HomeMy Public PortalAbout100-2019 - Centerstone Solutions - Employee Assistance Programr
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PROFESSIONAL CONSULTING SERVICES AGREEMENT
THIS AGREEMENT made and entered into this /Mday of 2019 and referred to
as Contract -No. 100-2019, by and between the City of Richmond, In iana, a municipal corporation
acting by and through -its Board of Public works and Safety (hereinafter referred to as the "City")
and Centerstone Solutions, Inc., 601 Washington, Suite 102, Columbus, Indiana, 47201 (hereinafter
referred to as the "Contractor" ).
SECTION I. STATEMENT AND SUBJECT OF WORK
City *hereby retains Contractor to provide professional consultation advisory services for the
Employee Assistance Program ("EAP") for the City of Richmond Human Resources Department.
The proposal of Contractor, received on January 1, 2019, is attached hereto as Exhibit "A", which
Exhibit consists of five (5) pages, and is hereby incorporated by reference and made a part of this
Agreement. Contractor shall perform all wJ ork and provide all services described on Exhibit "A."
Should any provisions, terms, or conditions contained in any of the documents attached hereto as
Exhibits, or in any of the documents incorporated by reference herein, conflict with any , of the
provisions, terms, or conditions of this Agreement, this Agreement shall be controlling.
Contractor shall perform all work herein in a timely manner, conforming to all applicable
professional standards.
The Contractor shall furnish all labor, material, equipment, and services necessary for the proper
completion of all work specified.
No performance of services shall commence until the following has been met:
1. The City is in receipt of any required certificates of in
2. The City is in receipt of any required affidavit signed by Contractor in
accordance with Indiana Code 22-5-1.7-11(a)(2); and
3. A purchase order has been issued by the Purchasing Department.
SECTION II. STATUS OF CONTRACTOR
Contractor shall -be deemed to be an independent contractor and is not an employee or agent of the
City of Richmond. The Contractor shall provide, at its own expense, competent supervision of the
work.
SECTION III. COMPENSATION
City shall pay Contractor a- total sum not to exceed Six Thousand Five Hundred Seventy Dollars and
Zero Cents ($6,570.00) for EAP services and for the complete performance of all work described
herein in a satisfactory and proper manner.
Contract No. 100-2019
Page 1 of 5
SECTION IV. TERM OF AGREEMENT
This Agreement shall be effective when signed by all parties, to be effective in accordance with its
terms as of January 1, 2019, and shall continue in effect until December 31, 2019. This agreement
shall not automatically renew.
Notwithstanding the term of this Agreement, City may terminate this Agreement in whole or in part,
for cause, at any time by giving at least five (5) working days written notice specifying the effective
date and the reasons for termination which shall include- but not be limited to the following:
a. failure, for any reason of the Contractor to fulfill in a timely manner
its obligations under this Agreement;
b. submission of a report, other work product, or advice, whether oral or written, by the
Contractor to the City that is incorrect, incomplete, or does not meet reasonable
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professional standards in any material respect;
c. ineffective or improper use of funds provided under this Agreement;
d. suspension or termination of the grant funding to the City under which this Agreement
is made; or
e. unavailability of sufficient funds to make payment on this Agreement.
In the event of such termination, the City shall be required to make payment for all work performed
prior to the date this Agreement is terminated, but shall be relieved of any other responsibility herein.
This Agreement may also be terminated, in whole or in part, by mutual Agreement of the parties by
setting forth the reasons for such termination, the effective date, and in the case of partial
termination,' the portion to be terminated.
SECTION V. INDEMNIFICATION AND INSURANCE
Contractor agrees to obtain insurance and to indemnify the City for any damage or injury to person or
property or any other claims which may arise from the Contractor's conduct or .performance of this
Agreement, either intentionally or- negligently; provided, however, that nothing contained in this
Agreement shall . be construed as rendering the Contractor liable for acts of the City, its officers,
agents, or employees. Contractor shall as a prerequisite to this Agreement, purchase and -thereafter
maintain such insurance as will protect it from the claims set forth below which may arise out of or
result from the Contractor's operations under this Agreement, whether such operations by the
Contractor or by any sub -contractors or by anyone directly or indirectly employed by any of them, or
by anyone for whose acts the Contractor may be held responsible.
Coverage
Limits
A. worker's Compensation & Disability Requirements Statutory
B. Employer's Liability $1003000
Page 2of5
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C. Malpractice/Errors & Omissions Insurance $1,000,000 each occurrence
$2,000,000 each aggregate
SECTION VI. COMPLIANCE WITH WORKER' S COMPENSATION LAW
Contractor shall comply with all provisions of the Indiana worker's Compensation law, and shall,
before commencing work under this Agreement, provide the City a certificate of insurance, or a
certificate from the industrial board shoving that the Contractor has complied with Indiana Code
Sections 22-3 -2--5, 22--3 --5-1 and 22-3 -5-2. If Contractor is an out of state employer and therefore
sub j ect to another state's worker's compensation law, Contractor may choose to comply with all
provisions of its home state's worker's compensation law and provide - the . City proof of such
compliance in lieu of complying with the provisions of the Indiana worker's Compensation- Law.
SECTION VII. COMPLIANCE WITH INDIANA E-VERIFY PROGRAM REQUIREMENTS
Pursuant to Indiana Code 22-5-1.7, Contractor is required to enroll in and verify the work eligibility
status of all newly hired employees of the contractor through the Indiana E--Verify program.
Contractor is not required to verify the work eligibility status of all newly hired employees of the
contractor through the Indiana E-Verify program if the Indiana E--Verify program no longer exists.
Prior to the performance of this Agreement, Contractor shall provide to the City its signed Affidavit
affirming that Contractor does not knowingly employ an unauthorized alien in accordance with IC
22-5-1.7=11 (a) (2). In the event Contractor violates IC 22-5-1.7 the Contractor shall be required to
remedy the violation not later than thirty (30) days after the City notifies the Contractor of the
violation. If Contractor fails to remedy the violation within the thirty (30) day period provided
above, the City shall consider the Contractor to be in breach of this Agreement and this Agreement
will be terminated. If the City .determines that terminating this Agreement would be detrimental to
the public interest or public property, the City may allow this Agreement to remain in effect until the
City procures a new contractor. If this Agreement is terminated under this section, then pursuant to
IC 22-5-1.7-13 (c) the Contractor will remain liable to the City for actual damages.
SECTION VIII. IRAN INVESTMENT ACTIVITIES
Pursuant to Indiana Code (IC) 5-22-16.5, Contractor certifies that Contractor- is not engaged in
investment activities in Iran. In the event City determines during the- course of this Agreement that
this certification is no longer valid, City shall notify Contractor in writing of said determination and
shall give contractor ninety (90) days within which to respond to the written notice. In the event
Contractor fails to demonstrate to the City that the Contractor has ceased investment activities in Iran
within ninety (90) days after the written notice is given to the Contractor, the City may proceed with
any remedies it may have pursuant to IC 5-22-16.5. In .the event the City determines during the
course of this Agreement that this certification is no longer valid and said determination is not
refuted by Contractor in the manner set forth in IC 5-22-16.5, the City reserves the right to consider
the Contractor to be in breach of this Agreement and terminate the agreement upon the expiration of
the ninety (90) day period set forth above.
SECTION IX. PROHIBITION AGAINST DISCRIMINATION
A. Pursuant to Indiana Code 22-9-1--10, Contractor, any ' sub -contractor, or any person acting on
behalf of Contractor or any sub -contractor shall not discriminate against any employee or
Page 3. of 5
applicant for employment to be employed in the performance of this Agreement, with respect
to hire, tenure, terms, conditions or privileges of employment or any matter directly or
indirectly related to employment, because of race, religion, color, sex, disability, national
origin, or ancestry.
B. Pursuant to Indiana Code 5--16--6-1, the Contractor agrees:
1. That in the hiring of employees for the performance of work under this Agreement of
any subcontract hereunder, Contractor, any subcontractor, or any person acting on
behalf of Contractor or any subcontractor, shall not discriminate by reason of race,
religion, color, sex, national origin or ancestry against any citizen of the State of
Indiana who is qualified and available to perform the work to which the employment
relates;
2. That Contractor, 'any sub --contractor, or any person action on behalf of Contractor or
any subcontractor shall in ' no manner discriminate -against or intimidate any
employee hired for the performance of work under this Agreement on account of
race, religion, color, sex, national origin or ancestry;
3. That there may be deducted from the amount payable to Contractor by the City under
this Agreement, a penalty of five dollars ($5.00) for each person for each calendar
day during which such person was discriminated against or intimidated in violation of
the provisions of the Agreement; and
4. That this Agreement may be canceled or terminated by the City and all money due or
to become due hereunder may be forfeited, for a second or any subsequent violation
of the terms or conditions of this section of the Agreement.
C. Violation of the terms or conditions of this Agreement relating to discrimination or
intimidation shall be considered a material breach of this Agreement.
SECTION X. MISCELLANEOUS
This Agreement is personal to the parties hereto } and neither party may assign ' or delegate any of its
-rights or obligations hereunder without the prior written consent of the other party. Any such
delegation or assignment, without the prior written consent of the other party, shall be null and void.
This Agreement shall be- controlled by and interpreted according to Indiana law and shall be binding
upon the parties, their successors and assigns. This document constitutes the entire Agreement
betvVeen the parties, although it may be altered or amended in whole or in part at any time by filing
with the Agreement a Written instrument setting forth such changes signed by both parties. By
executing this Agreement the parties agree that this document supersedes any previous discussion,
negotiation, or conversation relating -to the subject matter contained herein.
This Agreement may be simultaneously executed in severat counterparts, each of which shall be an
original and all of .which shall constitute but one and the same -instrument.
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The parties hereto submit to jurisdiction of the courts of Wayne County, Indiana, and any suit arising
out of this Contract must be filed in said courts. The parties specifically agree that no arbitration or
mediation shall be required prior to the commencement of legal proceedings in said Courts. By
executing this Agreement, Contractor is estopped from bringing suit or any other action in .any
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alternative forum, venue, or in front of any other tribunal, court, or administrative body other than the
Circuit or Superior Courts of Wayne County, Indiana, regardless of any right Contractor may have to
bring such suit in front of other tribunals or in other venues.
s
Any person executing this Contract in a representative capacity hereby warrants that he/she has been
'duly authorized by his or her principal to execute this Contract.
In the event of any breach of this Agreement by Contractor, and in addition to any other damages or
remedies, Contractor shall be liable for all costs incurred by City in its efforts to enforce this
Agreement, including but not limited to, City's reasonable attorney's fees.
In the event that an ambiguity, question of intent, or a need for interpretation of this Agreement
arises, this Agreement shall be construed as if drafted jointly by the parties, and no presumption or
burden of proof shall arise favoring or disfavoring any party by virtue of the authorship of any of the
provisions of this Agreement.
IN WITNESS WHEREOF, the parties have executed this Agreement at Richmond, Indiana, as of the
day and year first written above, although signatures may be affixed on different dates.
"CITY" "CONTRACTOR'
THE CITY OF RICHMOND, CENTERSTONE SOLUTIONS, INC.
INDIANA by and through its 601 Washington, Suite 102
Board of Public Works and Safety Columbus, Indiana, 47201
By: �
ei
Vicki.Robinson, President
Y.-
By:
By: //2'Gu2���F�
Printed: � Zwi� �'4b�f
Title:
APPROVED: i Date:
. Sno, r
1q,Date:Iq
. Page 5 *of 5
EMPLOYEE ASSISTANCE PROGRAM (EAP) SERVICE AGREEMENT
The Employee Assistance Program (EAP) Services Agreement shall become effective on the
I st day of January 2019, by and between Centerstone Solutions (hereafter referred to as
"SOLUTIONS") and City of Richmond (hereafter referred to as "CLIENT"). Pursuant to this
agreement, SOLUTIONS and CLIENT agree to the following terms.
A. SOLUTIONS SHALL PROVIDE THE FOLLOWING:
1. Problem -solving and coaching services for employees and their household members,
including regular full --time and part-time employees. The EAP is a short --term problem -
solving model and eligible individuals will receive six (6) sessions per person, per issue, per
year on a confidential self -referral or a supervisory referral basis.
2. The EAP model focuses on short-term problem solving, which shall consist of assessment,
brief problem resolution, and referral as appropriate. Individuals will receive a brief
intervention plan based on the presenting issue, treatment goals, and appropriate
interventions based on session eligibility. These services are not to be considered free
mental health benefits for which the individual may be covered, but rather services available
prior to entering mental health benefits to resolve life issues that may impact the normal
productive functioning of an employee.
3. Confidentiality will be maintained and the limits of confidentiality will be explained to
each employee and or participating individuals prior to their program participation.
4. Access to EAP is available on a 24-hour a day, seven-day a week basis via a toll free
telephone number, including access to crisis line services if needed.
5. Locations for service includes a provider network with office locations to accommodate
those seeking confidential appointments during day or evening hours at a location
convenient to the individual's work or home.
6. Referrals will be made when in the best interest of the employee or household member. A
referral is typically made to a professional to meet the treatment needs identified during the
assessment. Other referrals will be made to community agencies, legal or financial
professionals, or other entities deemed appropriate. Fees for professional services by
resources other than those described herein as provided by SOLUTIONS shall be the
responsibility of the employee or individual, his or her group health plan, or other benefit
programs, as applicable.
7. EAP Professional Services will be provided by individuals with a minimum of a master's
degree, meeting the state licensing board requirements for their profession. These shall
include a combination of licensed clinical social workers, marriage and family therapists,
mental health counselors, addiction counselors, and other behavioral health clinicians as
defined by the state of practice.
I EXHIBIT -A PACE _�_OFE.
8. Client records shall be respected and kept confidential. Indiana Code 25--40 ensures privacy
of employee assistance records. In the event there is a potential threat of harm to one -self or
others, appropriate notification shall be made, and confidentiality breached, in accordance
with the law.
9. Insurance will be maintained with limits of $1 million (per occurrence)/$3 million (general
aggregate) professional liability errors &omissions coverage (including malpractice) and $1
million (per occurrence)/$3 million (general aggregate) comprehensive general liability
coverage (including mental anguish).
10. Employee & Supervisory orientations will be provided to inform employees o f EAP
services available, as well as resources available to managers and supervisors.
11. Basic Supervisory Training, will be provided to supervisors/managers on how to identify
and address job performance issues, learn ways to utilize EAP resources such as
management consultations and the management referral process, and receive other helpful
supervisory tools to optimize employee performance.
12. workplace Trainings on topics such as leadership development, professional skills
development, workplace respect, wellness, and achieving balance are available. Two (2)
hours of training are included in this agreement. Additional trainings are available at a rate
of $3001hour.
13. Management Consultations & Referrals are available on an ongoing basis. An EA
Professional will consult with managers/supervisors to develop a course of action for
employees or work teams who are not functioning at their best. when appropriate, the EA
Professional will guide leadership on making a formal management or mandatory referral.
14. Critical Incident Response (CIR) services are available when an unexpected or traumatic
event impacts the workplace.
15. Onsite Health/Wellness or Benefit Fairs attendance to educate employees of EAP
services will be provided by SOLUTIONS.
16. Utilization Reports will be provided on a quarterly basis to quantify the use of EAP
services and trends relating to demographics, issues, referrals, organizational services, etc.
17. Promotional materials to promote the EAP and its services will be provided on an ongoing
basis to CLIENT.
18. Work/Life Online Resource (fundamental) shall be available to all employees and their
household members with a company password assigned to access resources to help with
professional and daily living needs.
EXHIBIT PAGE OF�
B. SCOPE OF SERVICES:
Due to the dual client relationship that is inherent in an EAP, services which impact both
the company and the employee are outside the EAP's scope of service. An example of this
is providing a Fitness for Duty evaluation to determine whether an employee is able to
perform duties due to their current mental or emotional state. Although SOLUTIONS
would not provide the evaluation, we would assist in a referral to a psychologist trained in
performing these types of evaluations.
Other services which fall outside the EAP scope of service include services which do not
match a short-term intervention model such as court reports and psychological testing
which is a specific function within testing and evaluation services.
A list of services that are outside the scope of the EAP include:
• Family Medical Leave Act evaluations
• Fitness for Duty evaluations
• Evaluations for worker's compensation claims, disability claims, or legal proceedings
■ Court --ordered treatment and services
• Custody evaluations
• Psychological testing
1. Implementation assistance of the EAP by advising employees of the existence of the EAP
through the following: program announcement via mail or email; displaying brochures,
information cards, and posters in public places; include EAP information in employee
handbook and new hire packets; links on intranet if applicable; and integrate into
appropriate policies and training programs.
2. Promotion of the EAP program to employees on an ongoing basis and distribute
information as provided by SOLUTIONS.
3. Training space and time to allow for EAP orientations, training of supervisors, and other
training as scheduled by CLIENT.
4. Employee count on at least a yearly basis or as designated by SOLUTIONS.
5. Health Benefit Administrator information will be provided to SOLUTIONS including the
benefit plan administrator contact information and health benefit plan information and
guidelines to assist the EAP when a referral may be necessary.
6. Company Policies to SOLUTIONS related to EAP services such as union agreements and
workplace policies related to substance use, attendance, workplace violence, etc.
3
EXHIBIT . PAGE 3 0F
D. COMPENSATION:
CLIENT will be billed monthly in the amount of $1.50 per employee per month based on 365
employees ($6,570 total for full year) for all services rendered by SOLUTIONS under this
agreement. Payment is due within 30 days of invoice. Both parties to this agreement may consider
service changes and revised rates at the end of the contracted year.
E. INDEMNIFICATION:
SOLUTIONS will indemnify and hold CLIENT and its affiliates or subsidiaries harmless from
any and all loss, liability, expenses (including reasonable attorney fees) and claim for damages or
injury arising or allegedly arising from SOLUTIONS's provision of services, treatment or
referrals under this agreement, including any malpractice action. CLIENT will indemnify and
hold SOLUTIONS from any and all liability, loss, expenses (including reasonable attorney fees)
and claim for damages or injury arising solely from CLIENT's or an affiliate or subsidiary's
actions to SOLUTIONS, relating to a particular employee who has sought assistance under the
EAP.
F. THIS AGREEMENT
This agreement will be binding on CLIENT and its successors and assigns and on SOLUTIONS
and its successors and assigns.
G. GENERAL TERMS AND CONDITIONS
1. Term: This agreement is effective January 1, 2019, and shall continue through December
31, 2019.
2. Confidentiality: Neither party shall request of the other party the disclosure of confidential
information concerning any eligible person unless as required by law, without first obtaining
a written consent from the individual or by the individual's legal representative. In addition,
any information concerning CLIENT, its products, services, personnel policies, or any
other aspect of its business learned by SOLUTIONS in the course of providing services
under this Agreement shall be held in confidence and not disclosed by SOLUTIONS
without the prior written consent of CLIENT. Notwithstanding the confidential treatment of
CLIENT's business information, SOLUTIONS may identify CLIENT's as its client.
3. Amendment: This Agreement represents the final expression of all terms and conditions of
the Agreement and supersedes all prior written or oral representations, agreements, terms or
conditions affecting this Agreement. This Agreement may only be amended by a subsequent
written agreement signed by both parties.
4. Illegal or Invalid Provisions: In the event any provision of this Agreement is held illegal or
invalid for any reason, such illegality or invalidity will not affect the remaining parts of this
Agreement and the Agreement will be construed and enforced as if the invalid provision had
never been inserted.
EXHIBIT (� PAGE LV.0F _6_
5. CLIENT and SOLUTIONS hereby agree that this Agreement in no way constitutes a
principal or agency relationship, and specifically that SOLUTIONS is not the agent for
CLIENT nor any of its affiliates or subsidiaries. That the actions, recommendations, and
treatments provided or prescribed by SOLUTIONS are not attributable in any manner to
CLIENT but are meant for the benefit of the eligible individual solely upon the knowledge,
skill, and supervision of SOLUTIONS employees.
6. Notice: Any notice sent under this agreement will be deemed as received at the time of
personal delivery or five days after mailed by first class certified or registered mail, postage
prepaid, to the address stated below or to another address designated in writing by the
receiving party.
CENTERSTONE SOLUTIONS CITY OF RICHMOND
Program Director Human Resources
601 Washington Street, Ste. 102 50 North 5th Street
Columbus, IN 47201 Richmond, IN 47374
7. Waiver of Breach: No delay by a party in seeking a remedy as a result of a breach of any
provision of this agreement will be deemed to be a waiver of that breach. A waiver of one
breach by a party will not be deemed to be a waiver of any subsequent breach.
8. Governing Lave: This Agreement will be governed by and interpreted in accordance with
the laws of the State of Indiana.
9. Counterparts: This agreement is executed in several counterparts, each one of which will
be deemed to be the original.
IN WITNESS WHEREOF, the parties hereto have caused this agreement to be executed on their
behalf by their duly authorized officers of the day and the year written below.
CENTERSTONE SOLUTIONS
By: 'l%*�
Laura. A. Gibbons, Progr
Date
CITY OF RICHMOND
B:
5
EXHIBIT � PAGE �0�
Page 1 of 2
70
ACCORV CERTIFICATE OF LIABILITY INSURANCE
DATE (M MID DIYYYY)
OS/05/2D19
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
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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
Willis Towers Watson Southeast, Inc. fka Willis of Tennessee, Inc.
C/o 26 Century Blvd
P.O. Box 305191
CONTACT
NAME:
PHCNN x 1--877-945-7378 _FAX
No : 1-888-467-2378
E-MAIL certificates@willis.com
ADDRESS:
INSURER 5 AFFORDING COVERAGE
NAIC#
Nashville, TN 372305191 USA
INSURER A: Mental Health Risk Retention Group
44237
INSURED
INSURER B : Scottsdale Insurance Company
41297
Centerstone Solutions, Inc. (fka Advantage Behavioral)
Carol Bean
INSURER C : ,Travelers Casualty and Surety Company of A
31194
INSURER D :
44 Vantage Way
Suite 400
Nashville, TN 37228
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: W12254091 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
OF INSURANCE
ADDLSUBRTYPE
INSD
WVD
POLICY NUMBER
POLICY EFF
MM IDDNYYY
POLICY EXP
MM/DDIYYYY
LIMITS
X
1 COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
OCCUR
CLAIMS -MADE F-1PREMISESS
DAMAGE TO
(Ea occurrence)
$ 300,000
MED EXP (Any one person)
$ 10,000
A
PERSONAL & ADV INJURY
$ 1,000,000
COP0001807
11/06/2018
11/06/2019
N'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 1,000,000
GE
POLICY E PRO LOC
JECT
PRODUCTS -COMP/OP AGG
$ 1,000,000
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
$
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
B
X
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
XLS0102043
11/06/2018
11/06/2019
EACH OCCURRENCE
$ 31000,000
X
AGGREGATE
$ 3,000, 000
DED RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETOR/PARTNER/EXECUTIVE
STATUTE I ER
E.L. EACH ACCIDENT
$
OFFICER/M EMBER EXCLUDED? ❑
N / A
(Mandatory in NH)
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
If es, describe under
DESCRIPTION OF OPERATIONS below
A
Professional Liability
COP0001807
11/06/2018
11/06/2019
Limit of Insurance
$1,000,000
Aggregate
$11200,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schodule, may be attached if more space is required)
SEE ATTACHED
CERTIFICATE HOLDER CANCELLATION
City of Richmond, IN
50. North 5th Street
Richmond,,IN 47374
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
D;�` 0.s�
@ 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
SR ID: 18352195 BATCH: 1313373
AGENCY CUSTOMER ID:
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ACO � ADDITIONAL REMARKS SCHEDULE Page 2 of 2
AGENCY
NAMED INSURE❑
Willis Towers Watson southeast, Inc. fka Willis of Tennessee, Inc.
Centerstone Solutions, Inc. (fka Advantage Behavioral)
Carol Bean
44 Vantage Way
POLICY NUMBER
See Page 1
Suite 400
Nashville, TN 37228
CARRIER
NAIC CODE
See Page 1
See Page 1
EFFECTIVE DATE: See Page 1
ADDITIONAL REMARKS
A4UKU 1 U1 (1UU81U1 ) D 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
SR ID: 18352195 BATCH: 1313373 CERT: W12254091