trade dress, mask work utility design or other proprietary righ of any third party. b. Contractor shall have control of the defense and settlement of any claim that is subject to subparagraph of this paragraph; however neither contractor nor any attorney engaged by Contractor shall defend the claim in th name of Deschutes County or any department or agency thereof, nor purport to act as legal representative of the :aunty or any of its departments or agencies without first receiving from the County's legal counsel, in a form and canner determined appropriate by the County's legal counsel, authority to act as legal counsel for the County, n )r shall Contractor settle any claim on behalf of the Count without the approval of the County's legal counsel. c. To the extent permitted by Article XI, Section 10, of the Oregon Constitution and the Oregon Tort Claims A( t, ORS 30.260 through 30.300, County shall defend, save, hold harmless and indemnify Contractor and its ( fficers, employees and agents from and against all claims, suits, actions, losses, damages, liabilities costs and ex )enses Page 7 of 11— Behavioral Health - Personal Services Contract No. 2010-387 of any nature resulting from or arising out of, or relating to the activities of County or its officers, emr loyees, contractors, or agents under this Contract. 22. Compliance with provisions, requirements of funding source and Federal and State laws, statutes rules, regulations, executive orders and policies. Debt Limitation. This Contract is expressly subject to th e debt limitation of Oregon counties set forth in Article XI, Section 10, of the Oregon Constitution, and is contingei It upon funds being appropriated therefore. a. Any provisions herein, which would conflict with law, are deemed inoperative to that extent. h. Contractor shall comply with all federal, state and local laws, regulations, executive orders and ord lances applicable to the Contract. c. Without limiting the generality of the foregoing, Contractor expressly agrees to comply with the followin t laws, regulations and executive orders to the extent they are applicable to the Contract: 1) Titles VI and VII of the Civil Rights Act of 1964, as amended; 2) Sections 503 and 504 of the Rehabilitation Act of 1973, as amended; 3) the Americans with Disabilities Act of 1990, as amended and ORS 659A.112 through 659A.139; 4) Executive Order 11246, as amended; 5) the Health Insurance Portability and Accountability Act of 1996; 6) the Age Discrimination in Employment Act of 1967, as amended, and the Age Discrimination Act of 1 )75, as amended; 7) the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended; 8) ORS Chapter 659A, as amended; 9) all regulations and administrative rules established pursuant to the foregoing laws; and 10) all other applicable requirements of federal and state civil rights and rehabilitation statutes, rul ;s and regulations. d. The above listed laws, regulations and executive orders and all regulations and administrative rules este )fished pursuant to those laws are incorporated by reference herein to the extent that they are applicable to the C cntract and required by law to be so incorporated. e. Contractor shall comply with all mandatory standards and policies that relate to resource conservation and r !covery pursuant to the Resource Conservation and Recovery Act (codified at 42 USC 6901 et. seq.). Section 6002. of that Act (codified at 42 USC 6962) requires that preference be given in procurement programs to the purchase of specific products containing recycled materials identified in guidelines developed by the Environmental Protection ,gency. Current guidelines are set forth in 40 CFR Parts 247-253. f. Contractor shall comply with federal rules and statutes pertaining to the Substance Abuse, Prevention, and Tr€ atment Block Grant, including the reporting provisions of the Public Health Services Act (42 USC 300x through 3( Ox -64). Without limiting the generality of the preceding sentence, Contractor shall comply with the requirements s forth below: 1) Women's Services. All Providers of A&D 61 and A&D 62 services (including Counties that )rovide such services directly), must: a) Treat the family as a unit and admit both women and their children if appropriate. b) Provide or arrange for the following services to pregnant women and women with der endent children: 1. Primary medical care, including referral for prenatal care; 2. Pediatric care, including immunizations, for their children; 3. Gender -specific treatment and other therapeutic interventions, e.g. sexual and r hysical abuse counseling, parenting training, and child care; 4. Therapeutic interventions for children in custody of women in treatment, which a (dress, but are not limited to, the children's developmental needs and issues of abu ;e and neglect; and 5. Appropriate case management services and transportation to ensure that wom ?n and their children have access to the services in (1) through (2) above. 2) Pregnant Women. All Providers of A&D services other than A&D 70 services (including Count ?,s that provide such services directly) must: a) Within the priority categories, if any, set forth in a particular Service Descriptio 1, give preference in admission to pregnant women in need of treatment who seek, or are r 3ferred for, and would benefit from, such services; b) Perform outreach to inform pregnant women of the availability of treatment services rgeted to them and the fact the at pregnant women receive preference in admission tc these programs; Page 8 of 11— Behavioral Health - Personal Services Contract No. 2010-387 c) If the Provider has insufficient capacity to provide treatment services to a pregnant ✓oman, refer the woman to another Provider with capacity or if no available treatment capacity can be located, refer the women to the Department's Office of Alcohol and Drug Abuse progr lms for referral to another provider in the state. 3) Intravenous Drug Abusers. All Providers of A&D services other than A&D 70 services (ir cluding Counties that provide such services directly) must: a) Within the priority categories, if any, set forth in a particular Service Description and sr, eject to the preference for pregnant women described above, give preference in admis ;ion to intravenous drug abusers; b) If the Provider reaches 90 percent of its capacity to admit intravenous drug abus( rs, the Provider must attempt to refer an intravenous drug abuser seeking admission, to mother Provider and provide notice of such referral or attempted referral to the Department's C ffice of Alcohol and Drug Abuse Programs; c) If the Provider receives a request for admission to treatment from an intravenous drug abuser, the Provider must, unless the Provider succeeds in referring the individual to another F rovider with treatment capacity under the circumstances described in (2) above, admit the in iividual to treatment not later than: 1) 14 days after the request for admission to Provider's services is made; or 2) 120 days after the date of such request if no provider has the capacity to ad nit the individual on the date of such request and, if interim services are made available i of less than 48 hours after such request. d) For purposes of (3) above, "Interim Services" means: 1) Services for reducing the adverse health effects of such abuse, for promoting the health of the individual, and for reducing the risk of transmission of disease, including tor, iseling and education about HIV and tuberculosis, the risks of needle sharing, the i sks of transmission of disease to sexual partners and infants, and steps that can be t Iken to ensure that HIV and tuberculosis transmission does not occur; 2) Referral for HIV to TB treatment services, where necessary; and 3) Referral for prenatal care if appropriate, until the individual is admitted to a Pr( Ivider's services. 4) Providers who treat recent intravenous drug users (those who have injected drug , within the past year) in more than one-third of their capacity, shall carry out outreach acti ities to encourage individual intravenous drug abusers in need of such treatment to L 'Idergo treatment, and shall document such activities. 4) Infectious Diseases. All Providers of A&D services other than A&D 70 services (including C )unties that provide such services directly) must: a) Complete a risk assessment for infectious disease including Human Immunodeficient y Virus (HIV) and tuberculosis, as well as sexually transmitted diseases, based on pr )tocols established by the Department, for every individual seeking services from the Provider; and b) Routinely make tuberculosis services available to each individual receiving servi, .es for alcohol/drug abuse either directly or through other arrangements with public or nc i -profit entities and, if the Provider denies an individual admission on the basis of lack of c pacity, refer the individual to another provider of tuberculosis services. c) For purposes of (2) above, "tuberculosis services" means: 1) Counseling the individual with respect to tuberculosis; 2) Testing to determine whether the individual has contracted such disease and to ,ting to determine the form of treatment for the disease that is appropriate for the individua and 3) Appropriate treatment services. 5) Infectious Diseases. Neither County nor any Provider of A&D services shall knowingly and Nillfully make or cause to be made any false statement or representation of a material fact in connecti )n with the furnishing of items or services for which payments may be made by the Department. 6) Oregon Residency. A&D services funded through this Agreement may only be provided to re;idents of Oregon. Residents of Oregon are individuals who live in Oregon. There is no minimum am )Lint of time an individual must live in Oregon to qualify as a resident so long as the individual intE nds to remain in Oregon. A child's residence is not dependent on the residence of his or her parents. q child living in Oregon may meet the residency requirement if the caretaker relative with whom the ;hild is living is an Oregon resident. 7) Tobacco Use. All Providers of A&D services (including Counties that provide such services c irectly) that have designated treatment capacity for children, adolescents, pregnant women, and wom m with Page 9 of 11— Behavioral Health - Personal Services Contract No. 2010-387 dependent children must implement a policy to eliminate smoking and other use of tobacc( at the facilities where the services are delivered to on the grounds of such facilities. 8) Department of Human Services Referrals. All providers of A&D Services other than A&D 70 ervices must, within the priority categories, if any, set forth in a particular Service Description and su )ject to the preference for pregnant women and intravenous drug users described above, give prefer ince in service delivery to persons referred by the Department. 9) Barriers to Treatment. Where there is a barrier to delivery of an A&D Service due to culture, lender, language, illiteracy, or disability, Contractor shall develop support services available to adc -ess or overcome the barrier, including: a) Providing, if needed, hearing impaired or foreign language interpreters. b) Providing translation of written materials to appropriate language or method of communic jtion. c) Providing devices that assist in minimizing the impact of the barrier. d) Not charging clients for the costs of measures, such as interpreters, that are required to provide nondiscriminatory treatment. 10) Contractor shall not knowingly and willfully make or cause to be made any false stater lent or representation of a material fact in connection with the furnishing of items or Services fo which payments may be make by Department. g. To the extent Contractor provides any service whose costs are paid in whole or in part by Medicaid, Contras Jr shall comply with the federal and state Medicaid statutes and regulations applicable to the service, including but no limited to: 1) Keep such records as may be necessary to disclose the extent of services furnished to clients an 1, upon request, furnish such records or other information to the Department, the Medicaid fraud sectio 1 of the Oregon Department of Justice and the Secretary of Health and Human Services; 2) Comply with all applicable disclosure requirements set forth in 42 CFR Part 455, Subpart B; 3) Comply with any applicable advance directive requirements specified in 42 CFR Section 431.1C 7(b)(4); and 4) Comply with the certification requirements of 42 CFR Sections 455.18 and 455.19. h. Contractor shall comply with the Pro -Children Act of 1995 (codified at 20 USC Section 6081 et. seq.). 23. Waiver. a. County's delay in exercising, or failure to exercise any right, power, or privilege under this Contract s 'all not operate as a waiver thereof, nor shall any single or partial exercise or any right, power, or privilege uni ler this Contract preclude any other or further exercise thereof or the exercise of any other such right, power, or pri, 'lege. b. The remedies provided herein are cumulative and not exclusive of any remedies provided by law. 24. Governing Law. This Contract shall be governed by and construed in accordance with the laws of the State of Oregon without regard to principles of conflicts of law. a. Any claim, action, suit or proceeding (collectively, "Claim") between County and Contractor that arises rom or relates to this Contract shall be brought and conducted solely and exclusively within the Circuit Court of De: chutes County for the State of Oregon; provided, however, if a Claim shall be brought in federal forum, then it hall be brought and conducted solely and exclusively within the United States District Court for the District of Oregc 1. b. CONTRACTOR, BY EXECUTION OF THIS CONTRACT, HEREBY CONSENTS TO THE IN PER; ONAM JURISDICTION OF SAID COURTS. The parties agree that the UN Convention on International Sales of Goods shall not apply. 25. Severability. If any term or provision of this Contract is declared by a court of competent jurisdiction to be illec al or in conflict with any law, the validity of the remaining terms and provisions shall not be affected, and the rig its and obligations of the parties shall be construed and enforced as if this Contract did not contain the particular erm or provision held invalid. 26. Counterparts. This Contract may be executed in several counterparts, all of which when taken togethE r shall constitute one agreement binding on all parties, notwithstanding that all parties are not signatories to thf same counterpart. Each copy of this Contract so executed shall constitute on original. 27. Notice. Except as otherwise expressly provided in this Contract, any communications between the parties hr reto or notices to be given hereunder shall be given in writing, to Contractor or County at the address or number s 't forth below or to such other addresses or numbers as either party may hereafter indicate in writing. Delivery ma be by personal delivery, facsimile, or mailing the same, postage prepaid. Page 10 of 11— Behavioral Health - Personal Services Contract No. 2010-387 a. Any communication or notice by personal delivery shall be deemed delivered when actually given to the designated person or representative. b. Any communication or notice sent by facsimile shall be deemed delivered when the transmitting r Lachine generates receipt of the transmission. To be effective against County, such facsimile transmission hall be confirmed by telephone notice to the County Administrator. c. Any communication or notice mailed shall be deemed delivered five (5) days after mailing. Any notice un Jer this Contract shall be mailed by first class postage or delivered as described in Exhibit 1A and Exhibit 1 B. 28. Merger Clause. This Contract and the attached exhibits constitute the entire agreement between the parties. a. All understandings and agreements between the parties and representations by either party concern ig this Contract are contained in this Contract. b. No waiver, consent, modification or change in the terms of this Contract shall bind either party unless in writing signed by both parties. c. Any written waiver, consent, modification or change shall be effective only in the specific instance and for the specific purpose given. 29. Identity Theft Protection. Contractor and subcontractors shall comply with the Oregon Consumer Identity The t Protection Act (ORS 646A.600 et seq.). 30. Survival. All rights and obligations shall cease upon termination or expiration of this Contract, except for the rig its and obligations set forth in Sections 4, 5, 8, 9, 15, 17, 18, 20-28, 29 and 31. 31. Representations and Warranties. a. Contractor's Representations and Warranties. Contractor represents and warrants to County that: 1) Contractor has the power and authority to enter into and perform this Contract; 2) this Contract, when executed and delivered, shall be a valid and binding obligation of Contractor enforce able in accordance with its terms; 3) Contractor has the skill and knowledge possessed by well-informed members of its industry, ti cede or profession and Contractor will apply that skill and knowledge with care and diligence to perform the W )rk in a professional manner and in accordance with standards prevalent in Contractor's industry, trade or profe ;sion; 4) Contractor shall, at all times during the term of this Contract, be qualified, professionally competent, a id duly licensed to perform the Work; 5) Contractor prepared its proposal related to this Contract, if any, independently from all other propos€ -s, and without collusion, fraud, or other dishonesty; and 6) Contractor's making and performance of this Contract do not and will not violate any provision of any ap )licable law, rule or regulation or order of any court, regulatory commission, board or other administrative agency. b. Warranties Cumulative. The warranties set forth in this paragraph are in addition to, and not in lieu of, ar i other warranties provided Page 11 of 11— Behavioral Health - Personal Services Contract No. 2010-387 EXHIBIT 1 DESCHUTES COUNTY SERVICES CONTRACT Contract No. 2010-387 STATEMENT OF WORK, COMPENSATION PAYMENT TERMS and SCHEDULE 1. Contractor shall perform the following work: Contractor shall provide Alcohol & Drug treatment services as outlined in Exhibit 1A & Exhibit 1B, attached A. REGULATIONS & DUTIES Contactor shall comply with all applicable provisions of that certain 2009-2011 County Financial Assistance Contract, as amended, including applicable Service Descriptions attached thereto, effect ie July 1, 2009, Contract #127295 between the State of Oregon acting by and through its Department of Human Services and Deschutes County. Contractor agrees to comply with the rules and regulations of County, applicable provisions in the Contract between County and the Department, incorporated hen iin by reference, as of the effective date of the Contract, applicable provisions of the Administrative Ru 's and Procedures of the Department, applicable Federal regulations and all provisions of Federal a id State statutes, rules and regulations relating to Contractor's performance of services under tl is Contract. Any act or duty of County, imposed upon County by Department, which, by the nature of tl is Contract County determines to be within the scope of this Contract and is to be performed )y Contractor, Contractor shall perform on behalf of County. No federal funds may be used to provi le services in violation of 42 USC 14402. 2. The maximum compensation. a. The maximum compensation under this Contract, including allowable expenses is, $180,000. Wh m such funds are exhausted, County will notify Contractor and no further payment under this Contract ill be made or required. b. Contractor shall not submit invoices for, and County shall not pay for any amount in excess of t maximum compensation amount set forth above. 1) If this maximum compensation amount is increased by amendment of this Contract, the amendm€ nt shall be fully effective before Contractor performs work subject to the amendment. 2) Contractor shall notify County in writing of the impending expiration of this Contract thirty (° )) calendar days prior to the expiration date. c. Contractor shall be entitled to reimbursement for expenses as set forth in Exhibit 5 ❑ YES ® NO [Check one] 3. Schedule of Performance or Delivery. a. County's obligation to pay depends upon Contractor's delivery or performance in accordance with t ie schedule listed in Exhibits 1A & 1 B. b. County will only pay for completed work that conforms to the terms of the Contract. 4. Renewal. This Contract may be renewed, subject to the following conditions: a. Renewal will be based on the County Annual Implementation Plan approved by the Department. b. Renewal is subject to the availability of funding. Page 1 of 1 - Exhibit 1 — Personal Service Contract No.2010-387 EXHIBIT 1-A DESCHUTES COUNTY SERVICES CONTRACT Contract No. 2010-387 IN CUSTODY ADDICTIONS TREATMENT STATEMENT OF WORK, COMPENSATION PAYMENT TERMS and SCHEDULE 1. Contractor shall perform the following work: Contractor is responsible for providing a continuum of addiction treatment services to criminal offenders frc m the time they are incarcerated in the County jail and after they are released into the community. Services ill be provided in the County jail or the Work Center and may be required to continue after release frc m custody. Each individual treatment plan must be adapted to the current status of the offender within t corrections system. A. METHOD AND PLACE OF GIVING NOTICE, SUBMITTING BILLS AND MAKING PAYMENTS Contractor shall submit monthly reports following the end of each calendar month, but no later than 30 da �s following the end of the calendar month. The report, created by Contractor and approved by County, sh 311 include a summary of services, including, but not limited to, date of bill, amount billed, billing period includi lg month and year, amount billed year-to-date, names of clients enrolled and enrollment date. All notices, b Is and payments shall be made in writing and may be given by personal delivery or by mail. Contractor sr all submit the final monthly report under this Contract no later than July 8, 2011. Notices, bills, and paymer is sent by mail should be addressed as follows: Contractor: Pfeifer & Associates 23 NW Greenwood Ave. Bend, OR 97701 Attn: Sally Pfeifer Phone: (541) 383-4293 County: Deschutes County Sheriff's Office 63333 W. Hwy 20 NE Bend, OR 97701 Phone: (541) 389-4454 Attn. Capt. Ruth Jenkin B. SERVICES TO BE PERFORMED Services shall be provided and documented in a legible manner consistent with professional aid community standards of care. Throughout the term of this Contract, Contractor must: a. Hold and attach a current copy of their non -provisional license/letter or approval issued by 1 ie State of Oregon Department of Human Services Addictions and Mental Health Division (AMH) b. Be able to ensure equal access to services for clients with diverse cultural or Iangua ae requirements, geographic barriers, and/or transportation needs. c. Maintain an accounting and financial management system which complies with genen Ily accepted accounting principles and which is adequate to meet federal and state governm !nt requirements. The system must provide adequate documentation, monitoring, access E nd reporting concerning the organization's financial position. d. Obtain Sheriff Office approval prior to implementing a new inmate treatment program. e. Obtain Sheriff Office approval for all volunteers and staff prior to volunteers and staff enter ig the jail or work center. Sheriff approval is dependent on a criminal history check. Names, d ite of birth and other needed personal information for each volunteer or staff member be provid d. Volunteers who come to the jail or work center on a regular basis and all staff must complete ne jail volunteer program, provided by the Sheriff. Page 1 of 3 - Exhibit 1A — Personal Service Contract No.2010-387 All referrals to the addictions treatment program will originate with inmates at the Deschut is County Jail. Referrals to Contractor's addictions program will be from those inmates who ha 'e attended Contractor's initial motivational enhancement class. Contractor shall coordinE :e closely with Jail staff to identify those clients most appropriate for referral to treatment slo s. Decisions regarding placement in one of the slots available under this Contract will be based client's motivation, risk for reoffending or return to jail, and lack of access to other resources 1)i - treatment. )rtreatment. The inmates referred to the addictions treatment programs shall be, determined :o be in need of addictions treatment and will have been sentenced for a term of at least three (3) months. Jail staff and Contractor may refer an inmate with less than three month on the it sentence if it is determined that the inmate would benefit from services and an opening exis s. At any time, and in addition to the conducting the motivational enhancement classes, Contract )1- shall rshall provide addictions treatment services to males located at the Work Center and femal is located at the jail for a total of at least 36 inmates per year. Contractor agrees to remove from treatment services those inmates who represent a physical )1- psychological rpsychological safety risk to others or themselves until such time jail staff and Contract )r determine the inmate is safe to receive treatment services. 2. At a minimum, Contractor shall: a. Appoint a treatment service coordinator to work with jail staff on scheduling, referrals, and oth ?,r treatment service issues. b. Consult with Sheriff's Office staff regarding inmates who are appropriate to receive servic is while incarcerated in jail facility and who meet criteria and eligibility (as stated in Paragraph B section f) to participate in treatment program. c. Conduct pre-screening to prioritize inmates with most significant addiction issues, whe e addiction is deemed a highly significant barrier to recovery and rehabilitation. d. Provide an initial, pre -addiction treatment, motivational enhancement class for inmates in net id of services at the jail or work center. The on-going motivational class will consist of five (5) )1- six rsix (6) twice -weekly sessions with attendance by an average of ten (10) to fifteen (15) inmatE s, lasting approximately an hour and a half. e. Provide on-site addiction treatment services to female inmates in Deschutes County jail and :o male inmates in the Work Center. These on-site services shall include group sessions three (3) or four (4) times a week and individual sessions at least one (1) time a week, each lasting approximately an hour and a half. f. Prior to an inmate being released from custody, complete an assessment to identify tho ie inmates at highest risk for relapse or re -offending and provide continued treatment servic is post -release at a duration and intensity necessary to decrease the likelihood of recidivism. g. Give a definite place and time for post -release treatment services when an inmate is release id from custody. h. Provide treatment services to inmates who meet criteria and eligibility to participate in treatmE �t program on an open enrollment basis. i. Enter data in Oregon Treatment Court Management System (OTCMS) on a monthly bas s. Submit outcome reports to Sheriff's Office and Behavioral Health Department. Outcome repos is will need to include information on abstinence, duration of treatment, and successful treatmE �t completion within the constraints of both the County's privacy policies and all applicable laws. j. Attend meetings with the Sheriff's Office, Behavioral Health Department, and Parole & Probatil n Department for those inmates scheduled to be released and receive continued treatment. These services will be performed under the direction and authority of the Deschutes County sheriff's Offi :e and Behavioral Health Department in close coordination with the Parole and Probation Department. 3. The maximum compensation. Dependent upon successful quarterly review, the County Sheriff's Office shall pay Contractor for In custody treatment services on a fee -for service basis at a maximum rate of $7,500 monthly, separ2 :e from any payment for post release treatment services. Monthly payment is dependent on Contract )1- Page r Page B,of 3 - Exhibit 1A — Personal Service Contract No.2010-387 providing the Sheriff's Office with the number of inmates attending the motivational class and t number of inmates enrolled in alcohol and treatment programs for the prior month. The maximL m compensation for the services under this Exhibit 1-A of the Agreement is $90,000. When this maximL m compensation has been reached, no further payment under this portion of the Agreement will be ma le or required. It is intended that the maximum compensation be expended in relatively equal monthly amounts to assure a steady availability of service slots to inmates. In order to accomplish this, reimbursement \ fill be as follows: a. No later than thirty (30) days after the end of each month, Contractor shall send to the Sherif ''s Office the names of inmates enrolled in services, their enrollment date, and type of servic :s provided. After receipt of this information, payment will then be issued for that month. A final st of enrolled inmates shall be provided to the Sheriff's Office no later than July 8, 2011. b. Contractor is expected to have an average of 10-15 inmates attend the motivational class. c. During the term of this Agreement, Contractor is expected to provide alcohol and drug treatmE nt services to a minimum of 36 inmates. Upon approval of the amount of compensation to be paid each month by the Behavioral Health Departme it, the Sheriff's Office shall be responsible for reimbursing Contractor for post release services as set out in Exhibit 1B. Page 3 of 3 - Exhibit 1A — Personal Service Contract No.2010- t`-, !` EXHIBIT 1-B DESCHUTES COUNTY SERVICES CONTRACT Contract No. 2010 POST RELEASE ADDICTIONS TREATMENT STATEMENT OF WORK, COMPENSATION PAYMENT TERMS and SCHEDULE 1. Contractor shall perform the following work: Contractor agrees to abide by the following in providing and receiving compensation under the post relea 3e portion of this Contract. Contractor will report all information on post -release services to Deschutes Coui ty Health Services. Compensation for post release services will be authorized by Deschutes County Hea th Services and paid by the Deschutes County Health Services through the Sheriff's Office. A. METHOD AND PLACE OF GIVING NOTICE, SUBMITTING BILLS AND MAKING PAYMENTS Contractor shall submit monthly reports following the end of each calendar month, but no later than 30 days following the end of the calendar month. The report, created by Contractor and approved )y County, shall include a summary of services, including, but not limited to, date of bill, amount billE d. billing period including month and year, amount billed year-to-date, names of clients enrolled a id enrollment date. All notices, bills and payments shall be made in writing and may be given by persoi al delivery or by mail. Contractor shall submit the final monthly report under this Contract no later than J ily 8, 2011. Notices, bills, and payments sent by mail should be addressed as follows: Contractor: Pfeifer & Associates 23 NW Greenwood Ave. Bend, OR 97701 Attn: Sally Pfeifer County: B. Definitions: Phone: (541) 383-4293 Deschutes County Health Services 2577 NE Courtney Drive Bend, OR 97701 Phone: (541) 322-7516 Attn: Nancy England a. Low Income/Indigent: For the purposes of this Contract, an indigent is any person who is at or below 125% of 1 ie federal poverty level as published by the US Department of Health and Human Services a id does not have sufficient money, credit, or property to be self-supporting. b. Level I (Outpatient): Outpatient treatment services provided to the individual in regularly scheduled face-to-fE e therapeutic sessions. Such services may include individual, group and family counseling, as well as long-term support for relapse prevention. Level I consists of 1-9 hours/week of service. c. Level II (Intensive Outpatient): This level of service affords the individual the opportunity to remain in his or her existi ig environment (social, familial, vocational), while still benefiting from a therapeutic, structur program. It is an outpatient service consisting of at least nine hours of service per week or individuals who meet the ASAM PPC 2R placement criteria for this level of care. SL :;h services may include individual, group and family counseling as well as long term support or relapse prevention. Page 1 of 7 - Exhibit 1B — Personal Service Contract No.2010-387 C. SERVICES TO BE PERFORMED 1. Provide Out-patient Alcohol and Drug Services to low-income, uninsured priority individuals who e -e released from jail and/or work center. Outpatient services will include a combination of the followir g: assessment, group and individual counseling, family education and treatment, case managemE nt (including coordination with Jail and Parole & Probation), relapse prevention and urinalysis screening. a. Participate in meetings as scheduled with Behavioral Health, Jail and Parole & Probation staff. b. Enter data in Oregon Treatment Court Monitoring (OTCMS) software and provide quarte ly reports on clients served, length of time in treatment, successful treatment completion aid recidivism rates (new charges while in treatment) 2. County Services. County shall provide Contractor, at County's expense, with material and servic )s described as follows: a. Services will be paid for based on a case rate as outlined under 3B. In addition to this case rate, Contractor may charge the client a co -pay, depending upon client's ability to pay. The co -pay will be a maximum of $5 per visit. 3. Consideration. A. To be eligible for services under these funds, clients must have started treatment services wh le incarcerated in the jail or work center, been released from jail, and been identified by jail staff aid Contractor staff as needing post -release treatment services. Clients who receive treatment servic :s must also qualify as low income as defined under 1B (a). Contractor is responsible for determini ig eligibility, based upon the criteria set forth or referred to herein. Contractor will need to have clier ts complete a financial application and verify income information with pay stubs, etc. to determi le eligibility. B. Case Rate Compensation: a. Subject to the maximum monthly payment of $7500, as identified in Exhibit 1A, Contractor \ ill receive a case rate of $1,875 per enrolled client. This rate will be paid for each client who me( ts the criteria for either Level I or Level II A&D services (described 1B) and is enrolled in At D services with the Office of Addictions and Mental Health Services under Client Proce ;s Monitoring System (CPMS). Case rate will cover all treatment services per enrollment episo 1e regardless of duration of treatment. b. If a client does not successfully engage in treatment within thirty (30) days after initial enrollmE nt (as defined by attendance at a minimum of 3 sessions within thirty (30) days, Contractor agre :s to enroll an additional client in services under the same case rate slot, with no additional char ie to the County. 4 The Maximum compensation and payment method. A. The maximum compensation under the post release portion of this Contract is $90,000 — servinc a minimum of 48 clients — and will consist of case rate payment only. When such funds are exhausted, io further payment under this Contract will be made. B. Contractor shall not submit invoices for, and County shall not pay for any amount in excess of 1 -ie maximum compensation amount set forth immediately above. If this maximum compensation amoun is increased by amendment of this Contract, the amendment shall first become fully effective belt re Contractor performs work subject to the amendment. Contractor shall notify County in writing of t impending expiration of this Contract thirty (30) calendar days prior to the expiration date. C. It is intended that the maximum compensation be expended in relatively equal monthly amounts to assure a steady availability of service slots to clients. In order to accomplish this, reimbursement will )e as follows: Contractor will enroll and be reimbursed for a maximum of four (4) clients per month under t its Contract. This will be new clients who enroll in post jail release A&D services in that month. Page lof 7 - Exhibit 1B — Personal Service Contract No.2010-387 • No later than 30 days after the end of each month, Contractor shall send to County the names of clients who have been enrolled under this Contract, enrollment date, and a statement of eligibility as outlined in 3A. County shall then issue payment for that mon h • It is expected that Contractor will fill all four (4) slots each month. However, if four (4) clien s. who meet the criteria under 3A, do not apply for services in one month, Contractor may carry t ie vacant slot into the next month. Contractor will not be reimbursed for any slots over the montl ly maximum of four (4) unless there have been unfilled slots from previous months. • The final list of enrolled clients will be sent to the County no later than July 8, 2011. Page 3 of 7 - Exhibit 1B — Personal Service Contract No.2010-387 AD 66/2009-2011 Page 1 of 4 Service Name: CONTINUUM OF CARE SERVICES Service 11) Code: A&1) 66 1. Set -vice Description Continuum of Care Services (A&1) 66) arc services delivered to youth and adults with substance use disorders. The purpose of A&1) 66 Services is to build upon resilience, assisting individuals to nlakc healthier lifestyle choices and to promote recovery from substance use disorders. A&D 66 Services consist of case management, clinical care and continuing care delivered when therapeutically necessary and consistent with the developmental and clinical needs of the individual. For purposes of A&D 66, case management, clinical care and continuing care have the following meanings: Case Management services are flexible, community-based, recovery and client -oriented services that enhance the scope of the addiction treatment and recovery continuum by providing the individual with a single point of contact fbr multiple health and serial service systems and assisting the individual in advocating for his or her needs. Case management services assist the individual with needs that generally are thought to be outside the realm of substance use disorder treatment. Case management services also assist individuals transitioning from community settings to residential care and from residential care back to community settings. Clinical Care services are assessment, counseling and treatment services, meeting the Standards for Outpatient and Residential Alcohol and Drug Treatment Programs (set forth in OAR 415-051-0000 through 415-051-0155, as such rules may he amended from time to time). The services may also include medically prescribed pharmacological agents approved by the U.S, Food and Drug Administration for the treatment of substance use disorders, i.e., methadone, buprenorphine, acamprosate and naltrexone. Continuing Care services are services provided to individuals in treatment to sustain their commitment to recovery and consist of ongoing intermittent contact by the individual with 21 treatment Provider including, hut not limited to, telephone outreach, participation in individual or group counseling, self help groups and programs, and transitional housing. A&,[) 66 Services are provided at one of the l rllowing levels of care as therapeutically necessary and consistent with the clinical need of the individual: Level 1 (Outpatient) Non-residential treatment services provided to the individual in regularly scheduled face -lo -lace therapeutic sessions. This level of service consists of 1-6 hours per veck of face -to -Face therapeutic sessions for adolescents and 1-0 hours per week for adults. Such services may include individual, group and fancily counseling, as well as long-term support for recovery management including relapse prevention. A 1) 66 (1'1'0323-09 Approved 6/4/2009 Page 4 of 7 - Exhibit 1 B — Personal Service Contract No.2010-387 Al) 66/2009-2011 Page 2 of -4 Level 11 (Intensive Outpatient) This level of service affords the individual the opportunity to remain in his or he existing environment (social, familial, vocational), while still benefiting from a therapeutic, structured program. It is a non-residential service consisting of at least nine hours of race -lo -face contact per week for adults and at least six hours of face -to -lace contact per week for adolescents who meet. the administrative rale placement requirements for this level of care. Level ll Providers may provide evening services, clay treatment services, or partial hospitalization. Such Services may include individual, group and family counseling, as well as medically -prescribed pharmacological agents. Level 111 Non-medical Detoxification This level of service provides twenty-four hour observation, monitoring and treatment for individuals who are suffering from alcohol or other drug intoxication or withdrawal. Subject to the preference for pregnant women and intravenous drug users described in Exhibit (i, Required Federal "Perms and Conditions, County must give preference in A&D 66 service delivery to persons referred by DHS and persons referred hy Drug Treatment Courts within County's service area . I1. Performance ,Standards and Quality Measures Providers of A&1) 66 Services funded through this Contract must also have a current license issued by the _Department in accordance with OAR 415-012-0000 through 415-012- 0090. Providers of A&D 66 Continuing Carc Level 1 and 11 Services funded through this Agreement must comply with OAR 415-051-0000 through 415-051-0155 and ()AR 415- 020-0000 through 415-020-0090, as such rides may be revised from time to time. Providers ofA&1) 66 Continuing Carc Level 1ft Services funded through this Agreement must comply with OAR 415-050-0000 through 415-050-0095, as such rules may be revised from time to time. With respect to each individual that Provider serves with funds provided under this Agreement, Provider shall deliver all A&t) 66 Services therapeutically necessary for the individual lrom the date Provider begins serving the individuai through the elate set forth in the Financial Assistance Award. A Provider may riot use A&D 66 funds provided under this Agreement to deliver A&D 66 Continuing Care Level I or Level 11 services to any individual enrolled in the Oregon Health Plan for chemical dependency benefits. Providers must refer such individuals to the identified health care sevicc delivery provider for A&D 66 Services. The quality of the A&D 66 Services supported with funds provided tinder this Agreement will be measured in accordance with the criteria set forth below. These criteria are applied on a countywide basis each calendar quarter (or portion thereof) during the period for which the Binds are awarded for A&D 66 Services under this Agreement. County must develop and implement quality assurance /quality improvement processes to improve, progressively as measured hy the criteria set forth below, the quality of A&D 66 Services supported -with finds provided under this Agreement. The Department may recommend additional actions to improve quality. AD 66 G'1'0323 -D9 Approved 6/4/2009 Page 5 of 7 - Exhibit 1B — Personal Service Contract No.2010-387 Al) 66/2009-2011 Page 3 of 4 Access: Access is measured by Department as the percentage of County residents estimated by Department surveys to need treatment who are enrolled in A&D 66 Services. Engagement: Fngagemenl is measured by Department as the percentage of individuals receiving A&D 66 Services with funds provided through this Agreement who enter treatment following positive assessment. Retention: Retention is measured by Department as the percentage of individuals receiving A&D 66 Services with funds provided through this Agreement who are actively engaged in treatment for 90 days or more. Reduced Use: Reduced use is remeasured by Department as the percentage of individuals engaged in and receiving A&D 66 Services with funds provided through this Agreement who reduce their use of alcohol or other drugs during treatment, as reported in CPMS upon termination of treatment. Completion: Completion is measured as the percentage of individuals engaged in and receiving A&D 66 Services with funds provided through this Agreement who complete two thirds of their treatment plan and are not abusing alcohol or other drugs aL the time services are terminated. 411. Special Reporting, Requirements All individuals receiving A&1) 66 Services with funds provided under this Agreement must be enrolled in CPMS, arid the individual's CPMS record ler A&D 66 Services must he maintained, as specified in Department's CPMS manual. 1V. Financial Assistance Calculation and Disbursement Procedures A, Calculation of financial Assistance. The funds awarded for A&D 66 services are intended to be general financial assistance 10 the County for A&D 66 services. Accordingly, the Department will not track delivery of A&D 66 services or service capacity on a per unit basis, so long as the County offers and delivers A&D 66 services as part of its CM11P. Total Department financial assistance for all A&D 66 Services delivered under a particular linc of the Financial Assistance Award shall not exceed the total funds awarded for A&D 66 Services as specified in that line of the Financial Assistance Award. B. Disbursement of Financial Assistance. Unless a different disbursement method is specified in that line of the Financial Assistance Award, Department will disburse the financial assistance awarded for A&D 66 Services in 0 particular line of the Financial Assistance Award, to County in substantially equal monthly allotments during the period specified in that line of the Financial Assistance Award, subject to the following: Af) 66 (;70323-09 Approved 6/4/2.009 Page 6 of 7 - Exhibit 1B — Personal Service Contract No.2010-387 AT) 66/2009-2011 Page 4 of d 1. Department may, upon written request of County, adjust monthly allotments. 2. Upon amendment to the Financial Assistance Award, Department shall adjust monthly allotments as necessary, to reflect changes in the funds awarded for A&1) 66 services on that line of the Financial Assistance Award. C. Agreement Settlement. Agreement Settlement will be used to confirm the offer and deli very of A&1) 66 Services by County as part of its CMIIY, based on data properly reported in CPMS or through other reports required or permitted by this Service Description or an applicable Specialized Service Requirement. Page 7 of 7 - Exhibit 1B — Personal Service Contract No.2010-387 EXHIBIT 2 DESCHUTES COUNTY SERVICES CONTRACT Contract No. 2010-387 INSURANCE REQUIREMENTS Contractor shall at all times maintain in force at Contractor's expense, each insurance noted below. Insurance coverage must apply on a primary or non-contributory basis. All insurance policies, except Professional Liability, shall be written on an occurrence basis and be in effect for the term of this contract. Policies written on a "claims made" basis must be approved and authorized by Deschutes County. Contractor Name: Pfeifer & Associates Workers Compensation insurance in compliance with ORS 656.017, requiring Contractor and all subcontractors to provide workers' compensation coverage for all subject workers, or provide certification of exempt status. Employer's Liability Insurance with coverage limits of not less than $500,000 must be included. Professional Liability insurance with an occurrence combined single limit of not less than: Per Occurrence limit Annual Aggregate limit ❑ $500,000 ❑ $500,000 ® $1,000,000 0 $1,000,000 D $2,000,000 ® $2,000,000 Professional Liability insurance covers damages caused by error, omission, or negligent acts related to professional services provided under this Contract. The policy must provide extended reporting period coverage, sometimes referred to as "tail coverage" for claims made within two years after this contract is completed. ® Required by County ❑ Not required by County (one box must be checked) Commercial General Liability insurance with a combined single limit of not less than: Per Single Claimant and Incident ❑ Oregon Tort Claims Act limits O $1,000,000 O $2,000,000 All Claimants Arising from Single Incident D Oregon Tort Claims Act limits D $2,000,000 © $3,000,000 Commercial General Liability insurance includes coverage for personal injury, bodily injury, advertising injury, property damage, premises, operations, products, completed operations and contractual damages. The Oregon Legislature has adopted legislation which establishes tort claims limits for actions against local public bodies, including their officers, agents and employees. The tort claims act limits are automatically adjusted on July 1 every year. By separate endorsement, the policy shall name Deschutes County, its officers, agents, employees and volunteers as an additional insured. The additional insured endorsement shall not include declarations that reduce any per occurrence or aggregate insurance limit. The contractor shall provide additional coverage based on any outstanding claim(s) made against policy limits to ensure that minimum insurance limits required by the County are maintained. Construction contracts may include aggregate limits that apply on a "per location" or "per project" basis. Z Required by County ❑ Not required by County (One box must be checked) Page 1 of 2 - Exhibit 2 - Personal Service Contract No. 2010-387 Automobile Liability insurance with a combined single limit of not less than: Per Occurrence ❑ $500,000 ❑ $1,000,000 D $2,000,000 Automobile Liability insurance includes coverage for bodily injury and property damage resulting from operation of a motor vehicle. Commercial Automobile Liability Insurance shall provide coverage for any motor vehicle (symbol 1 on some insurance certificates) driven by or on behalf of Contractor during the course of providing services under this contract. Commercial Automobile Liability is required for contractors that own business vehicles registered to the business. Examples include: plumbers, electricians or construction contractors. An Example of an acceptable personal automobile policy is a contractor who is a sole proprietor that does not own vehicles registered to the business. ❑ Required by County ® Not required by County (one box must be checked) Additional Requirements. Contractor shall pay all deductibles and self-insured retentions. A cross -liability clau ;e or separation of insured's condition must be included in all commercial general liability policies required by ti is Contract. Contractor's coverage will be primary in the event of loss. Certificate of Insurance Required. Contractor shall furnish a current Certificate of Insurance to the County witt the signed Contract. The Certificate shall provide that there shall be no cancellation, termination, material changE or reduction of limits of the insurance coverage without at least 30 days written notice from the Contractor's insur r to the County. The Certificate shall also state the deductible or, if applicable, the self-insured retention level. For commercial general liability coverage, the Certificate shall also provide, by policy endorsement, that Deschutes County, its agents, officers, employees and volunteers are additional insureds with respect to Contractor's services provided under this Contract. The endorsement must be in a format acceptable to Deschutes County. If requested, complete copies of insurance policies shall be provided to the County. Risk Management review Date Page 2 of 2 - Exhibit 2 - Personal Services Contract No. 2010-387 EXHIBIT 3 DESCHUTES COUNTY SERVICES CONTRACT Contract No. 2010-387 CERTIFICATION STATEMENT FOR CORPORATION OR INDEPENDENT CONTRACTOR NOTE: Contractor Shall Complete A or B in addition to C below: A. CONTRACTOR IS A CORPORATION, LIMITED LIABILITY COMPANY OR A PARTNERSHIP. I certify under penalty of perjury that Contractor is a [check one]: Corporation LI Limitec) Liability Company 11 Partnership. authorized to do business in the State of Oregc 1. Signature Title Date B. CONTRACTOR IS A SOLE PROPRIETOR WORKING AS AN INDEPENDENT CONTRACTOR. Contractor certifies under penalty of perjury that the following statements are true: 1. If Contractor performed labor or services as an independent Contractor last year, Contractor filed federal aid state income tax returns last year in the name of the business (or filed a Schedule C in the name of t business as part of a personal income tax return), and 2. Contractor represents to the public that the labor or services Contractor provides are provided by in independently established business registered with the State of Oregon, and 3. All of the statements checked below are true. NOTE: Check all that apply. You shall check at least three (31 - to establish that you are in Independent Contractor. The labor or services I perform are primarily carried out at a location that is separate from r residence or primarily carried out in a specific portion of my residence that is set aside as tie location of the business. I bear the risk of loss related to the business or provision of services as shown by factors su :h as: (a) fixed-price agreements; (b) correcting defective work; (c) warranties over the services Dr (d) indemnification agreements, liability insurance, performance bonds or professional liabil ty insurance. I have made significant investment in the business through means such as: (a) purchasi ig necessary tools or equipment; (b) paying for the premises or facilities where services E -e provided; or (c) paying for licenses, certificates or specialized training. I have the authority to hire other persons to provide or to assist in providing the services anc if necessary to fire such persons. Each year I perform labor or services for at least two different persons or entities or I routinf ly engage in business advertising, solicitation or other marketing efforts reasonably calculated to obtain new contracts to provide similar services. Contractor Signature Date Page 1 of 2 - Exhibit 3 - Personal Services Contract No. 2010-387 C. Representation and Warranties. Contractor certifies under penalty of perjury that the following statements are true to the best of Contractor's knowledge: 1. Contractor has the power and authority to enter into and perform this contract; 2. This contract, when executed and delivered, shall be a valid and binding obligation of Contractor enforceal le in accordance with its terms; 3 The services under this Contract shall be performed in a good and workmanlike manner and in accordan ;e with the highest professional standards; and 4. Contractor shall, at all times during the term of this contract, be qualified, professionally competent, and di ly licensed to perform the services. 5. To the best of Contractor's knowledge, Contractor is not in violation of any tax laws described in OF S 305.380(4), 6 Contractor understands that Contractor is responsible for any federal or state taxes applicable to a ly consideration and payments paid to Contractor under this contract; and 7 Contractor has not discriminated against minority, women or small business enterprises in obtaining a iy required subcontracts. Contractor Signature Date Page 2 of 2 - Exhibit 3 - Personal Services Contract No. 2010-387 EXHIBIT 4 DESCHUTES COUNTY SERVICES CONTRACT Contract No. 2010-387 Workers' Compensation Exemption Certificate (To be used only when Contractor claims to be exempt from Workers' Compensation coverage requirements) Contractor is exempt from the requirement to obtain workers' compensation insurance under ORS Chapter 656 for the following rea: on (check the appropriate box): II SOLE PROPRIETOR • Contractor is a sole proprietor, and • Contractor has no employees, and • Contractor shall not hire employees to perform this contract. CORPORATION - FOR PROFIT • Contractor's business is incorporated, and • All employees of the corporation are officers and directors and have a substantial ownership interest* in le corporation, and • The officers and directors shall perform all work. Contractor shall not hire other employees to perform I pis contract. CORPORATION - NONPROFIT • Contractor's business is incorporated as a nonprofit corporation, and • Contractor has no employees; all work is performed by volunteers, and • Contractor shall not hire employees to perform this contract. PARTNERSHIP • Contractor is a partnership, and • Contractor has no employees, and • All work shall be performed by the partners; Contractor shall not hire employees to perform this contract, and • Contractor is not engaged in work performed in direct connection with the construction, alteration, rep iir, improvement, moving or demolition of an improvement to real property or appurtenances thereto. LIMITED LIABILITY COMPANY • Contractor is a limited liability company, and • Contractor has no employees, and • All work shall be performed by the members; Contractor shall not hire employees to perform this contract, anc • If Contractor has more than one member, Contractor is not engaged in work performed in direct connection v ith the construction, alteration, repair, improvement, moving or demolition of an improvement to real property or appurtenances thereto. *NOTE: Under OAR 436-050-050 a shareholder has a "substantial ownership" interest if the shareholder owns 10% of the corporation )r, if less than 10% is owned, the shareholder has ownership that is at least equal to or greater than the average percentage of ownershit of all shareholders. **NOTE: Under certain circumstances partnerships and limited liability companies can claim an exemption even when perform �g construction work. The requirements for this exemption are complicated. Consult with County Counsel before an exemption reques is accepted from a contractor who shall perform construction work. Contractor Printed Name Contractor Signature • Contractor Title Date Page 1 of 1 - Exhibit 4 - Personal Services Contract No. 2010-387 EXHIBIT 4 DESCHUTES COUNTY SERVICES CONTRACT Contract No. 2010-387 Workers' Compensation Exemption Certificate (To be used only when Contractor claims to be exempt from Workers' Compensation coverage requirements) Contractor is exempt from the requirement to obtain workers' compensation insurance under ORS Chapter 656 for the following reas m (check the appropriate box): SOLE PROPRIETOR • Contractor is a sole proprietor, and • Contractor has no employees, and • Contractor shall not hire employees to perform this contract. CORPORATION - FOR PROFIT • Contractor's business is incorporated, and • All employees of the corporation are officers and directors and have a substantial ownership interest* in le corporation, and • The officers and directors shall perform all work. Contractor shall not hire other employees to perform t its contract. Fl CORPORATION - NONPROFIT • Contractor's business is incorporated as a nonprofit corporation, and • Contractor has no employees; all work is performed by volunteers, and • Contractor shall not hire employees to perform this contract. El PARTNERSHIP • Contractor is a partnership, and • Contractor has no employees, and • All work shall be performed by the partners; Contractor shall not hire employees to perform this contract, and • Contractor is not engaged in work performed in direct connection with the construction, alteration, rep 3ir.. improvement, moving or demolition of an improvement to real property or appurtenances thereto. LIMITED LIABILITY COMPANY • Contractor is a limited liability company, and • Contractor has no employees, and • All work shall be performed by the members; Contractor shall not hire employees to perform this contract. an • If Contractor has more than one member, Contractor is not engaged in work performed in direct connection \ fith the construction, alteration, repair, improvement, moving or demolition of an improvement to real propert or appurtenances thereto. *NOTE: Under OAR 436-050-050 a shareholder has a "substantial ownership" interest if the shareholder owns 10% of the corporatior or, if less than 10% is owned, the shareholder has ownership that is at least equal to or greater than the average percentage of ownershi of all shareholders. **NOTE: Under certain circumstances partnerships and limited liability companies can claim an exemption even when perforn ing construction work. The requirements for this exemption are complicated. Consult with County Counsel before an exemption reque t is accepted from a contractor who shall perform construction work. Contractor Printed Name' Contractor Title Contractor Signature Date Page 1 of 1 - Exhibit 4 - Personal Services Contract No. 2010-387 EXHIBIT 5 DESCHUTES COUNTY SERVICES CONTRACT Contract No. 2010-387 Expense Reimbursement 1. Travel and Other Expenses. (When travel and other expenses are reimbursed.) a. It is the policy of the County that all travel shall be allowed only when the travel is essential to the norrr al discharge of the County responsibilities. 1) All travel shall be conducted in the most efficient and cost effective manner resulting in the IDE st value to the County. 2) Travel expenses shall be reimbursed for official County business only. 3) County shall not reimburse Contractor for any item that is not otherwise available for reimbursemE nt to an employee of Deschutes County per Deschutes County Finance Policy F 1, "REIMBURSEMENT FOR MISCELLANEOUS EXPENSES AND EXPENSES INCURRED WHILE TRAVELING ON COUNTY BUSINESS," dated 11/8/06. 4) County may approve a form other than the County Employee Reimbursement Form for Contractor to submit an itemized description of travel expenses for payment. 5) Personal expenses shall not be authorized at any time. 6) All expenses are included in the total maximum contract amount. b. Travel expenses shall be reimbursed only in accordance with rates approved by the County and of Ily when the reimbursement of expenses is specifically provided for in Exhibit 1, paragraph 3 of tl is Contract. c. The current approved rates for reimbursement of travel expenses are set forth in the above describ policy. d. County shall not reimburse for any expenses related to alcohol consumption or entertainment. e. Except where noted, detailed receipts for all expenses shall be provided. f. Charge slips for gross amounts are not acceptable. g. County shall not reimburse Contractor for any item that is not otherwise available for reimbursement to an employee of Deschutes County. 2. Approved reimbursements: a. Mileage. Contractor shall be entitled to mileage for travel in a private automobile while Contractor is acting within the course and scope of Contractor's duties under this Contract and driving over the mi lst direct and usually traveled route to and from Bend, Oregon. 1) Reimbursement for mileage shall be equal to but not exceed those set by the United States Gen€ -al Services Administration ("GSA") and are subject to change accordingly. 2) To qualify for mileage reimbursement, Contractor shall hold a valid, current driver's license for 1 -le class of vehicle to be driven and carry personal automobile liability insurance in amounts not IE ss than those required by this contract. 3) No mileage reimbursement shall be paid for the use of motorcycles or mopeds. b. Meals. 1) Any reimbursement for meals shall be for actual cost of meals incurred by Contractor while act ng within the course and scope of Contractor's duties under this contract. 2) For purposes of calculating individual meals where the Contractor is entitled only to a partial c ay reimbursement, the following maximum allocation of the meal expenses applies: a) Breakfast, $10; b) Lunch, $12; c) Dinner, $22. 3) Except in the event of necessary overnight travel as provided below, partial day meal expenses sl all be reimbursed as follows and only while Contractor is acting within the course and scope of Contractor's duties under this contract: a) Breakfast expenses are reimbursable if Contractor is required to travel more than two (2) hot rs: before the start Contractor's regular workday (i.e. 8:00 a.m.). b) Lunch expenses are reimbursable only if Contractor is required to travel overnight and beg ns the journey before 11:00 am or ends the journey after 11:00 a.m. c) Dinner expenses are reimbursable only if Contractor is required to travel more than two ;2) hours after Contractor's regular workday (i.e. 5:00 p.m.). Page 1 of 2 - Exhibit 5 to Personal Services Contract No. 2010-387 4) Breakfast and dinner expenses are reimbursable during Contractor's necessary overnight tra) el while acting within the course and scope of Contractor's duties under this contract and shall r of exceed those set by the GSA. and are subject to change accordingly. c. Lodging. 1) County shall reimburse Contractor for Contractor's actual cost of lodging necessary to provi le service to the County and shall not exceed the maximum lodge set by the GSA for Bend, Oregon. 2) Reimbursement rates for lodging are not considered "per diem" and receipts are required or reimbursement. d County shall not reimburse Contractor in excess of the lowest fair for any airline ticket or vehicle ren al charges. 3. Exceptions. Contractor shall obtain separate written approval of the County Administrator for a iy exceptions to the expense items listed above prior to incurring any expense for which reimbursement sr 311 be sought. Page 2 of 2 - Exhibit 5 to Personal Services Contract No. 2010-387 Exhibit 6 DESCHUTES COUNTY SERVICES CONTRACT Contract No. 2010-387 Compliance with provisions, requirements of funding source and Federal and State laws, statutes, rules, regulations, executive orders and policies. Conflicts of Interest Contractor certifies under penalty of perjury that the following statements are true to the best of Contractor's knowledge: If Contractor is currently performing work for the County, State of Oregon or federal government, Contrac or by signature to this Contract declares certifies that; Contractor's Work to be performed under this Contr, ict create no potential or actual conflict of interest as defined by ORS 244 and no rules or regulations of Contractor's employee agency (County State or Federal) would prohibit Contractor's Work under t its Contract. Contractor is not an "officer," "employee," or "agent" of the County, as those terms are used in ORS 30.265. No federally appropriated funds have been paid or shall be paid, by or on behalf of Contractor, to any per: un for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with the award -g of any federal contract, the making of any federal grant, the making of any federal loan, the entering intc of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of ny federal contract, grant, loan, or cooperative agreement. a. If any funds other than federally appropriated funds have been paid or shall be paid to any person or influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with 1 pis federal contract, grant, loan, or cooperative agreement, Contractor agrees to complete and sub nit Standard Form -LLL "Disclosure Form to Report Lobbying," in accordance with its instructions. 1) Standard Form -LLL and instructions are located in 45 CFR Part 93 Appendix B. 2) If instructions require filing the form with the applicable federal entity, Contractor shall then a a material condition of this Contract also file a copy of the Standard Form -LLL with the Department. 3) This filing shall occur at the same time as the filing in accordance with the instructions. b. Contractor understands this certification is a material representation of fact upon which the County nd the Department has relied in entering into this Contract. Contractor further understands that submiss on of this certification is a prerequisite, imposed by 31 USC 1352 for entering into this Contract. c. Any person who fails to file the required certification shall be subject to a civil penalty of not less tl an $10,000 and not more than $100,000 for each such failure. d. Contractor shall include the language of this certification in the award documents for all sub -awards a all tiers (including subcontracts, sub -grants, and contracts under grants, loans and coopera ive agreements) and that all sub -recipients shall certify and disclose accordingly. e. Contractor is solely responsible for all liability arising from a failure by Contractor to comply with :he terms of this certification. f. Contractor promises to indemnify County for any damages suffered by County as a result of Contract pr's failure to comply with the terms of this certification. 3. Contractor understands that, if this Contract involves federally appropriated funds, this certification i ; a material representation of facts upon which reliance was placed when this Contract was made or entE -ed into, submission of this certification is a prerequisite for make or entering into this Contract imposec by Section 1352, Title 311, U.S. Code and that any person who fails to file the required certification shal be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each failure. /, .; Contractor Signature Date Page 1 of 2 - Exhibit 7 to Personal Services Contract No. 2010-387 Exhibit 7 DESCHUTES COUNTY SERVICES CONTRACT Contract No. 2010-387 BUSINESS ASSOCIATE AGREEMENT County will make available and/or transfer to Contractor certain Information, in conjunction with goods or services that are being provided by Contractor to County, that is confidential and must be afforded special treatment and protection. Contractor will have access to and/or receive from County certain Information that can be used or disclosed on y in accordance with this Agreement and the HHS Privacy Regulations. To the extent required by 42 U.S.C. 1171 et seq. enacted by the Health Insurance Portability and Accountability Act of 1996 and regulations promulgated thereunder, Contractor assures County that Contractor will appropriately safeguard protected health information made available to or obtained by Contractor. Contractor further agrees to comply with applicable laws relating to protected health information and with respe :;t to any task or other activity Contractor performs on behalf of County, to the extent County would be required to comply with such requirements. For purposes of this Agreement, the following terms shall apply: A. Contractor shall be considered a BUSINESS ASSOCIATE; B. County shall be considered a COVERED ENTITY; C. HHS Privacy Regulations shall mean the Code of Federal Regulations (C.F.R.) at Title 45, Section 160 and 164, Individual shall mean the person who is the subject of the Information, and has the same meaning as the term 'individual' is defined by 45 C.F.R. 164.501; and Secretary shall mean the Secretary of the Department of Health and Human Services (HHS) and any other officer or employee of HHS to whom the authority involved has been delegated; Information shall mean any health information provided and/or made available by County to Contractor, and has the same meaning as the term 'health information' as defined by 45 C.F.R. 160.102. Contractor agrees it shall: Not use or further disclose such information other than as permitted or required by this Agreement. Contractor shall not, except as necessary for the proper management, administration and performancE of its duties under this Agreement, use, reproduce, disclose, or provide to third parties, any confidentia document or information relating to the County, its members or to clients of County or its members without the prior written consent or authorization of the County or of the client. If Contractor uses such information for the purposes set forth above, it will only do so if the disclosure is required by law or Contractor obtains reasonable assurances from the person to whom the information is disclosed that it will be held confidentially and used or further disclosed only as required by law or for the purpose for which Contractor disclosed it to the person. Contractor shall ensure that its personnel, employees, affiliates and agents maintain the confidentiality of patient health information and business information )f County. Page 1 of 2 - Exhibit 7 to Personal Services Contract No. 2010-387 Not use or further disclose the information in a manner that would violate the requirements of applicab law, if done by County; Use appropriate safeguards to prevent use or disclosure of such information other than as provided fo by this Agreement; Report to County any use or disclosure of such information not provided for by this Agreement of whicl Contractor becomes aware; Ensure that any subcontractors or agents to whom Contractor provides protected health information received from County agree to the same restrictions and conditions that apply to Contractor with respe ;t to such information; Make available protected health information in accordance with applicable law, i.e., the Code of Feden I Regulations (C.F.R.) at Title 45, Sections 160 and 164; Maintain standard records, pursuant to this agreement, and to provide such records and other necess; ry information to the County as may be requested in writing and as permitted by law. Contractor agrees that all records kept in connection with this agreement are subject to review and audit by the County upon reasonable notice of a minimum of 14 work days from the date of written request by the County. 8. Make Contractor's internal practices, books, and records relating to the use and disclosure of protected health information received from County available to the Secretary of the United Stat )s Health & Human Services for purposes of determining County's compliance with applicable la% (in all events, Contractor shall immediately notify County upon receipt by Contractor of any sup h request, and shall provide County with copies of any such materials); 9. Upon termination of this Agreement, Contractor shall promptly return all protected health information received from County. If the return of protected health information is not feasible, Contractor shall continue the protections required under this contract to the protected health information consistent with the requirements of this Attachment and the HIPAA privacy standards. Date: SignatuFe:, Contractor: Pfeifer & Associates Title - Page 2 of 2 - Exhibit 7 to Personal Services Contract No. 2010-387 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY VflC DI 00 D7_ 502076502WC (E d 1-04) RENEWAL AGREEMENT — INFORMATION PAGE This information page supersedes any previous information pages ATTACH TO YOUR CURRENT POLICY Entity Type: IND I V I DUAL /SOLE PROPR I ETOR Policy No.: WC4-3NC-502076010 Prior Policy No.: WC4-3NC-502076--019 1. The Insured: SALLY PFEIFER DBA: PFEIFER AND ASSOCIATES Mailing Address: 23 NW GREENWOOD AVE BEND OR 97701-2078 FEIN: 931254085 Risk ID No.: DNQ Suffix: 502 Other workplaces not shown above: 617 SW CASCADE,REDMOND OR 97756 51.470 HWY 97 NUM 3A,LA PINE OR 97734 2. The policy period is from 9 /01/2010 to 9 /01/2011 12:01 a.m. standard time at the address of the insurec as stated above. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensaition Law of the stags listed here: OR B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in it+r:;m 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident Bodily Injury by Disease Bodily Injury by Disease $500,000 each accident $600,000 policy limit $500 ,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: For residual market policies, the Oregon Residual Market Limited 0/her States nsurance Endorsement—WC 36 03 06 replaces Part Throe—Othor States Insurance of the polity, D. This policy includes these endorsements and schedules; (See Extension of Information Page -- Item 3D) 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates, and Rating Plane All information shown on the attached Extension of Information Page — Item 4 is subject to verification and change L ✓ audit. Minimum Premium: 266 Deposit Premium: 1 ,293 Total Estimated Policy Premium: $1,854 Reporting Frequency: Semi-annua I ly Servicing/Issuing Office: PORTLAND A/R Producer INSURANCE CENTER Liberty Northwest Insurance Corporation cc: INSURANCE CENTER 62940 O.B. RILEY RD STE #1 BEND opt 97701 000002 6/17/2010 EFS ;ms Countersigned By: Dexter Legg, 1103-30 Vice President and Secretary Liberty Northvi est,. M1lCmher rfllbcm Mnrtual Group WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY 502073S02WC EXTENSION OF INFORMATION PAGE — ITEM 4 Peel WC Of o0 04 (Ec 1-04) Classification of Operations _ Code No. Estimated Remuneration Rate per $100 of Remuneration Estill ated Prer ium OREGON — 36 — 1 SALLY PFEIFER YID# — BOJ61ZB.L602) SCHOOL—PROFESSIONAL EMPLOYEES—& CLERICAL 9868 300,900 .67 ,016 ',016 Merit Rating (.90) $500 Max 9885 —202 Non—Exp Rated Cdt (.69) $500 Max: P041 —200 Terrorism Premium 9740 3D0,900 ,01 30 Catastrophe Premium 9741 300,900 .01 0 Entity estimated premium: 1,674 Estimated premium: 1,674 Expense constant: 0900 180 1,854 Insured: SALLY PFEIFER 00000 6/17/2010 EFS ms Policy No: WC4-3N0--002076-0 10 Libei t Nort. YWCA, Menther '(111, ✓Mau On!<imop WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY 502076502WC Description o` Charge STATE ASSESSMENTS AND S OR Insurance Guaranty A OR WCp Premium Assessme Insured: SALLY PFE I FER 000605 WC Cul 00 05 {E(, 1-04) EXTENSION OF INFORMATION PAGE... ITEM 4 MISCELLANEOUS VALUES 6/17/2010 EFS ms Policy No: WC4-3NC-502076-•010 arge Libert North vest,. Member of l.ilr�>1vct�nl cm���, Code ND. Rate Estimated C IRCHARGES : sec jet ion Surcharge 9682 ,0000;16 it 9865 4.000016 0 6/17/2010 EFS ms Policy No: WC4-3NC-502076-•010 arge Libert North vest,. Member of l.ilr�>1vct�nl cm���, WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY 5020705n7WC Form No. WC WC WC WC WC WC WC WC WC WC WC WC WC WC WC 00030B 000406 000414 0004210 000422A 350301 360305 360305 360401 360405A 360406 36040-7 360601E 9906048 990644 WO 01 i 00 03 (E( 1-04) EXTENSION OF INFORMATION PAGE -- ITEM 3D Tile Anni rahlp S AfP'G' PARTNERS, OFFICERS AND OTHERS EXCLUSION PREMIUM DISCOUNT NOTIFICATION OF CHANGE IN OWNERSHIP CATASTROPHE (OTHER THAN ACTS OF TERRORISM) PREMIUM TERRORISM RISK INSURANCE REAUTHORIZATION ACT DISCLOSURE OREGON UNSAFE EQUIPMENT EXCLUSION OREGON RESIDUAL MARKET LIMITED OTHER STATES INSURANCE OREGON LIMITS OF LIABILITY OREGON MERIT RATING OREGON SIMPLIFIED ASSIGNED RISK ADJUSTMENT PROGRAM OREGON PREMIUM DUE DATE ASSIGNED RISK LOSS SENSITIVE RATING PLAN OREGON CANCELATION OREGON MEDICAL REIMBURSEMENT OREGON CONFIDENTIAL RECORDS Insured: SALLY PFE I FFR oonoo3 6/17/2010 EFS :ms OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR policy N0: WC4 -3NC-502076 -010 Liber LT Nord i vest MErnhcr rzf I bi: nn' Nttltt (4,300 ' 1 14uurtu- CERTIFICATE 1F LIABILITY INSURANCE z z2i:009 PRODUCER THIS CERTIFICATE IS ISSI, S A MATTER OF INFORMATION TRIA, INC . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATI HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OF 644 NE Greenwood Ave. Ste. 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOV '. Bend, OR 97701 (541) 382-9111 INSURERS AFFORDING COVERAGE I NAIC# INSURED Pfeifer and Associates, Inc u„a «„ricers at Lioyas of weon, us nuK, ins INSURER A:' INSURER B. 23 NW Greenwood Ave. INSURER C. Bend, OK 97701 INSURER D 1 INSURER E. COVERAGES 1 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED_ NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. -- INSR LTR ADM. INSRD I IYPE OE INSURANCE POLICY NUMBER I POLICY EFFECTIVE DATE(MMDD/YY) POLICY EXPIRATION DATE r"nnrDD/w) LIMITS A X GENERAL LIARILRY , COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ITAKFAG1 PREMISES ((Ea T curencc) $ 50,000 X l CLAIMS MADE OCCUR MED EXP (Any one person) $ 5,000 X PROFESSIONAL NA0969279540 11/21/09 11/21/10 PERSONAL&ADV INJURY 5 LIABILITY GENERAL AGGREGATE 5 3, 000, 000. GENT- AGGREGATE LINN! APPL POLICY (-�' j 7ECPRO T _ IES -- _ PER LOC PRODUCTS -COMP/OPAOG 3 1,000,000 AUTOMOBILE_ LIABIL IIY -- ANYAUTO ALL OWNED AUTOS --ISCHEDULED AUTOS I I TIRED AUTOS NON-OWNED AUTOS II COMBINED SINGLE LIMIT (Ea accident) 3 BODILY INJURY (Per person) (P BOrrarcidenU INJURY S �. PROPERTY DAMAGE (PeraccidenCl GARAGE LIABILITY ANY AUTO 0 AUIOONLY- ILA ACCID[N1 S OTHER THAN EA ACC AUTOONLY AGO 1 EXCESS/UMBREI I A LIABILITY OCCUR --1 DEDUCT IP,LE i RETENTION $ CLAIMS MADE 1 EACH OCCUP,RENCL R 5 ?, AGGREGATE WORKERSCOMPEN.SATION AND EMPLOYERS LIABILITY ANY PROPRIETOR'PARTNERL XLCUTIvb OF ICCRT4EMBER EXCL MIN, If yes, describe under SPECIAL PROVISIONS below '� ORYTATUVLIMIIS LTOR CNH ER 5 E,L EACH ACCIDENT E.L. DISE-ASE - FA EMPLOYE[ E.L. DISEASE - POLICY LIMI1 — 3 1 OTHER ' DESCRIPTION OF OPERATIONS / LOCATIONS r VF HICLES/ EXCI USIONS ADDED BY ENDORSL-MENI / SPECIAL PROVISIONS ADDITIONAL INSURED: DESCHUTES COUNTY, ITS OFFICERS, AGENTS, EMPLOYEES, AND VOLUNTEERS CERTIFICATE HOLDER CANCELLATION Deschutes County 1130 NW Harriman St Bend, OR 97701 SHOULD ANY OE THE ABOVE DESG1113ED POLICIES RE CANCE1 I_ ED 131)51111 1HE L XPIR 11rTN DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR 10 MAIL DAYS WR '11N NOnCE TO I IE CERTIFICATE HOLDER NAMLD 10 THE LEI 1, BUT FAIE_UHL 10 DO S0 SI 4L. IMPOSE NO OBLIGAI ION OR LIABILITY OF ANY KIND UPON THE INSURER, 11 S AGI -[TES '11 REPRESENTATIVES_ AIJTHORILI=D REPRESENTATIVE ACORD 25 (2001 /08) ©ACORD CORPORATION 19 18 ! i4L Jfu,M CtK I It-ICA-FE -IF LIABILITY INSURANCE12/22/2 )09 PRODUCER TRIA, INC . 644 NE Greenwood Ave. Ste. 1 THIS CERTIFICATE IS ISSU1 5 A MATTER OF INFORMATION ONLY AND CONFERS NO 1-uGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELON, Bend, OR 97701 (541) 382-9111 INSURERS AFFORDING COVERAGE NAIC# INSURED Pfeifer and Associates, Inc INSURER A'. Truck Insurance Exchange INSURER R 23 NW Greenwood Ave. iNsuRER C. Bend, OR 97701 INSURER D- I INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR yI[�' DDRL LTR INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE IMMEDD/YY1 I POLICY EXPIRATION I DATEIMM/DD/YY1 LIMITS A GENERAL LIABILITY EACH OCCURRENCE s 2,000, ) 0 0 X COMMERCIAL GENERAL LIABILITY ED DRPREMISMIS 10 RLN IES (Ea occurencc) $ 100, ) 00 CLAIMS MADE X I OCCUR MED EXP (Any one person) $ 5, )00 035059841 06/11/09 i 06/11/10 PERSONAL &ADV INJURY $ 2,000, )00 GENERAL AGGREGATE $ 4,000, ) 0 0 _ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2 , 0 0 0, ) 00 . POLICY I 1 SCOT LOC ( AUTOMOBILELIABILITY — ANY AUTO 4 COMBINED SINGLE L11,91T (Ea accident) — ALL OWNED AUTOS SCHEDULED AUTOS, I BODILY INJURY (Per person) $ $ HIRED AUTOS NON -OWNEDAUTOS BODILY INJURY (Peraccident) PROPERTY DAMAGE $ (Peraccidenl) GARAGE LIABILITY AUTOONLY-EA .ACCIDENT $ . ANYAIJTO EA ACC OTHER THAN 5 - _- — AUTOONLY. AGG ,. 5 EXCESSUMBRELLA LIABILITYi EACH OCCURRENCE 5 !-- OCCUR I CLAIMS MADE AGGREGATE 5 $ I DEDIIC1IBI_E 5 —11 I1ETE1TT ION 5 $ WORKERSCOIJIPENSATION AND WCSTATU I TORYLIMITS OER ER. $ EMPLOYERS LIABILITY ANY PROPRIETOR,'PAR r�uERE XDC;III I VL EL_ EACH ACCIDENT OFFICER/MEMBER EX( uOED, E.L. DISEASE - EA EMPLOYEE 5 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT 5 OTHER DESCRIPTION OF OPERATIONS! I_GCAT IONS; VEHICLES ! EXCLUSIONS ADDED BY ENDORSE MENT i SPECIAL PROVISIONS 23 NW Greenwood Ave., Bend, OR 97701 16440 Finley Butte, La Pine, OR 97739 544 SW 4th St., Redmond, OR 97756 164 NE Greenwood Ave, Bend, OR 97701 19 SW D St, Madras, OR 97741 CERTIFICATE HOLDER Deschutes County CANCELLATION SHOULD ANY OF 111E ABOVE- 11E50818ED POLICIES BE CANCELLED BE=FORE THE EXPIRA 104' DATE 1555-1LEOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS 55 1 R N r.101 ICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFL BUT FAILURE TO DO SO X11 I IMPOSE NO 011I ICATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS REPRESENTATIVE S. AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) © ACORD CORPORATION 19£ 3 STATE OF OREGON DEPARTMENT OF HUMAN SERVICES ADDICTIONS 4: MENTAL HEALTH T TVISION CERTIFICATE OF APPROVAL signifies that Pfeifer and Associates 23 NW Greenwood Bend Oregon 97701 i.q in Albstantial chmplianaweitli the following Oregon Administrativf Ruie9 • OAR 415-051-0000 through 415-051-0065; OutpatientAlcohol & Drug Treiit»ieatt services; 6 OAR 415.0514136; DUDE Rehabilitation services; 6 OAR 415-054-0005 through 415-054-0040; DUI' Information services; • OAR 415-055-0000 through 415-055-0035; Restricted Driving 'Accuse sen iict: ,Date: Expires: 4ir si 30, 2011_ DePzety . ssista e: Director POLICY CHANGE ENDORSEMENT NO. 1 THIS ENDORSEMENT CHANGES THE POLICY - PLEASE READ IT CAREFULLY Company: Policy Number: Policy Change Effective Date: Named Insured: Underwriters at Lloyds, London NA0969279540 11/21/2009 Pfeifer & Associates Inc Coverage Parts Affected: Professional Liability It is hereby understood and agreed that the MM 413 CM&R Ed 0305 — Additional Insured - Designated Person or Organization Endorsement in deleted in its entirety and replaced by the attached. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. DATE OF ISSUE: January 20, 2010ltms By: ADDITIONAL INSURED DESIGNATED PERSON OR ORGANIZATION It understood and agreed that Policy SECTION Ill — WHO IS AN "INSI IRFD" R is amended to include \� is VI\VIA JIVVV 1 . . ..• WFin .� ... .... .__ as an "Insured" the person or organization shown below as an "Insured" but only with respect to liability arising out of your operations or premises owned by or rented to you. Name of Person or Organization: Deschutes County, its Officers, Agents, Employees and Volunteers 63360 Britta Street Bend, OR 97701 Deschutes County Health Services 2577 NE Courtney Drive Bend, OR 97701 All other terms and conditions remain unchanged. Attached to and forming part of Policy No. NA0969279540 of Underwriters hereon. Effective Date: November 21, 2009 Insured: Pfeifer and Associates, Inc. MM 413 CM&R Ed 0305 For and on behalf of Underwriters: U.S. Risk Underwriters 6 panda11(:.(:.\s.(1 u,uiwu('fol) By: (Authorized Representative) MAR -09-2010 TUE 03:5l F't LNW Fit FAX Na s00 607 0719 ` 71 V "L.=6-- � 5f 5 - 3" WORKERS COMPENSATION AND EMPJ_oYERS LIABILITY INSURANCE POLICY 502070S01WC RENEWAL AGREEMENT -INFORMATION PAGE This information page sUpersodes elny previous Information pages ATTACH TO YOUR CURRENT POLICY Entity Type: INDIVIDUAL/SOLE PRPPRIETOR Policy No.: WC4-3NC-$0Rn75^1114 Prior Policy No.: WC4--eNC:-502670-111 a 1. The insured: SALLY F1 IMI DBA; PFEIFER AND AsSoetATEs MaiUnpAddress. 23 NW RREENW000 AVE RENO OR 97701 P, 0 vvc0000c� (Ed 14 t) FEIN: 931264865 Risk ID No.: alio Suffix: SO 1 Outer workplaces not shown above: 817 cW cJCADE,REDMOND OR 07756 51470 HWY 97 Num 3A,LA PINE OR 47734 2. The policy period is from i' to a /01/2010 12:01 a,rn. standard time et the addra:ws of the Insured as stated above. 9/24/09 3 A. Workers Cornponsatlon Insurance: Part One of the policy applies to the Workers Compensation Law of the stales listed here: OR B, Employers Liability Insurance: Part Two of the policy applies to work in each stele risted in i{t*m 3A. The limits of our liability under Fart Two ore: Bodily Injury by Accident aactily Injury by Disease Bodily injury by 17rsease $50Q,o00 aacl>taccident $6130 ,000 policy limit C500 ,000 each employee C. Other States Insurance: Part Three of the policy tippflos to the stoics, If any, rented hors: Nano D. This policy includes these endorsements and schedules: (See Elctension of information Page - Item 3D) 4. Tho prflmium for this policy will be determined by aur Manuals of Rules, Classifications, Rates, and Rating Plans. Ali information shown on the attached Extdnsfon of Information Pogo -- Item 4 is st:taj4=t to $led. cane.^. end change by aui Minimum Premium: 269 Deposit Premium: 1 ,4313 Total stirnated Policy Premium: S2,A82 Reporting Frequency: semi-annually SeNteing/Issuinp Office: PORTLAND A/R Producnr: INSURANCE CENTER Liberty Northwest Insurance Corporation t ant INSURANCE.CENTER 62940 O.R. RILEY RD STE Irl SEND OR 97701 7/02/2009 EFS :ms Countersigned By: 7 O xt�sr Lr+g1;i, Vice President and Secretary Liberty Northwest IdnnbarnrtlperyMPIP' :,09 WORKERS COMPENSATION AND =MPLOYERS LIABILITY INSURANCE POLICY WC o0 DC 02 502076S02WC (Ed 1 04) RENEWAL AGREEMENT -- INFORMATION PAGE This information page supersedes any previous information pages ATTACH TO YOLIR CURRENT POLICY Entity Type: 1 ND 1 V 1 DUAL /SOLE PROPRIETOR Policy No.: W=4-3NC-5 0207 6-0 10 Prior Policy No.: WC4-3NC-502076--019 1. The Insured: SALLY PFE I FER ORA: PFEIFER AND ASSOCIATES Mailing Address: 23 NW GREENWOOD AVE BEND OR 97701-2078 FEIN: 931254685 Risk ID No.: MO Suffix: S02 Other workplaces not shown above: 517 SW CASCADE,REDMOND OR 97756 51470 HWY 97 NUM 3A,LA P1NE OR 97734 2. The policy period is from 0101/2010 to 9 /01/2011 12:01 a.m. standard time at the address of the insured as stated above. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: OR B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in hem 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident Bodily Injury by Disease Bodily Injury by Disease $500 ,000 each accident $500,000 policy limit 9600 1000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: For residual market policies, the Oregon Residual Market Limited 0/her State Insu ance Endorsement -WC 36 03 05 replaces Part Three -Other States Insurance of the policy, D. This policy includes these endorsements and schedules; (See Extension of Information Page Item 3D) 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates, and Rating Plans. All information shown on the attached Extension of Information Page -- Item 4 is subject to verification and change by and L Minimum Premium: 256 Deposit Premium: 1,293 Total Estimated Policy Premium: $1,854 Reporting Frequency: Semi-annually Servicing/issuing Office: PORTLAND A/R Producer: INSURANCE CENTER Liberty Northwest Insurance Corporation cc: INSURANCE CENTER 62940 0.B. RILEY RD STE #1 BEND OR 97701 OCCOM 6/17/2010 EFS ;ms Countersigned By: Dexter Legg, 1103-30 Vice President end Secretary Liberty Northwest. Mrtmbw of nutty Mttual G '.)up WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY 502076S02WC 1NC 00 D( 04 (Ed. 1 04) EXTENSION OF INFORMATION PAGE - ITEM 4 Page 1 Classification of Operations . Code No. Estimated Remuneration Rate Per $100 of Remuneration Estirnatr 1 Premiur i OREGON — 36 — 1 SALLY PFEIFER wCD# - 656 [ 5D21 .23 SCHOOL—PROFESSIONAL EMPLOYEES—a CLERICAL 0868 300,900 ,57 2,016 2,616 Merit Rating (.90) $500 Max: 9885 —2]2 Non—Exp Rated Cd't (.09) $500 Max: 9041 —270 Terrorism Premium 9740 300,900 ,07 30 Catastrophe Promium 9741 300,900 .01 a_ Entity estimated premium: 1,674 Estimated prflmium: 1,E74 Exponso constant: 0900 190 1,E54 InSUfEd; SALLY PFE I FER 000001 611717.010 EFS ms Policy No: wc4--3N0--502075.-rJ 10 Liberty Northw ;st, h1cM��r o!Illitny Aii ,,, it Erne WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY 502076so2WC WC 00 0( 05 (Eci, 1- D4) EXTENSION OF INFORMATION PAGE -- ITEM 4 MISCELLANEOUS VALUES Descri tion of Charge Code No, Rite Estimated Char9 STATE ASSESSMENTS AND SURCHARGES: OR Insurance Guaranty Association Surcharge 9682 ,0000% D OR IVCD Premium Assessment l 9a65 4.0000°4 96 InsurEd: SALLY PFE I FER 000 005 6/17/2D1D EFS ms Policy No: WC4-3NC-402076-•010 Liberty Northwes \krr hoof hibi-rry Mkm 1 Cimur WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY sO�n�GSn7WC WC000I03 (Ed. 1 04) EXTENSION OF INFORMATION PAGE -- ITEM 3D Form No.: A.nnlir_ahje State 5: WC WC WC UiC WC WC We WC wc wc WC WC WC WC WC 000308 000406 000414 000421'C 000422A 360301 360305 360306 360401 36D405A 300406 360407 360601E 9906046 990644 PARTNERS, OFFICERS AND OTHERS EXCLUSION PREMIUM D I SCOUNT NOTIFICATION OF CHANGE IN OWNERSHIP CATASTROPHE (OTHER THAN ACTS QF TERRORISM) PREMIUM TERRORISM R I SK INSURANCE REAi.JTI IOfl I ZAT I ON ACT D I Sr LOSURF' OREGON UNSAFE EQUIPMENT EXCLUSION OREGON RESIDUAL. MARKET LIMITED OTHER STATES INSURANCE OREGON LIMITS OF LIABILITY OREGON MERIT RATING OREGON SIMPLIFIED ASSIGNED RISK ADJUSTMENT PROGRAM OREGON PREMIUM DUE DATE ASSIGNED RISK LOSS SENSITIVE RATING PLAN OREGON CANCELAT ION OREGON MEDICAL REIMBURSEMENT OREGON CONFIDENTIAL_ RECORDS OR OR OR OR OR OR OR oR OR OR OR OR OR OR OR lnSured; SALLY PFE I PER 1403 6/17/2010 EFS :m policy No: WC4-5NC-502076••010 Liberty Northwest Mcmhcr of 1.focrty itucmI t,lniq, ACOR®n' CERTIFICATE OF LIABILITY INSURANCE 8/5/2010 PF.ODUCE-R TRIA, INC 644 NE GREENWOOD AVE SUITE 1 BEND, OR 97701 541-382-9111 INSURED Pfeifer and Associates I 23 NW Greenwood Ave Bend, OR 97701 THIS CERTIFICATE IS ISSUED AS A MATTER OF NFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE MAIC# INSURER A: Truck Insurance Exchange INSURER B: INSURER C. INSURER 0: INSURER E: V THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY RFDUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY RE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AI L THE TERMS, EXCLUSIONS AND CONDITIONS 00 SUCH POLICIES, ADG REC_,A TF 1 IMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR MN) L LTR tHSRD TYPE OF INSURANCE POLICY NUMBER POLICY ErFEC1IVE DATE(MM/DD/YY) POLICYEXPIRATION DATE (MM'DD/YY) LIMITS ° - GENERAL LIABILITY EACH OCCURRENCE S 2,000,0)0 X COMMERCIAL GENERA_ LIABILITY UAMAGEIU}LENT EU PREMISES (Ea eccurence) $ 100,0)0 1 CJAIMSMADE r X I OCCUR MED EXP (Any one person) $ 5, 0 )0 A 035059841 06/11/10 06/11/11 PERSONAL &ADV INJURY $ 2,000,0)0 r--- _ GENERAL AGGREGATE S 4,000,0)0 AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/CP AGG $ 2,000,0)0 GENS_ ��_� POLICY - _1 JFCI 1 LOC AUTOMOBILE LIABI Ill Y COMBINED SINGLE LIMIT $ ANYAUTO (Ea accident) ALL OWNED AUTOS— BODILYINJURY SCHEDULED ATOS (Porpertnn) HIRED AUTOS BODILY INJURY YON-O'W'NLDAUTOS (f'craccident) PROPERTY DAMAGE (Peraxident) GARAGE LIABILITY AUTO ONLY EA ACCIDENT $ ANYAUTO OTHER THAN EA ACC $ — AUIOONLY: AGG 0 f EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ _ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ 0 WORKERS COMPENSATION AND I WCSTATLF OTR TORYL[M1TS ER EMPLOYERS LIABILITY ANY PROPRIETORJPARTNENEXLCUTIVE E.L. EACH ACCIDENT $ oFFICCEEEMBEH EXCLUDED? E.L. DISEASE EA EMPLOYEE $ 11yes,describeunder ' E.L DISEASE - POLICY LIMIT —"""--"-- $ SPECIAL PROVISIONS below OTHER DESCRIPTION OE OPERATIONS/ LOCATIONS / VEHICLE.; / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS i 23 NW Greenwood Ave., Bend, OR 97701 16440 Finley Butte Rd., La Pine, OR 97739 544 SW 4th St., Redmond, OR 97756 164 NE Greenwood Ave., Bend, OR 97701 19 SW D St., Madras, OR 97741 CERTIFICATE HOLDER Deschutes County Health Services 2577 NE Courtney Dr. Bend, OR 97701 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TI1- EXPIR TION DATE THEREOF, TBE ISSUING INSURER WILL ENDEAVOR TO MAIL 3Q_.. DAYS WE [TEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LETT, BUT FAILURE TO 00 SO S. A._ IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENT`. O/1 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD25(2001/08) ©ACORD CORPORATION 1 88 ACQRDn, CERTIFICATE OF LIABILITY INSURANCE ) 8/5/2010 PRODUCER TRIA, INC 644 NE GREENWOOD AVE SUITE 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. BEND, OR 97701 541-382-9111 INSURERS AFFORDING COVERAGE NAIC# INSURED PFEIFER AND ASSOCIATES INC .11._ `N INSURER n: °`"ITE"' AT LLo1G5 OP Lam, "s RIsIC INC INSURER B: 23 NW GREENWOOD AVE INSURER G: BEND, OR 97701 INSURER 0: 1 1INSURER 5: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TI-IE INSURED NAMED ABOVE FOR. THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM CR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WH(CI1 THIS OFRTIF,CATE MAY RC ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS 00 SUCH HAVE BEENREDUCED BY PAID Cl AIMS POLICIES -At�unGVATC. i,iiv;,,,�,�!OWN ivv.Y i,. -� INS11 NDIX4 orn NSW) TYPE OH IN`.IIRANCE POLICY NUMBER PO� L_(CO-EFFECTIVE DAT E(MMIOD/YY) POLICY EXPIRATION ! DAIL(MM'DD: Y) LIMITS GENERAL I !ABILITY EACH OCCURRENCE $ 1, 0 0 0, 0 )0 X COMMERCIAL GENERAL LIABILITY DAMAGE I0 RENTEIf— PREMISES Ea oceurence) $ 50,0 ) O X CLAIMSMADC [X II OCCUR MED EXP (Any oneperson) $ 1 A NA0969279540 11/21/09 11/21/10 PERSONALSADVINJURY 5 PROFESSIONAL GENERAL AGGREGATE S 3,000,0)0 GEYL AGGREGATE LIMIT APPLIES PER: POLICY �__ LPRO JCCT I [00 PRODUCTS- COMP/OP AGG 1 , 0 0 0 , 0 ) 0 AUTOMOBILE: (ABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) ALL OWNED AUTOS SCHEDULED AUTOS BODILYINJURY (Perpersron) HIRED AUTOS NON-OWNEDAU FOS B0DILYINJURY (PeraccIdent) $ PROPERTY DAMAGE (PcracoaeM) 5 GARAGELIABILITY A11100NLY EA ACCIDENT S ANY AUTO OTHERTIIAN EA ACC 5 -... .. AUTOONLY: AOG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE 5 I ,_I OCCUR I CLAIMSMADE AGGREGATE 5 --- ---- 1$ DEDUCTIBLE- — -' ------ - I 5 WORKERSCOMPENSATIONAND RETENTION $ - II WCSYRI`L1 T07H `TORYLIMI IS FH S. EMP! DYERS' I IABILIIY ANY PROPRIE70RPA RTNEWEXEC' E.L. EACH ACCIDENT S OrrlCr-VMEr DER EXCLUDED, E.L. DISEASE EA EMPLOYEE $ Ilyycs,desoribeundor SPECIALPROVISIONSESow - E.L. DISEASE- POLICY LIMIT $ OTHER DESCRfPT{ON OEOPFRATIONS /I OCA I IONS/ VEI-[ICLES/ EXCLUSIONS ADDED SY ENDORSEMENT /SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION Deschutes County Health Services 2577 NE Courtney Dr. Bend, OR 97701 SHOULD ANY OF THE ABOVE DFSCHIBED POLICIES BE CANCELLED BECORF THE EXPIS TION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS VJF !TSN NOTICE TO THE CEIITIOCATE 001 DER NAMED TO IHE LEFT, BUT FAII-LIRE TO 00 S? L :ALI IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THF INSURER, ITS AGENT OP REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD25(2001/08) UACORD CORPORATION 108 POLICY CHANGE ENDORSEMENT NO. 1 THIS ENDORSEMENT CHANGES THE POLICY- PLEASE READ IT CAREFULLY Company: Policy Number: Policy Change Effective Date: Named Insured: Underwriters at Lloyds, London NA0969279540 11/21/2009 Pfeifer & Associates Inc Coverage Parts Affected: Professional Liability It is hereby understood and agreed that the MM 413 CM&R Ed 0305 — Additional Insured - Designated Person or Organization Endorsement in deleted in its entirety and replaced by the attached. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. DATE OF ISSUE: January 20, 2010Rms By: ADDITIONAL INSURED DESIGNATED PERSON OR ORGANIZATION It is understood and agreed that Policy SECTION HI — WHO IS AN "INSURED" B. is amended to include as an `Insured" the person or organization shown below as an "insured" but only with respect to liability arising out of your operations or premises owned by or rented to you. Name of Person or Organization: Deschutes County, its Officers, Agents, Employees and Volunteers 63360 Britta Street Bend, OR 97701 Deschutes County Health Services 2577 NE Courtney Drive Bend, OR 97701 All other terms and conditions remain unchanged. Attached to and forming part of Policy No. NA0969279540 of Underwriters hereon. Effective Date: November 21, 2009 Insured: Pfeifer and Associates, Inc. MM 413 CM&R Ed 0305 For and on behalf of Underwriters: U.S. Risk Underwriters 6 i-nulali C. i:Ixa (7w loan( A) By: (Authorized Representative)