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HomeMy WebLinkAboutPD04-277 - Original - Valley Medical Center - Corrections Facility Medical Services - 07/01/2004 %eZcords MAO eme KENT Document W..9MINOTON CONTRACT COVER SHEET This is to be completed by the Contract Manager prior to submission to City Clerks Office. All portions are to be completed, if you have questions, please contact Mary Simmons, City Clerks Office. Vendor Name: r�t lIr UN'(� I ©�.��11� tZ. Contract Number: PP 0q' This is assigned by Mary Simmons Vendor Number: Project Name: da�& Contract Effective Date: (v Contract Termination Date: Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: 19fiA, &&ZC. Department: Abstract-��n ADCL7832 07102 -.000"' 000"0,4 KENT WASHINOTON CORRECTIONS FACILITY MEDICAL SERVICES AGREEMENT between the City of Kent and Public Hospital District No. 1 of King County, dba Valley Medical Center Occupational Health Services THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and Public Hospital District No. 1 of King County, dba Valley Medical Center Occupational Health Services, a non-profit municipal corporation organized under the laws of the State of Washington, located and doing business at 3600 Lind Avenue SW, Suite 170, Renton, Washington 98055 (hereinafter the "Vendor"). AGREEMENT I. Description of Work. Vendor shall provide comprehensive medical services for the City of Kent Corrections Facility ("facility") in accordance with this Agreement, any attachments incorporated herein, and the written policies and procedures developed to carry out the terms of this Agreement. In the event there is a conflict between the terms of this Agreement, the terms of the attachments or exhibits, and the terms of the written policies and procedures, the order of priority shall be this Agreement, the attachments or exhibits to this Agreement, and then the policies and procedures written to carry out the terms of this Agreement. II. Time for Performance. The work under this Agreement shall begin on or about July 1, 2004, and shall continue through December 31, 2006. This Agreement may be extended beyond the original term subject to the written agreement of the parties. III. Level of Service and Compensation. The City shall pay Vendor for services provided in accordance with the following: A. Staff - Level of Service and Hourly Rates. Staffing levels and hourly rates are set forth below. The staffing levels may be altered at the request of the City with thirty (30) days advance written notice to the Vendor. The Vendor shall provide the following level of service for staff on the days indicated and at the hourly rates indicated: ANNUAL HOURS POSITION 2080 Licensed Practical Nurse ("LPN") @ $28.691hr. 40 Hours per week Work performed Monday through Friday from 9:00 a.m. until 1:00 p.m., and Saturday and Sunday from 9:30 a.m. to 8:00 p.m. Total annual cost of$59,675.20 JAIL MEDICAL SERVICES AGREEMENT- 1 ANNUAL HOURS POSITION 2080 Registered Nurse ("RN") @ $48.65/hr. 8 hours per day, 40 hours per week Work performed Monday through Friday from 12:30 p.m. until 9:00 p.m. Total annual cost of$101,192.00 208 Physician's Assistant ("PA") @ $62.81/hr. 4 hours per week to be worked two (2) days per week in two-hour shifts. Total annual cost of$13,064.48 The total annual expense for Vendor staff at the above level of service and at the above hourly rates shall be $173,931.68. The hourly rates of the LPNs, RNs, and PAS may be increased by Vendor one time each year pursuant to an applicable labor contract or the policy of Valley Medical Center; provided, that such increase is given to all employees of Valley Medical Center that work within the class in which the employee who receives the increase works, and the City is provided thirty (30) days advance written notice of such increase; and further provided that such increase shall not exceed the increase negotiated by Vendor. B. Estimated Administrative Expenses. The Vendor shall provide the following administrative services: 1. On-call for telephone consultation with RN, PA, Medical Director, Jail Health Administrator or other doctor; 2. Billing, records management, storage, and scheduling; 3. Medical director oversight; and 4. Administrative oversight. These administrative services shall be provided at an annual rate of$39,878. C. Estimated Pharmacy and Supply Expenses. Pharmaceuticals shall be provided by Vendor and shall be billed to the City on a monthly basis. The Vendor shall take all reasonable steps to ensure that pharmacy and supply costs are kept to a minimum. Vendor shall bill the City only for actual pharmaceuticals and supplies utilized by the City. D. Cost Cutting Measures. Vendor recognizes the City's desire to cut costs and provide more efficient medical services for inmates. Vendor shall endeavor to keep costs to a minimum, and shall work with City staff to develop programs and protocols that reduce expenditures. Vendor shall work with JAIL MEDICAL SERVICES AGREEMENT-2 City staff to reduce the cost of prescription medloations, dental care, psychiatric care, administrative expenses, staffing expenses, etc. IV. Payment. The Vendor shaft submit payment invoices within fifteen (15) days of the conclusion of each month. The City shall provide payment within thirty (30) calendar days of receipt of an accurate invoice from Vendor. If the City objects to all or any portion of an invoice, it shall notify the Vendor and reserves the option to only pay that portion of the invoice not in dispute. In that event, the parties will immediately make every effort to settle the disputed portion. Payment invoices shall be accompanied by a report that contains the following information: 1. A monthly schedule and a summary of any deviations from the monthly schedule; 2. The number of inmates for whom Vendor staff performed service and the type of service provided; 3. The number of times hospital and off-site medical service was utilized; and 4. The type and cost of pharmaceuticals for each inmate. V. Medical Services. Vendor shall provide the medical services listed below. The medical services shall be provided in conformance with written policies and procedures agreed to by the parties. A. Assistance with intake screening as requested. B. Fourteen (14)day health appraisal. C. Sick call — Medical clinic. D. Telephone consultation services. E. Patient referrals — Specialty care - Hospital care - Ancillary services at a preferred rate and as agreed to by the parties. F. Emergency care when Vendor staff present. G. Palliative dental care. H. Pharmacy services. I. Mental health— Psychiatric services. J. Health education of inmates. K. Transfer of medical information. L. Medical records maintenance. M. Equipment and disposable medical supplies. N. Tuberculosis testing, Hepatitis B vaccines, and First aid services to facility staff. O. Detoxification monitoring and treatment. P. Reporting medical care needs to court when inmate in custody. Q. Reporting high cost or high risk medical care needs to facility commander. JAIL MEDICAL SERVICES AGREEMENT-3 VI. Program Support Services. A. Quarterly Meetings and Report. The Vendor and City shall meet on at least a quarterly basis. The parties shall discuss all matters relating to the provision of medical care at the facility, including but not limited to: 1. Policies and procedures; 2. Medical staffing; 3. Pharmaceutical dispensing and costs; 4. Costs of medical care at the facility; 5. Manners in which cost savings and time efficiency can be achieved; 6. The number of inmates served the previous quarter; 7. Any reports filed or required of Vendor; 8. Off-site referrals (utilization and review); 9. Recovery of costs from the inmates; 10. The manner in which medical care at the facility can be improved; and 11. Medical Audit as provided by this Agreement. Summary minutes of all meetings shall be prepared and maintained by Vendor and distributed to attendees with copies retained for future reference. Vendor shall prepare and participate in external reviews, inspections, and audits as requested and shall participate in the preparation of responses to critiques. Vendor shall develop and implement plans to address/correct identified deficiencies. A quarterly report shall be prepared by the Vendor that contains all of the items listed in 1-11 above. The quarterly report for the preceding quarter shall be due on April 30, July 31, October 31, and January 31 of each year. B. Annual Report. An annual report shall be submitted by the Vendor no later than January 31 of each year. The annual report shall provide a synopsis of the information set forth in the monthly and quarterly reports for the year prior. C. Medical Audit. Vendor will randomly review charts monthly for practice issues and patient outcomes. Vendor will deliver the results of these audits via the quarterly report. The City reserves the right to perform regular chart review by independent physicians of outpatient and inpatient medical records to determine whether the appropriate level of medical care is being provided. JAIL MEDICAL SERVICES AGREEMENT-4 D. Infection Control. In cooperation with the local health department, Vendor will develop a program to prevent and monitor incidents of communicable disease. Data will be collected that records the incidents of communicable disease at the facility. The program, and all reporting of infectious diseases, shall consider the guidelines set forth by the Centers for Disease Control (CDC), Occupational Safety & Health Administration (OSHA) regulations, the Washington Industrial Safety & Health Administration regulations (WISHA), and all other applicable state and federal laws. E. Policy and Procedures. Policy and procedures will be developed, maintained, and reviewed annually by Vendor in cooperation with the City for all aspects of the health care delivery system. These documents will be in compliance with community-wide standards and state statutes. Any variance from these policies and procedures must be approved by the City in writing. The initial policies will be developed within 30 days of signing this Agreement. F. Utilization Review. Vendor shall review all charges from outside vendors for accuracy and appropriateness prior to reimbursement. G. Credentialing. Vendor staff shall, at all times, have current state licenses and current certification in CPR. All staff attest that they have never had their professional license revoked. Copies of current professional licenses shall be kept on file with the facility commander. H. Accreditation. Vendor will cooperate with the City in the event the City seeks accreditation. 1. Disaster Plan. Vendor shall, in conjunction with the City, develop procedures for disaster preparedness in the event of a natural or man-made disaster. The plan shall establish a response procedure for: (1) dealing with simultaneous injuries or illness to a large number of inmates; or (2)the medical or pharmaceutical needs of inmates upon release from the facility in the event an evacuation of the facility is necessary. The disaster plan shall be coordinated with Valley Medical Center, Auburn General Hospital, and any other local medical facilities that would be utilized in the event of a disaster. J. Inmate Co-Pay. Vendor shall cooperate with the City in the event the City institutes a system for the collection of an inmate co-pay. K. Development of Information for the Collection of Inmate Co-Pay. For a complete one month period, Vendor shall keep a log and provide a monthly report to establish the amount of co-pay that the City may charge. The following information shall be recorded in a monthly log and shall be provided on a quarterly basis. 1. The number of patients seen by the Vendor; 2. The amount of time that each patient is seen (this can be reduced to an average for all patients); JAIL MEDICAL SERVICES AGREEMENT-5 3. The cost of medications and supplies provided to or used on each inmate (this can be reduced to an average for all patients); 4. The hourly rate of the medical staff attending to the inmate; and 5. The average cost of each inmate visit based upon the factors set forth in 1-4 above. L. Correctional Facility Responsibilities. The City will provide Vendor with an examination room and utilities. The City will provide security staff for on site and off-site supervision and transportation of inmates for medical services. The City shall provide housekeeping and cleaning supplies, all office and medical records supplies, and laundry services. Vll. Staffina. A. Recruitment and Credentialing Program. Vendor shall recruit and interview candidates who are currently licensed or certified in the State of Washington to work at the facility. Vendor shall interview each candidate with a special focus on professional expertise, emotional stability, and motivation. Initial and continued use of staff and subcontractors at the facility shall be subject to approval of the City. The City reserves the right to prohibit any of the Vendor's employees and/or independent contractors from performing services with regard to this Agreement. All regular Vendor personnel shall be required to pass a records check conducted by the City for initial and/or continued employment, and the City shall fingerprint and run a criminal history check of all staff who will be working at the facility. All personnel shall comply with current and future state, federal, and local licensing requirements; all policies and procedures of the City and the facility; and accreditation standards, in the event the City seeks accreditation. Copies of all licenses and certifications of Vendor personnel shall be maintained in facility files. Copies of the job descriptions shall also be on file at the facility. Personnel files of all subcontractors and contract employees shall be made available to the facility commander, or his or her designee upon request. These files shall include copies of current Washington licenses, proof of professional certification, DEA numbers, malpractice insurance certificates, evaluations, and position responsibilities. Personal telephonic contact information for Vendor's staff and subcontractors shall be provided to facility staff. Vendor shall notify the facility commander prior to discharging, removing, or failing to renew contracts of professional staff. Any replacement personnel shall be subject to approval of the City. Such approval shall not be unreasonably withheld. JAIL MEDICAL SERVICES AGREEMENT-6 B. Employee Training and Orientation. Vendor will provide initial orientation for the health services staff. The City will provide on site security orientation to all medical staff, which will not exceed four(4)hours. C. Staff Absences. Vendor will provide staff seven (7)days per week with adequate coverage for sick time, vacation time, and educational leave for professional staff. Employees who are ill, at training, on vacation, or otherwise unavailable for work will be replaced whenever possible. Vacation time will be scheduled and covered by other staff as deemed necessary. Vendor shall immediately notify the City of any staff absence. D. Security Clearance. Vendor staff shall be subject to and shall comply with all security regulations and procedures of the City and the facility. Violations of regulations may result in the employee being denied access to the facility. In this event, Vendor shall provide alternate personnel to supply services described herein, subject to the City's approval. The City shall provide security for Vendor staff and agents consistent with security provided to other City employees. Vlll. Miscellaneous. A. Indemnification. The Vendor shall defend, indemnify, and hold the City, its officers, officials, employees, agents, and volunteers harmless from any and all, claims, injuries, damages, losses or suits, including all legal costs and attorney's fees, arising out of or in connection with the performance of this Agreement, except for injuries and damages caused by the sole negligence of the City. The City's inspection or acceptance of any of Vendor's work when completed shall not be grounds to avoid any of these covenants of indemnification. The provisions of this section shall survive the expiration or termination of this Agreement. The obligation to indemnify, defend, and hold harmless the City and its agents and employees under this subparagraph extends, but shall not be limited to any claim, demand, or cause of action brought by or on behalf of any employee of the Vendor, against the City, its officers, agents, or employees and includes any judgment, award, and cost arising there from, including attorney's fees. IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THIS INDEMNIFICATION CONSTITUTES THE VENDOR'S WAIVER OF IMMUNITY UNDER INDUSTRIAL INSURANCE, TITLE 51, RCW, SOLELY FOR THE PURPOSES OF THIS INDEMNIFCATION. THE PARTIES ACKNOWLEDGE THAT THEY HAVE MUTUALLY NEGOTIATED THIS WAIVER. B. Termination. The City may, by written notice of default to the Vendor, terminate this Agreement, in whole or in part, if Vendor fails to provide the services called for in this Agreement within the time specified herein, or if funding no longer becomes available for the services described herein. JAIL MEDICAL SERVICES AGREEMENT-7 Either party may temvnate this Agreement, in whole or in part, for any reason by providing written notice to the other party sixty(60) days prior to the effective date of termination. C. Notification. Each party shall identify an individual who can receive notification and assist in solving problems which may arise out of or in connection with the performance of this Agreement. CITY: VENDOR: Kent Corrections Commander Patricia Vincent, Director City of Kent Police Department Occupational Health Services, 220 Fourth Avenue South Valley Medical Center Kent, WA 98032 3600 Lind Ave. SW, Suite 170 Renton, WA 98055 (253)856-5934 (telephone) (425)656-5020 (telephone) (253)856-6960 (facsimile) (425) 656-5419 (facsimile) All communications regarding this Agreement shall be sent to the parties at the addresses listed above, unless notified to the contrary. Any written notice hereunder shall become effective three (3) business days after the date of mailing by registered or certified mail, and shall be deemed sufficiently given if sent to the addressee at the address stated in this Agreement or such other address as may be hereafter specified in writing. D. Insurance. Vendor shall procure and maintain for the duration of the Agreement, insurance of the types and in the amounts described in Exhibit "A," attached and incorporated into this Agreement by this reference. E. Independent Contractor. Vendor shall be an Independent Contractor, the City being interested only in the results obtained under this Agreement. This Agreement does not create an agency relationship between Vendor and the City. Vendor is not an agent or legal representative of the City for any purpose. Vendor is not granted any express or implied right or authority to assume or create any obligation or responsibility on behalf of or in the name of the City or to bind the City in any manner. F. Work Performed at Vendor's Risk. Vendor shall take all necessary precautions and shall be responsible for the safety of its employees, agents, and subcontractors in the performance of the contract work and shall utilize all protection necessary for that purpose. All work shall be done at Vendor's own risk, and Vendor shall be responsible for any loss of or damage to materials, tools, or other articles used or held for use in connection with the work. JAIL MEDICAL SERVICES AGREEMENT-8 G. Limitation of Actions. Vendor must, in any event, file any lawsuit arising from or connected with this Agreement within 120 calendar days from the date of the occurrence giving rise to such suit or Vendor's ability to file that suit shall be forever barred. This section, which was specifically bargained for by the parties, limits any applicable statutory limitations period. H. Discrimination. In the hiring of employees for the performance of work under this Agreement or any sub-contract, the Vendor, its sub-contractors, or any person acting on behalf of the Vendor or sub-contractor shall not, by reason of race, religion, color, sex, age, sexual orientation, national origin, or the presence of any sensory, mental, or physical disability, discriminate against any person who is qualified and available to perform the work to which the employment relates. Vendor shall execute the attached City of Kent Equal Employment Opportunity Policy Declaration, Comply with City Administrative Policy 1.2, and upon completion of the contract work, file the attached Compliance Statement. I. Recyclable Materials. Pursuant to Chapter 3.80 of the Kent City Code, the City requires its contractors and consultants to use recycled and recyclable products whenever practicable. A price preference may be available for any designated recycled product. J. Non-Waiver of Breach. The failure of either party to insist upon strict performance of any of the covenants and agreements contained in this Agreement, or to exercise any option conferred by this Agreement in one or more instances shall not be construed to be a waiver or relinquishment of those covenants, agreements or options, and the same shall be and remain in full force and effect. K. Resolution of Disputes and Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Washington. If the parties are unable to settle any dispute, difference, or claim arising from the parties' performance of this Agreement, the exclusive means of resolving that dispute, difference, or claim, shall only be by filing suit exclusively under the venue, rules, and jurisdiction of the King County Superior Court, King County, Washington, unless the parties agree in writing to an alternative dispute resolution process. In any claim or lawsuit for damages arising from the parties' performance of this Agreement, each party shall pay all its legal costs and attorney's fees incurred in defending or bringing such claim or lawsuit, in addition to any other recovery or award provided by law; provided, however, nothing in this paragraph shall be construed to limit the City's right to indemnification under Section IX(A) of this Agreement. L. Assignment. Any assignment of this Agreement by either party without the written consent of the non-assigning party shall be void. If the non-assigning party gives its consent to any assignment, the terms of this Agreement shall continue in full force and effect and no further assignment shall JAIL MEDICAL SERVICES AGREEMENT-9 be made without additional written consent. M. Modification. No waiver, alteration, or modification of any of the provisions of this Agreement shall be binding unless in writing and signed by a duly authorized representative of the City and Vendor. N. Entire Agreement. The written provisions and terms of this Agreement, together with any Exhibits attached hereto, shall supersede all prior verbal statements of any officer or other representative of the City, and such statements shall not be effective or be construed as entering into or forming a part of or altering in any manner this Agreement. All of the above documents are hereby made a part of this Agreement. O. Compliance with Laws. The Vendor agrees to comply with all federal, state, and municipal laws, rules, and regulations that are now effective or In the future become applicable to Vendor's business, equipment, and personnel engaged in operations covered by this Agreement or accruing out of the performance of those operations. IN WITNESS, the parties below execute this Agreement, which shall become effective on the last date entered below. VALLEY MEDICAL CENTER, CITY OF KENT: OCCUPATIONAL HEALTH SERVICES By: By: (signature) signature) Print AName: PM.� �s.A► Print me: Jim White Its f�.(n .-&:.s+� wj ✓M C G(s—� I✓+�No+fit_ Its Mayor (10f) 0 DATE: ( I3• / 'c/ DATE:_T APPROVE M: en ity Atto JAIL MEDICAL SERVICES AGREEMENT-10 CITY OF KENT ADMINISTRATIVE POLICY NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998 SUBJECT: MINORITY AND WOMEN SUPERSEDES: April 1, 1996 CONTRACTORS APPROVED BY Jim White, Mayor POLICY: Equal employment opportunity requirements for the City of Kent will conform to federal and state laws. All contractors, subcontractors, consultants and suppliers of the City must guarantee equal employment opportunity within their organization and, if holding Agreements with the City amounting to $10,000 or more within any given year, must take the following affirmative steps: 1. Provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 2. Actively consider for promotion and advancement available minorities and women. Any contractor, subcontractor, consultant or supplier who willfully disregards the City's nondiscrimination and equal opportunity requirements shall be considered in breach of contract and subject to suspension or termination for all or part of the Agreement. Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public Works Departments to assume the following duties for their respective departments. 1. Ensuring that contractors, subcontractors, consultants, and suppliers subject to these regulations are familiar with the regulations and the City's equal employment opportunity policy. 2. Monitoring to assure adherence to federal, state and local laws, policies and guidelines. EEO COMPLIANCE DOCUMENTS- 1 EXHIBIT A INSURANCE REQUIREMENTS FOR JAIL MEDICAL SERVICES AGREEMENT Insurance The Vendor shall procure and maintain for the duration of the Agreement, insurance against claims for injuries to persons or damage to property which may arise from or in connection with the performance of the work by the Vendor, their agents, representatives, employees or subcontractors. A. Minimum Scope of Insurance Vendor shall obtain insurance of the types described below: 1. Automobile Liability insurance covering all owned, non-owned, hired and leased vehicles. Coverage shall be written on Insurance Services Office (ISO) form CA 00 01 or a substitute form providing equivalent liability coverage. If necessary, the policy shall be endorsed to provide contractual liability coverage. 2. Commercial General Liability insurance shall be written on ISO occurrence form CG 00 01 and shall cover liability arising from premises, operations, independent contractors and personal injury and advertising injury. The City shall be named as an insured under the Contactor's Commercial General Liability insurance policy with respect to the work performed for the City. 3. Medical Malpractice insurance covering the Vendor for acts, errors and omissions of medical staff. 4. Workers' Compensation coverage as required by the Industrial Insurance laws of the State of Washington. S. Minimum Amounts of Insurance Vendor shall maintain the following insurance limits: 1. Automobile Liability insurance at levels no less than those required by state law. 2. Commercial General Liability insurance shall be written with limits no less than $1,000,000 each occurrence, $6,000,000 general aggregate. 3. Medical Malpractice insurance shall be provided with limits no less than $1,000,000 per occurrence. EXHIBIT A (Continued) C. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions for Automobile Liability and Commercial General Liability: 1. The Vendor's insurance coverage shall be primary insurance as respect the City. Any insurance, self-insurance, or insurance pool coverage maintained by the City shall be excess of the Vendors insurance and shall not contribute with it. 2. The Vendor's insurance shall be endorsed to state that coverage shall not be cancelled by either party, except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the City. 3. The City of Kent shall be named as an additional insured on all policies (except Professional Liability) as respects work performed by or on behalf of the Vendor and a copy of the endorsement naming the City as additional insured shall be attached to the Certificate of Insurance. The City reserves the right to receive a certified copy of all required insurance policies. The Vendor's Commercial General Liability insurance shall also contain a clause stating that coverage shall apply separately to each insured against whom claim is made or suit is brought, except with respects to the limits of the insurer's liability. D. Vendor's Insurance For Other Losses The Vendor shall assume full responsibility for all loss or damage from any cause whatsoever to any tools, Vendor's employee owned tools, machinery, equipment, or motor vehicles owned or rented by the Vendor, or the Vendor's agents, suppliers or contractors as well as to any temporary structures, scaffolding and protective fences. E. Waiver of Subrogation The Vendor and the City waive all rights against each other any of their Subcontractors, Sub-subcontractors, agents and employees, each of the other, for damages caused by fire or other perils to the extend covered by Builders Risk insurance or other property insurance obtained pursuant to the Insurance Requirements Section of this Contract or other property insurance applicable to the work. The policies shall provide such waivers by endorsement or otherwise. F. Acceptability of Insurers Insurance is to be placed with insurers with a current A.M. Best rating of not less than ANIL EXHIBIT A (Continued) G. Verification of Coverage Vendor shall furnish the City with original certificates and a copy of the amendatory endorsements, including but not necessarily limited to the additional insured endorsement, evidencing the Automobile Liability and Commercial General Liability insurance of the Vendor before commencement of the work. H. Subcontractors Vendor shall include all subcontractors as insureds under its policies or shall fumish separate certificates and endorsements for each subcontractor. All coverages for subcontractors shall be subject to all of the same insurance requirements as stated herein for the Vendor. P•lCiviNFILES1OpenFiles10702\lnsuranesExhibit doc DATE(MMID)IYY) AC 03 PRODUCER THIS CERTIFICATE IS ISSUED AS A M TIER OF INFORMATION ONLY Keenan Healthcare AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE 901 Calla Amanecer, Suite 200 AFFORDED BY THE POLICES BELOW. San Clemente, CA 92673 `1'ione: (949)940-1760 Fax: (949) 369-0324 INSURERS AFFORDING COVERAGE .rSURED INSURER A- Lexington Insurance/American International Group Public Hospital District# 1 of King County INSURER B: Dba: Valley Medical Center VMRER C' 400 South 43'd Street INSURER D: Renton,WA 98055 INSURER E COVERAGES THIS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE 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 CERTBf[CATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY POLICY IRATION INS TYPE OF INSURANCE POLICY NUMBER EFFECTIVE DATE DATE LIMITS OENERALLIABILIY EACH OCCURRENCE § 1,500,000 SIR' ®COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Anyone Are) § III❑0 CLAIMS MADE® OCCUR APED EXP(Any one person) A _ 6790448• 000/03 09/30J04 PERSONAL a ADV INJURY § — GENERALAGGREGATE § 6,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ O POLICY p PROJECT[-]LDD AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT § ❑ANY AUTO (Each acddent) ❑ALL OWNED AUTOS BODILY INJURY ❑ SCHEDULED AUTOS (Per person) § HIRED AUTOS BODILY INJURY § a NON-OWNED AUTOS (Per eeoldsnt) PROPERTY DAMAGE § (Per accident) GARAGELKWUTY AUTO ONLY-EA ACCIDENT $ EA ANY AUTO OTHER THAN ACC § ❑ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE § 5,000,000' EX u OCCURR ® CLAIMSMADE AGGREGATE § 5,000,000. A 6790448` 09/30/03 09/30/04 § ❑DEDUCTIBLE § ® RETENTION § 1.500,000 SIR WCSTATu oTH- WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY EL EACH ACCIDENT § E DISEASE-EA EMPLOYEE § EL DISEASE-POLICY LIMIT § OTHER 1.5 MiU$8 Mil A Healthcare Professional 679p44$• 09/3p/03 09/30104 Mpg Self- Liability Insurance Insured Retention DESCRIPTION OF OPERATIONSILOCATIO NINE iiai! USIONS ADDED BY ENDORSEMBrVSPECIAL PROVISIONS ' Excess of$1,500,000/$6,000,000 Aggregate Selfdnsured Retention Evidence of Healthcare Professional Liability and General Liability Insurance for Valley Medical Center . CERTIFICATE HOLDER ADDITIONAL INSURED;INSUREDLETTOL _ CANCELLATION SHOUID ANY OF THE ABOVE DESCRIBM POLICIES BE CANCER»BEIMB THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL.BNDBAVOR TO MAIL 30-D=WRYITBN NOR® .Iley Medical Center TO THE CBRTRIICATa ROLDme NAMED T'O THE LEFT,BUT FALURB TO MAIL SUCH NOTICE 400 South 43rd Street SHAM RBPIMPOSBMENT NO osuoAMO N OR LIABGrrY OF ANY Term UroN THE COMPANY,ITS AGENTS Renton, WA 98055 Arne j ACORD 25S(7-97) �—,mACORD CORPORATION 198a Un i gard Insurance Company PO Box 90701 , Bellevue, WA 98009-0701 BUSINESS AUTO COVERAGE PART The Business Auto Coverage Part consists of this Declarations and the Coverage Forms and Endorsements indicated as applicable. ITEM ONE DECLARATIONS POLICY NUMBER: BA609553 ACCOUNT NUMBER: 333453 Form of Business: ❑ individual ❑ Joint Venture ❑Limited Liability Company ® Corporation ❑ Partnership ❑ Organization (Other than Partnership, Joint Venture or Limited LiabilityCompany) Coverage Forms and Endorsements applicable to this Coverage Part: See Schedule of Forms and Endorsements ESTIMATED TOTAL PREMIUM Insured's Copy 09/29103R CA0002 0699 Copyright, insurance Services Office, Inc. 1986 Page t of 4 11665 ITEM TWO SCHEDULE OF COVERAGES AND COVERED AUTOS _ This policy provides only those coverages where a charge is shown in the premium column below.Each of these coverages will apply or to those"autos"shown as covered"autos"."Autos"are shown as covered"autos"for a particular coverage by the entry of one or more of the symbols from the COVERED AUTO Section of the Business Auto Coverage Form next to the name of the coverage. COVERED AUTOS (Entry of one or more LIMIT of the symbols from the COVERED AUTO COVERAGES Section of the Garage THE MOST WE WILL PAY FOR ANY ONE PREMIUM Coverage Form shows ACCIDENT OR LOSS which autos are covered autos) LIABILITY 718 11000,000 $18,448 . PERSONAL INJURY SEPARATELY STATED IN EACH PIP PROTECTION (or equivalent ENDORSEMENT MINUS No—fault Coverage) Dad. ADDED PERSONAL INJURY SEPARATELY STATED IN EACH ADDED PROTECTION (or equivalent PIP ENDORSEMENT Added No—fault Coverage) PROPERTY PROTECTION SEPARATELY STATED IN THE P.P.I. INSURANCE (Michigan only) ENDORSEMENT MINUS Dad. FOR EACH ACCIDENT MEDICAL PAYMENTS 7 5,000 $1 ,606. UNINSURED MOTORISTS 7 UNDERINSURED MOTORISTS (When not included in 7 11000,000 $1 , 756 . . Uninsured Motorists Coverage) PHYSICAL DAMAGE ACTUAL CASH VALUE OR COST OF COMPREHENSIVE COVERAGE REPAIR. WHICHEVER IS LESS MINUS 7,8 See schedDed FOR EACH COVERED $1 ,963. AUTO. BUT NO DEDUCTIBLE APPLIES TO LOSS CAUSED BY FIRE OR LIGHTNING See ITEM FOUR for hired or borrowed "autos". PHYSICAL DAMAGE ACTUAL CASH VALUE OR COST OF SPECIFIED CAUSES OF REPAIR. WHICHEVER IS LESS MINUS $25 LOSS COVERAGE FOR EACH COVERED AUTO FOR LOSS CAUSED BY MISCHIEF OR VANDALISM See ITEM FOUR for hired or borrowed "autos". PHYSICAL DAMAGE ACTUAL CASH VALUE OR COST OF COLLISION COVERAGE REPAIR. WHICHEVER IS LESS MINUS 7,8 See SchedDed FOR EACH COVERED $4,086. AUTO. See ITEM FOUR for hired or borrowed "autos". PHYSICAL DAMAGE TOWING AND LABOR for each disablement Not Available in Californm) of e rivate asawn sr "auto" PREMIUM FOR ENDORSEMENTS Insured' s Copy 09/29/03R Page 2 of 4 CA0002 0699 11686 BUSINESS AUTO COVERAGE PART (Continued) ITEM THREE See"SCHEDULE OF COVERED AUTOS YOU OWN" ITEM FOUR SCHEDULE OF HIRED OR BORROWED COVERED AUTO COVERAGE AND PREMIUMS. LIABILITY COVERAGE—RATING BASIS COST OF HIRE ESTIMATED COST RATE PER EACH $100 FACTOR (If liab. STATE OF HIRE FOR COST OF HIRE Cov. is primary) PREMIUM EACH STATE WA if any 1 .926 included TOTAL PREMIUM included Cost of hire means the total amount you incur for the hire of "autos" you don't own (not including "autos" you borrow or rent from your partners or employees or their family members). Cost of hire does not include charges for services performed by motor carriers of property or passengers. PHYSICAL DAMAGE COVERAGE LIMIT OF INSURANCE COVERAGES THE MOST WE WILL PAY RATE PREMIUM DEDUCTIBLE ACTUAL CASH VALUE.COST OF REPAIRS OR $30, 000 WHICHEVER IS LESS,MINUS 0 . 850 $5 COMPREHENSIVE $250 Ded.FOR EACH COVERED AUTO. BUT NO DEDUCTIBLE,APPLIES TO LOSS CAUSED BY FIRE OR LIGHTNING ACTUAL CASH VALUE,COST OF REPAIRS OR SPECIFIED WHICHEVER IS LESS.MINUS CAUSES OF LOSS $25 Ded.FOR EACH COVERED AUTO FOR LOSS CAUSED BY MISCHIEF OR VANDALISM ACTUAL CASH VALUE,COST OF REPAIRS OR COLLISION $30,000 WHICHEVER IS LESS.MINUS 0 . 850 $6. $5 00 Ded FOR EACH COVERED AUTO. TOTAL PREMIUM $21 . min PHYSICAL DAMAGE COVERAGE for covered"autos"you hire or borrow is excess unless indicated below by an"X"in the box. ❑ If this box is checked PHYSICAL DAMAGE COVERAGE applies on a direct primary basis and for purposes of the condition entitled OTHER INSURANCE,any covered"auto"you hire or borrow is deemed to be a covered"auto"you own. Insured's Copy 09/29103R CA0002 0699 Page 3 of 4 11667 BUSINESS AUTO COVERAGE PART (Continued) ITEM FIVE SCHEDULE FOR NON-OWNERSHIP LIABILITY Named Insured's Business Rating Basis Number Premium Other than a Number of Employees Social Service Agency Numbers of Partners Social Service Agency Nuntber of Employees Number of Volunteers ITEM SIX SCHEDULE FOR GROSS RECEIPTS OR MILEAGE BASIS -LIABILITY COVERAGE - PUBLIC AUTO OR LEASING RENTAL CONCERNS RATES Estimated LJ Yearly Per$100 of Gross Receipts PREMIUMS El Per Mile ❑Gross Receipts LIABILITY AUTO MEDICAL LIABILITY AUTO MEDICAL Mdea a COVERAGE PAYMENTS COVERAGE PAYMENTS TOTAL PREMIUMS MINIMUM PREMIUMS When used as a premium basis: FOR PUBLIC AUTOS Gross Receipts means the total amount to which you are entitled for transporting passengers, mail or merchandise during the policy period regardless of whether you or any other carrier originate the transportation.Gross Receipts does not include: A. Amounts you pay to railroads, steamship lines, airlines and other motor carriers operating under their own ICC or PUC permits. B. Advertising Revenue. C. Taxes which you collect as a separate item and remit directly to a governmental division. D. C.O.D.collections for cost of mail or merchandise including collection fees. Mileage means the total live and dead mileage of all revenue producing units operated during the policy period. FOR RENTAL OR LEASING CONCERNS Gross receipts means the total amount to which you are entitled for the leasing or rental of "autos" during the policy period and includes taxes except those taxes which you collect as a separate item and remit directly to a governmental division. Mileage means the total of all live and dead mileage developed by all the "autos" you leased or rented to others during the policy period. I nsur ed's Copy 09/29/ 03R [sage a of a CA0002 0699 Mesa s Keenan HealthCare 9orCalleAmanecer 949940-1760 Suiteaoo 949-369-0324 fax San Clemente, CA9z673 www keenanassoc com License No 0451271 October 18, 2004 City of Kent 1230 South Central Avenue Kent,WA 98032 Re: Public Hospital District No. 1 of King County DBA: Valley Medical Center Excess—TFe I care-P-r-oTe—ssional and G7e—n eral laablhty Insurance Policy No. HPC 5087684-00 To Whom It May Concern: Enclosed is a certificate of healthcare professional and general liability insurance coverage for Public Hospital District No. 1 of King County d.b.a.:Valley Medical Center. Coverage is provided by Steadfast Insurance Company,a member of the Zurich Insurance Group, for limits of liability of$5,000,000 each occurrence/ $5,0000,000 General Aggregate, excess of a Self Insured Retention of$1,500,000/$6,000,000 aggregate. Should yo .have any questions regarding the enclosed,please contact our office T - isk Manager Cc Karrie Dosch Valley Medical Center Risk Management Department DATE(M CORD •�.�� _ :- "r_ MIDD/YY) p �,; --, 1 0/0 712 0 0 4 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Keenan Healthcare AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE 901 Calle Amanecer, Suite 200 AFFORDED BY THE POLICES BELOW. San Clemente, CA 92673 Phone: (949) 940-1760 Fax. (949) 369-0324 INSURERS AFFORDING COVERAGE INSURED INSURER Steadfast Insurance Company(Zurich Ins Group) Public Hospital District# 1 of King County INSURER B Dba: Valley Medical Center INSURER 400 South 43`d Street INSURER D Renton,WA 98055 INSURER E COVERAGES THIS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE 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 POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS POLICY POLICY INSR EFFECTIVE EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE DATE MMIDD/YY MWDD/V LIMITS ——-- NERAL!iABIUT' -- GAGK-OCOUBSCS^.G ' -GG $iR* --_ ® COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ ❑❑ CLAIMS MADE® OCCUR MED EXP(Any one person) $ A ❑_ HPC 5087684-00 09/30/04 09/30/05 PERSONAL&ACV INJURY $ ❑-- GENERAL AGGREGATE $ 6,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ ❑ POLICY ❑ PROJECT❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ❑ ANY AUTO (Each accident) $ ❑ ALL OW NED AUTOS BODILY INJURY ❑ SCHEDULED AUTOS (Perperson) $ ❑ HIRED AUTOS BODILY INJURY $ ❑ NOWOWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY—EA ACCIDENT $ EA ANY AUTO OTHER THAN ACC $ ❑ AUTO ONLY AGO $ EXCESS LIABILITY EACH OCCURRENCE $ 5,000,000- ❑ OCCURR ® CLAIMS MADE AGGREGATE $ 5,000,000- A HPC 5087684-00 09/30/04 09/30/05 $ _ ❑ DEDUCTIBLE ® RETENTION $ 1,500,000SIR WC STATU- OTH- _ WORKERS COMPENSATION AND TORV LIMITS ER EMPLOYERS'LIABILITY E L EACH ACCIDENT $ E L DISEASE—EA EMPLOYEE $ EL DISEASE—POLICY LIMIT $ OTHER $1 5 MIV$6 Mil A Healthcare Professional HPC 5087684-00 09/30/04 09/30/05 Agg Self- Liability Insurance Insured Retention DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Excess of$1,500,000/$6,000,000 Aggregate Self-Insured Retention Evidence of Healthcare Professional Liability and General Liability Insurance for Valley Medical Center with respects to the Occupational Health Services CERTIFICATE HOLDER ® ADDITIONAL INSURED,INSURED LETTER A CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE City of Kent TO THE CERTIFICATE HOLDER NAMED TO THE LEFF, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS 1230 South Central Avenue OR REPRESENTATIVES Kent,WA 98032 AU`rHO5gMjZZRESENTATr l ACORD 25-S(7-97) ®A CORPORATION 1988 ACO'�D :`m a x.•,s -"%„"�„ DATE(MM/DDIYY) e rIr `� > *�, a .,; ,�r ,-�-c "� ```.,�:�' "Y-- 09/03/2004 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY re Keenan AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISKeenan Healthca Calls A lthCa er, Suite 200 CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE , AFFORDED BY THE POLICES BELOW. San Clemente, CA 92673 Phone: (949) 940-1760 Fax: (949) 369-0324 INSURERS AFFORDING COVERAGE INSURED INSURER Lexington Insurance/American International Group Public Hospital District# 1 of King County INSURER Dba: Valley Medical Center INSURER C. 400 South 43`d Street INSURER D Renton,WA 98055 INSURER E COVERAGES THIS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE 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 POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS POLICY POLICY LtrTR TYPE OF INSURANCE POLICY NUMBER EFFDECTIVE EXPIRATION M MMID LIMBS GENERAL LIABILITY FACHOCCURRENCE $ 1,500,000 SIR' ® COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ ❑❑ CLAIMS MADE® OCCUR MED EXP(Anyone person) $ A ❑_ 6790448" 09/30/03 D9/30/04 PERSONAL B ADV INJURY $ ❑— GENERAL AGGREGATE $ 6,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ ❑ POLICY ❑ PROJECT❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ❑ ANY AUTO (Each accident) $ ❑ ALL OWNED AUTOS BODILY INJURY ❑ SCHEDULED AUTOS (Per parson) $ ❑ HIREDAUTOS BODILY INJURY ❑ (Per acudent) $NON-OWNED AUTOS ❑_ PROPERTY DAMAGE $ ❑ (Per student) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ FA ANY AUTO OTHER THAN ACC $ ❑ AUTO ONLY AGG $ EXCESS LIABILITY EACH OCCURRENCE $ 5,000,000- ❑ OCCURR ® CLAIMS MADE AGGREGATE $ 5,000,000- A 6790448' 09/30/03 09/30/04 $ ❑ DEDUCTIBLE $ ® RETENTION $ 1,500,000 SIR WC STATU- OTH• WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY E L EACH ACCIDENT $ EL DISEASE-EA EMPLOYEE $ E L DISEASE-POLICY LIMIT $ OTHER $1 5 MIV$6 Mil A Healthcare Professional 6790448" 09/30/03 09/30/04 Agg Self- Liability Insurance Insured Retention DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Excess of$1,500,000/$6,000,000 Aggregate Self4nsured Retention Evidence of Healthcare Professional Liability and General Liability Insurance for Valley Medical Center with respects to the Occupational Health Services. "Carrier endorsement#16 attached CERTIFICATE HOLDER ADDITIONAL INSURED,INSURED LETTER A CANCELLATION SHOULD ANY OF TIM ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.THE ISSUWG COMPANY WRL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE City of Kent TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL AffOSE NO OBLIGATION OR LIABH.Xry OF ANY KIND UPON THE COMPANY,ITS AGENTS 1230 South Central Avenue UT� REP Kent,WA 98032 ACORD 25.S(7-97) C ACORD CORPORATION 1988 ENDORSEMENT NO. 16 This endorsement, effective 12:01 AM: August 18, 2004 Forms a part of policy no.: 6790448 Issued to: PUBLIC HOSPITAL DISTRICT NO. 1 OF KING COUNTY DBA: VALLEY MEDICAL CENTER By: LEXINGTON INSURANCE COMPANY ADDITIONAL INSURED COVERAGE It is agreed that coverage under this policy shall apply to the following additional Insured(s), but only to the extent that coverage is provided said additional Insured(s) in the underlying insurance and then only for such hazards for which coverage is afforded under said underlying insurance as listed in the Schedule of Underlying Insurance, and further providing that the full limits of insurance shown therein are applicable. Additional Insured(s) The City of Kent 220 Fourth Ave., S Kent, WA 98032 All other terms, conditions and exclusions of the policy remain unchanged. i Authorized Representative or countersignature (where required by law) 57699 (6/93) HCO041 INSURED'S COPY 1