HomeMy WebLinkAboutMINUTES - 04261994 - 1.174 To: BOARD OF SUPERVISORS
FROM:Mark Finucane, Health Services Director ��`� Contra
By: Elizabeth A. Spooner, Contracts Administrator Costa
DATE: April 14, 1994 CountySUBJECT: Approval of Contract #24-767 with Edith Burnett-Johnson
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
I. RECOMMENDED ACTION:
Approve and authorize the Health Services Director, or his designee
(Lorna Bastian) , to execute on behalf of the County, Standard Contract
#24-767 with Edith Burnett-Johnson, in the amount of $43, 686, for the
period from April 1, 1994 through March 31, 1995, to provide family
intervention services under the County's Youth Interagency Assessment
and Consultation . Team (YIACT) Program. This Contract includes a
three-month automatic extension through June 30, 1995, in the amount
of $10, 922.
II. FINANCIAL IMPACT:
This Contract is funded 100% by Federal SAMHSA Block Grant funds. No
County funds are required. t
III. REASONS FOR RECOMMENDATIONS/BACKGROUND:
Under Standard Contract #24-767, Edith Burnett-Johnson will provide
community- and home-based mental health intervention services to
severely emotionally disturbed minors who are chronically at risk for
out-of-home placement (i.e. , hospitalization and/or residential
treatment) and their families, through March 31, 1995.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR REC MMEN TI N OF BOARD C MMITTEE
APPROVE OTHER
SIGNATURE(S)
ACTION OF BOARD ON APPROVED AS RECOMMENDED OTHER
VOTE OF SUPERVISORS
UNANIMOUS (ABSENT ) I HEREBY CERTIFY THAT THIS IS A TRUE
AYES: NOES: AND CORRECT COPY OF AN ACTION TAKEN
ABSENT: ABSTAIN: AND ENTERED ON THE MINUTES OF THE BOARD
Contact: Lorna Bastian (313-6411) OF SUPERVISORS ON THE DATE SHOWN.
CC: Health Services (Contracts) ATTESTED --CA,".Q_-1
Risk Management
Phil Datetelor.Clerk of the 9031d of
Auditor-Controller Suvervisors and County Administrator
Contractor
M382/7-83 ,
BY � �QQ. DEPUTY
t Contra Costa County CONTRACT EMPLOYEE Number 24-767
Standard Form 1/87 STANDARD CONTRACT Fund/Org # 5947
(Purchase of Services) Account # 2310
1. Contract Identification. Other #
Department: Health Services - Mental Health Division
Subject: Community-based intensive intermittent mental health
se es to severely emotionally disturbed minor
ou y's YIACT Program
2. r ' County of Contra Costa, California (County) , or t e FTenamed
above, and the following named Contractor mutually agree and promise as follows:
Contractor: EDITH BURNETT-JOHNSON
Capacity: Self-employed individual Taxpayer ID #556-86-5216
Address: 243 Heron Drive, Pittsburg, California 94565
3. Term. The effective date of this Contract is April 1. 1994 and it terminates
March 31. 1995 unless sooner terminated as provided herein.
4. Payment Limit. County's total payments to Contractor under this Contract shall not
exceed4S 3,686.
5. County's Obligations. County shall make to the Contractor those payments described in
the Payment Provisions attached hereto which are incorporated herein by reference,
subject to all the terms and conditions contained or incorporated herein.
t 1 �T��YM'y:'
6. Contractor's Obligations. Contract 11^pr6,, e those services and carry out that
work described in the Service P1°-an at ac heto which is incorporated herein by
reference, subject to all the itilns contained or incorporated herein.
7. General and Special Conditions. This Contract is subject to the General Conditions and
Special Conditions (if any) attached hereto, which are incorporated herein by
reference.
8. Pro ect. This Contract implements in whole or in part the following described Project,
the application and approval documents of which are incorporated herein by reference:
Current Federal SAMHSA Block Grant (#29-472) and any revisions or modifications
thereof, a copy of which is on file in the office of the County's Mental Health
Director.
9. Legal Authority. This Contract is entered into under and subject to the following
legal authorities: California Government Code Section 26227 and 31000.
10. Signatures. These signatures attest the parties' agreement hereor.
r
C1444 COUNTY OF CONTRA COSTA. CALIFORNIA
ATTEST: Phil Batchelor, Clerk of the Board
Aam'T :
BOARD OF ' UPERV RS of Supervisors and County Administrator
By By
Chairman/Designee Deputy
CONTRACTOR
By By
XXXXXXXXXXXXXXXXXXXXXXXKKKKKKKKKKKKKKXXXX-
(Designate business capacity A) (Designate business capacity B)
Note to Contractor: For corporations (profit or nonprofit), the contract must be signed by tvo officers. Signature A must be
that of the president or vice-president and Signature B must be that of the secretary or assistant secretary (Civil Code Section
1190 and Corporations Code Section 313). All signatures must be acknowledged as set forth on page two.
Contra Costa County Standard Form 1/87
APPROVALS/ACKNOWLEDGEMENT
Number 24-767
APPROVALS
RECOMMENDED BY DEPARTMENT FORM APPROVED
By By
Designee
APPROVED: COUNTY ADMINISTRATOR
By
ACKNOWLEDGEMENT
State of California ACKNOWLEDGEMENT (By Corporation,
Partnership, or Individual)
County of
The person(s) signing above for Contractor, personally known to me in the
individual or business capacity(ies) stated, or proved to me on the basis of
satisfactory evidence to be the stated individual or the representatives) of the
partnership or corporation named above in the capacity(ies) stated, personally
appeared before me today and acknowledged that he/she/they executed it, and
acknowledged to me that the partnership named above executed it or acknowledged
to me that the corporation named above executed it pursuant to its bylaws or a
resolution of its board of directors.
Dated:
[Notarial Seal]
Notary Public/Deputy County Clerk
-2-
Contra' Costa County PAYMENT PROVISIONS Standard Form 6/90
(Fee Basis Contracts)
Number 24-767
1. Payment Amounts. Subject to the Payment Limit of this Contract and subject to the
following Payment Provisions, County will pay Contractor the following fee as full
compensation for all services, work, expenses or costs provided or incurred by
Contractor:
[Check one alternative only. ]
[ ] a. $ monthly, or
[ ] b. $ per unit, as defined in the Service Plan, or
[ ) c. $ after completion of all obligations and conditions herein.
[R] d. $ 19.32 per hour, not to exceed 2.080 hours or a total of4S 0.186; and
In addition, County will reimburse Contractor for the reasonable costs of
allowable expenses actually incurred in the provision of services hereunder
for needed supplies and for daily use of a private automobile following
arrival at the work site, at a rate of 29 cents per mile, but not to exceed
$3.500 for all allowable expenses.
2. Payment Demands. Contractor shall submit written demands. Said demands shall be made
on County Demand Form D-15 and in the manner and form prescribed by County. Contractor
shall submit said demands for payment no later than 30 days from the end of the month
in which the contract services upon which such demand is based were actually rendered.
Upon approval of said payment demands by the head of the County Department for which
this Contract is made, or his designee, County will make payments as specified in
Paragraph 1. (Payment Amounts) above.
3. Penalty for Late Submission. When Contractor fails to submit to County a timely demand
for payment as specified in Paragraph 2. (Payment Demands) above, and as a result of
Contractor's late submission the County is unable to obtain reimbursement from the
State of California or otherwise; to the extent the County's recovery of funding is
prejudiced, County shall not pay Contractor for such services, even though such
services were fully provided.
4. Right to Withhold. County has the right to withhold payment to the Contractor when,
in the opinion of the County expressed in writing to the Contractor, (a) the
Contractor's performance, in whole or in part, either has not been carried out or is
insufficiently documented, (b) the Contractor has neglected, failed or refused to
furnish information or to cooperate with any inspection, review or audit of its
program, work or records, or (c) Contractor has failed to sufficiently itemize or
document its demand(s) for payment.
5. Audit Exceptions. Contractor agrees to accept responsibility for receiving, replying
to, and/or complying with any audit exceptions by appropriate County, State or Federal
audit agencies occurring as a result of its performance of this Contract. Contractor
also agrees to pay to the County within 30 days of demand by County the full amount of
the County's obligation, if any, to the State and/or Federal government resulting from
any audit exceptions, to the extent such are attributable to the Contractor's failure
to perform properly any of its obligations under this Contract.
Initials:
Contractor County Dept.
Contra Costa County PAYMENT PROVISIONS Standard Form 6/90
(Fee Basis Contracts)
Number 24-767
6. Required Audit. If Contractor is funded by $25,000 or more in federal grant funds in
any fiscal year from any source, Contractor shall provide to County at Contractor's
expense an audit conforming to the requirements set forth in the most current version
of Office of Management and Budget Circular A-133. If Contractor is funded by $25,000
to $100,000 in federal grant funds in any fiscal year from any source, Contractor shall
arrange for conduct of the federally-required audit biennially and shall submit the
audit to County in the time, form, and manner required by the most current version of
Office of Management and Budget Circular A-133 and by County. If Contractor is funded
by $100,000 or more in federal grant funds in any fiscal year from any source,
Contractor shall arrange for the audit to County in the time, form, and manner required
by the most current version of Office of Management and Budget Circular A-133 and by
County. Contractor is solely responsible for arranging for the conduct of the audit,
and for its cost, and County may withhold the estimated cost of the audit or 10 percent
of the contract amount, whichever is larger, or the final payment, from Contractor
until County receives the audit from Contractor.
Initials:
Contractor County Dept.
SERVICE PLAN
Number 24-767
Service Activities. During the term of this Contract, Contractor
shall work cooperatively with the County's Contract monitor to
provide professional community- and home-based mental health
intervention services to County-designated severely emotionally
disturbed minors and their families. Contractor's services shall
be provided in the time, place, and manner required by County and
shall include, but may not be limited to, the following:
a. Mental health services and interventions including, but
not limited to: individual and family counseling sessions;
emergency and crisis response interventions; case management
linkage and consultation; and family support.
b. All preparation for community-based service delivery,
including the procurement of any necessary materials.
C. Completion of documents required by County for data
collections and/or billing to third-party payors.
d. Other required paperwork, such as charting, reports,
letters, memos, and any other documents requested by the County's
Contract monitor, in the time, form and manner required by County.
Initials•
Contractor County Dept.
SPECIAL CONDITIONS
Number 24-767
1. Withholding and FICA Deductions. Notwithstanding Paragraph 14.
(Independent Contractor Status) of the General Conditions, for purposes of
withholding state and federal taxes and Social Security only from payments
due, the Contractor will be treated as an employee and the Auditor-Controller
will make deductions for these purposes as if Contractor was an employee.
Contractor agrees that for all other purposes, Contractor is not a County
employee and remains an independent contractor. Contractor further agrees
that the County has no obligation to provide, and the Contractor will not be
provided with, workers ' compensation insurance or fringe benefits, including
but not limited to, vacation, sick leave, retirement, and health plan
coverage.
2 . Insurance. Paragraph 19. (Insurance) of the General Conditions is
hereby deleted and replaced by the following paragraph:
1119. Insurance.
a. Automobile Liability Insurance. During the entire term of
this Contract and any extension or modification thereof, Contractor shall
keep in effect a policy or policies of motor vehicle liability insurance,
with an endorsement to include the County and its officers and employees as
additional insureds, for any use Contractor makes of a private automobile in
the performance of this Contract, as required by State law and in amounts not
less than:
(1) $100, 000 for personal injury to, or death of, one person;
(2) $300, 000 for injury to, or death of, two or more persons,
per occurrence; and
(3) $ 50, 000 for property damage.
Contractor shall provide County with a certificates) of insurance evidencing
motor vehicle liability insurance as required herein no later than the
effective date of this Contract. If Contractor should renew the insurance
policy(ies) or acquire either a new insurance policy(ies) or amend the
coverage afforded through an endorsement to the policy at any time during the
term of this Contract, then Contractor shall provide current certificate(s)
of insurance. The insurance policy or policies provided by Contractor shall
include a provision for thirty (30) days written notice to County before
cancellation or material change of the above-specified coverage. Said
policy(ies) shall constitute primary insurance as to the County, the State
and Federal Governments, their officers, agents, and employees, so that other
insurance policies held by them or their self-insurance program(s) shall not
be required to contribute to any loss covered under the Contractor's
insurance policy or policies.
b. Professional Liability Insurance. Contractor shall provide
and keep in effect a policy or policies of professional liability insurance
Initials:
Contractor County Dept.
1
SPECIAL CONDITIONS
Number 24-767
including coverage against errors and omissions (malpractice) with a minimum
coverage limit of $1, 000, 000 per occurrence for all damages resulting from
professional services provided by Contractor under this Contract.
Not later than the effective day of this Contract, Contractor shall provide
County with a certificate(s) of insurance evidencing the above liability
insurance. Contractor shall provide County with new certificates of
insurance if there is any change in coverage. "
3 . Automatic Contract Extension. Notwithstanding Paragraph 3 . (Term) of
this Contract, unless this Contract is terminated by either party pursuant to
Paragraph 5. (Termination) of the General Conditions prior to March 31, 1995,
the term of this Contract shall be automatically extended from March 31, 1995
through June 30, 1995. During its extended term, this contract is
nevertheless subject to all the terms and conditions applicable during its
initial term, including but not limited to General Conditions Paragraph 5.
(Termination) , except as to payment for services rendered during the extended
term. The purpose of this automatic three-month extension is to allow for
continuation of services as specified in this Contract, to avoid interruption
of payment to Contractor, and to allow County time in which to complete a
novation or renewal contract for Contractor and County Board 'of Supervisors
approval. As to any such three-month extension:
a. The Contract Payment Limit, specified in Paragraph 4 . (Payment
Limit) of this Contract, is increased by $10,922 (the three-month Payment
Limit) and County's total payments to Contractor for said three-month
extension shall not exceed this three-month Payment Limit, subject,
nevertheless, to the aforesaid novation -or renewal contract.
b. Subject to the three-month Payment Limit specified above, County
shall pay Contractor as follows:
(1) For the period April 1, 1995 through June 30, 1995, $19.32 per
hour, not to exceed 520 hours of service or a total of
$10,047; and
(2) County shall also reimburse Contractor for the reasonable
costs of allowable expenses actually incurred in the provision
of services hereunder for needed supplies and for daily use of
a private automobile following arrival at the work site, at a
rate of 29 cents per mile, but not to exceed 875 for such
allowable expenses.
C. Contractor shall continue to provide services as set forth in the
Service Plan, subject to any amendments thereto.
d. This three-month contract extension shall be subject to any further
agreement (novation) which Contractor and County may enter into covering the
provision of services during the contract period immediately following the
contract period specified in Paragraph 3. (Term) , in accordance with Contra
Initials:
Contractor County Dept.
2
SPECIAL CONDITIONS
Number-24-767
Costa County's current revision of the project specified in Paragraph 8.
(Project) of the Standard Contract.
4. Endorsements. Contractor shall not in its capacity as a contractor with
Contra Costa County publicly endorse or oppose the use of any particular
brand name or commercial product without the prior approval of the Board of
Supervisors. In its County contractor capacity, Contractor shall not
publicly attribute qualities or lack of qualities to a particular brand name
or commercial product in the absence of a well-established and widely
accepted scientific basis for such claims or without the prior approval of
the Board of Supervisors. In its County contractor capacity, Contractor
shall not participate or appear in any commercially-produced advertisements
designed to promote a particular brand name or commercial product, even if
Contractor is not publicly endorsing a product, as long as the Contractor's
presence in the advertisement can reasonably be interpreted as an endorsement
of the product by or on behalf of Contra Costa County. Notwithstanding the
foregoing, Contractor may express its views on products to other contractors,
the Board of Supervisors, County officers, or others who may be authorized by
the Board of Supervisors or by law to receive such views.
Initials:
Contractor County Dept.
3
Contra'Costa County Standard Form 1/87
GENERAL CONDITIONS
(Purchase of Services)
1. Compliance with Law. Contractor shall be subject to and comply with all Federal, State and local
laws and regulations applicable with respect to its performance under this Contract, including but not
limited to, licensing, employment and purchasing practices; and wages, hours and conditions of
employment, including nondiscrimination.
2. Inspection. Contractor's performance, place of business and records pertaining to this Contract
are subject to monitoring, inspection, review and audit by authorized representatives of the County, the
State of California, and the United States Government.
3. Records. Contractor shall keep and make available for inspection and copying by authorized
representatives of the County, the State of California, and the United States Government, the
Contractor's regular business records and such additional records pertaining to this Contract as may be
required by the County.
a. Retention of Records. The Contractor shall retain all documents pertaining to this Contract
for five years from the date of submission of Contractor's final payment demand or final Cost Report;
for any further period that is required by law; and until all Federal/State audits are complete and
exceptions resolved for this contract's funding period. Upon request, Contractor shall make these records
available to authorized representatives of the County, the State of California, and the United States
Government.
b. Access to Books and Records of Contractor, Subcontractor. Pursuant to Section 1861(v)(1)
of the Social Security Act, and any regulations promulgated thereunder, Contractor shall, upon written
request and until the expiration of four years after the furnishing of services pursuant to this Contract,
make available to the Secretary of Health and Human Services or to the Comptroller General, or any of
their duly authorized representatives, this Contract and books, documents, and records of Contractor
that are necessary to certify the nature and extent of all costs and charges hereunder.
Further, if Contractor carries out any of the duties of this Contract through a subcontract with a value
or cost of $10,000 or more over a twelve-month period, such subcontract shall contain a clause to the
effect that upon written request and until the expiration of four years after the furnishing of services
pursuant to such subcontract, the subcontractor shall make available, to the County, to the Secretary or
to the Comptroller General, or any of their duly authorized representatives, the subcontract and books,
documents, and records of the subcontractor that are necessary to verify the nature and extent of all costs
and charges thereunder.
This special condition is in addition to any and all other terms regarding the maintenance or retention
of records under this Contract and is binding on the heirs, successors, assigns and representatives of
Contractor.
4.. Reporting Requirements. Pursuant to Government Code Section 7550, Contractor shall include
in all documents or written reports completed and submitted to County in accordance with this Contract,
a separate section listing the numbers and dollar amounts of all contracts and subcontracts relating to
the preparation of each such document or written report. This section shall apply only if the payment
limit under this Contract exceeds $5,000.
1
Contra 'Costa County Standard Form 1/87
GENERAL CONDMONS
(Purchase of Services)
5. Termination.
a. Written Notice. This Contract may be terminated by either party, at their sole discretion,
upon thirty-day advance written notice thereof to the other, and may be cancelled immediately by written
mutual consent.
b. Failure to Perform. The County, upon written notice to Contractor, may immediately
terminate this Contract should the Contractor fail to perform properly any of its obligations hereunder.
In the event of such termination, the County may proceed with the work in any reasonable manner it
chooses. The cost to the County of completing Contractor's performance shall be deducted from any sum
due the Contractor under this Contract, without prejudice to the County's rights otherwise to recover
its damages.
C. Cessation of Funding. Notwithstanding Paragraph 5.a. above, in the event that Federal,
State, or other non-County funding for this Contract ceases, this Contract is terminated without notice.
6. Entire Agreement. This Contract contains all the terms and conditions agreed upon by the parties.
Except as expressly provided herein, no other understanding, oral or otherwise, regarding the subject
matter of this Contract shall be deemed to exist or to bind any of the parties hereto.
7. Further Specifications for Operating Procedures. Detailed specifications of operating procedures
and budgets required by this Contract, including but not limited to, monitoring, evaluating, auditing,
billing, or regulatory changes, may be developed and set forth in a written Informal Agreement between
the Contractor and the County. Such Informal Agreements shall be designated as such and shall not be
amendments to this Contract except to the extent that they further detail or clarify that which is already
required hereunder. Such Informal Agreements may not enlarge in any manner the scope of this
Contract, including any sums of money to be paid the Contractor as provided herein. Informal
Agreements may be approved and signed by the head of the County Department for which this Contract
is made or his designee.
8. Modifications and Amendments.
a. General Amendments. This Contract may be modified or amended by a written document
executed by the Contractor and the Contra Costa County Board of Supervisors or, after Board approval,
by its designee, subject to any required State or Federal approval.
b. Administrative Amendments. Subject to the Payment Limit, the Payment Provisions and
the Service Plan may be amended by a written administrative amendment executed by the Contractor
and the County Administrator or his designee, subject to any required State or Federal approval,
provided that such administrative amendments may not materially change the Payment Provisions or the
Service Plan.
9. Disputes. Disagreements between the County and Contractor concerning the meaning,
requirements, or performance of this Contract shall be subject to final determination in writing by the
head of the County Department for which this Contract is made or his designee or in accordance with
the applicable procedures (if any) required by the State or Federal Government.
2
Coetra'Costa County Standard Form 1/87
GENERAL CONDITIONS
(Purchase of Services)
I
10. Choice of Law and Personal Jurisdiction.
a. This Contract is made in Contra Costa County and shall be governed and construed in
accordance with the laws of the State of California.
b. Any action relating to this Contract shall be instituted and prosecuted in the courts of
Contra Costa County, State of California.
11. Conformance with Federal and State Regulations and Laws. Should Federal or State regulations
or laws touching upon the subject of this Contract be adopted or revised during the term hereof, this
Contract shall be deemed amended to assure conformance with such Federal or State requirements.
12. No Waiver by County. Subject to Paragraph 9. (Disputes) of these General Conditions, inspections
or approvals, or statements by any officer, agent or employee of the County indicating the Contractor's
performance or any part thereof complies with the requirements of this Contract, or acceptance of the
whole or any part of said performance, or payments therefor, or any combination of these acts, shall not
relieve the Contractor's obligation to fulfill this Contract as prescribed; nor shall the County be thereby
estopped from bringing any action for damages or enforcement arising from any failure to comply with
any of the terms and conditions of this Contract.
13. Subcontract and Assignment. This Contract binds the heirs, successors, assigns and
representatives of Contractor. The Contractor shall not enter into subcontracts for any work
contemplated under this Contract and shall not assign this Contract or monies due or to become due,
without the prior written consent of the County Administrator or his designee, subject to any required
State or Federal approval.
14. Independent Contractor Status. This Contract is by and between two independent contractors and
is not intended to and shall not be construed to create the relationship between the parties of agent,
servant, employee, partnership, joint venture or association.
15. Conflicts of Interest. Contractor, its officers, partners, associates, agents, and employees, shall
not make, participate in making, or in any way attempt to use the position afforded them by this
Contract to influence any governmental decision in which he or she knows or has reason to know that
he or she has a financial interest under California Government Code Sections 87100, et seq., or
otherwise.
16. Confidentiality. Contractor agrees to comply and to require its officers, partners, associates,
agents and employees to comply with all applicable State or Federal statutes or regulations respecting
confidentiality, including but not limited to, the identity of persons served under this Contract, their
records, or services provided them, and assures that:
a. All applications and records concerning any individual made or kept by Contractor or any
public officer or agency in connection with the administration of or relating to services provided under
this Contract will be confidential, and will not be open to examination for any purpose not directly
connected with the administration of such service.
3
Cdnti4.Costa County Standard Form 1/87
GENERAL CONDITIONS
(Purchase of Services)
b. No person will publish or disclose or permit or cause to be published or disclosed, any list
of persons receiving services, except as may be required in the administration of such service. Contractor
agrees to inform all employees, agents and partners of the above provisions, and that any person
knowingly and intentionally disclosing such information other than as authorized by law may be guilty
of a misdemeanor.
17. Nondiscriminatory Services. Contractor agrees that all goods and services under this Contract
shall be available to all qualified persons regardless of age, sex, race, religion, color, national origin, or
ethnic background, or handicap, and that none shall be used, in whole or in part, for religious worship
or instruction.
18. Indemnification. The Contractor shall defend, indemnify,save, and hold harmless the County and
its officers and employees from any and all claims, costs and liability for any damages, sickness, death,
or injury to person(s) or property, including without limitation all consequential damages, from any cause
whatsoever arising directly or indirectly from or connected with the operations or services of the
Contractor or its agents, servants, employees or subcontractors hereunder, save and except claims or
litigation arising through the sole negligence or sole willful misconduct of the County or its officers or
employees. Contractor will reimburse the County for any expenditures, including reasonable attorneys'
fees, the County may make by reason of the matters that are the subject of this indemnification, and if
requested by the County will defend any claims or litigation to which this indemnification provision
applies at the sole cost and expense of the Contractor.
19. Insurance. During the entire term of this Contract and any extension or modification thereof, the
Contractor shall keep in effect insurance policies meeting the following insurance requirements unless
otherwise expressed in the Special Conditions:
a. Liability Insurance. The Contractor shall provide comprehensive liability insurance,
including coverage for owned and non-owned automobiles, with a minimum combined single limit
coverage of$500,000 for all damages, including consequential damages, due to bodily injury, sickness or
disease, or death to any person or damage to or destruction of property, including the loss of use thereof,
arising from each occurrence. Such insurance shall be endorsed to include the County and its officers
and employees as additional insureds as to all services performed by Contractor under this agreement.
Said policies shall constitute primary insurance as to the County, the State and Federal Governments,
and their officers, agents, and employees, so that other insurance policies held by them or their self-
insurance program(s) shall not be required to contribute to any loss covered under the Contractor's
insurance policy or policies.
b. Workers' Compensation. The Contractor shall provide workers' compensation insurance
coverage for its employees.
C. Certificate of Insurance. The Contractor shall provide the County with (a) certificate(s)
of insurance evidencing liability and worker's compensation insurance as required herein no later than
the effective date of this Contract. If the Contractor should renew the insurance policy(ies) or acquire
either a new insurance policy(ies) or amend the coverage afforded through an endorsement to the policy
at any time during the term of this Contract, then Contractor shall provide (a) current certificate(s) of
insurance.
4
Contrw Costa County Standard Form 1/87
GENERAL CONDITIONS
(Purchase of Services)
d. Additional Insurance Provisions. The insurance policies provided by the Contractor shall
include a provision for thirty (30) days written notice to County before cancellation or material changes
of the above specified coverage.
20. Notices. All notices provided for by this Contract shall be in writing and may be delivered by
deposit in the United States mail, postage prepaid. Notices to the County shall be addressed to the head
of the County Department for which this Contract is made. Notices to the Contractor shall be
addressed to the Contractor's address designated herein. The effective date of notice shall be the date
of deposit in the mails or of other delivery, except that the effective date of notice to the County shall be
the date of receipt by the head of the County Department for which this Contract is made.
21. Primacy of General Conditions. Except for Special Conditions which expressly supersede General
Conditions, the Special Conditions (if any) and Service Plan do not limit any term of the General
Conditions.
22. Nonrenewal. Contractor understands and agrees that there is no representation, implication, or
understanding that the services provided by Contractor under this Contract will be purchased by County
under a new contract following expiration of termination of this Contract, and waives all rights or claims
to notice or hearing respecting any failure to continue purchase of all or any such services from
Contractor.
23. Possessory Interest. If this Contract results in the Contractor having possession of, claim to or
right to the possession of land or improvements, but does not vest ownership of the land or improvements
in the same person, or if this Contract results in the placement of taxable improvements on tax exempt
land (Revenue & Taxation Code Section 107), such interest or improvements may represent a possessory
interest subject to property tax, and Contractor may be subject to the payment of property taxes Ievied
on such interest. Contractor agrees that this provision complies with the notice requirements of Revenue
& Taxation Code Section 107.6, and waives all rights to further notice or to damages under that or any
comparable statute.
24. No Third-Party Beneficiaries. Notwithstanding mutual recognition that services under this
Contract may provide some aid or assistance to members of the County's population, it is not the
intention of either the County or Contractor that such individuals occupy the position of intended third-
party beneficiaries of the obligations assumed by either party to this Contract.
25. Copyrights and Rights in Data. Contractor shall not publish or transfer any materials produced
or resulting from activities supported by this agreement without the express written consent of the County
Administrator. If any material is subject to copyright, the County reserves the right to copyright such
and the Contractor agrees not to copyright such material. If the material is copyrighted, the County
reserves a royalty-free, nonexclusive, and irrevocable license to reproduce, publish, and use such
materials, in whole or in part, and to authorize others to do so.
5
QUESTIONNAIRE FOR DETERMINING INDEPENDENT .
CONTRACTOR PAYMENT M=OD
All new or renewal independerit contractor agreements that do not meet IRS criteria for
independent contract status must be paid through the payroll system so that withholding
taxes and Social Security can be deducted by the County. Please complete the
following questionnaire- for each self-employed individual with whom you intend to
contract (note: this form does not apply in the case of contracts with corporations,
temporary help agencies, partnerships or established businesses with a Taxpayer
Identification number) . �I I
CONTRACTOR NA`E : 1 , 1�1 ���Social. Security —VID `b
CONTRACT M-HBER: 24-767
YES NO
1. Do I, as the employer, have the right to
control not only the result of the work,
but also the way in which it is done?
2. Pm I setting the independent contractor's
hours?
3. Is the independent contractor restricted
from taking jobs from other businesses
at the same time they are working for me?
4. Do I or other departments have employee(s)
with similar duties as the independent
contractor?
5. Does the County supply assistants to the
contractor?
6. Is the duration of employment for a
specific period of time rather than a
specific job? ( )
7. Does the County furnish training, tools,
or equipment to the contractor?
A "yes" answer to any of the above questions will constitute
justification for paying the contractor through the payroll.
system.
CONTRACTOR APPROVAL: PREPARED BY:
The answers to the above questions ;
accurately reflect my anticipated .
working relationshi`p� with the County.
U)a S�,, t � RE D AND PROVED BY:
7Healc i Services Depar eat
2/19/91