HomeMy WebLinkAboutCigna Behavioral Health Inc; 2007-04-20;AGREEMENT FOR EMPLOYEE ASSISTANCE PROGRAM SERVICES
CIGNA BEHAVIORAL HEALTH, INC.
THIS AGREEMENT is made and entered into as of the c^?/j day of
, 20<97 by and between the CITY OF CARLSBAD, a municipal_
corporation, ("City"), and CIGNA Behavioral Health, Inc., a Minnesota corporation
(hereinafter "CBH" or "Contractor"), with its principal place of business located at 11095
Viking Drive, Suite 350, Eden Prairie, MN 55344. Connecticut General Life Insurance
Company ("CGLIC") and CBH are affiliated corporations (indirect subsidiaries) of
CIGNA Corporation.
RECITALS
A. City has adopted an Employee Assistance Program ("EAP") which
includes a short-term counseling program as described in the policy ("Policy") between
City and Connecticut General Life Insurance Company ("CGLIC") and wishes to provide
certain other EAP services to its employees, their dependents, and members of their
households who reside in California.
B. City requires the professional services of an employee assistance
program ("EAP") plan administrator that is experienced in administering employee
assistance program services and benefits as further described below.
C. Contractor has agreed to provide child/elder care, adult life issues,
financial, education, and law services resources ("EAP Services") to City for City's
employees, their dependants and members of their households who reside in California
("Participants") and to provide certain employer account services.
D. Contractor has the necessary experience in providing professional EAP
Services and advice related to City's EAP program.
E. Selection of Contractor is expected to achieve the desired results in an
expedited fashion.
F. Contractor has submitted a proposal to City and has affirmed its
willingness and ability to perform such work.
NOW, THEREFORE, in consideration of these recitals and the mutual covenants
contained herein, City and Contractor agree as follows:
1. SCOPE OF WORK
City retains Contractor to perform, and Contractor agrees to render, those services (the
"Services") that are defined in attached Exhibit "A", which is incorporated by this
reference in accordance with this Agreement's terms and conditions.
This Agreement, including Exhibit A and its attachments supersedes any information,
term or condition presented in CIGNA Behavioral Health, Inc.'s response ("Response")
to City's Request for Proposal ("RFP") that may be conflicting or contradictory.
Additionally, should there be any inconsistency or conflict between the provisions of this
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Agreement and any Exhibit or attachment thereto, the terms and conditions of this
Agreement shall control and take precedence over any Exhibit or attachment thereto
that is inconsistent or in conflict with this Agreement.
2. STANDARD OF PERFORMANCE
While performing the Services, Contractor will exercise the reasonable professional
care and skill customarily exercised by reputable members of Contractor's profession
practicing in the Metropolitan Southern California Area, and will use reasonable
diligence and best judgment while exercising its professional skill and expertise.
3. TERM
The term of this Agreement will be effective April 9, 2007 through December 31, 2008.
The City Manager may amend this Agreement to extend it for three (3) additional one
(1) year periods or parts thereof in an amount that will be negotiated by the parties in
good faith. Extensions will be based upon a satisfactory review of Contractor's
performance, City needs, and appropriation of funds by the City Council. The parties will
prepare a written amendment indicating the effective date and length of the extended
Agreement.
4. TIME IS OF THE ESSENCE
Time is of the essence for each and every provision of this Agreement.
5. COMPENSATION
The total fee payable for the Services to be performed during the initial Agreement term
are set forth in Attachment 4 of Exhibit A. The not-to-exceed fee is based on a per
employee/per month basis as further described in Attachment 4 of Exhibit A.
6. STATUS OF CONTRACTOR
Contractor will perform the Services in Contractor's own way as an independent
contractor and in pursuit of Contractor's independent calling, and not as an employee of
City. Contractor will be under control of City only as to the result to be accomplished,
but will consult with City as necessary. The persons used by Contractor to provide
services under this Agreement will not be considered employees of City for any
purposes.
The payment made to Contractor pursuant to the Agreement will be the full and
complete compensation to which Contractor is entitled. City will not make any federal or
state tax withholdings on behalf of Contractor or its agents, employees or
subcontractors. City will not be required to pay any workers' compensation insurance or
unemployment contributions on behalf of Contractor or its employees or subcontractors.
Contractor agrees to indemnify City within thirty (30) days for any tax, retirement
contribution, social security, overtime payment, unemployment payment or workers'
compensation payment which City may be required to make on behalf of Contractor or
any agent, employee, or subcontractor of Contractor for work done under this
Agreement. At the City's election, City may deduct the indemnification amount from any
balance owing to Contractor.
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7. SUBCONTRACTING
Contractor will not subcontract any portion of the Services without prior written approval
of City. If Contractor subcontracts any of the Services, Contractor will be fully
responsible to City for the acts and omissions of Contractor's subcontractor and of the
persons either directly or indirectly employed by the subcontractor, as Contractor is for
the acts and omissions of persons directly employed by Contractor. Nothing contained
in this Agreement will create any contractual relationship between any subcontractor of
Contractor and City. Contractor will be responsible for payment of subcontractors.
Contractor will ensure every subcontractor and every subcontractor of a subcontractor
performs its responsibilities in accordance the terms of this Agreement unless
specifically noted to the contrary in the subcontract and approved in writing by City.
8. OTHER CONTRACTORS
The City reserves the right to employ other Contractors in connection with the Services.
9. INDEMNIFICATION
In the event that Contractor, its officers, directors, employees or agents are made
parties to any judicial or administrative proceeding arising in whole or in part out of any
function negligently performed by the City, including the functions and obligations set
forth in the Privacy Addendum, then the City shall indemnify and hold Contractor
harmless for any and all judgments, settlements, and costs (including reasonable
attorneys' fees) which Contractor incurs or pays in connection therewith except that City
shall not be required to reimburse for such amounts if the court rendering the judgment
or the agency making the award determines that the liability underlying the judgment or
award (or attorneys' fees with respect thereto) was caused by the negligence, fraud or
criminal conduct of Contractor, its agents, employees, officers or directors.
In the event that City, its officers, directors, employees, agents or affiliates are made
parties to any judicial or administrative proceeding arising in whole or in part out of any
function negligently performed by Contractor under this Agreement, including the
functions and obligations set forth in the Privacy Addendum, then Contractor shall
indemnify and hold City harmless for any and all judgments, settlements and costs
(including reasonable attorneys' fees) which City incurs or pays in connection therewith
except that Contractor shall not be required to reimburse for such amounts if the court
rendering the judgment or the agency making the award determines that the liability
underlying the judgment or award (or attorneys' fees with respect thereto) was caused
by the negligence, fraud or criminal conduct of City, its agents, affiliates, employees,
officers or directors. The foregoing does not include indemnification for the negligent
acts or omissions of Participating Providers. By contract, Contractor requires
Participating Providers to maintain adequate amounts of professional liability insurance,
and Participating Providers remain responsible for their own professional conduct.
In the event that the parties have been found jointly and severally liable to a third party,
liability shall be apportioned consistent with the relative degree of fault of each party.
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In the event litigation is instituted by a third party against the City and/or CIGNA
Behavioral concerning any matter under the Plan, each party to this Agreement shall
have sole authority to select legal counsel of its choice.
The indemnifications provided for by the foregoing paragraphs shall survive the
termination of this Agreement.
10. INSURANCE
Contractor will obtain and maintain for the duration of the Agreement and any and all
amendments, insurance against claims for injuries to persons or damage to property
which may arise out of or in connection with performance of the services by Contractor
or Contractor's agents, representatives, employees or subcontractors. The insurance
will be obtained from an insurance carrier admitted and authorized to do business in the
State of California. The insurance carrier is required to have a current Best's Key Rating
of not less than "A-:V".
10.1 Coverages and Limits.
Contractor will maintain the types of coverages and minimum limits indicated below,
unless City Attorney or City Manager approves a lower amount. These minimum
amounts of coverage will not constitute any limitations or cap on Contractor's
indemnification obligations under this Agreement. City, its officers, agents and
employees make no representation that the limits of the insurance specified to be
carried by Contractor pursuant to this Agreement are adequate to protect Contractor. If
Contractor believes that any required insurance coverage is inadequate, Contractor will
obtain such additional insurance coverage, as Contractor deems adequate, at
Contractor's sole expense.
10.1.1 Commercial General Liability Insurance. $1.000.000 combined
single-limit per occurrence for bodily injury, personal injury and property damage. If the
submitted policies contain aggregate limits, general aggregate limits will apply
separately to the work under this Agreement or the general aggregate will be twice the
required per occurrence limit.
10.1.2 Automobile Liability (if the use of an automobile is involved for
Contractor's work for City). $1,000,000 combined single-limit per accident for bodily
injury and property damage.
10.1.3 Workers' Compensation and Employer's Liability. Workers'
Compensation limits as required by the California Labor Code and Employer's Liability
limits of $1,000,000 per accident for bodily injury. Workers' Compensation and
Employer's Liability insurance will not be required if Contractor has no employees and
provides, to City's satisfaction, a declaration stating this.
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10.1.4 Professional Liability. Errors and omissions liability appropriate to
Contractor's profession with limits of not less than $1,000,000 per claim. Coverage must
be maintained for a period of five years following the date of completion of the work.
10.2. Additional Provisions. Contractor will ensure that the policies of insurance
required under this Agreement contain, or are endorsed to contain, the following
provisions:
10.2.1 The City will be named as an additional insured on General
Liability.
10.2.2 Contractor will obtain occurrence coverage, excluding Professional
Liability, which will be written as claims-made coverage.
10.2.3 This insurance will be in force during the life of the Agreement and
any extensions of it and will not be canceled without thirty (30) days prior written notice
to City sent by certified mail pursuant to the Notice provisions of this Agreement.
10.3 Providing Certificates of Insurance and Endorsements. Prior to City's execution
of this Agreement, Contractor will furnish certificates of insurance and endorsements to
City.
10.4 Failure to Maintain Coverage. If Contractor fails to maintain any of these
insurance coverages, then City will have the option to declare Contractor in breach, or
may purchase replacement insurance or pay the premiums that are due on existing
policies in order to maintain the required coverages. Contractor is responsible for any
payments made by City to obtain or maintain insurance and City may collect these
payments from Contractor or deduct the amount paid from any sums due Contractor
under this Agreement.
10.5 Submission of Insurance Policies. City reserves the right to require, at anytime,
complete and certified copies of any or all required insurance policies and
endorsements.
11. BUSINESS LICENSE
Contractor will obtain and maintain a City of Carlsbad Business License for the term of
the Agreement, as may be amended from time-to-time.
12. ACCOUNTING RECORDS
Contractor will maintain complete and accurate records with respect to payments made
to Contractor by City under this Agreement. All records will be clearly identifiable.
Contractor will allow a representative of City during normal business hours to examine,
audit, and make transcripts or copies of such fee payment records created pursuant to
this Agreement. Contractor will allow inspection of City's fee payment records for a
period of three (3) years from the date of final payment under this Agreement.
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13. OWNERSHIP OF DOCUMENTS
All work product produced by Contractor or its agents, employees, and subcontractors
pursuant to this Agreement solely for the City is the property of City. In the event this
Agreement is terminated, all work product produced by Contractor or its agents,
employees and subcontractors solely for the City pursuant to this Agreement will be
delivered at once to City. Contractor will have the right to make one (1) copy of the work
product for Contractor's records.
14. NOTICES
The name of the persons who are authorized to give written notices or to receive written
notice on behalf of City and on behalf of Contractor under this Agreement.
For City: For Contractor:
Name Name Keith Dixon
Title Title President & CEO
Department Address 11095 Viking Drive. Suite 350
City of Carlsbad Eden Prairie. MN 55344
Address Phone No. 952.996.2000
Phone No.
Each party will notify the other immediately of any changes of address that would
require any notice or delivery to be directed to another address.
15. CONFLICT OF INTEREST
City will evaluate Contractor's duties pursuant to this Agreement to determine whether
disclosure under the Political Reform Act and City's Conflict of Interest Code is required
of Contractor or any of Contractor's employees, agents, or subcontractors. Should it be
determined that disclosure is required, Contractor or Contractor's affected employees,
agents, or subcontractors will complete and file with the City Clerk those schedules
specified by City and contained in the Statement of Economic Interests Form 700.
Contractor, for Contractor and on behalf of Contractor's agents, employees,
subcontractors and consultants warrants that by execution of this Agreement, that they
have no interest, present or contemplated, in the projects affected by this Agreement.
Contractor further warrants that neither Contractor, nor Contractor's agents, employees,
subcontractors and consultants have any ancillary real property, business interests or
income that will be affected by this Agreement or, alternatively, that Contractor will file
with the City an affidavit disclosing this interest.
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16. GENERAL COMPLIANCE WITH LAWS
Contractor will keep fully informed of federal, state and local laws and ordinances and
regulations related directly to the Services provided by Contractor which in any manner
affect those employed by Contractor, or in any way affect the performance of the
Services by Contractor. Contractor will at all times observe and comply with these laws,
ordinances, and regulations and will be responsible for the compliance of Contractor's
services with all applicable laws, ordinances and regulations.
Contractor will be aware of the requirements of the Immigration Reform and Control Act
of 1986 and will comply with those requirements, including, but not limited to, verifying
the eligibility for employment of all agents, employees, subcontractors and consultants
that the services required by this Agreement.
17. DISCRIMINATION AND HARASSMENT PROHIBITED
Contractor will comply with all applicable local, state and federal laws and regulations
prohibiting discrimination and harassment.
18. DISPUTE RESOLUTION
If a dispute should arise regarding the performance of the Services the following
procedure will be used to resolve any questions of fact or interpretation not otherwise
settled by agreement between the parties. Representatives of Contractor or City will
reduce such questions, and their respective views, to writing. A copy of such
documented dispute will be forwarded to both parties involved along with recommended
methods of resolution, which would be of benefit to both parties. The representative
receiving the letter will reply to the letter along with a recommended method of
resolution within ten (10) business days. If the resolution thus obtained is unsatisfactory
to the aggrieved party, a letter outlining the disputes will be forwarded to the City
Manager. Appropriate senior parties of the Contractor and the City shall negotiate in
good faith to attempt to resolve the dispute before pursuing other remedies. Nothing in
this procedure will prohibit the parties from seeking remedies available to them at law or
contract.
19. TERMINATION
In the event of the Contractor's failure to prosecute, deliver, or perform the Services,
City may terminate this Agreement upon thirty (30) days written notice to Contractor
specifying the manner in which Contractor has materially breached its obligations under
this Agreement. The Agreement shall terminate automatically at the expiration of such
thirty (30) day period if Contractor has not cured its breach within such period and
delivered satisfactory evidence of such cure to the City.
This Agreement shall terminate, at the option of Contractor, on the thirtieth (30th) day
following written notice to the City that City fails to pay the Contractor its compensation
as provided in Exhibit A;
Notwithstanding Section 3 above, either party upon tendering sixty (60) days written
notice to the other party may terminate this Agreement without cause.. Contractor will
be paid for work performed to the termination date; however, the total will not exceed
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the lump sum fee payable under this Agreement. If applicable, City will make the final
determination as to the portions of tasks completed and the compensation to be made.
20. COVENANTS AGAINST CONTINGENT FEES
Contractor warrants that Contractor has not employed or retained any company or
person, other than a bona fide employee working for Contractor, to solicit or secure this
Agreement, and that Contractor has not paid or agreed to pay any company or person,
other than a bona fide employee, any fee, commission, percentage, brokerage fee, gift,
or any other consideration contingent upon, or resulting from, the award or making of
this Agreement. For breach or violation of this warranty, City will have the right to annul
this Agreement without liability, or, in its discretion, to deduct from the Agreement price
or consideration, or otherwise recover, the full amount of the fee, commission,
percentage, brokerage fees, gift, or contingent fee.
21. CLAIMS AND LAWSUITS
By signing this Agreement, Contractor agrees that any Agreement claim submitted to
City must be asserted as part of the Agreement process as set forth in this Agreement
and not in anticipation of litigation or in conjunction with litigation. Contractor
acknowledges that if a false claim is submitted to City, it may be considered fraud and
Contractor may be subject to criminal prosecution. Contractor acknowledges that
California Government Code sections 12650 et seq.. the False Claims Act applies to
this Agreement and, provides for civil penalties where a person knowingly submits a
false claim to a public entity. These provisions include false claims made with deliberate
ignorance of the false information or in reckless disregard of the truth or falsity of
information. If City seeks to recover penalties pursuant to the False Claims Act, it is
entitled to recover its litigation costs, including attorney's fees. Contractor acknowledges
that the filing of a false claim may subject Contractor to an administrative debarment
proceeding as the result of which Contractor may be prevented to act as a Contractor
on any public work or improvement for a period of up to five (5) years. Contractor
acknowledges debarment by another jurisdiction is grounds for City to terminate this
Agreement.
22. JURISDICTIONS AND VENUE
Any action at law or in equity brought by either of the parties for the purpose of
enforcing a right or rights provided for by this Agreement will be tried in a court of
competent jurisdiction in the County of San Diego, State of California, and the parties
waive all provisions of law providing for a change of venue in these proceedings to any
other county.
23. SUCCESSORS AND ASSIGNS
It is mutually understood and agreed that this Agreement will be binding upon City and
Contractor and their respective successors. Neither this Agreement or any part of it nor
any monies due or to become due under it may be assigned by Contractor without the
prior consent of City, which shall not be unreasonably withheld.
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24. ENTIRE AGREEMENT
This Agreement, together with any other written document referred to or contemplated
by it, along with the purchase order for this Agreement and its provisions, embody the
entire Agreement and understanding between the parties relating to the subject matter
of it. In case of conflict, the terms of the Agreement supersede the purchase order.
Neither this Agreement nor any of its provisions may be amended, modified, waived or
discharged except in a writing signed by both parties.
25. AUTHORITY
The individuals executing this Agreement and the instruments referenced in it on behalf
of Contractor each represent and warrant that they have the legal power, right and
actual authority to bind Contractor to the terms and conditions of this Agreement.
CONTRACTOR/
(sign hire)
, «4V 0 1 jCtfw IrVis t du nk- <- tt a
(print name/title)
CITY OF CARLSBAD, a municipal
corporation of the State of California
Bv:
City Manager or Mayor
ATTEST:
(sign here)
Cfo
(print name/title)
(e-mail address)
LOftRAINE M
City Clerk
If required by City, proper notarial acknowledgment of execution by contractor must be attached.
If a Corporation. Agreement must be signed by one corporate officer from each of the following
two groups.
"Group A.
Chairman,
President, or
Vice-President
**Group B.
Secretary,
Assistant Secretary,
CFO or Assistant Treasurer
Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary
under corporate seal empowering the officer(s) signing to bind the corporation.
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APPROVED AS TO FORM:
Deputy City Attorney
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EXHIBIT "A"
SCOPE OF SERVICES
CALIFORNIA NON-COUNSELING EMPLOYEE ASSISTANCE PROGRAM SERVICES
I. Contractor EAP Services: Responsibilities of Contractor
Assessment and Referral Services
1.1 The services set forth herein shall be available to Participants in the service area
identified in Attachment 1.
1.2. Life Events Services: For family care, legal/financial information, Healthy Rewards
(telephonic), and Emotional Weil-Being Online (Awareness Series, Frequently Asked Questions,
Article Library, AccessCare which includes initial registration, online eligibility check, self-
assessment tool, and Provider Directory and Search vehicle) ("Full-Service Life Events"),
Contractor shall provide assessment and referral services as requested by Participant or City.
Legal assessment and referral services are not available to Participants if the issue is related to
a potential cause of action against City. Online behavioral health services ("Online Services"),
shall be provided pursuant to the terms of Attachment 5 of this Agreement. Any additional
services ("Menu Options") purchased by City are attached hereto as Attachment 6 to this Exhibit
A.
1.3 Contractor shall be available to Participants for assessments and referrals through a toll-
free telephone number maintained by Contractor twenty-four (24) hours a day, seven (7) days a
week.
1.4 Participant calls to the Contractor 800 number will be answered by a personal advocate
who will obtain appropriate information and refer the Participant to a resource qualified to
address the problem.
1.5 Contractor shall arrange for access for Participants to contracted specialty firms or to local
resources for assessment and referral. Participants shall be responsible for costs of services
provided pursuant to a referral. Contracted specialty firms may offer Participant a discount rate.
Life Events legal services shall include, at no charge to Participants, an initial thirty (30) minute
consultation. As of the Effective Date of the Agreement, contracted specialty firms that provide
direct services to Participants are CLC Incorporated (legal and financial), located in Granite Bay,
CA and Workplace Options (life event services).
1.6 Contractor will provide City Account Services as set forth in Attachment 2 to this Exhibit A.
Employee Communication Services
1.7 Unless otherwise agreed upon by the parties, Contractor, at its expense, shall supply to City
the communication materials related to EAP services as set forth in Attachment 3 to this Exhibit
A. All communication materials shall be delivered by Contractor to one location as designated
by City for distribution by City as set forth in paragraph 2.1, unless otherwise agreed upon in
advance by the parties.
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Management Reports
1.8 Contractor will provide standard reports on a quarterly basis to City. Without the
appropriate written consent of the Participant, Contractor will provide no information to City or
any third party which is Participant-specific or that includes any Participant identifiable
information.
Substance Abuse Professional Services
1.9 Contractor shall provide to City access to participating providers that have, as of January
1, 2004, successfully completed the qualification training and passed the exam required and
continues to meet all on-going requirements for a provider to be identified as a Department of
Transportation ("DOT") Substance Abuse Provider (SAP). For employees designated by City as
holding a DOT regulated position, Contractor will consult with City and/or City's designated
employee representatives as to SAP process and actions required in response to violations,
provide City with name(s) of SAP who is knowledgeable in the applicable modal rule, ensure the
SAP is aware of customer-specific communication and/or process requirements, monitor case
progress and disposition, and assist with return to work planning pursuant to City's policies and
procedures."
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II. City Responsibilities
2.1 The City agrees to distribute to participating employees the communication materials
described in paragraph 1.7, above, at City's expense. The City will also cooperate with
Contractor in efforts to otherwise communicate with Participants concerning the services
available to them pursuant to this Agreement.
2.2 The City shall inform Contractor of the City's management policies and procedures to guide
supervisors in effectively handling employees with performance problems in order for Contractor
to provide the training set forth in Attachment 2.
2.3 City will compensate Contractor for services provided under this Agreement as set forth in
Attachment 4 to this Exhibit A. Retroactive adjustments to the amount of the per employee per
month fees paid to Contractor shall be limited to twelve (12) months prior to the date either party
notifies the other of such a retroactive adjustment.
2.4 Contractor shall have the right to revise Contractor's fees and/or the number of hours
available to City as City Account Services (i) after the initial term of the Agreement (April 9, 2007
through December 31, 2008), (ii) at any time thereafter, but no more frequently than once every
twelve (12) months after the initial April 9, 2007 through December 31, 2008 term, by giving City
not less than thirty (30) days' prior written notice, and (iii) when the number of employees varies
by more than 10% from the number included on the first Contractor billing for the initial April 9,
2007 through December 31, 2008 term and each subsequent twelve (12) month period of the
Agreement.
2.5 City agrees that, annually, at least ninety (90) days' prior to the anniversary date of the
effective date of this Agreement, City shall furnish to Contractor the number of employees who
are Participants by state of residence.
III. MISCELLANEOUS
Confidential Information
3.1 Contractor and the City agree not to use for any purposes other than the performance of
this Agreement or to disclose to others any confidential or proprietary technical or business
information of the other party obtained in connection with the performance of any services
rendered, without the prior written consent of the other party. Each party shall treat and shall
require its employees to treat as strictly confidential all information it has learned in the course of
this Agreement, and in discussions and proposals leading up to this Agreement including any
patient identifiable information received pursuant to Participant's consent. Contractor shall
maintain financial, and administrative records in accordance with applicable laws, and those
records shall be the property of Contractor. The provisions of this section shall survive the
termination of this Agreement.
3.2 Contractor assumes no responsibiljty for employment-related supervision of any City
employee; such supervision and/or decisions regarding the employee are the sole responsibility
of the City.
3.3 The terms of Attachment 7, Privacy Addendum, shall be incorporated herein.
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IV. Determination of California Participants' Eligibility
4.1. As the insurer for the short-term counseling benefit for California Participants, CGLIC is
required under the Health Insurance Portability Act of 1996 ("HIPAA") and the privacy
regulations promulgated thereunder, to distribute a Privacy Notice, as defined under HIPAA, to
those employees. In order for CGLIC to comply with this requirement, City shall furnish to
Contractor Health as agent for CGLIC such eligibility information electronically on a monthly
basis according to the specifications set forth in Attachment 8 to this Exhibit A. It is mutually
understood that the effective performance of this Agreement by Contractor will require that it be
advised on a timely basis by the City during the continuance of this Agreement of the identity of
City's California employee Participants.
ATTACHMENT 1
SERVICE AREA
California
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ATTACHMENT 2
EMPLOYER ACCOUNT SERVICES
As part of Contractor's Fees set forth in Attachment 4 hereto, City has purchased
a number of hours for twelve month period from the effective date of this
Agreement from Contractor for use in the delivery of the following City Account
Services. The number of hours to be provided by Contractor for City Account
Services in each twelve (12) month period shall be 10 hours per 1,000
employees included in the first Contractor bill for each twelve (12) month period.
Pro-rata adjustments in this number of hours may be computed pursuant to
Section 2.4 of this Agreement.
* Employee Orientation Sessions
* Management/Supervisory Training Sessions
* Educational/Wellness Seminars
* Critical Incident Response Services
* Executive Briefings
* City's on-site EAP promotional activities conducted by Contractor
EAP managers or Contractor contracted EAP affiliates
* Other City Account Services - City Account Services requested by
City for which Contractor notifies City that those services shall be
counted against City Account Services' hours, including but not
limited to, executive briefings, reduction in workforce counseling,
and City's on-site EAP promotional activities conducted by
Contractor EAP managers or Contractor contracted EAP affiliates.
Delivery of these City Account Services shall be as agreed upon by the parties.
In the event City does not utilize or only partially utilizes these City Account
Services' hours during the twelve (12) month period to which they relate, City
shall not be entitled to any refund or account credit, or to carry those hours
forward. If City cancels its request for these services or reduces the number of
hours initially requested after an independent provider has been secured by
Contractor, Contractor shall deduct that number of hours the provider had been
secured from City Account Services' hours.
Additional City Account Services' hours may be purchased by City from
Contractor at Contractor's fee-for-service rates in effect at the time of the request
for such City Account Services. Delivery of these additional City Account
Services' hours shall be as agreed upon by the parties.
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ATTACHMENT 3
EAR COMMUNICATION MATERIALS
Employee Brochures: 1 for each employee, includes wallet cards
Managers' Guides: 1 per each 10 employees
Orientation Video As agreed upon by the parties
Posters: 5 posters for every 100 employees
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ATTACHMENT 4
COMPENSATION
1. The fee for the services contained herein is $2.47 per employee per
month. City agrees to pay Contractor on the first day of each covered month.
Payments by City shall be sent to Contractor at the address listed in this
Agreement.
2. Substance Abuse Professional Services: The fee for this service is
$950.00 per case.
3. Mediation Services: Employer to purchase directly from and to be
provided by Consolidated Legal Concepts, outside the scope of this Agreement:
The fee for this service is $515.00 for set-up and management. In addition,
Mediation Services must be purchased in three (3) hour blocks of time for a fee
of $150.00 per hour or any portion thereof.
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ATTACHMENT 5
ONLINE BEHAVIORAL HEALTH SERVICES
1. Online Services
Online Behavioral Health Services are offered as a supplement to the
other behavioral health services furnished under this Agreement. These Online
Services provide one more way for Participants to get information and help;
however, these Online Services:
• Are NOT a substitute for therapy
• Are NOT a means of requesting or delivery of crisis services,
and
• Do NOT come with a guarantee of any effect on the
utilization of other services, such as therapy, in-patient
services or health care services.
2. Confidentiality
The parties recognize that the Online Services are most effective if
Participants perceive them - and the services actually are - confidential.
Consequently, City agrees that:
• City will not institute systems or policies that involve tracking
specific use (e.g. specific topics explored) of the Online Services by
its Participants.
3. Access
Contractor and City acknowledge that City has sole responsibility for
determining the balance to be allowed during working hours and on City's work
sites of Participant activity to be devoted solely to work activities versus
Participant activity that may be devoted to personal topics (including, for
example, lunch). City acknowledges that the Online Services are intended to
increase Participant morale and productivity by providing ready access to useful
resources on topics that may be draining Participant energy and attention. City
further acknowledges that in some circumstances, the only safe or convenient
access to the Online Services might be on the work site or during work hours
(e.g. in cases of domestic abuse). City agrees to develop its policy on use of the
Online Services during work hours and using City equipment and to
communicate that policy to its Participants during the course of communicating
the availability of the Online Services.
4. Communications Materials
City agrees that any of its communications with its Participants or with any
other third party describing the Online Services will be consistent with the Online
Servjces descriptions supplied by Contractor and/or the entity hosting the Online
Services ("Online Services Provider").
18
5. Copyright
City acknowledges that the Online Services Provider has copyright
interests in the material available through the Online Services. City
acknowledges further that the material available through the Online Services is
not to be considered in the public domain, or to be other than a published work
with all rights reserved under the Intellectual Property Laws. City agrees not to
remove any copyright notices in favor of the Online Services Provider on any
electronic or hardcopy materials. City agrees not to copy the material available
through the Online Services for any purpose whatsoever, except as may be
necessary to a) make purchase decisions concerning the Online Services or b)
communicate the availability of the Online Services to Participants. (By way of
example and not by way of limitation, City shall not copy materials off the Online
Services and use them as handouts during employee and/or manager training
programs unless the materials are specifically so marked as available for such
use.) City agrees not to take any action inconsistent with the copyright and
trademark ownership rights of the Online Services Provider related to the Online
Services.
6. Limitations of Liability
NEITHER CIGNA BEHAVIORAL NOR THE ONLINE SERVICES
PROVIDER MAKES ANY WARRANTIES, EXPRESS OR IMPLIED, WITH
RESPECT TO THE ONLINE SERVICES, AND BOTH CIGNA
BEHAVIORAL AND THE ONLINE SERVICES PROVIDER EXPRESSLY
DISCLAIMS ANY AND ALL OTHER WARRANTIES, WHETHER
EXPRESS OR IMPLIED, INCLUDING ALL WARRANTIES OF
MERCHANTABILITY AND WARRANTIES OF FITNESS FOR A
PARTICULAR PURPOSE WITH RESPECT TO THE ONLINE SERVICES.
NEITHER CIGNA BEHAVIORAL NOR THE ONLINE SERVICES
PROVIDER SHALL BE LIABLE FOR ANY SPECIAL, INDIRECT,
INCIDENTAL, CONSEQUENTIAL OR EXEMPLARY DAMAGES ARISING
FROM THE USE OF THE ONLINE SERVICES.
19
ATTACHMENT 6
MENU OPTIONS****
Substance Abuse Professional (SAP) Network
**** Only those additional Menu Options purchased by City will be listed on this page.
20
ATTACHMENT 7
PRIVACY ADDENDUM
I. GENERAL PROVISIONS
Section 1. Effect. Effective as of January 1, 2007, the terms and provisions of
this Addendum are incorporated in and shall supersede any conflicting or
inconsistent terms and provisions of the Agreement for Employee Assistance
Program Services to which this Addendum is attached, including all exhibits or
other attachments thereto and all documents incorporated therein by reference
(the "Agreement"), except for any provisions of the Agreement which are more
stringent regarding the use or disclosure of PHI by Contractor than this
Addendum. Any such more stringent provisions in the Agreement shall prevail
over this Addendum. This Addendum sets out terms and provisions relating to
the use and disclosure of protected health information without written
authorization from the individual.
Section 2. Amendment. Contractor, City (also referred to as "Plan Sponsor")
and the Group Health Plan that is the subject of the Agreement (also referred to
as "the Plan") agree to amend this Addendum to the extent necessary to allow
either Contractor or the Group Health Plan to comply with the Privacy Rules (45
C.F.R. Parts 160 and 164), the Standards for Electronic Transactions (45 C.F.R.
Parts 160 and 162) and the Security Standards (45 C.F.R. Part 142) (collectively,
the "Standards") promulgated or to be promulgated by the Secretary and all other
applicable regulations or statutes. Contractor, City and the Group Health Plan
will fully comply with all applicable Standards and will amend this Addendum to
incorporate any material required by the Standards.
Section 3. Definitions. Capitalized terms used herein without definition shall
have the respective meanings assigned to such terms in Part IV of this
Addendum.
II. OBLIGATIONS OF CIGNA BEHAVIORAL
Section 1. Use and Disclosure of Protected Health Information. Contractor
may use and disclose Protected Health Information, ("PHI") only as required to
satisfy its obligations or as permitted under the Agreement, or as permitted or
required by law, but shall not otherwise use or disclose any Protected Health
Information. Contractor shall not use or disclose, and shall ensure that its
directors, officers and, employees do not use or disclose, Protected Health
Information in any manner that would constitute a violation of the Privacy
Standards if done by the Group Health Plan, except that Contractor may use and
disclose Protected Health Information (i) for the proper management and
administration of Contractor, (ii) to carry out the legal responsibilities of
Contractor or (iii) to provide Data Aggregation services relating to the health care
operations of the Group Health Plan.
21
Section 2. Disclosure of Protected Health Information to Group Health Plan
Sponsor.
The Group Health Plan acknowledges and agrees that the Privacy Rules allow
the Group Health Plan to permit Contractor to disclose or provide access to PHI,
other than Summary Health Information, to the Plan Sponsor only after the Plan
Sponsor has amended its plan documents to provide for the permitted and
required uses and disclosures of PHI and to require the Plan Sponsor to provide
a certification to the Plan that certain required provisions have been incorporated
into the Plan documents before the Plan may disclose, either directly or through
a business associate, such as Contractor, any PHI to the Plan Sponsor. The
Group Health Plan hereby warrants and represents that no PHI will be provided
to the Plan Sponsor nor to any of its employees, agents or other persons under
its control. Therefore no such Plan document amendments have been made nor
any such certification received from the Plan Sponsor.
Section 3. Other Information to Plan Sponsor or Plan. Upon the written
request of Plan or Plan Sponsor, Contractor will provide certain other information
including, but not limited to, information about Contractor's arrangements with
health care providers ("Other Information") to Plan Sponsor's designated
employee. Plan Sponsor acknowledges that in receiving Other Information under
these provisions, it acts in its capacity as Plan Administrator, as that term is
defined by the Employee Retirement Income Security Act of 1974, as amended.
Other Information will be kept confidential and will be used by Plan Sponsor
solely for the purpose of satisfying its fiduciary responsibilities with respect to
administration of the Plan, and will be handled and maintained in accordance
with all fiduciary obligations owed to participants in the Plan.
Section 4. Safeguards Against Misuse of Information. Contractor agrees
that it will use appropriate safeguards to prevent the use or disclosure of
Protected Health Information other than as allowed under the terms and
conditions of this Addendum or as permitted or required by law.
Section 5. Reporting of Violations. Contractor shall report to the Group
Health Plan any use or disclosure of the Protected Health Information not
provided for by this Addendum of which it becomes aware.
Section 6. Disclosures to and Agreements by Third Parties.
Contractor shall ensure that each agent and subcontractor to whom it provides
PHI received from the Plan, or created by Contractor on behalf of the Plan
agrees to substantially similar restrictions and conditions with respect to
Protected Health Information that apply to Contractor pursuant to this Addendum.
(b) Upon Group Health Plan's or City's written request, Contractor will provide
Protected Health Information and/or Other Information to certain designated
third-parties who assist in administering the Plan and are authorized by the
Group Health Plan to receive such information ("Designated Third Parties") solely
for the purpose of assisting in the carrying out of Plan administration functions.
Such parties may include, but are not limited to, third-party administrators,
consultants, brokers, auditors, successor administrators or insurers, and stop-
loss carriers. Group Health Plan shall enter into and maintain an agreement with
each agent and subcontractor or other third party to which it directs Contractor to
disclose PHI under which such agent, subcontractor or other third party is legally
22
bound by substantially similar restrictions with respect to Protected Health
Information that apply to Contractor pursuant to this Addendum.
(c) It is acknowledged and agreed that the Privacy Rules require the Group
Health Plan to maintain policies and procedures to ensure that any PHI that it
uses, requests or discloses be no more than the minimum necessary to
accomplish the intended purpose. The Group Health Plan hereby warrants and
represents that any requests that it makes for PHI to be disclosed to it or to any
third parties will be for no more than the minimum amount necessary for the
intended purpose.
(d) Any other provision of this Addendum notwithstanding, Contractor may
decline to disclose to any third party any information which the Agreement
provides may not be disclosed to the City.
Section 7. Access to Information.
Request made to the Plan. When an individual requests access to PHI
contained in a designated record set and such request is made directly to
the Plan or City, the Plan shall so notify Contractor within two (2) business
days of receipt of such request. Contractor shall make such PHI available
directly to the Participant within the time required in 45 C.F.R. Section
164.524.
Request made to Contractor. If a Participant directs a request for access to PHI
contained in such designated record set to Contractor, Contractor will provide the
PHI to the individual within the time required in 45 C.F.R. Section 164.524.
Responsibility for denials and responding to requests. In the case of either
subsection (a) or (b) above, the Plan delegates to Contractor the duty to
determine, on behalf of the Plan, whether to deny access to PHI requested and
the duty to provide any required notices and review.
Agent for the Plan. It is understood and agreed that in all activities performed
pursuant to this section, Contractor acts as agent of and on behalf of the Plan
and/or City. When responding to an individual's request for access, it may inform
such individual of that fact and that there may be other PHI about that individual
created or maintained by the Plan and/or its other business associates and not
included in Contractor's response. Contractor shall not be responsible for
performing any of the duties described herein with respect to any such other PHI.
Section 8. Availability of Protected Health Information for
Amendment.
Handling of Requests by Contractor. When an individual requests amendment of
PHI contained in a designated record set and created or received by Contractor
or its subcontractors, and such request is made directly to the Plan or City, within
two (2) working days of its request, the Plan shall forward such request to
Contractor for handling except that the Plan shall retain and handle all requests
to the extent that they pertain to individually identifiable health information (i.e.
enrollment information) originated by the Plan, Plan Sponsor, or its other
business associates. Contractor shall respond to such forwarded requests as
well as to any such requests that it receives directly as required by Section
164.526 except that Contractor shall forward to the Plan for handling any
23
requests for amendment of PHI originated by the Plan, Plan Sponsor or its other
business associates.
Responsibility for denial of request. With respect to those requests handled by
Contractor under subparagraph (a) above, the Plan delegates to Contractor the
duty to determine, on behalf of the Plan, whether to deny a request for
amendment of any PHI and the duty to provide any required notices and review
as well as, in the case of its determination to grant such a request, the duty to
make any amendments in accordance with the terms of the Privacy Rules. In all
other instances, the Plan retains all responsibility for handling such requests,
including any denials, in accordance with the Privacy Rules.
Amendments by the Plan. Whenever Contractor is notified by the Plan that the
Plan has agreed to make an amendment pursuant to such a request which it
handles hereunder, Contractor shall incorporate any such amendments in
accordance with Section 164.526.
Agent for the Plan. It is understood and agreed that in all activities performed
pursuant to this section, Contractor acts as agent of, and on behalf of, the Plan
and/or City. When responding to requests for amendment of PHI, Contractor
may inform such individual of that fact and that there may be other PHI about that
individual created or maintained by the Plan and/or its other business associates
and not included in Contractor's response. Contractor shall not be responsible
for performing any of the duties described herein with respect to any such other
PHI.
Section 9. Accounting of Disclosures
(a) Request made to the Plan. When an individual requests an accounting of
disclosures pursuant to Section 164.528, and such request is made directly to
the Plan or City, the Plan shall so notify Contractor within two (2) business days
of receipt of such request.
(b) Request made to Contractor. If a Participant directs a request for accounting
to Contractor, Contractor will provide the accounting to the participant within the
time required in 45 CFR Section 164.528.
(c) Agent for the Plan. It is understood and agreed that in all activities performed
pursuant to this section, Contractor acts as agent of, and on behalf of, the Plan
and/or City. When responding to requests for an accounting of disclosures,
Contractor may inform such individual of that fact and that there may be other
disclosures of PHI about that individual made by the Plan and/or its other
business associates and not included in Contractor's response. Contractor shall
not be responsible for performing any of the duties described herein with respect
to any such other PHI or disclosures.
Section 10. Other Requests. Contractor shall handle Participant requests
made to it for privacy protection for PHI pursuant to the requirements of the
Privacy Rules at Section 164.522.
Section 11. Processes and Procedures. In carrying out its duties set forth in
Sections II, 7, 8, 9 and 10 above, Contractor may establish procedures and
processes for requests from individuals as permitted by the Privacy Rules,
including the requirement that requests be made in writing and the creation of a
24
form for use by individuals in making such requests. As appropriate, Contractor
shall utilize the same or similar procedures regarding requests from individuals
for access to PHI that it applies to its own health care plan administration
business.
Section 12. Availability of Books and Records. Contractor hereby agrees to
make its internal practices, books and records relating to the use and disclosure
of Protected Health Information available to the Secretary for purposes of
determining the Group Health Plan's compliance with the Privacy Rules.
Section 13. Protection of Electronic PHI. With respect to Electronic Protected
Health Information, no later than the compliance date for the Security Standards
and at all times thereafter Contractor shall:
(a) Implement administrative, physical, and technical safeguards that
reasonably and appropriately protect the confidentiality, integrity, and
availability of the Electronic Protected Health Information that Contractor
creates, receives, maintains, or transmits on behalf of the Plan as required
by the Security Standards;
(b) Ensure that any agent, including a subcontractor, to whom Contractor
provides such information agrees to implement reasonable and
appropriate safeguards to protect it; and
(c) Report to the Plan any Security Incident of which it becomes aware.
III. TERMINATION OF AGREEMENT WITH CIGNA BEHAVIORAL
Section 1. Termination Upon Breach of Provisions Applicable to
Protected Health Information. Any other provision of this Agreement
notwithstanding, this Agreement may be terminated by the Group Health
Plan upon ten (10) business days prior written notice to Contractor in the
event that Contractor materially breaches any obligation of this Addendum
and fails to cure the breach within such ten (10) day period; provided that
in the event that termination of this Agreement is not feasible, in the Group
Health Plan's sole discretion, Contractor hereby acknowledges that the
Group Health Plan shall have the right to report the breach to the
Secretary.
Section 2. Use of Protected Health Information upon Termination.
The parties hereto agree that it is not feasible for Contractor to return or
destroy PHI at termination of this Agreement, therefore, the provisions of
this Addendum shall survive termination of this Agreement and
Contractor shall limit any further uses and disclosures of such PHI to the
purpose or purposes which make the return or destruction of such PHI
infeasible.
25
IV. DEFINITIONS FOR USE IN THIS ADDENDUM
"Data Aggregation" shall mean the combining of Protected Health
Information by Contractor with the Individually Identifiable Health
Information created or received by Contractor in its capacity as a business
associate of another covered entity, to permit data analyses that relate to
the health care operations of the Group Health Plan and the other covered
entity.
"Designated Record Set" shall mean the, payment, claims adjudication,
and case or medical management record systems maintained by or for the
Group Health Plan, or used, in whole or in part, by or for the Group Health
Plan to make decisions about individuals. As used herein the term
"Record" means any item, collection, or grouping of information that
includes Protected Health Information and is maintained, collected, used,
or disseminated by or for the Group Health Plan.
"Electronic Protected Health Information" shall mean PHI that is
transmitted by or maintained in electronic media as that term is defined in
45 CFR 160.103.
"Group Health Plan" shall mean the Group Health Plan (as defined in the
Employee Retirement Income Security Act of 1974, as amended, (ERISA)
at 29 U.S.C. §1191b(a)) maintained by the Plan Sponsor that is identified
in this Agreement as the health Plan for or on behalf of which Contractor is
obligated to perform any function or activity involving the use or disclosure
of Protected Health Information pursuant to this Agreement.
"Individually Identifiable Health Information" shall mean information
that is a subset of health information, including demographic information
collected from an individual, and:
(i) is created or received by a health care provider, Health Plan,
health care clearinghouse (as those terms are defined in the
Privacy Standards), or employer; and
(ii) relates to the past, present, or future physical or mental health
or condition of an individual; the provision of health care to an
individual; or the past, present or future payment for the
provision of health care to an individual; and (a) identifies the
individual, or (b) with respect to which there is a reasonable
basis to believe the information can be used to identify the
individual.
"Privacy Standards" shall mean the Standards for Privacy of Individually
Identifiable Health Information, 45 C.F.R. Parts 160 and 164.
26
"Protected Health Information" shall mean Individually Identifiable
Health Information transmitted or maintained in any form or medium that
Contractor creates or receives from or on behalf of the Group Health Plan
in the course of fulfilling its obligations under this Agreement. "Protected
Health Information" shall not include (i) education records covered by the
Family Educational Rights and Privacy Act, as amended, 20 U.S.C.
§1232g, and (ii) records described in 20 U.S.C. §1232g(a)(4)(B)(iv).
"Secretary" shall mean the Secretary of the United States Department of
Health and Human Services.
"Security Incident" shall h ave the same meaning as the term "security
incident" as set forth in 45 CFR 164.304.
"Summary Health Information" shall mean information, that may be
Individually Identifiable Information, and (i) that summarizes the claims
history, claims expenses, or type of claims experienced by individuals
covered by the Group Health Plan; and (ii) from which the information
described at 45 C.F.R. §164.514(b)(2)(i) has been deleted, except that the
geographic information described in 45 C.F.R. §164.514(b)(2)(i)(B) need
only be aggregated to the level of a five-digit zip code.
V. INDEMNIFICATION
Section 1. By Contractor. Contractor will indemnify Plan and City for and hold
them, their directors, officers, and employees harmless from and against all costs
(other than plan benefit claims), damages, judgments, attorneys' fees, expenses,
and liabilities of any kind or nature for which Plan or City may become liable
resulting from any claim, legal action, or proceeding arising directly or indirectly
out of Contractor's negligent or intentional use or disclosure of PHI in violation of
the terms of this Addendum.
Section 2. By Plan and City. Plan and City will indemnify Contractor for and
hold it, its directors, officers, and employees, harmless from and against all costs,
damages, judgments, attorney's fees, expenses and liabilities of any kind or
nature for which Contractor may become liable resulting from any claim, legal
action, or proceeding arising directly or indirectly out of release of PHI to Plan,
City or any third party to whom Plan or City requests Contractor to release PHI,
or arising out of the use of such information by Plan, City or such a third party, or
any negligent or intentional violation of the terms of this Addendum by Plan or
City.
27
CITY OF CARLSBAD
By:
CIGNA BEHAVIORAL HEALTH, INC.
Name: Keith Dixon
Title:
Date:
Title: President & CEO
Date:
WITH RESPECT TO THE PRIVACY
ADDENDUM ONLY:
ITY'S PLAN)
Group Health Plan is a defined term
under HIPAA (see 45 C.F.R. 160.103)
It generally refers to an employee
welfare benefit plan maintained by an
employer for its employees. Typically,
an employer (Plan Sponsor) will
designate an individual or a
committee to carry out Group Health
Plan Responsibilities. An individual so
authorized to act on behalf of the
Group Health Plan should sign here.
Date: 4- H-
28
ATTACHMENT 8
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ACORD-DATECMM/bb/YYYY)
04/02/2007
PRODUCER .Aon Risk Services, inc. of PennsylvaniaOne Liberty Place1650 Market Street
Suite 1000
Philadelphia PA 19103 USA
PHONE- (8665 283-7122 FAX- (847) 953-5390
INSURED
CIGNA Behavioral Health, Inc.
(A Subsidiary of CIGNA Corp.)
11095 Viking Drive
Suite 350
Eden Prairie MN 55344 USA
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSt
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DO(
PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN E
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
A
A
B
A
B
C
ADD'I
DSSRD TYPE OF INSURANCE
5ENERAL LIABILITY
* COMMERCIAL GENERAL LIABILITY
CLAIMS MADE [X | OCCUR_
GENT. AGGREGATE LIMIT APPLIES PER:
1 POLICY 1 1 PRO- [x~| LOC
1 1 1 1 JECT 1 1
AUTOMOBILE LIABILITY
X ANY AUTO
"5T ALL OWNED AUTOS
3T SCHEDULED AUTOS
3T HIRED AUTOS
3T NON OWNED AUTOS
GARAGE LIABILITY
1 ANY AUTO
EXCESS /UMBRELLA LIABILITY
[OCCUR | | CLAIMS MADE
[DEDUCTIBLE
| RETENTION
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR / PARTNER / EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under SPECIAL PROVISIONS
below
OTHER
Misc Liab cvg
POLICY NUMBER
HDOG21734500
ISAH0822481A
WLRC44441421
AOS
WLRC44441433
CA
SCFC44441445
WI
FZ0701651
Professional Liability
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.
INSURERS AFFORDING COVERAGE NAIC#
INSURERA: ACE American Insurance Company 22667
INSURERS: Indemnity Insurance Co of North America 43575
INSURER c Lloyd's of London 0005FI
INSURER D:
| INSURER E: |
JRED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
:UMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY
SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
POLICY EFFECTIVE
DATE(MM\DD\YY)
07/01/06
07/01/06
07/01/06
07/01/06
07/01/06
03/30/07
POLICY EXPIRATION
DATE(MMVDDWY)
07/01/07
07/01/07
U//UJ./U/
07/01/07
07/01/07
03/30/08
LIMITS
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES (Ea occurence)
MED EXP (Any one oerson)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGO
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
(Per accident)
AUTO ONLY - EA ACCIDENT
OTHER THAN
AUTO ONLY :
EAACC
AGO
EACH OCCURRENCE
AGGREGATE
X |WC STATU-
TORY yMrrg 1OTH-
ER
Ei. EACH ACCIDENT
E.L. DISEASE-EA EMPLOYEE
E.L. DISEASE-POLICY LIMIT
Per occurrence
$1,000,000
$100,000
$5,000
$1,000,000
$3,000,000
$1,000,000
$1,000,000
$1,000,000
$1,000,000
$1,000,000
$1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
City of Carlsbad is included as Additional Insured with respect to the General Liability policy.Certificate No : 570021795953 Holder Identifler :=
B
£j
S=
S
City of CarlsbadAttn: Debbie Jackson
1635 Faraday AvenueCarlsbad CA 92008 USA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 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. ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
NOT TRANSFERABLE
BUS. NUMBER
1223711
DATE ISSUED
1/9/2007
SIC CODE
8999
OWNER FIRM OR
CORPORATION NAME
BUSINESS NAME
MAILING ADDRESS
CITY AND STATE
CITY OF CARLSBAD
BUSINESS REGISTRATION CERTIFICATE
POST IN CONSPICUOUS PLACE
The, pwMn. firm or ujipurtun named Mow !• gran** IN* burinm otrMcaoi punuMtt » na prmWora ot ttw ay Bukms UGWM On*unc» to wm« I
CMy an or conduct ttw burinHa. tradt. oOng. protauion, cdhKMan or occupraon dMcrtMd brtaw. Inumct or aw cwttkaM b not an •ndohMrnftn; n
i ot oomptanci viflh ottwr ordbuncos or tonn. TNi liranu Is ItjtMd without wiHorilon the* ttM IOMIMO to Mb)Md to or kmunpt torn lowulna by It
BUSINESS LOCATION
11095 VIKING DRSTE 350
SIC DESCRIPTION
Services, Not Elsewhere Classified
CIGNA BEHAVIORAL HEALTH, INC.
CIGNA BEHAVIORAL HEALTH, INC.
11095 VIKING DRSTE 350
EDEN PRAIRIE, MN 55344-7234
EXPIRATION DATE
1/31/2008
KEEP FOR YOUR RECORDS
BUSINESS TAX RECEIPT
BUS. NO. 1223711
DATE ISSUED
1/9/2007
08.160 $50.00
BALANCE
TAXES PAID IN ACCORDANCE WITH Cm
BUSINESS TAX ORDINANCE
CITY OF CARLSBAD