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PD First Responder Counseling Services
AGREEMENT FOR PROFESSIONAL SERVICES FOR FIRST RESPONDER COUNSELING SERVICES This Agreement is made and entered into this � day of 72��by and between the CITY OF SAN RAFAEL (hereinafter "CITY'), and PUBLIC WETY FAMILY COUNSELING GROUP, INC. (hereinafter "CONSULTANT"). RECITALS WHEREAS, Public Safety is a demanding profession. It requires personnel to possess a myriad of skills and personality traits and use them in challenging and sometimes threatening situations. The San Rafael Police and Fire Departments have identified a need for specialized wellness resources and services for their employees, provided by professionals with experience providing wellness services to first responders. Public Safety is a high -stress, often dangerous job, and it is critical for Police and Fire Department employees to have specialized wellness resources and services available to them to manage the job-related stressors and perform their jobs successfully; and WHEREAS, Staff researched the availability of specialized wellness resources and counseling services geared towards first responders in the Bay Area. Public Safety Family Counseling Group is the only local service provider identified by Staff with the requisite experience in public safety counseling and wellness. Although there are other employee assistance programs available, they lack the specialized programs, resources, services, and trained personnel to deal with the specific needs of public safety personnel. Employee assistance programs are often difficult to access and lack culturally competent professionals; NOW, THEREFORE, the parties hereby agree as follows: PROJECT COORDINATION. A. CITY'S Project Manager. Lieutenant Lisa Holton is hereby designated the PROJECT MANAGER for the CITY and said PROJECT MANAGER shall supervise all aspects of the progress and execution of this Agreement. B. CONSULTANT'S Project Director. CONSULTANT shall assign a single PROJECT DIRECTOR to have overall responsibility for the progress and execution of this Agreement for CONSULTANT. Scott Dansie is hereby designated as the PROJECT DIRECTOR for CONSULTANT. Should circumstances or conditions subsequent to the execution of this Agreement require a substitute PROJECT DIRECTOR, for any reason, the CONSULTANT shall notify the CITY within ten (10) business days of the substitution. 2. DUTIES OF CONSULTANT. CONSULTANT shall perform the duties and/or provide services described as "BASE SERVICES" in the "Scope of Services and Compensation" attached hereto as Exhibit A and incorporated herein by reference. In addition, in the CITY'S sole discretion, and upon prior approval by the Police Chief, the Project Manager may authorize CONSULTANT in writing to perform any services described in the "ADDITIONAL SERVICES" section of Exhibit A. 3. DUTIES OF CITY. CITY shall pay the compensation as provided in Paragraph 4, and provide support and information as required for CONSULTANT to perform services under this Agreement. 4. COMPENSATION. For the full performance of the BASE SERVICES described herein by CONSULTANT, CITY shall pay CONSULTANT a flat fee of $50,000, as detailed in the Section 1 of the "COMPENSATION" section of Exhibit A attached. Should the CITY authorize any services described as ADDITIONAL SERVICES as provided in Section 2 above, CITY shall compensate CONSULTANT as described in Sections 2 and/or 3 of the "COMPENSATION" section of Exhibit A, provided that in no event shall the total compensation under this Agreement exceed $60,000. Payment will be made monthly upon receipt by PROJECT MANAGER of itemized invoices submitted by CONSULTANT. 5. TERM OF AGREEMENT. The term of this Agreement shall be for one year commencing on January 1, 2022 and ending on December 31, 2022. Upon mutual agreement of the parties, and subject to the approval of the City Manager the term of this Agreement may be extended for an additional period of up to one year. 6. TERMINATION. A. Discretionary. Either party may terminate this Agreement at the end of a calendar month without cause, upon no less than thirty (3 0) days written notice mailed or personally delivered to the other party. B. Cause. Either party may terminate this Agreement for cause upon fifteen (15) days written notice mailed or personally delivered to the other parry, and the notified parry's failure to cure or correct the cause of the termination, to the reasonable satisfaction of the parry giving such notice, within such fifteen (15) day time period. If necessary to avoid a patient abandonment, and upon agreement of the terminating parry, the termination date may be extended for up to fifteen (15) days. C. Effect of Termination. Upon receipt of notice of termination, neither parry shall incur additional obligations under any provision of this Agreement without the prior written consent K of the other. D. Return of Documents. Upon termination, any and all CITY documents or materials provided to CONSULTANT shall be delivered to CITY as soon as possible, but not later than thirty (30) days after termination. 7. OWNERSHIP OF DOCUMENTS. Any and all work, artwork, copy, posters, billboards, photographs, videotapes, audiotapes, systems designs, software, reports, designs, specifications, drawings, diagrams, surveys, source codes or any original works of authorship created by CONSULTANT or its subcontractors or subconsultants in connection with services performed under this Agreement shall be deemed the exclusive intellectual or otherwise licensed property of CONSULTANT and CONSULTANT shall retain all rights therein except where provided by a separate agreement. 8. INSPECTION AND AUDIT. Upon reasonable notice, CONSULTANT shall make available to CITY, or its agent, for inspection and audit, all documents and materials maintained by CONSULTANT in connection with its performance of its duties under this Agreement. CONSULTANT shall fully cooperate with CITY or its agent in any such audit or inspection. 9. ASSIGNABILITY. The parties agree that they shall not assign or transfer any interest in this Agreement nor the performance of any of their respective obligations hereunder, without the prior written consent of the other party, and any attempt to so assign this Agreement or any rights, duties or obligations arising hercunder shall be void and of no effect. 10. INSURANCE. A. Scope of Coverage. During the term of this Agreement, CONSULTANT shall maintain, at no expense to CITY, the following insurance policies: - 1. A commercial general liability insurance policy in the minimum amount of one million dollars ($1,000,000) per occurrence/two million dollars ($2,000,000) aggregate, for death, bodily injury, personal injury, or property damage. 2. An automobile liability (owned, non -owned, and hired vehicles) insurance policy in the minimum amount of one million dollars ($1,000,000) dollars per occurrence. 3. If any licensed professional performs any of the services required to be performed under this Agreement, a professional liability insurance policy in the minimum amount of one million dollars ($1,000,000) per occurrence/two million dollars ($2,000,000) aggregate, to cover any claims arising out of the CONSULTANT's performance of services under this Agreement. Where CONSULTANT is a professional not required to have a professional license, CITY reserves 3 the right to require CONSULTANT to provide professional liability insurance pursuant to this section. 4. If it employs any person, CONSULTANT shall maintain worker's compensation insurance, as required by the State of California, with statutory limits, and employer's liability insurance with limits of no less than one million dollars ($1,000,000) per accident for bodily injury or disease. CONSULTANT's worker's compensation insurance shall be specifically endorsed to waive any right of subrogation against CITY. B. Other Insurance Requirements. The insurance coverage required of the CONSULTANT in subparagraph A of this section above shall also meet the following requirements: 1. Except for professional liability insurance or worker's compensation insurance, the insurance policies shall be specifically endorsed to include the CITY, its officers, agents, employees, and volunteers, as additional insureds (for both ongoing and completed operations) under the policies. 2. The additional insured coverage under CONSULTANT'S insurance policies shall be "primary and noncontributory" with respect to any insurance or coverage maintained by CITY and shall not call upon CITY's insurance or self-insurance coverage for any contribution. The "primary and noncontributory" coverage in CONSULTANT'S policies shall be at least as broad as ISO form CG20 0104 13. 3. Except for professional liability insurance or worker's compensation insurance, the insurance policies shall include, in their text or by endorsement, coverage for contractual liability and personal injury. 4. By execution of this Agreement, CONSULTANT hereby grants to CITY a waiver of any right to subrogation which any insurer of CONSULTANT may acquire against CITY by virtue of the payment of any loss under such insurance. CONSULTANT agrees to obtain any endorsement that may be necessary to effect this waiver of subrogation, but this provision applies regardless of whether or not CITY has received a waiver of subrogation endorsement from the insurer. This section shall not apply to CONSULTANT'S professional liability insurance policy. 5. If the insurance is written on a Claims Made Form, then, following termination of this Agreement, said insurance coverage shall survive for a period of not less than five years. 6. The insurance policies shall provide for a retroactive date of placement coinciding with the effective date of this Agreement. 7. The limits of insurance required in this Agreement may be satisfied by a combination of primary and umbrella or excess insurance. Any umbrella or excess insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a primary and noncontributory basis for the benefit of CITY (if agreed to in a written contract or agreement) before CITY'S own insurance or self-insurance shall be called upon to protect it as a named insured. 51 8. It shall be a requirement under this Agreement that any available insurance proceeds broader than or in excess of the specified minimum insurance coverage requirements and/or limits shall be available to CITY or any other additional insured party. Furthermore, the requirements for coverage and limits shall be: (1) the minimum coverage and limits specified in this Agreement; or (2) the broader coverage and maximum limits of coverage of any insurance policy or proceeds available to the named insured; whichever is greater. No representation is made that the minimum Insurance requirements of this agreement are sufficient to cover the obligations of the CONSULTANT under this agreement. C. Deductibles and SIR's. Any deductibles or self-insured retentions in CONSULTANT's insurance policies must be declared to and approved by the PROJECT MANAGER and City Attorney and shall not reduce the limits of liability. Policies containing any self-insured retention (SIR) provision shall provide or be endorsed to provide that the SIR may be satisfied by either the named insured or CITY or other additional insured parry. At CITY's option, the deductibles or self-insured retentions with respect to CITY shall be reduced or eliminated to CITY's satisfaction, or CONSULTANT shall procure a bond guaranteeing payment of losses and related investigations, claims administration, attorney's fees and defense expenses. D. Proof of Insurance. CONSULTANT shall provide to the PROJECT MANAGER or CITY'S City Attorney all of the following: (1) Certificates of Insurance evidencing the insurance coverage required in this Agreement; (2) a copy of the policy declaration page and/or endorsement page listing all policy endorsements for the commercial general liability policy, and (3) excerpts of policy language or specific endorsements evidencing the other insurance requirements set forth in this Agreement. CITY reserves the right to obtain a full certified copy of any insurance policy and endorsements from CONSULTANT. Failure to exercise this right shall not constitute a waiver of the right to exercise it later. The insurance shall be approved as to form and sufficiency by PROJECT MANAGER and the City Attorney. 11. INDEMNIFICATION. A. CONSULTANT shall, to the fullest extent permitted by law, indemnify, release, defend with counsel approved by CITY, and hold harmless CITY, its officers, agents, employees and volunteers (collectively, the "City Indemnitees"), from and against any claim, demand, suit, judgment, loss, liability or expense of any kind, including but not limited to attorney's fees, expert fees and all other costs and fees of litigation, (collectively "CLAIMS"), arising out of CONSULTANT'S performance of its obligations or conduct of its operations under this Agreement. The CONSULTANT's obligations apply regardless of whether or not a liability is caused or contributed to by the active or passive negligence of the City Indemnitees. However, to the extent that liability is caused by the active negligence or willful misconduct of the City Indemnitees, the CONSULTANT's indemnification obligation shall be reduced in proportion to the City Indemnitees' share of liability for the active negligence or willful misconduct. In addition, the acceptance or approval of the CONSULTANT's work or work product by the CITY or any of its directors, officers or employees shall not relieve or reduce the CONSULTANT's indemnification obligations. In the event the City Indemnitees are made a party to any action, lawsuit, or other adversarial proceeding arising from CONSULTANT'S performance of or 5 operations under this Agreement, CONSULTANT shall provide a defense to the City Indemnitees or at CITY'S option reimburse the City Indemnitees their costs of defense, including reasonable attorneys' fees, incurred in defense of such claims. B. The defense and indemnification obligations of this Agreement are undertaken in addition to, and shall not in any way be limited by, the insurance obligations contained in this Agreement, and shall survive the termination or completion of this Agreement for the full period of time allowed by law. 12. NONDISCRIIVIINATION. CONSULTANT shall not discriminate, in any way, against any person on the basis of age, sex, race, color, religion, ancestry, national origin or disability in connection with or related to the performance of its duties and obligations under this Agreement. 13. COMPLIANCE WITH ALL LAWS. CONSULTANT shall observe and comply with all applicable federal, state and local laws, ordinances, codes and regulations, in the performance of its duties and obligations under this Agreement. CONSULTANT shall perform all services under this Agreement in accordance with these laws, ordinances, codes and regulations. CONSULTANT shall release, defend, indemnify and hold harmless CITY, its officers, agents and employees from any and all damages, liabilities, penalties, fines and all other consequences from any noncompliance or violation of any laws, ordinances, codes or regulations. 14. NO THIRD PARTY BENEFICIARIES. CITY and CONSULTANT do not intend, by any provision of this Agreement, to create in any third parry, any benefit or right owed by one parry, under the terms and conditions of this Agreement, to the other party. 15. NOTICES. All notices and other communications required or permitted to be given under this Agreement, including any notice of change of address, shall be in writing and given by personal delivery, or deposited with the United States Postal Service, postage prepaid, addressed to the parties intended to be notified. Notice shall be deemed given as of the date of personal delivery, or if mailed, upon the date of deposit with the United States Postal Service. Notice shall be given as follows: TO CITY's Project Manager: Lieutenant Lisa Holton City of San Rafael 1375 Fifth Avenue San Rafael, Ca 94901 TO CONSULTANT's Project Director: Scott Dansie Public Safety Family Counseling Group, INC. 3381 Walnut Blvd. Suite 210 Brentwood, Ca 94513 16. INDEPENDENT CONTRACTOR. For the purposes, and for the duration, of this Agreement, CONSULTANT, its officers, agents and employees shall act in the capacity of an Independent Contractor, and not as employees of the CITY. CONSULTANT and CITY expressly intend and agree that the status of CONSULTANT, its officers, agents and employees be that of an Independent Contractor and not that of an employee of CITY. 17. ENTIRE AGREEMENT — AMENDMENTS. A. The terms and conditions of this Agreement, all exhibits attached, and all documents expressly incorporated by reference, represent the entire Agreement of the parties with respect to the subject matter of this Agreement. B. This written Agreement shall supersede any and all prior agreements, oral or written, regarding the subject matter between the CONSULTANT and the CITY. C. No other agreement, promise or statement, written or oral, relating to the subject matter of this Agreement, shall be valid or binding, except by way of a written amendment to this Agreement. D. The terms and conditions of this Agreement shall not be altered or modified except by a written amendment to this Agreement signed by the CONSULTANT and the CITY. E. If any conflicts arise between the terms and conditions of this Agreement, and the terms and conditions of the attached exhibits or the documents expressly incorporated by reference, the terms and conditions of this Agreement shall control. 18. SET-OFF AGAINST DEBTS. CONSULTANT agrees that CITY may deduct from any payment due to CONSULTANT under this Agreement, any monies which CONSULTANT owes CITY under any ordinance, agreement, contract or resolution for any unpaid taxes, fees, licenses, assessments, unpaid checks or other amounts. 19. WAIVERS. The waiver by either party of any breach or violation of any term, covenant or condition of this Agreement, or of any ordinance, law or regulation, shall not be deemed to be a waiver of any other term, covenant, condition, ordinance, law or regulation, or of any subsequent breach or violation of the same or other term, covenant, condition, ordinance, law or regulation. The subsequent 7 acceptance by either party of any fee, performance, or other consideration which may become due or owing under this Agreement, shall not be deemed to be a waiver of any preceding breach or violation by the other parry of any term, condition, covenant of this Agreement or any applicable law, ordinance or regulation. 20. COSTS AND ATTORNEY'S FEES. The prevailing party in any action brought to enforce the terms and conditions of this Agreement, or arising out of the performance of this Agreement, may recover its reasonable costs (including claims administration) and attorney's fees expended in connection with such action. 21. CITY BUSINESS LICENSE / OTHER TAXES. CONSULTANT shall obtain and maintain during the duration of this Agreement, a CITY business license as required by the San Rafael Municipal Code CONSULTANT shall pay any and all state and federal taxes and any other applicable taxes. CITY shall not be required to pay for any work performed under this Agreement, until CONSULTANT has provided CITY with a completed Internal Revenue Service Form W-9 (Request for Taxpayer Identification Number and Certification). 22. SURVIVAL OF TERMS. Any terms of this Agreement that by their nature extend beyond the term (or termination) of this Agreement shall remain in effect until fulfilled and shall apply to both Parties' respective successors and assigns. 23. APPLICABLE LAW. The laws of the State of California shall govern this Agreement. 24. COUNTERPARTS AND ELECTRONIC SIGNATURE. This Agreement may be executed by electronic signature and in any number of counterparts, each of which shall be deemed an original, but all of which together shall constitute one document. Counterpart signature pages may be delivered by telecopier, email or other means of electronic transmission. IN WITNESS WHEREOF, the parties have executed this Agreement as of the day, month and year first above written. CITY OF SAN RAFAEL JIM Sc, City M r CONSULTANT ATTEST: AALAZ'�11 - LINDSAY LARA,11City Clerk APPROVED AS TO FORM: L -a kyjdAm— - 1 ROBERT F. EPSTEIN, dity Attorney D Name: Elizabeth Dansie, M.A. Title: President, CEO [If CONSULTANT is a corporation, add signature of second corporate officer] By: Name: Elisa Hughes, M.A. Title: Vice President, Secretary Public Safety Family Counseling Group, INC. Exhibit A — Scope of Services and Compensation SCOPE OF SERVICES The primary purpose of this service contract is the creation and implementation of a first-year peer support ream and Critical Incident Stress Management (CISM) program while providing 24/7/365 program response and support services to the City of San Rafael Police and Fire Departments (City) and their employees. BASE SERVICES 1. 24/7 On-Call/Standby Availability 1.1. Consultant will be available 24 hours a day, 7 days a week for Crisis Response and Stabilization Services for City and City's personnel. 2. Crisis Response and Stabilization services. Such services may include, but are not limited to critical incident stress debriefings, crisis management briefings, on-site response, crisis intervention, and in person consultation as necessary following extraordinary events encountered by City's personnel or impacting the performance of City personnel's duties. 2.1. Crisis Response and Stabilization Services may be rendered at City's offices, in the field, at Consultant's offices, or virtually as approved by Consultant. 2.2. In the event that Consultant is requested to respond to an active scene or incident, City personnel shall accompany Consultant when requested. 3. Individual Crisis Stabilization and Counseling Services 3.1. Consultant will provide Individual Crisis Stabilization and Counseling Services as requested for City personnel, including 24/7 availability as needed. 3.2. Consultant will provide first responder specialized support and short-term individual crisis intervention and, as necessary, appropriate professional referrals to City's employee assistance program or other suitable venue when indicated. 3.2.1. Short-term individual crisis intervention is defined as up to five (5) one-on-one crisis intervention sessions per quarter without the need for referral or authorization from City. Such sessions may be provided either in-person at Consultant's offices or virtually. 3.2.2. In the event that an employee requires more than five (5) hours of service per quarter, the City employee seeking service shall obtain written authorization in advance from City or authorize Consultant to contact City on behalf of the affected employee. The authorization process shall not require Consultant to disclose of the affected employee's crisis or other HIPAA information without the employee's consent. 3.2.3. Referrals to third party services such as employee assistance programs, outside wellness training, or recovery/treatment retreats are not covered under this Agreement and are subject to other agreements between City and the third -party provider. 4. Telephone, email, and virtual Consultations 4.1. Expert collaboration with City Personnel regarding issues related to Critical Incident Stress, crisis intervention, education needs, organizational matters, and other psychological services as requested. 4.2. Provide on-going consultation to the City's Peer Support Team on topics including, but not limited to, program development, team selection, and team operations. 4.3. Consult with City Personnel regarding critical incident stress management support education services for line, supervisory, and management staff as requested. 4.4. Unlimited telephone, email, and virtual consultations are provided as "Base Services" under this agreement. 5. Peer Support Team Member Services 5.1. Consultant will provide two, one-on-one check-in appointments per year for each peer support team member, coordinator, and liaisons for the purpose of fostering professional wellness in their assigned role and to support positive wellness habits. 6. Training Services 6.1. Introductory Program Presentations 6.1.1. Consultant will conduct up to twelve (six each for Fire and Police), introductory shift briefing presentations for the purpose of introducing Consultant's firm, services, and program goals. Consultant will also solicit and compile peer support team member nominations following a blind nomination process. 6.1.2. City agrees to make arrangements for professional, non -sworn, and other administrative personnel to attend one of the aforementioned trainings. 6.2. Command Presentation and Training 6.2.1. Consultant will conduct one presentation and training for Command Staff in order to familiarize them with CISM and peer support team program goals and operations. 6.3. Management/Supervisory Presentation and Training 6.3.1. Consultant will conduct one presentation and training for management and supervisory staff in order to familiarize them with CISM and peer support team program goals and operations. 6.4. Line Personnel Training 6.4. 1. Consultant will provide two, four-hour training blocks covering CISM, wellness, and resiliency for line level personnel. 6.4.2. Training will be presented at City facilities and may be open to outside agencies upon City's request with Consultant approval. 6.5. Initial Peer Support Team Member Training 6.5.1. Consultant will supply one (4 -day, 32 hour training) in-person presentation of the International Critical Incident Stress Foundation's Group Crisis Intervention and Assisting Individuals in Crisis (GRIN) training at City's location for the purpose of training all of City's selected and appointed peer team members. 6.5.1.1. City may elect to open this GRIN training to other outside agencies and charge a fee for attendance. 6.5.1.2. Training under this section is limited to a maximum of 42 people. 6.5.2. City may, at its option, elect to send up to 15 peer team members to GRIN training presented by Consultant at an outside location in lieu of hosting an agency exclusive course. 6.5.2.1. Outside training under this clause must occur within the one-year contract term and is subject to availability. 6.6. Regional Peer Support Continuing Education Training 6.6.1. Participation in Regional Peer Support Continuing Education Training for all City designated liaisons, coordinators, and peers is included as a Base Service. 6.6.2. Participating agencies share a rotating responsibility for hosting Regional Peer Support and Coordinator Meetings. Responsibility for hosting said trainings and meetings is split among participating agencies on a rotating basis. 6.6.3. Regional training may be offered in person or via a virtual electronic platform. 6.7. Peer Led Briefing Trainings 6.7.1. Consultant shall design and supply one 15 -minute training program designed to be presented by peer support team members during briefing or other short format gatherings. These training programs shall be designed to enhance resiliency, increase mental wellness, and/or address specific problems within the agency or industry as a whole (i.e., healthy alcohol consumption, dealing with personal crisis, available CISM resources). 7. Meetings 7.1. Consultant will help facilitate and attend peer support team meetings exclusively for City's peer support team members. Said meetings shall be set up by a Peer Support Team Coordinator or Liaison and should occur once per quarter. These meetings may be held/attended in-person or virtually. 7.2. Consultant will help facilitate and attend a monthly peer support team coordinator and liaison meeting. Said meetings shall be set up by a peer support team coordinator or liaison. These meetings may be held/attended in-person or virtually. 7.3. Consultant shall attend Command Staff meetings as requested for the purpose of discussing and making recommendations as to CISM and peer support program needs and goals. 8. Policy Development and Review 8.1. Consultant will supply City with a Sample Peer Support Policy and assist City personnel with review and recommendations for creating a comprehensive Peer Support Team and CISM Policy. 8.2. City shall have their own City Attorney and/or risk manager review any recommended policy prior to implementation. City is responsible for ensuring that any proposed policy is compliant with city, state, and federal law. 9. When City requests services to be rendered onsite, City shall make suitable space available to Consultant. When suitable space is not available, City shall make other location arrangements appropriate for the services to be rendered. 10. When Consultant is unavailable or unable to render services as indicated above, Consultant shall make necessary arrangements for referral to appropriate mental health professionals for coverage and make contact information available to City personnel. 11. Consultant shall not be responsible for computer, video, audio, or other technological needs for City or City's personnel to attend training or access services. ADDITIONAL SERVICES 1. Additional Individual Crisis Stabilization and Counselling Services 1.1. The City may elect to authorize additional Individual Crisis Stabilization and Counselling Services for impacted employees (beyond the 5 session per quarter afforded under section 2) on a case-by-case basis. 2. Additional Training and Meeting Services 2.1. Consultant may provide Critical Incident Stress Management or other training services within Consultant's scope of practice for line, supervisory, and management staff as requested by City. 2.1.1. Training requests must be submitted at least 90 days in advance. 2.2. Consultant may provide or attend additional meetings or other gatherings beyond those outlined above as requested by City. COMPENSATION 1. City shall compensate Consultant a flat base fee of $50,000.00 for one year for all "Base Services" outlined under Scope of Services Sections 1 through 8, subject to the following provisions. 1.1. Services may be rendered in-person, via telephone, email, or virtual platform based on the specific circumstances, nature, and needs of the service, City, and Consultant. Response services shall be provided in-person except under extraordinary circumstances. 1.2. Regional Peer Support Continuing Education Training may be provided in person or virtually and may be rescheduled, postponed, or cancelled for extraordinary events. 1.3. When Consultant is unavailable or unable to 24/7 standby/on-call availability, Consultant shall make necessary arrangements for referral to appropriate mental health professionals for coverage and any expense incurred by Consultant in doing so shall be the sole responsibility of Consultant. 2. Individual Crisis Stabilization and Counseling Services authorized beyond the 5 sessions per quarter outlined under "Base Services" section 2 and provided in Consultant's offices shall be compensated at a rate of $200.00 per hour on an "as -utilized" basis. 3. Additional Training and Meeting Services requested by City outside those outlined in base services and provided by consultant shall be compensated at a rate of $300.00 per hour on an "as -utilized" basis. 3.1.1. Billing for Training and Meeting Services shall include course development or preparation time as required to create or adapt training or otherwise prepare for presentation to City. 3.1.2. All services rendered away from Consultant's office in Brentwood, CA are billed "portal-to-portal" and include all time spent onsite. 3.1.3. ICISF Licensed training courses are subject to the following additional approximated fees. ICISF Registration and Licensing $300 per course Materials Fees $125 per person ICISF Certificates $10 per course, per person 4. Additional Service Terms 4.1. Services rendered under this Agreement do not include expert witness fees, deposition, court fees, representation, or testimony for or during any legal or formal administrative proceeding. Fees related to any actual or proposed action in any proceeding start at $500.00 per hour and are subject to a minimum advanced deposit prior to any required appearance. 4.2. Copyright and Right of Use 4.2.1. Any and all work, artwork, copy, posters, billboards, photographs, videotapes, audiotapes, systems designs, software, reports, designs, specifications, drawings, diagrams, surveys, source codes or any original works of authorship created by Consultant or its subcontractors or subconsultants in connection with services performed under this Agreement shall be deemed the exclusive intellectual or otherwise licensed property of Consultant and Consultant shall retain all rights therein except where provided by a separate agreement. 4.3. Third Party Insurance Verification 4.3.1. In the event that City utilizes a Third -Party Insurance Verification Service or requires specialized terms in addition to the insurance industry standard terms provided for in Consultant's current insurance policies an additional fee of $3000.00 per year shall apply. 4.4. HIPAA Requirements 4.4.1. Confidentiality of Consultant's services and records are governed by State and Federal statues, court decisions, ethical standards, and generally accepted business practices for their profession. Notwithstanding any other section of this Agreement, no record or other identifying information, including but not limited to HIPAA protected information shall be released without a valid court order, written authorization from the individual(s) affected by the information release, or other legal authority compelling release of such information. Additionally, compliance with any audit or inspection requirement contained herein necessitates an investment of Consultant's time, efforts, and resources in order to maintain the required confidentially of records subject to audit or inspection and as such, shall be considered billable hours and compensated according to this Agreement. This section shall supersede all other sections and shall survive termination, cancellation, or expiration and remain in effect indefinitely. 4.5. Confidentiality of Consultant's Information 4.5.1. The terms of this Agreement are considered public information pursuant to the California Public Records Act (Government Code section 6250 et seq.). The Parties agree to exercise at least the same care, legal and professional standards, security, and confidentiality for any confidential information received from the other party as they would for their own confidential and protected information. 4.6. Billing and Invoices 4.6.1. Consultant shall endeavor to provide a monthly utilization statement to the City no later than the 10th day of each month following the month in which services are provided. The utilization will include a description of services rendered and the date on which such services were provided. In addition, the monthly statement will provide a running account of hours utilized and remaining hours on account. Due to HIPAA restrictions individual client information will at no time be included in accounting information. Utilization statements shall be combined with monthly invoices for convenience. 4.6.2. City shall ensure timely requests for and utilization of Consultant's services. All services not utilized within the one-year term of this Agreement are non- refundable and will be lost as of June 30, 2022. Failure of City to utilize Consultant's services in a timely manner shall not be cause for a refund or extension of time. 5. The term of this Agreement shall be January 1, 2022 through December 31, 2022. This Agreement shall not be extended by amendment. EL j 13PHILADELPHIA L f INSURANCE COMPANIES .\ M-ilicr 4 Ilii• I'uki" NInrine l;ruuli Certificate of Liability Insurance Date Issued: 01 /12/2022 Underwritten by: Philadelphia Indemnity Insurance Company • One Bala Plaza, Suite 100 • Bala Cynwyd, PA 19004 • NAIC #: 18058 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: Public Safety Family Counseling Group, INC. Policy Number: AR 174542 Elizabeth Dansie Policy Term: 05/12/2021 to 05/12/2022 3381 Walnut Blvd. Suite 210 Brentwood, CA 94513 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 $ 2,000,000 $ 4,000,000 Supplemental Liability $ 2,000,000 $ 4,000,000 Licensing Board Defense $ 35,000 $ 35,000 Commercial General WA WA Liability N/A WA o Fire/Water Legal Liability Business Personal Property WA WA Vicarious Sexual $ 1,000,000 $ 1,000,000 Misconduct Non -Owned Auto $ 1,000,000 $ 1,000,000 Cyber Liability (Claims Made Form) $ 25,000 $ 25,000 Retroactive Date: 05/12/2021 Comments/Special Descriptions: Certificate Holder City of San Rafael - The City, its officers, agents, employees, and volunteers Lt. Lisa Holton 1375 Fifth Avenue San Rafael, CA 94901 QX Certificate Holder has been added as an additional insured 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. Authorized Representative C. Philip Hodson PI-PHCP-05 (03/01) THIS ENDORSEMENT CHANGED THE POLICY PLEASE READ IT CAREFULLY Additional Insured Endorsement This endorsement modifies insurance provided under the following: ALLIED HEALTHCARE PROVIDERS PROFESSIONAL AND SUPPLEMENTAL LIABILITY INSURANCE POLICY In consideration of the premium paid, this policy is amended as follows: City of San Rafael - The City, its officers agents, employees, and volunteers is hereby added as an Additional Insured, solely for Damages arising out of a Professional Incident covered under this policy. The Professional Incident must arise out of services provided by the Insured, under contract with City of San Rafael - The.City, its officers a ents em io ees and volunteers. Additional Insured Name and Mailing Address: City of San Rafael - The City, its officers, agents, employees, and volunteers Lt. Lisa Holton 1375 Fifth Avenue San Rafael, CA, 94901 All other terms and conditions of this policy remain unchanged Policy #: AR 174542 Effective on or after: 01/12/2022 Issued to: Public Safety Family Counseling Group, INC. Expiration date: 05/12/2022 cm .ACORV CERTIFICATE OF LIABILITY INSURANCE 44� DATE (MM/DD/YYYY) 1 01/13/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CCNTACT NAME: X PHONE FAX C A1C No R -MAIL ADDRESS- BUSHMAN INSURANCE & FINANCIAL SERVICES, LLC INSURERS AFFORDING COVERAGE NAIC# 6041-B LONE TREE WAY INSURERA: NATIONWIDE INSURANCE COMPANY OF AMERII 25453 BRENTWOOD CA 94513-5261 INSURER B; NATIONWIDE MUTUAL INSURANCE COMPANY 23787 INSURED INSURER C : A AUTOMOBILE INSURER D: PUBLIC SAFETY FAMILY COUNSELING GROUP INC INSURER E: 3381 WALNUT BLVD STE 210 07/01/2022 COMBINEDSINGLE IMIT $ Ea accident 1,000,000 BRENTWOOD CA 94513-4488 INSURER F, COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE ADDL BR POLICY NUMBER POLICY EFF M/DD/YYYY POLICY EXP M/DDJYYYY LIMITS A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FXI OCCUR X X ACP BPOZ 3100150843 07/01/2021 07/01/2022 EACH OCCURRENCE $ 1,000,000 ED PREMISES occurren a $ 300,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PR'T LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO OWNED V SCHEDULED AUTOS ONLY /1 AUTOS HIRED NON -OWNED AUTOS ONLY A AUTOS ONLY ACP BAZ 3100150843 07/01/2021 07/01/2022 COMBINEDSINGLE IMIT $ Ea accident 1,000,000 X BODILY INJURY (Per person) $ tid BODILY INJURY (Per accident) P ) $ PROPERTY IAMAGE Per acCWenl $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N ANYPROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/M EMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A ACP WC 3100150843 07/01/2021 07/01/2022 XSTATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E_ L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) See attached Acord 101 CERTIFICATE HOLDER CANCELLATION CITY OF SAN RAFAEL 1375 FIFTH AVENUE SAN RAFAEL CA 94901 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE RANDY A ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: A`QRp� ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED BUSHMAN INSURANCE & FINANCIAL SERVICES, LLC PUBLIC SAFETY FAMILY COUNSELING GROUP INC 3381 WALNUT BLVD STE 210 POLICY NUMBER ACP 3100150843 BRENTWOOD CA 94513-4488 CARRIER NAIC CODE EFFECTIVE DATE: 07/01/2021 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate Of Liability Insurance The City, including its elected officials, officers, employees, agents, and volunteers are named as Additional Insured. (for both ongoing and completed operations) The above mentioned businessowners policy includes data compromise coverage with a response expense limit of $50,000 and defense and liability limit of $50,000. The above mentioned businessowners policy includes identity recovery coverage with a limit of $25,000. The above mentioned businessowners policy includes computer attack coverage with a limit of $50,000. Waiver of subrogation applies on above listed businessowner policy and when required by written contract on above listed business auto policy. Primary non contributory applies to above listed businessowner policy and 30 day advanced notice of cancellation is provided. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BUSINESSOWNERS PB 60 03 0411 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MUNICIPALITIES OR PUBLIC AGENCY - INSURED PROVIDING PROFESSIONAL SERVICES This endorsement modifies insurance provided under the following: PREMIER BUSINESSOWNERS LIABILITY COVERAGE FORM The following is added to Section II. WHO IS AN INSURED: The municipality and/or public agency designated in the Schedule of this endorsement is also an insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused ,in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf in connection with your operations, other than the rendering of or the failure to render professional services, advice of instruction, subject to the following additional exclusion: This insurance, including any duty we have to defend "suits", does not apply to "bodily injury", "property damage" or "personal and advertising injury" that arises out of, in whole or in part, or is a result of, in whole or in part, the active or primary negligence of the municipality and/or public agency designated in the Schedule of this endorsement, whether or not such negligence has been assumed by you in a contract or agreement. All terms and conditions of this policy apply unless modified by this endorsement. SCHEDULE Municipality and/or Public Agency: CITY OF SAN RAFAEL 1375 FIFTH AVENUE SAN RAFAEL, CA, 94901 PB 60 03 0411 Page 1 of 1 BUSINESSOWNERS PB 29 97 07 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT - ADVANCED NOTICE - CANCELLATION OR MATERIAL COVERAGE REDUCTION This endorsement modifies insurance provided under the following: PREMIER BUSINESSOWNERS COMMON POLICY CONDITIONS In the event of cancellation (other than non-payment of premium) or material change that reduces or restricts the insurance afforded by this Policy, we agree to mail prior written notice of cancellation or material change to: SCHEDULE Name and Address: CITY OF SAN RAFAEL 1375 FIFTH AVENUE SAN RAFAEL, CA, 94901 Number of Days Advance Notice: 30 All terms and conditions of this policy apply unless modified by this endorsement. Includes copyrighted material of Insurance Services Office, Inc., with its permission. © ISO Properties, Inc., 2004 PB 29 97 07 07 Page 1 of 1 BUSINESSOWNERS PB 04 97 07 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: PREMIER BUSINESSOWNERS COMMON POLICY CONDITIONS SCHEDULE Name Of Person Or Organization: CITY OF SAN RAFAEL 1375 FIFTH AVENUE SAN RAFAEL, CA, 94901 In condition K. TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US, under paragraph 2. Applicable to Businessowners Liability Coverage, the following paragraph is added: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. All terms and conditions of this policy apply unless modified by this endorsement. Includes copyrighted material of Insurance Services Office, Inc., with its permission. © ISO Properties, Inc., 2004 PB 04 97 07 07 Page 1 of 1 CONTRACT ROUTING FORM INSTRUCTIONS: Use this cover sheet to circulate all contracts for review and approval in the order shown below. TO BE COMPLETED BY INITIATING DEPARTMENT PROJECT MANAGER: Contracting Department: Police / Fire Departments Project Manager: Lisa Holton, Lieutenant Extension: 415-485-3049 Contractor Name: Psychological Services Group Contractor's Contact: Scott Dansie Contact's Email: scottdansie@pWchservicesgroup.com ❑ FPPC: Check if Contractor/Consultant must file Form 700 Step RESPONSIBLE DESCRIPTION COMPLETED REVIEWER DEPARTMENT DATE Check/Initial 1 Project Manager a. Email PINS Introductory Notice to Contractor ❑ 12/1/2021 b. Email contract (in Word) & attachments to City Atty c/o Laraine.Gittens@cityofsanrafael.org ❑ 2 City Attorney a. Review, revise, and comment on draft agreement 1/11/2022 ® LG and return to Project Manager 12/20/2021 ® LG b. Confirm insurance requirements, create Job on (N/A) PINS, send PINS insurance notice to contractor 3 Project Manager Forward two (2) originals of final agreement to 1/11/2022 contractor for their signature 4 Project Manager When necessary, * contractor -signed agreement ® N/A agendized for Council approval *PSA > $75,000; or Purchase > $75,000; or Or Public Works Contract > $175,000 Date of Council approval F PRINT CONTINUE ROUTING PROCESS WITH HARD COPY 5 Project Manager Forward signed original agreements to City Attorney with printed copy of this routing form 6 City Attorney Review and approve hard copy of signed agreement 1abi� 7 City Attorney Review and approve insurance iq PINS, and bonds (for Public Works Contracts) y )/20 2D� 8 City Manager/ Mayor Agreement executed by Council authorized official W 9 City Clerk Attest signatures, retains original agreement and forwards copies to Project Manager