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HomeMy WebLinkAboutResolution - 2018-R0145 - Employee Assistance Program - TTUHSC - 04/26/2018Resolution No. 2018-RO145 Item No. 6.19 April 26, 2018 RESOLUTION BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: THAT the Mayor of the City of Lubbock is hereby authorized and directed to execute for and on behalf of the City of Lubbock, an Interlocal Cooperation Contract regarding Employee Assistance Program Services, by and between the City of Lubbock and the Texas Tech University Health Sciences Center, Department of Psychiatry through the Southwest Institute for Addictive Diseases, and related documents. Said Contract is attached hereto and incorporated in this resolution as if fully set forth herein and shall be included in the minutes of the City Council. Passed by the City Council on April 26, 2018 DANIEL M. POPE, MAYOR ATTEST: PV - Reb t a Garza, City Secretar APPROVED 6FNT: Leisa Hutcheson, Director of Human Resources & Risk Management vwxcdocs/RES.Interlocal Contract.TTUHSC EAP Services 03.08.2018 Resolution No. 2018-RO 145 City of Lubbock CON2079248 INTERLOCAL COOPERATION CONTRACT This Interlocal Cooperation Contract is entered into by and between the Agencies shown below as Contracting Parties, pursuant to the authority granted and in compliance with the provisions of "The Interlocal Cooperation Act"; see Texas Government Code, Chapter 791, et seq. I. CONTRACTING PARTIES The Receiving Agency: City of Lubbock, Texas (City) The Performing Agency: Texas Tech University Health Sciences Center, Department of Psychiatry through the Southwest Institute for Addictive Diseases (TTUHSC) II. STATEMENT OF SERVICES TO BE PERFORMED: A. TTUHSC agrees to provide Employee Assistance Program (EAP) services in the form of initial assessment, short term counseling, and referral interviews up to a maximum of eight (8) sessions per covered individual employee per contract year (June 1 through May 31). Should an employee seek and obtain treatment and/or counseling beyond the maximum of eight (8) sessions from any other source recommended by TTUHSC, the employee shall be responsible for payment of all costs associated with that treatment and/or counseling. B. TTUHSC agrees to provide EAP services to members of the immediate family of City of Lubbock employees without receiving any additional compensation. Such services to an employee's family member shall be provided within the maximum number of sessions (eight) specified in "A" above. Immediate family member is defined as spouse, child, parents, siblings, or any other dependent living in the same household with the employee. It is the responsibility of the City to determine who is eligible for services under this program. C. TTUHSC agrees to make appropriate referral of clients whose need for counseling services exceeds those provided by the EAP. Referrals are to be determined based on the needs of the individual and considering the cost effectiveness of services provided by the EAP or covered under the medical insurance plan. D. TTUHSC agrees to provide a 24-hour accessible hotline, available through either a local number or a toll free number, to all City covered employees and their families. E. TTUHSC agrees to provide intervention and crisis counseling services, including critical incident stress management (CISM) services, when requested by the City. F. TTUHSC agrees to provide staff orientation meetings as requested by the City to increase awareness and utilization of this EAP resource. G. TTUHSC agrees to provide educational seminars and preventative services at the request of the City. These educational seminars and preventative services will be provided at no additional cost to the City. H. TTUHSC agrees to provide supervisor/management training and consultation services to the City, available on an as needed basis at the discretion of the City. I. TTUHSC agrees to provide a representative to assist in planning with the City's Employee Benefits Section of Human Resources. 2018-02-28 Page 1 of 5 D00572972-024 I IIIIII IIII*IIIIIII II III IIIII IIII IIII IIIII IIIIII IIII IIII I IIIIII IIII IIIIIII II III IIIII IIII IIII IIIII IIIIII IIII IIII [ *CON2079248*31*215683423089968987683179462789470569026684522914*1*5***] PoweredbyASC City of Lubbock CON2079248 J. TTUHSC agrees to provide organizational assessment and intervention/prevention services for groups of the City's employees (i.e„ two or more employees), if requested by the City. K. TTUHSC agrees to provide, if requested by the City, employee work/life seminars on personal/family dynamics (work/life balance) and caring for aging parents (focusing on aspects of parental care and caregiver/family dynamics). L. TTUHSC agrees to provide promotional materials (i.e., brochures and posters) to ensure that employees of the City are aware of the EAP and the services that they are eligible to receive through the EAP. M. TTUHSC agrees to provide assessment of City employees who fail a drug or alcohol test required in accordance with the City's drug and alcohol testing policy for safety -sensitive positions and reasonable suspicion. In the case of City employees who have a commercial driver's license (CDL) and fall under the Department of Transportation (DOT) regulations, a referral will be made by TTUHSC to a Substance Abuse Professional (SAP) certified by the DOT, who will provide the DOT's required assessment and follow-up. The fees associated with the SAP's services, not to exceed $450.00 per occurrence, will be billed to the City by TTUHSC. However, costs associated with the SAP's treatment recommendations will be the responsibility of the City employee. N. Employees are responsible for notifying and arranging time off with their supervisor if they must enter treatment programs (inpatient and outpatient). TTUHSC agrees to work with the employee's supervisor in arranging for a smooth and positive re-entry into the work environment (in accordance with the Family and Medical Leave Act of 1993) and as an advocate for those employees who have been off the job in order to receive treatment. TTUHSC will assume the advocacy role only when the employee has given written consent or in the event of a mandatory referral by the supervisor related to poor job performance. O. TTUHSC agrees to provide the City with quarterly and annual utilization reports. P. TTUHSC agrees to act as a resource for compliance of the Drug Free Work Place Act. Q. TTUHSC agrees to assume responsibility to be in compliance with the Health Insurance Portability and Accountability Act of 1996 as amended. R. It is agreed by both parties that in order to protect the confidentiality of employees of the City, names and other information that may identify specific employees or family members who have used the service shall not be included in quarterly or annual statistical utilization reports. TTUHSC agrees to release and resolve the City from any and all liabilities that may occur from litigation and/or the resolution of the same resulting from the services rendered by TTUHSC insofar as allowed by the Constitution and the laws of the State of Texas. Both parties hereto recognize that information that is confidential under the Texas Open Records Act may not be released except pursuant to an Attorney General decision or court order. III. BASIS FOR CALCULATING REIMBURSABLE COSTS: This section is not applicable to this Contract. IV. CONTRACT AMOUNT: „.-0,,,u��iuiiiiuniimuimiuuufiiuii'imuu�uuiruiuniuiiuiiuiiuuipuuiiiiil, ". City of Lubbock CON2079248 The City agrees to a payment rate of $19.44 per employee per year for contract year one (June 1, 2018 to May 31, 2019). This rate shall be based upon the number of employees employed by the City (2206) as of the date of execution of this Contract. The total payment rate for this number of employees for contract year one is $42,884.64. If the City exercises its option to renew the Contract for a second year (June 1, 2019 to May 31, 2020), it agrees to a payment rate of $20.02 per employee per year for that 12 month period. If the City exercises its right to renew the Contract for a third year (June 1, 2020 to May 31, 2021), it agrees to a payment rate of $20.62 per employee per year for that 12 month period. The payment rate for the third year will remain in effect for years four and five, if the City chooses to continue receiving TTUHSC's services for those two years. The payment rate is subject to quarterly review and may be negotiated by the parties to this Contract in the event of significant changes in the employment census at the City. V. PAYMENT FOR SERVICES: Payments to TTUHSC shall be made on a monthly basis. TTUHSC shall send a monthly statement of charges to the City. The charges on the monthly statement will include the base payment for employee assistance services ($3573.72 in year one), plus any fees for SAP services as noted in Section II, Paragraph M of this Contract. Payments should be made to Texas Tech University Health Sciences Center, Department of Psychiatry, 3601 41h Street — STOP 8119, Lubbock, TX 79430-8119, Attention: Alan Korinek, Ph.D. All payments required to be made by either party to this Contract shall be made from current revenues available to the paying party. VI. TERM OF CONTRACT: This Contract shall become effective on June 1, 2018 and shall be for a period of one year, unless previously terminated pursuant to this article. The City has the option to renew this Contract annually for up to four additional one-year terms, contingent upon satisfactory performance evaluation by the City. Either party may terminate this Contract at any time with or without cause by giving the other party thirty (30) days written notice of termination. This Contract shall terminate immediately upon nonpayment. The City is responsible to notify employees that services are no longer available. VII. GENERAL PROVISIONS: This Contract may be amended in writing to include such provision(s) as the Parties may agree upon. Neither party shall have the right to assign or transfer their rights to any third parties under this Contract without prior written consent of the non -transferring party. Nothing in this Contract is intended nor shall be construed to create an employer/employee relationship between the contracting parties. The sole interest and responsibility of the parties is to ensure that the services covered by this Contract shall be performed and rendered in a competent, efficient, and satisfactory manner. If any term or provision of this Contract is held to be invalid for any reason, the invalidity of that section shall not affect the validity of any other section of this Contract provided that any invalid provisions are not material to the overall purpose and operation of this Contract. The remaining provisions of this Contract shall remain in full force and shall in no way be affected, impaired, or invalidated. 2018-0"IIIIIIIIIIIIInIIIIIIIIIINIIIIIIIIIIIII�IIIIII,I�III��IIIIIIIINIIIIIYIII,IIIulllllnllllllNIIIIIIIIVIIIII P=' City of Lubbock CON2079248 This Contract shall be governed by and construed and enforced in accordance with the laws of the State of Texas. Venue will be in accordance with the Texas Civil Practices and Remedies Code and any amendments thereto. TTUHSC shall ensure that its medical personnel providing medical services to the City employees procure and carry, at their sole cost and expense through the life of this Contract insurance protection hereinafter specified, in form and substance satisfactory to the City. The mutually agreed upon insurance carriers must be carriers authorized to do business in the State of Texas. A Certificate of Insurance specifying each and all coverage shall be on file with the City prior to the execution of this Contract Written notice of cancellation of any material change will be provided thirty (30) days in advance of cancellation or change. Required Coverage: TTUHSC shall ensure that its medical personnel obtain and maintain policies of insurance throughout this Contract term in limits as specified. TTUHSC shall maintain Professional Medical Liability Insurance coverage with a minimum of One Million and no/100 Dollars ($1,000,000) combined single limit in the aggregate and per occurrence. TTUHSC shall require each subcontractor with whom it contracts to provide activities as contemplated by this Contract, to obtain proof of insurance coverage as set forth herein and to provide to subcontractor, prior to such a person performing any such activities, a Certificate of Insurance establishing such coverage. THE UNDERSIGNED CONTRACTING PARTIES do hereby certify that, (1) the party paying for the performance of governmental functions or services must make those payments from current revenues, and (2) the amount of the payment fairly compensates the performing party for the services or functions performed. The contracting parties will utilize the contract dispute resolution process set forth in Chapter 2260 of the Texas Government Code to resolve a dispute arising under this Contract. THE CITY OF LUBBOCK, TEXAS further certifies that it has the authority to enter into this Contract. TTUHSC, on behalf of its Department of Psychiatry, Through Southwest Institute For Addictive Diseases further certifies that it has the authority to enter into this Contract. E-SIGNATURES: This Contract may be executed in two or more counterparts, each of which shall be deemed to be an original as against any party whose signature appears thereon, but all of which together shall constitute but one and the same instrument. Signatures to this Contract transmitted by facsimile, by electronic mail in "portable document format" (".pdf'), or by any other electronic means which preserves the original graphic and pictorial appearance of this Contract, shall have the same effect as physical delivery of the paper document bearing the original signature. [Signature Page Follows] 91w','iiimuuiiui�uiuiiuiuuiiiiiiiiuiiiuiiiiiiii�°iiiiniuiiiuiuiugiguiiiniiuumiiuuiiiiiiii `'"' City of Lubbock CON2079248 TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER Penny Harkey (Mar , 2018) Signature Penny Harkey Printed Name Vice President and Chief Financial Officer Title Mar 1,2018 Date CITY OF LUBBOCK Lj�%� Signature Daniel M. Pope Printed Name Mayor Title Date Garza, City Secretary Leisa Hutcheson, Director Human Resources & Risk Management 11111111111111111111111111111111111111111111uuimiuiiiiiii'°imiiiiuuui�uiumiuiuiiiuiuiimmiiili. Certificate of Insurance (Proof of Coverage) 07/25/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TIIIS CERTIFICATE DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Insured Name and Mailing Address* Program Administrator Alan W Korinek Administered By: 1709 29th Street CPH and Associates Lubbock, TX 79411 711 S. Dearborn, Suite 205 Chicago, IL 60605 *Additional insured locations are often requested by individual business owners who have more P. 312-987-9823 F. 312-987-0902 han one office. Your coverage is portable, meaning that you are covered at any location for info ancphins.com ractice under the occupation(s) listed on your policy. Underwritten By: Philadelphia Indemnity Insurance Company Coverage Policy #: 010460 jEffective Date: 08/27/2017 lExpiration Date: 08/27/2018 HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TI IE 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits of Liability Coverage Part EACH OCCURRENCE AGGREGATE (Per individual claim) (Total amount per policy year) $1,000,000 $5,000,000 Professional Liability Commercial General Liability N/A N/A Includes: General Liability, Fire & Water Legal Liability, and Personal Liability N/A N/A Property Coverage $1,000,000 $S'000'000 Supplemental Liability Unlimited Unlimited Defense Expense Coverage $35,000 $35,000 State Licensing Board Investigation Defense Coverage $15,000 $15,000 Assault Coverage $10,000 $35,000 Deposition Expense Benefit $5,000/ erson $50,000 Medical Expense Coverage $15,000 $15,000 First Aid Coverage Description/Special Provisions: Certificate Holder Cancellation Should any of the above described policy be cancelled before the expiration date thereof, the issuing insurer will endeavor to mail 30 days written notice to the certificate holder named to the left, but failure to do so shall impose no obligation or liability of any kind upon the insurer, PROOF OF COVERAGE its agents or representatives. Holder has also been added to the policy as an additional insured:** Yes/XNo �d� ! /' r P)'� **If the certificate holder is an ADDITIONAL INSURED, the policy(ies) Authorized Representative must be endorsed. A statement on this certificate does not confer rights to C. Philip Hodson the certificate holder in lieu of such endorsement(s). DISCLAIMER: The Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend, or alter the coverage afforded by tite policies listed thereon. ® PHII.ADELPHIA %C*� P HINSURANCL. COMPANIES & ASSOCIATES 11, Certificate of Liability Insurance Date Issued: 01/25/2018 Underwritten by: Philadelphia Indemnity Insurance Company - One Bala Plaza, Suite 100 • Bala Cynwyd, PA 19004 • NAIC #: 19193 Administered by: CPH & Associates • 711 S. Dearborn St. Ste 205 • Chicago, IL 60605 P 800.875,1911 F 312.987.0902 • info@cphins.com DISCLAIMER: This certificate is issued as a matter of information only and confers no rights upon the certificate holder. The Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend, or alter the coverage afforded by the policies listed thereon. Insured: Kristie L Collins Policy Number: E199932 9315 Primrose Ave. Policy Term: 01/27/2018 to 01/27/2019 Lubbock, TX 79424 Occupation: Licensed Professional Counselor Covered Locations Professional Liability Portable coverage not location specific Coverage Type Per Incident Aggregate (Occurrence Form) (Per individual claim) (Total amount per year) Professional Liability $ 1,000,000 $ 3,000,000 Supplemental Liability $ 1,000,000 $ 3,000,000 Licensing Board Defense $ 35,000 $ 35,000 Commercial General Liability NIA NIA o Fire/Water Legal Liability NIA N/A Business Personal Property NIA N/A Comments/Special Descriptions: Certificate Holder PROOF OF COVERAGE If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). Notice of Cancellation will only be provided to the first named insured in accordance with policy provisions, who shall act on behalf of all additional insureds with respect to giving notice of cancellation. L P)ti Awo�' Authorized Representative C. Philip Hodson Certificate of Insurance (Proof of Coverage) 10/0312017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Insured Name and MailingAddress* Program Administrator ariah C Dillard Administered By: 7 Lubbock, TXX 79414 CPH and Associates 711 S. Dearborn, Suite 205 Chicago, IL 60605 P. 312-987-9823 F. 312-987-0902 *Additional insured locations are often requested by individual business owners who have more han one office. Your coverage is portable, meaning that you are covered at any location for inforacphins.com ractice under the occupation(s) listed on your policy. Underwritten By: Philadelphia Indemnity Insurance Company Coverage Polic #: AR12068 lEffective Date: 10/31J2017 IE7piration Date: 10/31/2018 HE 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits of Liability Coverage Part EACH OCCURRENCE AGGREGATE (Per individual claim) (Total amount per policy year) $1,000,000 $3,000,000 Professional Liability Commercial General Liability N/A N/A Includes: General Liability, Fire & Water Legal Liability, and Personal Liability N/A N/A Property Coverage $1,000,000 $3,000,000 Supplemental Liability Unlimited Unlimited Defense Expense Coverage $35,000 $35,000 State Licensing Board Investigation Defense Coverage $15,000 $15,000 Assault Coverage $10,000 $35,000 Deposition Expense Benefit $5,000/ erson $50,000 Medical Expense Coverage $15,000 $15,000 First Aid Coverage Description/Special Provisions: Certificate Holder Cancellation Should any of the above described policy be cancelled before the expiration date thereof, the issuing insurer will endeavor to mail 30 days written notice to the certificate holder named to the left, but failure to do so shall impose no obligation or liability of any kind upon the insurer, PROOF OF COVERAGE its agents or representatives. Holder has also been added to the policy as an additional insured:**`" Yes/XNo� **If the certificate holder is an ADDITIONAL INSURED, the p0licy0es) Authorized Representative must be endorsed. A statement on this certificate does not confer rights to C. Philip Hodson the certificate holder in lieu of such endorsement(s). DISCLAIMER: The Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend, or alter the coverage afforded by the policies listed thereon. Certificate of Insurance (Proof of Coverage) 05/05/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Insured Name and Mailing Address* Program Administrator Madison Bishop Administered By: 6508 Harvard St. CPH and Associates Lubbock, TX 79416 711 S. Dearborn, Suite 205 Chicago, IL 60605 *Additional insured locations are often requested by individual business owners who have more P. 312-987-9823 F. 312-987-0902 than one office. Your coverage is portable, meaning that you are covered at any location for info(alcnhins.com practice under the occupation(s) listed on your policy. Underwritten By: Philadelphia Indemnity Insurance Company Coverage Policy #: AR26320 jEffective Date: 05/08/2017 lExpiration Date: 05/08/2018 HE 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits of Liability Coverage Part EACH OCCURRENCE AGGREGATE (Per individual claim) (Total am aunt per policy year) $1,000,000 $3,000,000 Professional Liability Commercial General Liability N/A N/A Includes: General Liability, Fire & Water Legal Liability, and Personal Liability N/A N/A Property Coverage $1,000,000 $3,000,000 Supplemental Liability Unlimited Unlimited Defense Expense Coverage State Licensing Board Investigation $35,000 $35,000 Defense Coverage $15,000 $15,000 Assault Coverage $10,000 $35,000 Deposition Expense Benefit $5,000/ erson $50,000 Medical Expense Coverage $15,000 $15,000 First Aid Coverage Description/Special Provisions: Certificate Holder Cancellation Should any of the above described policy be cancelled before the expiration date thereof, the issuing insurer will endeavor to mail 30 days written notice to the certificate holder named to the left, but failure to do so shall impose no obligation or liability of any kind upon the insurer, PROOF OF COVERAGE its agents or representatives. Holder has also been added to the policy as an additional insured:** Yes/XNo (' P) **If the certificate holder is an ADDITIONAL INSURED, the policy(ies) Authorized Representative must be endorsed. A statement on this certificate does not confer rights to C. Philip Hodson the certificate holder in lieu of such endorsement(s). DISCLAIMER; The Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend, or alter the coverage afforded by the policies listed thereon. Certificate of Insurance (Proof of Coverage) 08/14/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Insured Name and MailingAddress* Program Administrator Michael A Poundsdministered By: 1 Lubbock,bb ockTXX 79423 CPH and Associates 711 S. Dearborn, Suite 205 Chicago, IL 60605 P. 312-987-9823 F. 312-987-0902 *Additional insured locations are often requested by individual business owners who have more than one office. Your coverage is portable, meaning that yore are covered at any location for info(a`cphins.com ractice under the occupation(s) listed on your policy. Underwritten By: Philadelphia Indemnity Insurance Company Coverage Policy #: E243452 jEffective Date: 08/24/2017 IMpiration Date: 08/24/2018 HE 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits of Liability Coverage Part EACH OCCURRENCE AGGREGATE (Per individual claim) (Total amount per policy year) $1,000,000 $3,000,000 Professional Liability Commercial General Liability N/A N/A Includes: General Liability, Fire & Water Legal Liability, and Personal Liability N/A N/A Property Coverage $1,000,000 $3,000,000 Supplemental Liability Unlimited Unlimited Defense Expense Coverage $35,000 $35,000 State Licensing Board Investigation Defense Coverage $15,000 $15,000 Assault Coverage $10,000 $35,000 De osition Ex ense Benefit $5,000! erson $50,000 Medical Expense Coverage $15,000 $15,000 First Aid Coverage Description/Special Provisions: Certificate Holder Cancellation hould any of the above described policy be cancelled before the expiration date thereof, the its suing insurer will endeavor to mail 30 days written notice to the certificate holder named to he left, but failure to do so shall impose no obligation or liability of any kind upon the insurer, PROOF OF COVERAGE agents or representatives. Holder has also been added to the policy as an additional insured:** Yes/XNo CCCCe **If the certificate holder is an ADDITIONAL INSURED, the policy(ies) Authorized Representative must be endorsed. A statement on this certificate does not confer rights to C. Philip Hodson the certificate holder in lieu of such endorsement(s). DISCLAIMER: The Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend, or alter the coverage afforded by the policies listed thereon. r2 NASW Insurance Company, RRG Customer ID: 1HGLDVVCZZ7 Policy Number: G-3TJ8B2JI1-15-00 Effective Date: 06/07/2017 Expiration Date: 06/07/2018 OCCURRENCE GENERAL LIABILITY POLICY DECLARATIONS Named Insured: Nicole L Hernandez Address: 6413 27th Street Lubbocvk, TX 79407 Per Claim $1,000,000.00 $154.00 Aggregate $3,000,000.00 TOTAL PREMIUM FOR THIS COVERAGE PART: $154.00 THIS IS AN OCCURRENCE POLICY, COVERAGE IS EFFECTIVE UPON RECEIPT OF YOUR FIRST PREMIUM PAYMENT FOR THIS OCCURRENCE GENERAL LIABILITY POLICY. COVERAGE ONLY APPLIES TO PROPERTY DAMAGE, BODILY INJURY, PERSONAL INJURY, ADVERTISING INJURY, AND FIRE LEGAL LIABILITY STATED IN THE AFORESTATED POLICY FORM THAT ACTUALLY OCCUR AND ARE DISCOVERED ON OR AFTER THE DATE OF RECEIPT OF YOUR FIRST PREMIUM PAYMENT FOR THIS SPECIFIC POLICY COVERAGE, AND PRIOR TO THE TERMINATION DATE OF THIS SPECIFIC POLICY COVERAGE. TO BE COVERED UNDER THIS POLICY YOU MUST BE INSURED UNDER A PROFESSIONAL LIABILITY INSURANCE POLICY ISSUED BY THE NASW RISK RETENTION GROUP, INC. Authorized Representative: Brokered and Administered by: To Verify Claims History Contact: ■ Western Litigation, Inc. enue J NASW � RRG Plan Administrator Alma Garcia RoriaHei Glen A,IL61 9821 Katy Freeway, Suite 600 Peoria Heights, IL61616-5348 Tony Benedetto Insurance Company, RRG Lieense:CA#0 76076, ARp1372 Houston, TX 77024 Alma—Garcia@westernlitigation.com Fax:713-935-2479 Policy Forms & Endorsements: ASI-8888-04GL (June 5, 2015); For additional information and online applications: NASWinsure-com The NASW Ri,k Retention Group supports this polity with its f.0 fWlt , credit and—., and this palicV it rein —d with Lloyd',, London