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01/16/2013 ContractAMY HEA VIL IN, CPA CLERK OF THE CIRCUIT COURT DATE: January 31, 2013 TO: Pam Pumar, Administrator Human Resources Division FROM: Pamela G. HancaFk, C. At the January 16, 2013, Board of County Commissioner's meeting the Board granted approval and authorized execution of Item C2 an agreement with Upper Keys Specialty Physicians, LLC and Mariners Hospital, Inc. to perform applicant and employee drug screens. Enclosed is a duplicate original and a copy of the above - mentioned for your handling. Should you have any questions, please feel free to contact my office. cc: County Attorney w/o document Finance File/ Contract for Medical Services Monroe County and Mariners Hospital 1 - Purpose: Monroe Country ( "MC ") requires drug testing for its employees. Upper Keys Specialty Physicians, LLC, a Florida limited liability company and Mariners Hospital, Inc., a Florida not - for - profit corporation (collectively "Mariners Hospital ") are qualified and willing to provide to those services contained on the attached Exhibit A titled "Medical Services Provided by Mariners Hospital and Fees for Service ". Each of the entities comprising the defined term "Mariners Hospital" shall be severally liable for its own actions or omissions and there shall be no joint liability between either of the two entities. 2- Parties: Each of MC and Mariners Hospital are referred to as a party and collectively as the parties. This Contract states the terms of the agreement between the parties. The mailing address and points of contact for the parties are: Monroe County Ms. Pam Pumar Human Resources Administrator 1100 Simonton Street Key West, Florida 33040 Telephone: (305) 292 -4459 Mariners Hospital Mr. Eric D. Shatanof Corporate VP Managed Care, Network Development & Medical Management 6855 Red Road, Suite 600 Coral Gables, FL 33143 Telephone: 786 - 662 -7017 Facsimile: 786 - 662 -7334 3 -Term: The term of this Contract is annual beginning as of the Effective Day and automatically renewing for subsequent annual terms unless terminated according to section 4 of this Contract. This Contract is subject to annual appropriation by the Monroe County Board of County Commissioners. 4 - Termination for Convenience of the Parties: Either party may terminate this Contract for any reason after providing sixty (60) days advance written notice to the other party. 5- Services and Fees: A list of the services Mariners Hospital agrees to provide, and the fees MC agrees to pay for each service, is contained on the attached Exhibit A titled "Medical Services Provided by Mariners Hospital and Fees for Service." 6- Invoicing And Payment: MC shall pay Mariners Hospital for services provided pursuant to this Contract. All invoices will be paid in accordance with the Florida local Government Prompt Payment Act. 7 - Representations of Mariners Hospital A -Audit trail: Mariners Hospital agrees to maintain and make available records, consistent with all patient confidentiality and privacy laws, sufficient to permit a proper audit of its performance of this Contract. B- Debarment: Mariners Hospital represents that it has never had a contract, bid or proposal rejected, suspended, or cancelled due to any allegation of a failure to comply with any federal, state or local government law or regulation regarding competitive bidding or auditing or accounting standards. C — Insurance: Mariners Hospital represents that all physicians providing services under this Contract are in compliance with the laws of the State of Florida regarding financial responsibility to pay claims and costs ancillary thereto arising out of the rendering of, or the failure to render, medical care or services. Mariners Hospital will not reduce the level of its existing malpractice coverage during the term of this Contract. 8- Prohibition Against Assignment: Neither party shall assign all or any portion of its duties or rights under this Contract without the prior written consent of the other party in its sole and absolute discretion. 9- Independent Status: Mariners Hospital is an independent contractor. Neither it nor any of its personnel are employees or agents of MC. Neither Mariners Hospital nor its personnel will make any statement or representation on behalf of MC. 10- Paragraph Headings Not Dispositive: The parties agree that the headings given the paragraphs and other subdivisions of this Contract are for ease of reference only and are not dispositive in the interpretation of Contract language. 11 -No Presumption Against Drafter: The parties agree that this Contract has been freely negotiated by both parties, and that, in any dispute over the meaning, interpretation, validity, or enforceability of this Contract or any of its terms or provisions, there shall be no presumption whatsoever against either party by virtue of their having drafted this Contract or any portion thereof. 12- Governing Law and Venue: This Contract shall be construed, interpreted, and governed by the laws of the State of Florida. Venue for any litigation arising out of this Contract will be in Monroe County, Florida. 13- Entire Agreement: This Contract expresses the complete and final understanding of the parties hereto, that any and all negotiations and representations not included herein or referred to herein are hereby abrogated and that this Contract cannot be changed, modified or varied except by a written instrument signed by all parties hereto. There are no "private" or "side agreements." 14- Authority of Signatories: The persons signing this Contract represent that they authority to bind their principals to its terms. 15- Ethics Clause: Mariners Hospital warrants that it has not employed, retained or otherwise had act on his /its behalf any former County officer or employee in violation of Section 2 of Ordinance No. 10 -1990 or any County officer or employee in violation of Section 3 of Ordinance No. 10 -1990. For breach or violation of this provision the County may, in its discretion, terminate this contract without liability and may also, in its discretion, deduct from the contract or purchase price, or otherwise recover, the full amount of any fee, commission, percentage, gift, or consideration paid to the former County officer or employee. UNDERSTOOD AND AGREED TO THIS DAY OF DECEMBER, 2012 ( "Effective Date "). MARINERS HOSPITAL, INC. Authorized Representative D « P. 540�wc &, V/- Printed Name and Title V'X Witness L I��ZI�ZI 1I : 1: 11 1 1 • 1 A CO&ISS;ERS � BY Authorized Representative p Printed Name an4 Title J Witness UPPER KEYS SPECIALTY PHYSICIANS, LLC B Y Authorized Repr sentative &- D. Printed Name and Title l/ Witness �,) c. �r (SEAL) W MEA LIN, CLERK �ZX N O r.• L a. a 9 0 cn MONROE COUNTY ATTORNEY A �OV AST F RM' NTHIA L. ALL ASS IST AT COUNTY ATTORNEY Date ---i— "�— CLk IiW r rn CD - 0 .N M C 0 Exhibit A Medical Services Provided by Mariners Hospital and Fees for Service Dr. Lawyer will provide the below services during normal business hours of 8:30 a.m. to 3:30p.m., Monday thru Friday (walk -ins will be accepted if an appointment cannot be reasonably scheduled) and the services will be compensated in the amounts listed below: SERVICES REIMBURSEMENT 10 panel State Requirement Drug Screen (Collection of urine, urine drug analyses, and Medical Review Officer "MRO" review,) $95.00 per test 5 Panel Department of Transportation Requirement Drug Screen (Collection of urine, urine drug analyses, and MRO review) $95.00 per test Blood Alcohol Test (Blood draw, blood drug analyses, and MRO review) $95.00 per test PRODUCER 345 -949 -7988 MARSH MANAGEMENT SERVICES CAYMAN LTD. 23 LU% TREE BAY AVENUE GOVENORS SQUARE, BUILDING 4,2" FLOOR PO BOX 1051 GRAND CAYMAN KV1 -1102 CAYMAN ISLANDS wSURED Baptist Health South Florida, Inc., Baptist Hospital of Miami, Homestead Hospital, Mariners Hospital, South Miami Hospital, Doctors Hospital, Baptist Health Enterprise and Baptist Outpatient Services, West Kendall Baptist Hospital 6855 Red Road, 5th Floor Coral Gaffs, FL 33143 Attn: Paiqe Slone �_�e�lwvrRUSr«_sNws "'j, 1124/2013 IS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RK ON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER IVERAGE AFFORDED BY THE POLICIES BELOW. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSULTED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING AN REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDE BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_ LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS- LCTR TYPE OF INSURANCE POLICY NUMBER O CYM FFECTIV } DATE Y Lam GENERAL LIABILITY GENERAL AGGREGATE CO ILI MMERCIAL GENERAL LIABTY PRODUCTS - COUP/OP AGO. S CLAMS MADE r7—.R. PERSONAE- 6 ACV. INJURY ONMEWS 6 CONTRACTORS PROT EACH OGCU.E I I I FIRE DAMAGE V,,y are fiR} MEO. EXPENSE (Any Ora P—) COMPANIES AFFORDING COVERAGE COMPANY PINEAPPLE INSURANCE COMPANY, LTD - A COMPANY BODILY INJURY (per P_) B COMPANY BODILY INJURY (Per --i- ) C COMPANY PROPERTY DAMAGE D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSULTED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING AN REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDE BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_ LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS- LCTR TYPE OF INSURANCE POLICY NUMBER O CYM FFECTIV } DATE Y Lam GENERAL LIABILITY GENERAL AGGREGATE CO ILI MMERCIAL GENERAL LIABTY PRODUCTS - COUP/OP AGO. S CLAMS MADE r7—.R. PERSONAE- 6 ACV. INJURY ONMEWS 6 CONTRACTORS PROT EACH OGCU.E I I I FIRE DAMAGE V,,y are fiR} MEO. EXPENSE (Any Ora P—) Evidencing coverage is in effect. Coverage is subject tD all policy terms, conditions and deductibles. Monroe County BOCC Human Resources Administrator 1100 Simonton Street Key West, FL 33040 NY TIP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE =RA:DN DAT THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 32 DAYS WR TO TH rE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE N N OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. &%ak 06#ge*W Sewim Csyxc" Ltd. ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT BODILY INJURY (per P_) BODILY INJURY (Per --i- ) PROPERTY DAMAGE GARAGE LIABILITY ANY AUTO .. AUTO ONLY - EA ACCIDENT S OTHER THAN AUTO ONLY ...... ... EACH ACCJSEN AGGREGA EXCESS LIABILITY UMBRB2A FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE AGGREGATE WORKER'S COENSATIOKANO EMPLOYER'S LIABILITY MP THE PROPRIETORI ETiCL PARTN£RSIFXECUTIVE OFFICERS ARE g EXO- W STATU- TORY LMETS OTH £R EACH ACCIDENT DISEASE- POLICY LIMIT i DISEASE -EACH EMPLOYEE A OTHER HEALTHCARE PROFESSIONAL LIABILITY - CLAIMS MADE PIC 2012113 1011/2012 10112013 $1,500,000 AGGREGATE $1,500,000 EACH OCCURRENCE DESCRIPTIONS OF OPERATIONSn- OCATKM/SNELNCLESISPECIAL ITEMS Evidencing coverage is in effect. Coverage is subject tD all policy terms, conditions and deductibles. Monroe County BOCC Human Resources Administrator 1100 Simonton Street Key West, FL 33040 NY TIP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE =RA:DN DAT THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 32 DAYS WR TO TH rE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE N N OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. &%ak 06#ge*W Sewim Csyxc" Ltd. ACORI:X CERTIFICATE OF LIABILITY INSURANCE DAT 1/24/2012�� CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Aon Risk Services, Inc. of Florida CO NTACT NAME: PHONE Exe : 800- 743 -3486 ac No : 305- 372 -8018 1001 Brickell Bay Drive E ^ CN A Suite 1 100 ADDRESS: EACH OCCU RRENCE $ INSURERS AFFORDING COVERAGE NAIC i Miami, FL 33131 INSURER A: Samaritan Risk Retention Group 12511 INSURED INSURER B: $ INSURER C: Baptist Health Medical Group INSURER D: c/o Sandra Perez 6855 Red Road, Ste 200 Miami FL 33143 INSURER E: PERSONAL 8 ADV INJURY $ INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM /DD/YYYY POLICY EXP MM /DD /YYYY LIMITS GENERAL LIABILITY EACH OCCU RRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ CLAIMS -MADE 11 OCCUR MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ POLICY F7 PRO- LOC I I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Paraccident $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y/ N TORY LIMIT E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ NIA E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ Per Claim $250,000 A Professional Liability N N SPL1062 6/18/2012 6/18/2013 Aggregate $750,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Coverage includes Professional Liability on a Claims Made Coverage Form. Coverage is provided on a "scope of duties" basis while working for and/or on behalf of Upper Keys Family Medicine Steven Lawyer, DO - Retro Date: 10/16/2006 CERTIFICATE HOLDER CANCELLATION © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Monroe County, BOCC ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Simonton Street AUTHORIZED REPRESENTATIVE Key West FL 33040 AON RISK SERVICES © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD