Loading...
HomeMy WebLinkAboutCAG2024-135 - Original - Green River College - Affiliation Agreement: Nursing Students Clinical Practicums Hours - 03/12/2024 run%_i i v ur ncm i vrriUwL v-1C vwLi Sup/Mgr: Agreement Routing Form Dir Asst: 140 • For Approvals,Signatures and Records Management Dir/Dep: KEN T This form combines&replaces the Request for Mayor's Signature and Contract Cover (Optional) W A S H I N O T O N Sheet forms. (Print on pink or cherry colored paper) Originator: Department: Michael Armstrong Police Date Sent: Date Required: > 03/12/2024 03/20/2024 0 i a Authorized to Sign: Date of Council Approval: a Q Mayor or Designee Budqet Account Number: Grant? Yes NoFv� No funding Budget? Yes L:]No Type: N/A Vendor Name: Category: Green River College Contract Vendor Number: Sub-Category: = N/A Original E 0 Project Name: Green River College Affiliation Agreement cProject Details:% Affiliation Agreement allowing nursing to complete required c clinical practicums hours. a Agreement Amount: $0.00 Basis for Selection of Contractor: Other 3/12/24 "Memo to Mayor must be attached Start Date: 9,2429 ' A2 Termination Date: Auto renewal for 5 years Cn a Local Business?❑YesF—]Nol If meets requirements per KCC 3.70.100,please complete'Vendor Purchase-Local Exceptions'form on Cityspace. Business License Verification: ❑Yes In-Process1-1Exempt(KCC 5.01.045) Notice required prior to disclosure? Contract Number: Yes❑✓ No CAG2024- 135 Comments: The City of Kent Corrections Facility is partnering with Green River College to allow nursing students to complete required clinical practicums hours. c c as 3 o°c ar ar cc Date Received:City Attorney: Date Routed:Mayor's Office City Clerk's Office 3/14/24 adccW22373_1_20 Visit Documents.KentWA.gov to obtain copies of all agreements rev.20210513 .ji �• • A River COLLEGE EDUCATIONAL AFFILIATION AGREEMENT FOR STUDENTS OF Green River College And Kent Corrections This Agreement is made and entered into between Green River College, located at Auburn, Washington, and Kent Corrections, located at 1230 South Central Ave, Kent, WA, 98023. The purpose of this Agreement is for Kent Corrections, which is committed to training health care professionals, to provide desirable clinical learning experiences and facilities for Green River College's students who are enrolled in its Health Science Programs. In consideration of the mutual covenants and agreements contained herein, Green River College and Training Site agree as follows: I. GENERAL PROVISIONS A. Green River College and Training Site agree that contemporaneous with or following execution of this Agreement and within the scope of its provisions, Green River College may develop letter agreements with Training Site to formalize operational details of the clinical education program. These details include, but are not limited to, the following: • Beginning dates and length of experience; • Number of students eligible to participate in the clinical education program; • Specific days, hours and locations for the clinical education program; • Specific learning objectives and performance expectations for students; • Specific allocation of responsibilities for the faculty Liaison, clinical education Supervisor, and Preceptors, if any, referenced elsewhere in this Agreement; • Deadlines and format for student progress reports and evaluation forms. Any such letter agreements will be considered attachments to this Agreement, will be binding when signed by authorized representatives of each party, and may be modified by subsequent letter agreements signed by authorized representatives of each party. B. Green River College and Training Site will jointly plan the clinical education program and jointly evaluate students. Exchange of information will be maintained by on-site visits when practical and by letter or telephone in other instances. C. Green River College and Training Site will instruct their respective faculty, staff, and students participating in the clinical education program, to maintain confidentiality of student and patient information as required by law and by the policies and procedures of Green River College and Training Site. D. There will be no payment of charges or fees between Green River College and Training Site. E. There will be no discrimination against any program participant or applicant covered under this Agreement because of race, color, creed, religion, national origin, age, sex or sexual orientation, honorably discharged veteran or military status, gender identity, genetic information, marital status, pregnancy, the presence of any sensory, mental or physical disability, or the use of a trained guide dog or service animal by a person with a disability, nor will Green River College or Training Site engage in such discrimination in their employment or personnel policies. During the term of this Agreement, Kent Corrections, including any subcontractor, shall not discriminate on the bases enumerated at RCW 49.60.530(3). In addition, Kent Corrections, including any subcontractor, shall give written notice of this nondiscrimination requirement to any labor organizations with which Kent Corrections, or subcontractor, has a collective bargaining or other agreement. II. GREEN RIVER COLLEGE'S RESPONSIBILITIES A. Green River College will provide information to Training Site concerning its curriculum and the professional and academic credentials of its faculty for the students at Training Site. Green River College will designate an appropriately qualified and credentialed faculty member to coordinate and act as the Liaison with Training Site. Green River College will be responsible for instruction and administration of the students' academic education program. Green River College will notify Training Site in writing of any change or proposed change of its Liaison. Green River College will have the final responsibility for grading students. B. Green River College's faculty will meet with the Training Site clinical education Supervisor Preceptors, if any, at the beginning and end of the clinical education program to discuss and evaluate the clinical education program. These meetings will take place in person if practicable, otherwise by telephone conference. Green River College is responsible for arranging and planning the meetings. C. Green River College will provide the names and information pertaining to relevant education and training for all students enrolled in the clinical education program at least four weeks before the beginning date of the clinical education program. Green River College is responsible for supplying any additional information required by Training Site as set forth in this Agreement, prior to the arrival of students. Green River College will notify Training Site in writing of any change or proposed change in a student's status. D. Green River College will obtain evidence of current immunizations against diphtheria, tetanus, poliomyelitis, measles (rubeola), mumps, rubella (or a positive rubella titer), and of hepatitis B immunity status, documented by a protective titer, for those students who will be in contact with patients/clients. For each student born after 1956, Green River College will maintain on file records of positive titer or of post-1967 immunization for rubella and rubeola. At the time of immunization, students with no history of exposure to chickenpox will be advised to get an immune titer. Green River College will require yearly PPD testing or follow-up as recommended if the students are PPD- positive or have had BCG. Green River College will provide information to Training Site regarding student status concerning the above requirements. E. Green River College will assign to Training Site only those students who have satisfactorily completed the prerequisite didactic portion of the curriculum and who have evidence of completion of a CPR course based on American Heart Association or American Red Crossguidelines and related to the age group(s) with whom they will be working. F. Green River College shall ask each student who may be placed in Training Site to obtain his/her criminal history background record from the Washington State Patrol, pursuant to RCW 43.43.834 and RCW 43.43.838, to release a copy of that record to the Green River College, and to authorize the Green River College to transmit that record or copy thereof to Training Site. Before the start of training, Green River College will provide Training Site with the names of any students who have failed to provide the requested records, or who refuse to authorize the release of records to Training Site. The students will be informed that, whether or not they agree to obtain the record and agree to release it to Green River College and Training Site, Training Site may conduct the background inquiry directly and the Training Site may refuse placement of a student who does not provide the requested records or who has a record of prior criminal conduct. Training Site understands and agrees that any information forwarded to it by Green River College has been procured through this process. Green River College does not certify the veracity of the records provided and, furthermore, the obligation to conduct appropriate background checks and the liability for non-compliance therewith remains the responsibility of Training Site. G. Green River College will comply with and ensure to the extent possible that students comply with the policies and procedures established by Training Site. Green River College will notify each student of his/her status and responsibilities pursuant to this Agreement. This includes notification to students of the need to procure the insurance coverage required by the Training Site as identified in section V. C. below prior to being admitted to the Training Site. H. Green River College will encourage each student participating in the clinical education program to acquire comprehensive health and accident insurance that will provide continuous coverage of such student during his or her participation in the education program. Green River College will inform students that they are responsible for their own health needs, health care costs, and health insurance coverage. III. TRAINING SITE'S RESPONSIBILITIES A. Training Site will provide students with a desirable clinical education experience within the scope of health care services provided by Training Site. Training Site will designate in writing Preceptors, if any, to be responsible for the clinical education program, and will designate in writing one person as the clinical education Supervisor, who will maintain contact with the Green River College-designated Liaison to assure mutual participation in and review of the clinical education program and student progress. Training Site will submit in writing to Green River College the professional and academic credentials for the Preceptors and clinical education Supervisor. Training Site will notify Green River College in writing of any change or proposed change of the Preceptors or clinical education Supervisor. B. Training Site will provide students with access to sources of information necessary for the education program, within Training Site's policies and procedures and commensurate with patients' rights, including library resources and reference materials. C. Training Site will make available to students basic supplies and equipment necessary for care of patients/clients and the clinical education program. Within the limitation of facilities, Training Site will make available office and conference space for students and, if applicable, Green River College faculty. D. Training Site will submit required reports on each student's performance and will provide an evaluation to Green River College on forms provided by Green River College. E. Training Site retains full responsibility for the care of patients/clients, and will maintain the quality of patient care without relying on the students' clinical training activities for staffing purposes. F. Training Site will have the right to take immediate temporary action to correct a situation where a student's actions endanger patient care. As soon as possible thereafter, TrainingSite's clinical education Supervisor will notify Green River College of the action taken. All final resolutions of the student's academic status in such situations will be made solely by Green River College after reviewing the matter and considering whatever written factual information Training Siteprovides for Green River College; however, Training Site reserves the right to terminate the use of its facilities by a particular student where necessary to maintain its operation free of disruption and to ensure quality of patient care. G. On any day when a student is participating in the clinical education program at its facilities, Training Site will provide to such student necessary emergency health care or first aid for accidents occurring in its facilities. The student will be responsible for the costs of any and all care. H. Except as provided in this Agreement, Training Site will have no obligation to furnish medical or surgical care to any student. IV. STUDENTS' STATUS AND RESPONSIBILITIES A. Students will have the status of learners and will not replace Training Site personnel. Any service rendered by students is incidental to the educational purpose of the clinical education program. B. Students are required to adhere to the standards, policies, and regulations of Training Site during their clinical education program. C. Students will wear appropriate attire and name tags and will conform to the standards and practices established by Green River College during their clinical education program at Training Site. D. Students assigned to Training Site will be and will remain students of Green River College, and will in no sense be considered employees of Training Site. Training Site does not and will not assume any liability under any law relating to Worker's Compensation on account of any Green River College student's performing, receiving training, or traveling pursuant to this Agreement. Students will not be entitled to any monetary or other remuneration for services performed by them at Training Site, nor will Training Site otherwise have any monetary obligation to Green River College or its students by virtue of this Agreement. V. LIABILITY COVERAGE PROVISIONS A. Each party to this agreement shall indemnify the other for any negligent acts or omissions ofits own employees, officers, or agents in the performance of this Agreement. Neither party will be considered the agent of the other and neither party assumes any responsibility to the other party forthe consequences of any act or omission of any person, firm, or corporation not a party to this Agreement. B. Green River College is covered by the State of Washington Self-Insurance Program and the Tort Claims Act (Chapter 4.92 RCW). Claims against Green River College and its employees, officers, and agents in the performance of their duties under this Agreement will be paid from the tort claims liability account as provided in Chapter 4.92 RCW. C. In order to be accepted at the Training Site, students will be required to have medical malpractice and general liability coverage, whether through the student medical malpractice and general liability policies offered by the State of Washington, Office of Financial Management, Risk Management division, or otherwise, while working in the Training Site. The limits on the policies shall be, at a minimum, as follows: 1. General Liability coverage with limits no less than $1,000,000 per occurrence, $3,000,000 general aggregate. 2. Medical Professional Liability coverage with limits no less than $1,000,000 per occurrence, $3,000,000 general aggregate. D. Training Site maintains professional liability insurance coverage with Safety National. Through that coverage, Training Site provides liability coverage for its employees, officers, and agents in the performance of this Agreement, and further provides the means for defense and payment of claims that may arise against such individuals. VI. TERM A. This Agreement is effective beginning and will continue thereafter from year to year for up to five years from the effective date. Green River College and Training Site will jointly plan student placement in advance of each year's beginning, taking into account the needs of the Green River College for clinical placement, maximum number of students for whom Training Site can provide a desirable clinical education experience, and the needs of other disciplines or Green River Colleges requesting clinical placements. B. This agreement may be canceled by written notice 30 days prior to termination; however, such termination shall not become effective for the students then enrolled in the clinical education program if such termination prevents completion of their requirements for completion of the clinical education program. VII. PROVISIONS REGARDING BLOOD-BORNE PATHOGENS A. Green River College certifies that it has trained each student it sends to Training Site in universal precautions and transmission of blood-borne pathogens, and that it will send to Training Site only students who have been trained in and have practiced using universal precautions. Green River College has recommended the Hepatitis B (HBV) screening to all clinical education program students before assignment to Training Site. Students may waive the HBV series but are required to have a TB screening and be up-to-date on all other immunizations. Training Site will provide personal protection equipment that is appropriate for the tasks assigned to Green River College's students. B. In the event a student sustains a needle-stick injury or other substantial exposure to bodily fluids of another or other potentially infectious material while participating in the clinical education program at Training Site, Training Site agrees to provide the following services: • Being seen by Training Site's employee health service and/or emergency department as soon as possible after the injury; • Emergency medical care following the injury; • Initiation of HBV, Hepatitis C (HCV) and HIV protocol; • HIV counseling and appropriate testing. The student will be responsible for the costs of any and all care, testing, counseling, and obtaining necessary follow-up care. C. The source patient's HBV, HCV and HIV status will be determined by Training Site in the usual manner to the extent possible. VIII. MISCELLANEOUS-PROVISIONS A. Entire Agreement. This Agreement constitutes the entire agreement between the parties, and supersedes all prior oral or written agreements, commitments, or understandings concerning the matters provided for herein. B. Amendment. This Agreement may be modified only by a subsequent written Agreement executed by the parties. The provisions in this Agreement may not be modified by any attachment or letter agreement as described elsewhere in this Agreement. C. Order of Precedence. Any conflict or inconsistency in this Agreement and its attachments will be resolved by giving the documents precedence in the following order: 1. This Agreement; 2. Attachments to this Agreement in reverse chronological order. D. Governing Law. The parties' rights or obligations under this Agreement will be construed in accordance with, and any claim or dispute relating thereto will be governed by, the laws of the State of Washington. E. Notices. All notices, demands, requests, or other communications required to be given or sent by Green River College or Training Site, will be in writing and will be mailed by first-class mail, postage prepaid, or transmitted by hand delivery or facsimile, addressed as follows: (a) To Green River College: 12401 SE 320th Mail Stop: SC Auburn, WA 98092-3622 Attn: Dr. Roseann Berg, Dean of Instruction (253) 833-9111 (b) Kent Corrections 1230 South Central Ave Kent, WA 98023 Each party may designate a change of address by notice in writing. All notices, demands, requests, or communications that are not hand-delivered will be deemed received three (3) days after deposit in the U.S. mail, postage prepaid; or upon confirmation of successful facsimile transmission. F. Survival. Green River College and Training Site expressly intend and agree that the liability coverage provisions of this Agreement will survive the termination of this Agreement for any reason. G. Severability. If any provision of this Agreement, or of any other agreement, document or writing pursuant to or in connection with this Agreement, shall be held to be wholly or partially invalid or unenforceable under applicable law, said provision will be ineffective to that extent only, without in any way affecting the remaining parts or provisions of said agreement. H. Waiver. Neither the waiver by any of the parties hereto of a breach of or a default under any of the provisions of this Agreement, nor the failure of either of the parties, on one or more occasions, to enforce any of the provisions of this Agreement or to exercise any right or privilege hereunder, will thereafter be construed as a waiver of any subsequent breach or default of a similar nature, or as a waiver of any of such provisions, rights or privileges hereunder. I. Inspection. Training Site will permit, on reasonable notice and request, the inspection of clinical and related facilities by agencies charged with responsibility for accreditation of Green River College. J. HIPAA. Green River College voluntarily provides students with training on the requirements of the Health Insurance Portability and Accountability Act (HIPAA). Training Site will provide additional training on Training Site's specific HIPAA policies and procedures. Green River College will direct its students and faculty to comply with the policies and procedures of Training Site. No protected healthcare information (PHI) is anticipated to be exchanged between Training Site and Green River College. Solely for the purpose of defining students' role in relation to the use and disclosure of Training Site's PHI, students acting pursuant to this Agreement are defined as members of Training Site's workforce. However, Green River College's students and faculty shall not be considered to be employees of Training Site. COLLEGE FACILI By Shirley Bean B Shirley Bean Matthew StansKe Vice President for Business Administration Kent Police Department Deputy Chief of Police Approved as to form, Assistant Attorney General Attorney for College Signature: ShirteyBeaMMar 12,2024 13:25 PDT) Email: sbean@greenriver.edu DATE(MM/DD/YYYY) .ACC)R" CERTIFICATE OF LIABILITY INSURANCE ��. 8/25/2023 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Joyce Roberts Seattle-Alliant Insurance Services, Inc. PHONE FAX 401 Union Street, 31st Floor ([ut,rv_o,gg)...206-204-9175 f_l M91: E-MAIL Seattle WA98101 DREglLjp�mbers@alliant.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Westchester Surplus Lines Insu 10172 INSURED STATOFW-08 INSURERB; State of Washington 1500 Jefferson Street SE INSURER C: MS: 41466 INSURER D: Olympia WA 98504-1466 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:744839294 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 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY) FMMfDDNYYYI I LIMITS A X COMMERCIAL GENERAL LIABILITY G46807017007 9/1/2023 9/1/2024 EACH OCCURRENCE $1,000,000 AGE TO RENTED CLAIMS-MADE OCCUR PREMI Ea occurrence $100,000 X Ded$5,000 MED EXP(Any one person). $Excluded PERSONAL&ADV INJURY $1,000,000 HGEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 X POLICY jE LOC PRODUCTS-COMP/OP AGG $Ind in General OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea abddent ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E"L DISEASE-EA EMPLOYEE; $ IF yes,describe under DESCRJPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: Evidence of Insurance-State of Washington Medical Interns General Liability CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Evidence of Insurance AUTHORIZED REPRESENTATIVE @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD -0 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 8/25/2023 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME;. Joyce Roberts Seattle-Alliant Insurance Services, Inc. PHONE — - FAX 401 Union Street, 31 st Floor try,Ha,E:)): 206-204-9175 Arc,Re): Seattle WA 98101 pMAIIEss jerobe alliant.com INSURERS AFFORDING COVERAGE NAIC# INSURERA:Landmark American Insurance Co 33138 INSURED STATOFW-08 INSURER B: State of Washington 1500 Jefferson Street SE INsuRERc: MS:41466 INSURER D; Olympia WA 98504-1466 1NSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:1964871154 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 ADDLTYPE OF INSURANCE INSD SUER POLICY NUM�R POLICY EFF POLICY_yy LIMITS L TR M 1]D/YY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ AMA CLAIMS-MADE OCCUR PRE Eaocourance $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GE_N'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑JERQT- ❑ LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINEDSMLELINITT $ �Ea acc d ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS _ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Peraccident UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N TAT TE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? ❑ NIA (Mandatory in NH) E L.DISEASE-EA EMPLOYEE $ If yes,describe under _ 1!! F OPERATIONS belowE.L.DISEASE-POLICY LIMIT $ onal Liability LHR851477 9/1/2023 9/1/2024 Each Claim Limit 1,000,000 0/2010 Aggregate Limit 3,000,000 Deductible $2,500 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Insurance: State of Washington Participating Non-medical student intern professional liability CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Evidence of Insurance AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD