Loading...
HomeMy Public PortalAboutC-21-161 - CSUDH OCCUPATIONAL THERAPYCSU - C AL:FORNIA STAt9 UP) "Y=R31T I: JO`.!•>7G�=Z HL3 Procurement and Contracts 1000 E. Victoria Street Carson, CA 90747 - (310) 243-3799 This Agreement is entered into by and between California State University Dominguez Hills, on behalf of the Occupational Therapy Program (OT), hereinafter called "CSUDH" and the City of Carson , hereinafter called the "Occupational Therapy Provider Field Work Site or FWS." The Agreement shall be effective July 1, 2021 to June 30 2024 unless terminated by either party, after giving the other party sixty (60) days advance written notice and subject to Section III.C.. LIFIMM1 ITAM11I WHEREAS, CSUDH has an approved Occupational Therapy Curriculum and such Curriculum includes fieldwork experience and the use of those facilities and instruction which is available at FWS; and WHEREAS, CSUDH and FWS believe itto be to the mutual benefit ofthe parties hereto that students accepted into the Occupational Therapy Program use the clinical Facility for their fieldwork experience to become competent practitioners, NOW, THEREFORE, in consideration of the covenants, conditions and stipulations expressed and in consideration of the mutual benefits to be derived there from, the parties mutually agree as follows: I. Responsibilities of FWS FWS shall, A. Accept qualified students for fieldwork experience in Occupational Therapy, the maximum number not to exceed that number for which the program has been accredited, approved and/ or agreed upon. B. Appoint a qualified FWS Employee who will be responsible for directing, coordinating and supervising CSUDH OT students' experience at FWS as well as insure that the continuity and quality of services to clients is maintained. C. Establish educational objectives for the clinical experience, devise methods for their implementation, and continually evaluate to determine the effectiveness of the clinical experience D. Provide CSUDH with student evaluations on forms submitted by CSUDH. E. Notify CSUDH at mid-term or sooner, of any student who fails to meet the required standards of performance and competency. F. Not use students to replace regular FWS employees and not require students to render services except those services identified for their learning value as part of the fieldwork experience. 01007.00011721727.1 Page 1 of 4 G. Work with and assist CSUDH in carrying out CSUDH policies and procedures. H. Appoint only state licensed therapists to supervise CSUDH Occupational Therapy fieldwork students, while participating at FWS. All therapists must be licensed by the state in which the FWS is located. II. Responsibilities ofCSUDH CSUDH shall: A. Refer qualified students from the program to FWS who have adequate academic preparation for clinical practice and basic training for the handling of blood, blood products and body fluids consistent with the policies and regulations recommended by the Center for Disease Control and in compliance with any such guidelines from the California Public Health Services Department. B. Assign a Fieldwork Coordinator from the OT program who will coordinate and be responsible for student FWS activities. C. Assign mutually agreed upon dates and times for student placements. D. Require student be responsible for their professional activities and conduct while at FWS. FWS may at its discretion dismiss or remove any trainee from the fieldwork experience following due process, and after consulting with CSUDH prior to such dismissal. E. Require students to conform to all applicable policies, regulations and procedures, jointly specified by representatives of CSUDH and FWS. F. Provide current student fieldwork guidelines and objectives to the FWS and all appropriate forms for evaluation. G. At its sole cost and expense, insure its activities in connection with this agreement and obtain, keep in force, and maintain Insurance as follows: H. Provide Comprehensive or General Liability Insurance with a limit of One Million Dollars ($1,000,000), and Three Million Dollars ($3,000,000) in aggregate, per occurrence. I. The University shall maintain and provide evidence of workers' compensation and disability coverage as required by law. J. Require students to provide and maintain in force a One Million Dollar ($1,000,000) policy of professional liability insurance during the course of their activities under this Agreement. K. Require students to provide evidence of health coverage. L. Require students to provide documentation of appropriate immunization or immunity in compliance with OSHA Blood -Borne Pathogens Regulations, as well as requirements of the FWS. M. Require students to adhere to rules and regulations of FWS/CSUDH regarding confidentiality. III. General Provisions A. Neither CSUDH nor FWS shall discriminate against any candidate or student on the basis of race, color, religion, national origin, sex, age or sexual orientation. 01007.00011721727.1 Page 2 of 4 B. Pursuant to Government Code section 895.4, FWS shall indemnify, defend and hold harmless CSUDH and its elected and appointed officers, employees, and agents from and against all liability, including but not limited to demands, claims, actions, fees, costsd pen S�BH ases (including attorney and expert witness fees), arising from or connected with-(nd/or omissions arising from and/or relating to this Agreement. Such indemnification shalknot cover any claim due to the sole negligence or willful misconduct of CSUDH. G=� 1� Pursuant to Government Code section 895.4, CSUDH shall indemnify, defend and hold harmless FWS and its elected and appointed officers, employees, and agents from and against all liability, including but not limited to demands, claims, actions, fees, costs and expenses (including attorney and expert witness fees), arising from or connected with CSUDH acts and/or omissions arising from and/or relating to this MOU. Such indemnification shall not cover any claim due to the sole negligence or willful misconduct of FWS. C. The Agreement maybe terminated by either party at anytime, without cause, on 60 days prior written notice provided that such termination shall not be effective for any student who at the date of mailing of said notice was participating in or was selected to participate in said fieldwork experience until such student has completed the program. D. This Agreement may at anytime be altered, changed or amended in writing by mutual agreement of the parties. E, The OT fieldwork coordinator for CSUDH is: Daniel Swiatek, OTD, OTR/L. F. IN WITNESS whereof, this Agreement has been executed by and on behalf of the parties hereto by the signatures of their authorized respective agents the day and year written herein below. CALIFORNIA STATE UNIVERSITY, DOMINGUEZ HILLS Procurement, Contracts, Logistical & Support Services Carson, CA 90747 310-243-3799 mehernandezCfcsudh.edu By: 'r Its i 2� Designee Date Procurement and Contracts Logistical & Support Services FWS: The City of Carson Name: Lula Davis -Holmes Title: Mayor Address: 701 E. Carson St., Carson, California 90745 Phone: 310-952-1720 % 114skI Authorized Signature Date 01007.0001/721727.1 Page 3 of 4 APPROVED AS TO FORM: ATTEST: ' U By: By: Sunny K. Soltani, City Attorney 10n rroll, Chief Deputy City .,4_ 01007.0001/721727.1 Page 4 of 4 CERTIFICATE OF COVERAGE DATE (MWDDNYYY) 10/5/2021 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF EVIDENCE ONLY AND CONFERS NO RIGHTS TYPE OF COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR Alllant Insurance Services Inc. NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE MEMORANDUM(S) OF COVERAGE BELOW. 100 Pine Street, 11th Floor THIS CERTIFICATE OF COVERAGE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE San Francisco CA 94111 ISSUING COVERAGE PROVIDER, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE 7/1/2021 CERTIFICATE HOLDER. EACH OCCURRENCE IMPORTANT: IF THE CERTIFICATE HOLDER IS AN ADDITIONAL COVERED PARTY, THE MEMORANDUM OF COVERAGE MUST BE ENDORSED. A STATEMENT ON THIS CERTIFICATE DOES NOT CONFER RIGHTS TO THE CERTIFICATE HOLDER IN LIEU OF SUCH ENDORSEMENT(S). IMPORTANT: IF SUBROGATION IS WAIVED, SUBJECT TO THE TERMS AND CONDITIONS OF THE NAMED COVERED PARTY CSU, Dominguez Hills 1000 East Victoria Street Carson East 90747 MEMORANDUM(S) OF COVERAGE AN ENDORSEMENT MAY BE REQUIRED. A STATEMENT ON THE CERTIFICATE DOES NOT CONFER RIGHTS TO THE CERTIFICATE HOLDER IN LIEU OF SUCH ENDORSEMENT(S). PROGRAM AFFORDING COVERAGE A: CSURMA B: MED EXPENSE (Any one person) C: COVERAGES THIS IS TO CERTIFY THAT THE COVERAGE IS AFFORDED TO THE ABOVE NAMED MEMBER, AS PROVIDED BY THE MEMORANDUM(S) OF COVERAGE, FOR THE PERIOD SHOWN BELOW, NOT WITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE COVERAGE AFFORDED BY THE PROGRAM DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH MEMORANDUM(S) OF COVERAGE. THE FOLLOWING COVERAGE IS IN EFFECT. JPA LTR TYPE OF COVERAGE MEMORANDUM NUMBER COVERAGE EFFECTIVE DATE (MM/DD/YY) COVERAGE EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY CSURMA-LIAB-2122 7/1/2021 7/1/2022 EACH OCCURRENCE $ 2,000,000 COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) S 2,000,000 CLAIMS MADE � OCCUR MED EXPENSE (Any one person) S Excluded PERSONAL & ADV INJURY S2,000,000 X Contractual Liab X I SIR $250,000 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S4,000,000 MEMO ANDUM PROJECT LOC A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) $ ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS A WORKERS' COMPENSATION AND EMPLOYERS LIABILITY CSURMA-WC-2122 7/1/2021 7/1/2022X WC OTHER STATUTORY LIMITS ANY PROPRIETOR/PARTNER/ EXECUTIVE/OFFICER/MEMBER E.L. EACH ACCIDENT S1,000,000 EXCLUDED? E.L. DISEASE — EA EMPLOYEE $ 1,000,000 IF YES, DESCRIBED UNDER SPECIAL E.L. DISEASE — POLICY LIMIT S 1,000,000 PROVISION BELOW OTHER OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAUPROVISIONS Note: Workers' Compensation Coverage is provided as evidence only. Evidence of coverage as respects the Agreement for Occupational Therapy Program use the clinical Facility for fieldwork experience. Term of Agreement: July 1, 2021 - June 30, 2024. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED MEMORANDUM(S) OF COVERAGE The City of Carson APPROVED Attn: Lula Davis -Holmes G 701 E. Carson St. BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE MEMORANDUM(S) OF COVERAGE PROVISIONS. AUTHORIZED REPRESENTATIVE Carson CA 90745 10/11/2021 AC J?" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 10/5/2021 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 Alliant Insurance Services, Inc. 100 Pine Street, 11th floor San Francisco CA 94111 CONTACT Van Rin PHONE FAX • 415-403-1400 (AIC'No): 415-874-4810 ADDRESS: vrin@alliant.com INSURER(S) AFFORDING COVERAGE NAIC # Carson CA 90745 INSURERA: Lloyds of London 15792 B1724WLS21AO36 INSURED The California State University (CSU) 401 Golden Shore, 5th Floor INSURER B: INSURER C: INSURER D: Long Beach, CA 90802 INSURER E: CSU Dominguez Hills INSURER F: COVERAGES CERTIFICATE NUMBER: 975337119 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADSL SUER POLICY NUMBER POLICY EFF MM/DDfYYYY POLICY EXP MM DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Carson CA 90745 B1724WLS21AO36 7/1/2021 7/1/2022 EACH OCCURRENCE $2,000,000 X CLAIMS -MADE 71OCCUR DAMAGE TO PREMISES Ea occurrence $ 25,000 MED EXP (Any one person) $ 25,000 PERSONAL &ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 X POLICY F—] JER0. LOC PRODUCTS - COMP/OP AGG $4,000,000 $ 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 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE OR ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OF EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below I E.L. DISEASE_- POLICY LIMIT $ A Student Professional B1724WLS21AO36 7/1/2021 7/1/2022 $2,000,000 Each Claim Liability Insurance $4,000,000 Policy Aggregate Program (SPLIP) DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) THIS CERTIFICATE IS PROVIDED FOR EVIDENCE ONLY. General Liability and Professional Liability coverage is provided on a claims -made basis including a 3 year extended reporting period. Coverage extends to students enrolled in covered academic courses. Coverage extends to any affiliate institution to whom the Named Insured is obligated by written agreement to add as Additional Insured. Coverage applies only when there exists a written agreement between the University and the affiliate institution, which is executed prior to an incident giving rise to a claim for a covered loss. Re: Agreement for Occupational Therapy Program use the clinical Facility for fieldwork experience. Term of Agreement: July 1, 2021 - June 30, 2024. CERTIFICATE HOLDER CANCELLATION ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE APPROVED THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Carsonj) ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Lula Davis -Holmes /C AUTHORIZED REPRESENTATIVE 701 E. Carson St.10/11/2021 Carson CA 90745 /4xtf.—.-,. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD