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Contract 2012 2430
Contract #11 -2188 STATEWIDE HEALTH IMPROVEMENT PROGRAM SUBCONTRACT AGREEMENT between ANOKA COUNTY AND THE CITY OF COLUMBIA HEIGHTS THIS AGREEMENT is entered into between Anoka County through its Community Health & Environmental Services Department (Department), 2100 Third Avenue, Anoka, MN 55303 -5041, and the City of Columbia Heights (Columbia Heights), 590 40 Avenue NE, Columbia Heights, MN 55421. RECITALS: (1) As Grantee, Anoka County has accepted grant funds from, and entered into a Grant Agreement with, the Minnesota Department of Health based on Grantee's Work Plan. (2) Anoka County included grant activities associated with implementing policies and practices that create active communities. (3) Columbia Heights represents that it is qualified and willing to furnish these services. (4) Anoka County wishes to enter into an agreement with Columbia Heights for these services. NOW, THEREFORE, in consideration of the mutual promises and agreements contained in this agreement, Anoka County and Columbia Heights agree as follows: 1. TERM 1.1 This Agreement begins on January 1, 2012, and ends on June 30, 2013, unless earlier terminated as provided in Section 10. TERMINATION. 2. SERVICES 2.1 Columbia Heights agrees to have dedicated staff to work with the Department and provide services described in Attachment C according to the schedule set forth therein, unless otherwise modified and approved by Anoka County. 2.1.1 Activities may be guided by input from the Community Leadership Team. 2.2 Columbia Heights acknowledges that Anoka County is subject to the terms of the Minnesota Department of Health Statewide Health Improvement Program (SHIP) Grant Project Agreement (Attachment D), which terns relate to the activities that are funded by this agreement. 2.2.1 Columbia Heights agrees to assist Anoka County with any documentation and reporting necessary to comply with the terms in the SHIP Grant Project Agreement. 2.2.2 Columbia Heights agrees to comply with applicable terms in the SHIP Grant Project Agreement. 2.3 Columbia Heights agrees to grant Anoka County and the State of Minnesota the right to make, have made, reproduce, modify, distribute, perform or otherwise use the materials (as described in the SHIP Grant Project Agreement and Master Grant Contract for Community Health Boards) that are conceived or created by Columbia Heights under this Agreement. Contract #11 -2188 3. FUNDING 3.1 The maximum funding available for services provided by Columbia Heights under this Agreement is $18,000. 3.2 The cost of this Agreement is based upon a budget submitted by Columbia Heights and approved by the Department. A budget will be submitted for the 18 month period of this contract. 3.2.1 Columbia Heights agrees to request the Department's written approval for any budget change, including any change in the line item budget, submitted by Columbia Heights to the Department. 3.2.2 No more than 15% of the budget can be used for administrative costs. 3.3 Columbia Heights will submit monthly invoices to the Department based on actual expenses for services provided during that calendar month. 3.3.1 Program invoices will be submitted no later than the 30 day of the following month the services were provided. 3.3.2 Columbia Heights will use program invoices in a format approved by the Department. 3.4 Within 30 days after receiving a properly completed invoice, Anoka County will pay Columbia Heights in the manner provided by law for paying claims against Anoka County. 3.4.1 If Anoka County receives an improperly completed invoice, Anoka County will notify Columbia Heights within 5 days and Columbia Heights will submit a corrected invoice promptly. 3.5 Columbia Heights will submit the invoices to Anoka County Community Health & Environmental Services Department, 2100 Third Avenue, STE 600, Anoka, MN 55303 -5041. 3.5.1 Anoka County may withhold reimbursement until Columbia Heights submits all necessary or requested reports to Anoka County. 3.6 Anoka County may modify amounts under this agreement based upon actual expenditures and subject to the review and recommendations by the Department. 3.7 Columbia Heights will repay Anoka County for any funds not expended on permitted activities under this Agreement. 3.7.1 Columbia Heights and Anoka County will agree on repayment arrangements that are reasonable. 3.7.2 Any costs submitted in Columbia Heights's documentation that are not for permitted activities under this Agreement cannot be honored by Anoka County as an acceptable funding expenditure. 2 Contract #11-2188 4. STANDARDS AND ASSURANCES 4.1 Columbia Heights agrees to the provisions set forth in Attachment A — the Community Health Standards Assurances and Certifications. 4.1.1 References to Contractor in Attachment A and Attachment B are understood to be references to Columbia Heights. 5. AUDIT AND RECORDS RETENTION 5.1 Columbia Heights agrees that its records, documents, accounting procedures and practices, and other papers relevant to this agreement are subject to examination, duplication, transcription, and audit by Anoka County, Legislative or State Auditor under Minn. Stat. § 16B.06, subd. 4, and MHFA. 5.2 Columbia Heights agrees to maintain required records for at least 6 years after it receives final payment or this Agreement terminates, whichever is later. 6. INDEMNIFICATION 6.1 Columbia Heights agrees to hold harmless, indemnify, and defend Anoka County, its commissioners, officers, agents, and employees against any and all claims, expenses, (including attorneys fees), losses, damages, or lawsuits for damages, arising from or related to performing or failing to perform activities under this agreement, including but not limited to the negligence of Subgrantee. 6.2 Section 5. INDEMNIFICATION provisions do not independently create liability as to any third party. 6.2.1 These provisions are intended to protect Anoka County from any liability related to activities performed by Columbia Heights under this Agreement. 6.3 Nothing in this Agreement waives any limitation on liability provided by Minn. Stat. Chap. 466 or Minn. Stat. §§ 3.732 et seq. or any other applicable law. 7. INSURANCE 7.1 Columbia Heights agrees that, at all times during this Agreement in order to protect itself as well as Anoka County under Section 6. INDEMNIFICATION, it will have and keep in force the insurance, and will comply with the terms and conditions, specified in Attachment B. 7.1.1 Anoka County may withhold payment until Columbia Heights supplies the certificate(s) required in Attachment B. 7.1.2 Columbia Heights needs to provide Anoka County with renewal certificate(s) at least 30 days before coverage expires. 8. SUBCONTRACTING AND ASSIGNMENTS 8.1 Columbia Heights cannot subcontract unless Anoka County gives written approval. 8.1.1 Any subcontractor is subject to, and must meet, all agreement requirements. 8.1.2 Anoka County may give its approval subject to any conditions that it deems necessary. 3 Contract #11 -2188 8.2 Columbia Heights is responsible for all its subcontractors performance. 8.3 Columbia Heights cannot assign any interest in this agreement without Anoka County's written approval. 9. MODIFICATIONS 9.1 To alter, modify, or amend this agreement, the parties must agree in writing signed by their authorized representative(s). 9.1.1 An interpretation that is not viewed as material by the parties does not require signatures. 9.2 Anoka County contract manager must give prior written approval for any modification to this Agreement that would modify either the Work Plan or budget. 10. TERMINATION 10.1 This Agreement will terminate upon at least 30 days written notice specifying the termination date, given by either party, with or without cause. 10.2 If the Minnesota Department of Health terminates funding used for this Agreement, Anoka County may terminate this Agreement immediately upon written notice delivered to Columbia Heights. 10.3 Anoka County may terminate this Agreement immediately upon written notice delivered to Columbia Heights for a material breach. 10.3.1 A violation of any pertinent statute, ordinance, rule, or regulation by Columbia Heights constitutes a material breach. 10.3.2 Failure by Columbia Heights (including any employee or agent) to abide by any term, condition, or requirement in this Agreement constitutes a material breach if not corrected by Columbia Heights upon receiving notice of deficiency and request for compliance from Anoka County. 10.3.3 If Columbia Heights materially breaches this Agreement, Anoka County may recover from Columbia Heights any damages sustained by Anoka County that directly or consequently arise from Columbia Heights's breach. 10.4 Indemnity, Audit and other affirmative obligations, such as records retention and data practices provisions, survive this Agreement's termination. 11. NOTICE 11.1 Notice is to be given in writing, directed to Columbia Heights or to Laurel Hoff, Public Health Nursing Director, at the address stated above, and either sent by mail or delivered in person. 11.2 When notice is served by mail, it is deemed received 3 days after mailing. 4 Contract #11-2188 12. ENTIRE AGREEMENT 12.1 The parties' entire agreement is contained in this document. 12.2 This Agreement supersedes all oral agreements and negotiations by the parties relating to its subject matter. 12.3 All items referred to in this agreement are incorporated or attached and deemed to be part of the agreement. Columbia Heights having signed this agreement, and the Anoka County Board of Commissioners having approved this subcontract on December 13, 2011, and the proper County officials having signed this agreement, the parties agree to be bound by its provisions. ANOKA COUNTY City of Columbia Heights BY BY / tg Rhonda Sivarajah, Chair Anoka County Board of Commissioners Print Name: • 1' € $ Title: Art a .�� Dated: Dated: p L. Federal Tax ATTEST: Identification #: By: Jerry Soma County Administrator APPROVED AS TO FORM: Assistant Anoka County Attorney 5 Contract # 1 1 -2188 t2. •ENTIRE AGREEMENT 12.1 The parties' entire agreement is contained in this document. 12.2 This Agreement supersedes all oral agreements and negotiations by the parties relating to its subject matter. 12.3 All items referred to in this agreement are incorporated or attached and deemed to be part of the agreement. Columbia Heights having signed this agreement, and the Anoka County Board of Commissioners having approved this subcontract on December 13, 2011, and the proper County officials having signed this agreement, the parties agree to be bound by its provisions. ANOKA OUNTY A City of Columbia Heights 4 , / .4 , Rhonda Sivarajah, Chair 1 Anoka County Board of Commissioners Print Name: • 1" eGt $ Title: Dated: 2•— Federal Tax ATTf S'1 : / identification #: By: Jerry Son County Administrator • APPROVED AS TO FORM: �� •.�..r 4.. A4 4 rd. ,.L..✓ `l C -! 2- Asst. tant noka County Attorney 5 ATTACHMENT A COMMUNITY HEALTH STANDARD ASSURANCES AND CERTIFICATIONS I. NON - DISCRIMINATION A. Anoka County is an Affirmative Action /Equal Opportunity Employer. In accordance with Anoka County policies and applicable federal and state laws against discrimination, Contractor will not illegally exclude any person from full employment rights or participation in any program, service or activity or deny the benefits of, or otherwise subject any person to discrimination under, any program, service or activity. B. While performing the Contract, Contractor will not illegally discriminate against any employee or applicant for employment because of race, color, creed, religion, sex, national origin, marital status, public assistance status, disability, sexual orientation, or age. C. Contractor will comply with any applicable federal or state law regarding non - discrimination, including the following laws that may be applicable: The Equal Employment Opportunity Act of 1972, as amended, 42 U.S.C. §2000e, et seq., which prohibits discrimination in employment because of race, color, religion, sex or national origin; Executive Order 11246, as amended, which prohibits discrimination by U.S. Government contractors and subcontractors because of race, color, religion, sex or national origin, and supplemented with regulations at 41 C.F.R. pt. 60; The Rehabilitation Act of 1973, as amended 29 U.S.C. §701, et seq., and 45 C.F.R. 84.3 (J) and (K) implementing Sec. 504 of the Act, which prohibits discrimination against qualified handicapped persons in the access to or participation in federally funded services or employment; The Age Discrimination in Employment Act of 1967, as amended, and Minn. Stat. § 181.81, which generally prohibit discrimination because of age; The Equal Pay Act of 1963, as amended, 29 U.S.C. §206, which provides that an employer may not discriminate based on sex by paying employees of different sexes differently for the same work; Minn. Stat. Chap. 363, as amended, which generally prohibits discrimination because of race, color, creed, religion, national origin, sex, marital status, public assistance status, disability, sexual orientation, or age; Minn. Stat. § 181.59, which prohibits discrimination against any person by reason of race, color, or creed in any state or political subdivision contract for materials, supplies or construction; and The Americans with Disabilities Act of 1990, which generally prohibits discrimination based on disability. D. If the Contract is for more than $100,000.00 and Contractor has employed more than 40 full -time employees during the previous twelve months, Contractor certifies by signing the Contract that it has received a certificate of compliance from the Commissioner of Human Rights pursuant to Minn. Stat. § 363.073. E. No funds received under the Contract will be used to provide religious or sectarian training or services. II. DATA PRACTICES A. Data collected, created, received, maintained, disseminated, or used for any purpose while Contractor is providing services under the Contract is governed by the Minnesota Government Data Practices Act, Minn. Stat. Chap. 13, and rules adopted to implement the Act as well as other state and federal laws on data privacy. B. As to services provided pursuant to his Contract, Contractor agrees to comply with the statutes and rules, currently in effect and as amended, as if it were a governmental entity; pursuant to Minn. Stat. § 13.05, subd. 11, all remedies set forth in Minn. Stat. §13.08 may apply to Contractor. C. When required because services are being provided under a Minnesota Department of Human Services (DHS) program, the person identified in the Contract to receive notice is also designated responsible authority for data under Minn. Stat. 313.46, subd. 10(a)(4) unless someone else is expressly identified in the Contract. D. When services are funded under a DHS program, Contractor may access welfare data on individuals when necessary for program purposes to provide services under the Contract as permitted by law. E. When services are funded under a DHS program, Contractor will allow access to data to a responsible authority in the welfare system when access is necessary for administrating and managing programs as permitted by law or as authorized or required by state or federal law. F. Contractor is not required under the Contract to provide public data to the public if that same data is available from Anoka County. I11. RECORDS AUDIT /RETENTION A. Contractor agrees that its bonds, records, documents, accounting procedures and practices, and other papers relevant to the Contract are subject to examination, duplication, transcription, and audit by Anoka County, DHS (if services are funded under a DHS program), Legislative or State Auditor pursuant to Minn. Stat. § 16C.05, subd. 5, and U.S. Department of Health and Human Services; these documents are subject to review by the U.S. Comptroller General, or a duly authorized representative, if federal funds are used for work under the Contract. B. Contractor agrees to maintain these documents for 6 years from the last date services were provided or payment made, or longer if an audit in progress requires a longer retention period. C. If services are funded under a DHS program, Contractor agrees to comply with applicable DHS policies regarding social services recording and monitoring procedures as defined and described in the DHS rules and manuals. IV. WORKER HEALTH, SAFETY, AND TRAINING Contractor is solely responsible for the health and safety of its employees and agents while they are performing work under the Contract and will ensure that personnel are properly trained and supervised and, when applicable, licensed or certified appropriate to the tasks engaged in under the Contract; Contractor will comply with the "Occupational Safety and Health Act" and the "Employee Right to Know Act," Minn. Stat. §§ 182.65 et seq., where applicable. V. FAIR HEARING / GRIEVANCE PROCEDURE A. If services are funded under a DHS program, Contractor will assist the County in complying with Minn. Stat. § 256.045, Administrative and Judicial Review of Human Services Matters. B. Contractor agrees to have a grievance procedure for individuals receiving services under the Contract. VI. MANDATORY REPORTING Contractor will comply with Minn. Stat. § 626.556, Reporting of Maltreatment of Minors, and Minn. Stat. §§ 626.557 et seq., Reporting of Maltreatment of Vulnerable Adults, and any rules promulgated to implement the statutes. VII. BACKGROUND CHECKS A. Contractor will comply with requirements in Minn. Stat. § 144A.46 and Minn. Stat. § 144.057 related to background studies for employees, contractors, and volunteers. B. Contractor agrees that a person employed by Contractor who is disqualified under Minn. Stat. § 144.057 and not considered granted reconsideration of the disqualification by the Commissioner of Health will not be allowed to work in a position that requires direct contact with, or access to, Eligible Recipients. VIII. MEDICAL ASSISTANCE SERVICE PROVIDER If applicable, Contractor will enroll as a Medical Assistance service provider and obtain any needed physician's recommendation for treatment for all Medical Assistance eligible recipients. IX. SERVICE PERFORMANCE A. When services are funded under a DHS program, Contractor will provide Purchased Services in the amount, frequency, and duration specified in an Eligible Recipient's individual service plan [ISP], and will direct services toward achieving the goals and objectives specified in the ISP. B. Contractor must give the Eligible Recipient and county agency written notice before terminating Purchased Services to an Eligible Recipient. C. Contractor agrees to comply with applicable federal and state laws, rules and regulations, as well as local ordinances that are in effect while providing Purchased Services. -2- D. Except as otherwise specified in the Contract, Contractor will maintain control with respect to the methods, times, means and personnel used in providing Purchased Services. E. Contractor certifies that: services to be provided under this Contract are not otherwise available without cost to Eligible Recipients; payment claims for Purchased Services will be in accordance with rates of payment that do not exceed amounts reasonable and necessary to assure quality of service; rates of payment do not reflect any administrative or program costs assignable to private pay or third -party pay service recipients. X. FINAL PAYMENT A. Under Minn. Stat. § 270C.66, final payment may be withheld until Contractor furnishes Anoka County with proof that all outstanding withholding taxes, penalties and interest are paid. B. Anoka County may require proof in the form of a certificate issued by the Commissioner of Revenue. XI. INDEPENDENT CONTRACTOR A. Contractor is, and will remain, an independent contractor with respect to all services performed under the Contract. B. Nothing in the Contract creates or establishes a co- partner relationship between Anoka County and Contractor or makes Contractor an agent, representative, or employee of Anoka County for any purpose. C. No benefits available to Anoka County employees will accrue to Contractor or Contractor's employees or agents performing services under the Contract. XI1. MINNESOTA LAW A. Minnesota laws govern all questions related to the Contract. 13. The parties will venue any proceedings related to the Contract in the Anoka County District Court, State of Minnesota. XIII. SUBCONTRACTORS Under Minn. Stat. § 471.425, Contractor must pay any subcontractor for undisputed services provided by the subcontractor within 10 days after Contractor receives payment for services; Contractor agrees to pay interest as provided in Minn. Stat. § 471.425 on any undisputed amount not paid on time. XIV. EXCLUDED MEDICAL ASSISTANCE PROVIDERS By signing the Contract, Contractor certifies that it is not an excluded vendor under § 2005(b)(9) of Title XX of the Social Security Act. XV. DHS THIRD -PARTY BENEFICIARY A. When relevant, Contractor understands and agrees that DHS is a third -party beneficiary and an affected party under the Contract pursuant to Minn. Stat. § 245.466, Minn. R. pt. 9525.1870, or a similar legal requirement. B. Contractor agrees that DHS, as well as Anoka County, has standing to and may take any appropriate administrative action or sue Contractor for any appropriate relief in law or equity, including, but not limited to, rescission, damages or specific performance of all or any part of the Contract between Anoka County and Contractor. C. Contractor specifically acknowledges that Anoka County and DHS are entitled to, and may recover from Contractor, reasonable attorneys' fees and costs and disbursements associated with an action taken under this provision that is successfully maintained. D. This provision will not be construed to limit the rights of any party to the Contract or any other third -party beneficiary, nor will it be construed as a waiver of immunity under the Eleventh Amendment to the United States Constitution or any other waiver of immunity. -3- E. Subcontracts will have the same or similar language acknowledging that DHS is a third party beneficiary. XVI. PREVAILING WAGE Contractor will assure that any worker hired to provide services funded under the Contract who falls within any job classification established and published by the Minnesota Department of Labor & Industry will be paid, at a minimum, the prevailing wage rate as certified by that Department. XVII. SINGLE AUDIT ACT I f applicable, CONTRACTOR will comply with the Single Audit Act of 1984 (Public Law 98 -502) as amended (31 U.S.C. chap 75) and OMB Circular A -128 (or A -133 or A -110 as applicable). XVIII. HIPAA COMPLIANCE CONTRACTOR agrees to comply with all applicable requirements in the regulations adopted under the Health Insurance Portability and Accountability Act (HIPAA), including specifically the privacy regulations in 45 C.F.R. Parts 160 and 164. XIX. CONTRACTOR DEBARMENT, SUSPENSION, AND RESPONSIBILITY Federal regulation (45 C.F.R. § 92.35) prohibits Anoka County from purchasing goods or services with federal money from vendors who have been suspended or debarred by the federal government. Also Minn. Stat. § 16C.03 provides the Minnesota Commissioner of Administration with the authority to debar and suspend vendors. Vendors may be suspended or debarred when it is determined, through a duly authorized hearing process that they have abused the public trust in a serious manner. By signing this Contract, Contractor certifies that it and its principals* and employees: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from transacting business by or with the federal, state or local governmental department or agency; and b. Have not within a 3 year period preceding this contract: 1. been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain or performing a public (federal, state or local) transaction or contract; 2. violated any federal or state antitrust statutes; or 3. committed embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements or receiving stolen property; and c. Are not presently indicted or otherwise criminally or civilly charged by a governmental entity for: 1. commission of fraud or a criminal offense in connection with obtaining, attempting to obtain or performing a public (federal, state or local) transaction or contract; 2. violating any federal or state antitrust statutes; or 3. committing embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements or receiving stolen property; and d. Are not aware of any information and possess no knowledge that any subcontractor(s) that will perform work pursuant to this Contract are in violation of any of the certifications set forth above. By signing this Contract, Contractor certifies that it and its principals* and employees shall immediately give written notice to Anoka County should Contractor come under investigation for allegations of fraud or a criminal offense in connection with obtaining, or performing: a public (federal, state or local) transaction or contract; violating any federal or state antitrust statutes; or committing embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements or receiving stolen property. *APrincipals for purposes of the certifications means: officers; directors; owners; partners; and persons having primary management or supervisory responsibilities within a business entity (e.g. general manager; plant manager; head of a subsidiary, division, or business segment and similar positions. Rev. 3/1 3/ 07 -4- • ATTACHMENT B HS Form A ANOKA COUNTY HUMAN SERVICES INSURANCE REQUIREMENTS Anoka County does not represent that required coverage and limits will necessarily be adequate to protect Contractor, and such coverage and limits will not be deemed as a limitation on Contractor's liability to Anoka County in this contract. 1. Minimum Scope of Insurance: Coverage shall be at least as broad as follows: 1.1 General Liability Insurance - CGL coverage will be written on ISO occurrence form CG 00 01 98 (or substitute form providing equivalent coverage). Anoka County will accept claims made form (CG 00 02, or substitute form providing equivalent coverage), if the retroactive date is prior to the start of the contract date and the contractor agrees to maintain coverage or purchase an extended reporting period for at least two years following the completion of work. The Contractor shall include all subcontractors as insured under its policies or furnish separate certificates for each subcontractor where applicable. Subcontractors shall be subject to the same insurance requirements as stated herein for the Contractor. If Contractor's liability policies do not contain the standard ISO separation of insured provision, or a substantially similar clause, they shall be endorsed to provide -cross liability coverage. Unless the Department agrees in writing to waive the additional insured requirement, Anoka County will be included as additional insured under CGL, using ISO additional insured endorsement CG 20 26 or substitute providing equivalent coverage, and under the commercial umbrella, if any. This insurance will apply as primary insurance with respects to any other insurance or self - insurance program afforded to Anoka County. There will be no endorsement or modification of CGL to make it excess over other available insurance; alternatively, if the CGL states that it is excess or pro -rata, the policy will be endorsed to be primary with respect to the additional insured. Anoka County must be identified as the Certificate Holder on the certificate of insurance. 1.2 Business Automobile Liability - coverage will cover liability arising out of any auto (including owned, hired, and non - owned autos). 1.3 Workers' Compensation — Workers' Compensation and Employers Liability as required by the State of Minnesota. I.4 Professional Liability or Errors and Omissions Insurance - appropriate for the profession. 2. Minimum Limits of Insurance: Limits will be NO LESS THAN: 2.1 Commercial General Liability (CGL) and, if necessary, combined with Commercial Umbrella Liability: $1,500,000 each occurrence. If CGL insurance contains a general aggregate limit, it shall apply separately to this project. 2.2 Business Automobile Liability and, if necessary, combined with Commercial Umbrella Liability: $1,500,000 each accident for bodily injury and property damage. 2.3 Employers Liability: As required by the State of Minnesota 2.4 Professional Liability or Errors and Omissions: $1,500,000 per occurrence. 3. Other Insurance Provisions 3.1 All certificates of insurance will provide for 30 days' written notice to Anoka County prior to cancellation of any insurance. 3.2 Failure of Anoka County to demand such certificate or other evidence of full compliance with these insurance requirements or failure of Anoka County to identify deficiency from evidence that is provided shall not be construed as a waiver of Contractor's obligation to maintain such insurance. 3.3 In the event of dispute or claim, Contractor will provide certified copies of all insurance policies required above within 10 days of Anoka County's written request for said copies. If Contractor fails to maintain required insurance as set forth above, Anoka County will have right, but not the obligation, to purchase said insurance at contractor's expense or terminate this contract. -5- 'ht cc" o < d d -.t Cr V) P co ch r R. 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Cr - VQ cp t'' p O O 0.. co n p O -, .-- p h —.' u N -t v p Q. p 0 o cD o' ° `c o ' c �: s✓ o 6 CR; o ° �' to o co p � ` bq p ' Z CL P 0 CM CD N N C '•'O ').:1• Cw P ,-- S N CM O ..r - N 4 O N N N N `-a • CD z® N 0 6Q N J O Z O O N ® d CD O N d4 N aQ N 6Q N co O n W N CD EI CD u , P W iw . . - ,;;..• ,:e . .. Attachment D O.11.1{07A • , . • MDH • . Encumbrance Worksheet . .. • (Attach to all contracts,,grants, and amendments) ri-l&FS . .. . . Vendor Name: Vendor Number: Anoka County Community Health & Environmental Services D0001q31.i. . Address: Federal Employer 1.0. or Social Security #: 2100 3rd Ave. — Suite 600 41-6005752 ' . City, State, Zip: Minnesota Tax I.D. No. (if applicable): Anoka, MN 55303 . Starting Fiscal Year: 2012 Total Amount of Agreement: • $ 800,034 Start Date: January 1, 2012 End Date: June 30, 2013 • Accounting Information • . . Fiscal Year 1 2012-2013 • • Fund Dept ID Appr ID Project ID Activity ID Amount 2360 H123 7000 1-1121910 $ 800,034 H123 $ . H123 $ CFDA # (if Federal $) . . Fiscal Year 2 Fund Dept ID - Appr ID . Project ID Activity ID Amount - H123 $ . H123 • $ H123 $ CFDA # (if Federal $) ., Fiscal Year 3 • , Fund • Dept ID Appr ID Project ID Activity ID Amount H123 $ H123 $ H123 $ CFDA # (if Federal $) • • Financial Management Only , • i • ':'3'.2 :j:bireti I trg.Tirki:Hr - 4 .7 ,... , 44 A zt , . , 1,1k- 4 430; ,- .,., qAuthori .41,, th. .,,, ii , 1 4,4„,,: '1 414- ','- ,-ro '41 ,..MjaDate? 4: 1:;.EiiCti g O ;-.. ''..;1, ' 2. ..14'.4 l'fl' . A,VA7-0.1g taik °Tatizgaiidgleitt AiliMivgg:a.Fthliit 1 r 4 .1nriltiZ 9 IV i tigratgrireagga PERfiSrAraitSr r.Nal 0 4 X5+04tgA' 4 It. t Al I t It' - 3v , All,. ''`Ikigittlratitralnirtit4rig .. L> ' 4 5 0 1 0101i ql 0/1 rte PI ' 1:11 " ' l''`IiiMi:NitZlfL,,M444•01MQ4felfKrlitflir.diiftlilitZ4L,1!..' .wr, ' ''... 41 : ' 1 . '."' .i'ifi ' ii" O*414;,f;41M 4141 : Az. • ihtili ,■Lig A •',: :7 . i :1-'-...9,Z!ii-‘ iv. wveab . ..... . , . .. ... • • ....„ 1: F elif ti.sup:?- ; ,,-„I tmariaim 4-zwiliisilz., . c +1 untlDau.4. :, , ,,, L yelgo 3...v -4 NOTE: This page of the Agreement Contract contains confidential information and should not be reproduced or distributed externally without written permission from the Vendor Internal circulation of this page should only be to individuals/offices signing this Agreement Contract and those that require access to the tax identification number. . . Financial Management (651) 201-4622 . - 7/26/11 I . . ' • . ! • . 1 - - 1 J C Grant Project Agreement Number 3000004256 DEC Between the Minnesota Department of Health and Anoka County CHB 20 t011 1 Minnesota Department of Health Grant Project Agreement for Community Health Boards • THIS GRANT PROJECT AGREEMENT, and amendments and supplements thereto, is between the State of Minnesota, acting through its Commissioner of Minnesota Department of Health (hereinafter "STATE ") and Anoka County CHB, an independent organization, not an employee of the State of Minnesota, 2100 3rd Ave. — Suite 600, Anoka, MN 55303 (hereinafter "GRANTEE "), witnesseth that: WHEREAS, the STATE, pursuant to Minnesota Statute 144.0742 is empowered to enter into a contractual agreement for the provision of statutorily prescribed public health services; WHEREAS, the STATE and the GRANTEE have entered into master grant contract number 12- 700 -00054 (hereinafter "MASTER GRANT CONTRACT ") effective January' 1, 2009; . WHEREAS, the STATE, pursuant to Minn. Stat. §145.986 is empowered to award Statewide Health Improvement Program (hereinafter "SHIP ") grants to convene, coordinate, and implement evidence -based strategies targeted at reducing the percentage of Minnesota_ns who are obese or overweight and at reducing the use of tobacco; and WHEREAS, the GRANTEE in partnership with is the designated Lead Agency with authority to execute the project administration, management, implementation and reporting responsibilities for the SHIP grant; and WHEREAS, GRANTEE represents that it is duly qualified and willing to perform the services set forth herein. NOW, THEREFORE, it is agreed: 1. INCORPORATION OF MASTER GRANT CONTRACT. Clauses 1I and IV through XV of the MASTER GRANT CONTRACT are hereby incorporated by reference into this project agreement. Whenever the phrase "this grant contract" is incorporated by reference, it shall be interpreted to mean "this project agreement." • II. GRANTEE'S DUTIES. GRANTEE shall: A. Comply with the following grant administration requirements: General I . Work with STATE staff to finalize GRANTEE's work plans and budgets. The revised budget and work plan must be approved by STATE by January 20, 2012 and are incorporated into this GRANT PROJECT AGREEMENT by reference. 2. Perform the activities approved in the work plan. GRANTEE is expected to contact the STATE if the GRANTEE encounters difficulties. If grant deliverables are not completed satisfactorily, the STATE has the authority to withhold and /or recover SHIP funds. 3. Designate or hire a full -time SHIP coordinator or equivalent. HE- 01598 -08 (07/09) • 4 Grant Project Agreement Number 3000004256 F� Between the Minnesota Department of Health and Anoka County CHB E 2 ty i ` 4. Designate, hire, or contract project, fiscal, and administrative staff with the appropriate training and experience to implement all SHIP activities and to fulfill payroll, accounting, and administrative functions. 5. Participate in site visits from the STATE and all STATE - sponsored conference calls. 6. Participate in STATE - sponsored technical assistance calls, webinars and trainings. 7. Attend STATE - sponsored conferences, meetings and in- person trainings. 8. Participate with the STATE on evaluation, communications, hospital/community benefit work, health plan collaboration, and other collaborations to move the work of SHIP forward, as requested. Financial 9. Adhere to the request and approval process set forth by the STA'U in the Grantee Financial Reference Guide to be released by January 1, 2012. 10. Obtain prior approval from MDH for all subcontracts or mini- grants over $5,000, significant changes in grant activities, changes of more than 25 percent to any budget line item, surveys and out -of -state travel. 11. Act in a fiscally - responsible manner, including following standard accounting procedures, charging the SHIP grant only for the activities stated in the grant agreement, spending grant funds responsibly, properly accounting for how grant funds are spent, maintaining financial records to support expenditures billed to the grant, and meeting audit requirements. 12. Ensure that a local match equaling at least ten percent of the total funding award is provided and documented. 13. Ensure that administrative costs are explained and justifiable. 14. Allocate 5 -10% of overall funds for evaluation and designate a person to facilitate evaluation tasks. Evaluation funds may be used for staff time or in the form of an outside evaluation contractor. 15. Report to the STATE other funding sources, including grants from other sources, that are directed toward tobacco and obesity, and have accounting systems in place to track SHLP- funded activities separately from activities funded through other sources. 16. Use SHIP funds to develop new activities, expand or modify current activities that work to reduce tobacco use and exposure and prevent obesity, and/or replace discontinued funds from the STATE, the federal government, or another third party previously used to reduce tobacco use and exposure and prevent obesity. GRANTEE may not use SHIP funds to replace federal, state, local, or tribal funding GRANTEE currently uses to reduce tobacco use and exposure or prevent obesity (supplantation of funds). Reporting 17. Submit completed progress and evaluation reports according to the schedule below. The STATE will provide guidance regarding the required content of the reports. a. Interim report is due November 1, 2012 (for reporting period of January 1, 2012 — September 30, 2012) • b. Final report is due August 1, 2013 (for reporting period of October 1, 2012 — June 30, 2013) 18. Annually complete the Policy /System/Environmental Change section of the Planning and Performance Measurement Reporting System (PPMRS). 19. Provide grant - related information to the STA'1E upon request. • • Grant Project Agreement Page 2 HE- 01598 -08 (07/09) • Grant Project Agreement Number 3000004256 Between the Minnesota Department of Health and Anoka County CHB Lobbying 20. Use no more than $10,000 or five percent (whichever is less) of SHIP grant funds, including SHIP- funded staff time, in any grant year to influence the official action of a local governmental unit or tribal government regarding tobacco and obesity, either directly through communicating with elected officials or indirectly through urging the electorate or general public to communicate with elected officials. a. Grantees may use other funding sources to influence an official action of a local governmental unit or tribal government regarding tobacco and obesity, in accordance with federal and state law, grantee policy, and funding restrictions, but must clearly document which activities are covered by which funding source. b. Volunteers to the grantee who spend more than $250 of their own funds in any year to influence an official action of a local governmental unit may need to register as a lobbyist under M.S. 10A.01, Subd. 21. Information about registration is available from the State Campaign Finance and Public Disclosure Board (651/296 -5148 or 800/657- 3889). 21. Grantees may not use any SHIP grant funds to influence state legislation or administrative rules. a. Grantees may use other funding sources to influence state legislation or administrative rules regarding tobacco and obesity, in accordance with federal and state law, grantee policy, and funding restrictions, but must clearly document the alternate funding source that covers the activity. b. Volunteers to the grantee who spend more than $250 of their own funds in any year to influence state legislation or administrative rules may need to register as a lobbyist under M.S. 10A.01, Subd. 21. Information about registration is available from the State Campaign Finance and Public Disclosure Board (651/296 -5148 or 800/657- 3889). 22. Grantees may not use SHIP grant funds to participate or intervene in any political campaign on behalf of, or in opposition to, any candidate for public office. B. Beginning on January 1, 2012, comply with the following SHIP implementation requirements: 1. Convene and sustain a diverse and representative Community Leadership Team. 2. Convene Local Partnership groups as appropriate. 3. Implement activities according to approved work plans and budgets. 4. Conduct evaluation- related activities which are expected to include but not be limited to collecting evaluation data on strategies using standardized evaluation tools provided by the STATE, attending in -state evaluation trainings and technical assistance events, and writing and submitting reports required by the STATE. 5. Implement evaluation - related activities for each strategy using standardized tools provided by the STA I "E.. 6. Ensure that communication pieces funded by SHIP, such as advertisements, signage, printed materials, and web sites, conform to the uniform communication standards provided by the STATE. These standards include visual cues, such as logos, graphics, colors, and fonts, as well as • standardized terminology and key messages, to create a consistent look and message, and a SHIP "brand" across the state. • Grant Project Agreement Page 3 HE- 01598 -08 (07/09) Grant Project Agreement Number 3000004256 Between the Minnesota Department of Health and Anoka County CHB t 8 zoo# M III. CONSIDERATION AND TERMS OF PAYMENT. DEC !� t, LU t! A. Consideration for all services performed by GRANTEE pursuant to this project agreement shall be paid by the STATE as follows: 1. Compensation. The total obligation of the STATE for all compensation and reimbursement to GRANTEE shall not exceed Eight hundred thousand thirty four dollars ($800,034). 2. Matching Requirements. GRANTEE certifies that the following matching requirement, for the grant, will be met by GRANTEE: A local match of ten percent of the total funding allocation will be provided and documented. B. Terms of Payment The STATE shall make payment as follows: 1. All financial transactions will be on a reimbursement basis only. 2. Payments shall be made by the STATE promptly after GRANTEE'S presentation of invoices for services performed and acceptance of such services by the STA L E'S Authorized Representative pursuant to Clause V, except that the STATE reserves the right not to honor invoices that are submitted more than 30 days after the submission date specified below. 3. Invoices shall be completed on a form prescribed by the STATE for each month and submitted within 45 days after the end of the month according to the following schedule: Month Invoice Submission Date January 1, 2012 - January 31, 2012 March 15, 2012 February 1, 2012 - February 29, 2012 April 13, 2012 March 1, 2012 -March 31, 2012 May 15, 2012 April 1, 2012 - April 30, 2012 June 15, 2012 May 1, 2012 - May 31, 2012 July 13, 2012 June 1, 2012 - June 30, 2012 August 15, 2012 July 1, 2012 -July 31, 2012 September 15, 2012 August 1, 2012 - August 30, 2012 October 15, 2012 September 1, 2012- September 30, 2012 November 15, 2012 October 1, 2012 - October 31, 2011 December 15, 2012 November 1, 2012 - November 30, 2012 January 15, 2013 December 1, 2012- December 31, 2012 February 15, 2013 January 1, 2013 - January 31, 2013 March 15, 2013 February 1, 2013 - February 28, 2013 April 15, 2013 March 1, 2013 -March 31, 2013 May 15, 2013 April 1, 2013 -April 30, 2013 June 15, 2013 May 1, 2013 -May 31, 2013 July 15,2013 June 1, 2013 -June 30, 2013 August 15, 2013 Grant Project Agreement Page 4 HE-01598-08 (07/09) N J hag g air Grant Project Agreement Number 3000004256 Between the Minnesota Department of Health and Anoka County CHB IV- TERM OF AGREEMENT. This project agreement shall be effective on January 1, 2012, or upon the date that the final required signature is obtained by the STATE, pursuant to Minnesota Statutes, Section 16C.05, Subd. 2, whichever occurs later, and shall remain in effect until June 30, 2013, except for the • requirements specified in this project agreement with completion dates which extend beyond the termination date specified in this sentence. GRANTEE understands that NO work should begin under this project agreement until ALL required signatures have been obtained, and GRANTEE is notified to begin work by the STATE. V. STATE'S AUTHORIZED REPRESENTATIVE. The STATE'S Authorized Representative for the purposes • of administration of this project agreement is Rachel Cohen, Supervisor of Statewide Health Improvement Program, or his/her successor. Such representative shall have•final authority for acceptance of GRANTEE'S services and if such services are accepted as satisfactory, shall so certify continuing payment as outlined in Clause III, B. GRANTEE'S Authorized Representative for purposes of administration of this project agreement is Laurel Hoff or his/her successor. The GRANTEE'S Authorized Representative shall have full authority to represent GRANTEE in its fulfillment of the terms, conditions, and requirements of this project agreement. • VI. CANCELLATION. A. If the GRANTEE fails to comply with the provisions of this project agreement, the STATE may terminate this project agreement without prejudice to the right of the STATE to recover any money previously paid. The termination shall be effective five business days after the STATE mails, by certified mail, return receipt requested, written notice ofteiuiination to the GRANTEE at its last known address. - B. The STATE or GRANTEE may cancel this project agreement at any time, with or without cause, upon • thirty (30) days' written notice to the other party. C. Should this project agreement be terminated or canceled effective before June 30, 2013, the GRANTEE shall, within forty-five (45) days of the date of effective termination or cancellation, refund to the STATE all remaining unexpended monies received from the STATE under this project agreement. D. The STATE shall pay the GRANTEE for services satisfactorily performed pursuant to this project agreement before the effective date of termination or cancellation. VII. AMENDED STATUTES, REGULATIONS AND RULES. As used in this project agreement, the term "Modified Law" means laws that become effective while this project agreement is in effect, including Minnesota and United States statutory amendments and new statutes, rule amendments and new rules in • Minnesota Rules, and federal regulatory amendments and new federal regulations. Notwithstanding anything in clauses I through VI and VIII of this project agreement that conflicts with any Modified Law, GRANTEE agrees to comply with all Modified Law and GRANTEE understands and agrees that the STATE will comply with all Modified Law. The STATE will mail or deliver to GRANTEE a copy of all Modified Law affecting this project agreement. The STA FE will make all reasonable efforts to mail or deliver to GRANTEE a copy of any Modified Law at least fifteen (15) days before it becomes effective. • HE- 01598 -08 (07/09) Grant Project Ageement Page 5 • { ' I Grant Project Agreement Number Between the Minnesota Department of Health and Anoka County CHB 2 8 . 2011 V111. OTHER PROVISIONS: DEC U V Ul • A. Notwithstanding anything in clause I of this project agreement, clauses XV(B) through XV(I) of the MASTER GRANT CONTRACT shall not apply to this project agreement and shall not be incorporated by reference into this project agreement. • IN WITNESS WHEREOF, the parties have caused this project agreement to be duly executed intending to be bound thereby. APPROVED: 1. GRANTEE 2. STATE AGENCY • The Grantee certifier that the apprupriute persons(s) have executed the Project Agreement approval and certifcalion that STATE Ands have been project agreement on behalf of the Grantee as required by applicable encumbered as required by Minn. Slat. ,§§ 16A.15 and 16C.05. articles. bylaws. resolutions, or ordinances. ' By: JJ r-� (s3ith dele = ted authority) Rhonda Sivarajah, Chair t �} Title: Board of Commissioners Title: r Edwards, Acct Sup., r t � " Date: Date: Fin 1 j 1 Attest: By: erry So " a Title: County Ad) inistrator • Date: r - ( I -/( Distribution: Agency— Original (fully executed) Project Agreement Grauer ,! Stale Awl:ari_ed Representative • 11E-01598-08 (07/09) I I Grant Project Agreement Page 6 { AC CERTIFICATE OF LIABILITY INSURANCE DATE(MM / DD/YYYY) 1/16/2012 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 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 CONT Loretta Pelach first national insurance PHONE (651) 460 -6014 FAX (A/C. No. Ext): N (651) 460 -6625 Ross Nesbit Agencies, Inc. aoaRess : loretta @nesbitagencies.com 324 Oak St, PO Box 130 PRODUCER 00047674 CUSTOMER ID #: Farmington MN 55024 -0130 INSURER(S) AFFORDING COVERAGE NAIC # INSURED INsURERA:League Of Mn Cities Trust INSURER B : City of Columbia Heights INSURER C: 590 40th Avenue NE INSURER D : INSURER E : Columbia Heights MN 55421 INSURER F: COVERAGES CERTIFICATE NUMBER:CL116721919 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. NSR ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM /DDNYYY) (MM /DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,500,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) $ 500, 000 A X CLAIMS -MADE OCCUR X CMC33216 6/1/2011 6/1/2012 MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ Included X Errors & Omissions GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 1,500,000 POLICY IPRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1,500,000 BODILY INJURY (Per person) $ A ALL OWNED AUTOS X 0MC33216 6/1/2011 6/1/2012 BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON -OWNED AUTOS $ $ UMBRELLA LIAB — OCCUR EACH OCCURRENCE $ 1.000.000 EXCESS LIAB X CLAIMS -MADE AGGREGATE $ 1.000. 000 DEDUCTIBLE RETENTION $ MEL680 6/1/2011 6/1/2012 $ % WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N TORY LIMITS , ER ANY PROPRIETOR/PARTNER/EX ECUTIVE N / A E.L. EACH ACCIDENT $ 1,500,000 (Mandatory In NH) 00200103710 1/1/2012 1/1/2013 E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,500,000 ESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, tf more space Is required) ITH RESPECT To:AGREMENT ENTERED INTO BETWEEN ANOKA COUNTY THROUGH ITS COMMUNITY HEALTH & ENVIRONMENTAL SERVICES EPARTMENT (DEPARTMENT) AND THE CITY OF COLUMBIA HEIGHTS (COLUMBIA HEIGHT) It is understood and agreed the certificate older is named as additional insured. ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN COUNTY OF ANOKA ACCORDANCE WITH THE POLICY PROVISIONS. ATTN: HUMAN SERIVES DIVISION 2100 3RD AVENUE 5TH FLOOR AUTHORIZED REPRESENTATIVE ANOKA, MN 55303 F National Ins. /LP i :ORD 25 (2009/09) 01988-2009 ACORD CORPORATION. All rights reserved. S025 (200909) The ACORD name and logo are registered marks of ACORD JAN 1:82012 A , II T LIABILITY INSURANCE . _ , DA7E(MM /DD/YYYY) 1/16/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY, OR `NEGATIVELY AMEND,. EXTEND OR. ALTER THE COVERAGE AFFORDED BY THE 'POLICIES' BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. . IMPORTANT: If the certificate: holder is an ADDITIONAL INSURED, the policy(ies) must.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 .... - ..,N O I N E ACT ' Loretta Pelach '.. first national insurance (A/cC,No.Ext1: (651) 460 -6014 FAX No }: {651}460 -6625 Ross Nesbit Agencies, Inc. E-MAIL ADDRESS: lore tta@nesbitagencies.com 324 Oak St r PO Box 130 PRODUCER CUSTOMER m #: 00047674 Farmington MN 55024 -0130 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A :League Of Mn Cities Trust INSURER Et: ... .. City of. Columbia:Heights INS C 590 40th Avenue NE INSURER D: INSURER E : Columbia Heights MN 55421 - -- - INSURER F COVERAGES CERTIFICATE NUMBER :CL116721919 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW. HAVE BEEN ISSUED TO THE INSURED: NAMED ABOVE FOR THE POLICY PERIOD ' INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM`OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT. TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED: HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH. POLICIES: LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID' CLAIMS. INSR AODL SUER - - POLICY EFF •POLICY -EXP - .. LTR TYPE OF INSURANCE INSR WVD . POLICY NUMBER (MMJDDNYYYI, IMM /DOIYYYY) • 'LIMITS GENERAL LIABILITY : EACH OCCURRENCE $ 1,500,000 DAMAGE X COMMERCIAL GENERAL LIABILITY - PREMISES O (Ea occurrence) . $ 500 , 000 A X CLAIMS -MADE • OCCUR !,X CMC33216 6/1/2011 6/1/2012 MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY - $ Included X Errors & Omissions' GENERAL AGGREGATE: $ GE 'L. AGGREGATE LIMIT APPLIES. PER: PRODUCTS • COMP /OP AGG $ 1,500,000 POLICY' PRO- LOC $ JFCT AUTOMOBILE LIABILITY ' ' COMBINED SINGLE LIMIT $ 1,500,000 is (Ea accident) X ANY AUTO CMC33216' 6/1/2011 6/1/2012 BODILY ,INJURY (Per .person) $ A ALL OWNED :AUTOS X BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS ( Per. accident)' i . NON -OWNED AUTOS $ $ UMBRELLA LAB OCCUR EACH OCCURRENCE S 1.000.000 EXCESS LIAB X CLAIMS -MADE AGGREGATE $ 1.000.000 DEDUCTIBLE $ A RETENTION $ HELM) 6/1/2011 6/1/2012 $ WORKERS COMPENSATION WC STATU- OTH - A TORY LIMITS FR AND EMPLOYERS' UABILITY - � ANY PROPRIETOR /PARTNER/EXECUTIVE Yf N H / EL EACH ACCIDENT $ 1,500,000 OFFICER/MEMBER EXCLUDED? 00200103710 1/1/2 1/1/2013 E L DISEASE • EA EMPLOYE (Mandatory In NH} H) EMPLOYEE, $ If yes, descnbe under DESCRIPTION OF OPERATIONS below EL. DISEASE - POLICY LIMIT $ l , 500 , 000 DESCRIPTION OF OPERATIONS / LOCATIONS? VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space Is required)' WITH RESPECT TO:AGREMENT.ENTERED INTO BETWEEN :ANOKA COUNTY THROUGH ITS COMMUNITY HEALTH& ENVIRONMENTAL SERVICES DEPARTMENT (DEPARTMENT) AND THE CITY OF COLUMBIA HEIGHTS (COLUMBIA HEIGHT) It is understood and agreed the certificate holder is named as additional insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, 'NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. COUNTY OF ANOKA ATTN: HUMAN SERIVES DIVISION 2100 3RD AVENUE 5TH FLOOR AUTHORIZED REPRESENTATIVE ANOKA, MN 55303 __ + — 1 F National Ins. /LP "` i ACORD 25 (2009/09) © 1988 -2009 ACORD CORPORATION. All rights reserved. 1NS025 (200909) The ACORD name and logo are registered marks of ACORD I I COVENANT NUMBER: CIVIC 33216 ADDITIONAL COVERED PARTY -- MUNICIPAL, LIAI311.1'IN It is agreed that with respect to coverage afforded only for bodily injury, property- dntnuge and personal inj1Iry under Coverage A Municipal Liability Coverage, the Coverod Party provision is amended to include the person or organization named below, but only +with respect to, and to the extent o(' claims made upon the additional covered party by reason of the ae.ts or omissions of the City or its mlents or employees and not by reason of any act or omission of the additional coverer:! party or its agents or employees. NAMF. OF PI.RSQN OR O_Rc; IZATI(1i�1 LOCATION O }. lT MIST S <)1t C'(7NTRAC:T (R 0 ?ERATIO. • ANOKA COUNTY ANOKA COUNTY I-1RA RE ANOKA COUNTY CDBG PRO(: ;RAM A'TTN: KATE THUNSTUM, CD13G COORDINATOR 2100 3RD AVENUE ANOKA, MN 15303 All other terms and conditions remain unchanged. • t,;`-tar:.atoia(ta 6')(R cv I1,O ta2cI1) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - AUTOMATIC STATUS WHEN REQUIRED BY RITT N CONTRACT ITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section 11 - Who is An Insured is amended to a. All work, including materials, parts or include as an additional insured any person or equipment furnished in connection with organization you are required by a written contract such work, on the project (other than ser- to name as an additional insured. vice, maintenance or repairs) to be per - The written contract must be: formed by or on behalf of the additional in- sured(s) at the location of the covered 1. Currently in effect or becoming effective during operations has been completed: or the term of this policy; and b. That portion of "your work" out of which the 2. Executed prior to the "bodily injury," "property injury or damage arises has been put to its damage," "personal injury and advertising in- intended use by any person or organization jury." other than another contractor or subcon- . B. The insurance provided to the additional insured is tractor engaged in performing operations limited as follows: for a principle as a part of the same project. 1, That person or organization is only an addi- D. As respects the coverage provided under this tional insured with respect to liability arising out endorsement, Paragraph 4.b. Section IV — of: COMMERCIAL GENERAL LIABILITY a. "your ongoing operations" performed for the CONDITIONS is amended with the addition of the insured at the location designated in the fallowing: written contract; or 4. Other Insurance b. premises owned or used by you. b. Excess Insurance C. With respect to the insurance afforded to these This insurance is excess over: additional insureds, the following additional Any other valid and collectible insurance exclusions apply: available to the additional insured whether This insurance does not apply to: primary, excess, contingent or on any other 1. "Bodily injury ", "property damage" or "personal basis unless a written contract specifically requires that this insurance be either pri- and advertising injury" arising out of the render- ing of, or the failure to render, any professional mart' or primary and noncontributing. Where required by written contract, we will architectural, engineering or surveying ser- including: nconsider any other insurance maintained by vices, the additional insured for injury or damage a. The preparing; approving, or failing to pre- covered by this endorsement to be excess • pare or approve, maps, shop drawings, and noncontributing with this insurance. opinions, reports, surveys, field orders, When this insurance is excess, as a condi- change orders or drawings and specifica- tion of coverage, the additional insured ,ions; and shall be obligated to tender the defense and b. Supervisory, inspection, architectural or indemnity of every claim or suit to all other engineering activities. insurers that may provide coverage to the 2. "Bodily injury" or "property damage" occurring additional insured, whether on a contingent, after: excess or primary basis. WB 1890 04 08 West Bend Mutual Insurance Company Page 1 of 1 West Bend, Wisconsin 53095 I I i I II Appendix B: CGL Additional Insured Endorsements 403 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG20100704 ' THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS , LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations Information required to complete this. Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional exclu- organization (s) shown in the Schedule, but only sions apply: with respect to liability for "bodily. injury", "property '' This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage" occurring after: 11 I I�. caused, in whole or in part, by: 1. Your acts or omissions; or 1. All work, including materials, parts or equip- j 1 ment furnished in connection with such work, i s i ;, 2. The acts or omissions of those acting on your on the project (other than service, maintenance behalf; or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional insured(s) at the location of the the additional insured(s) at the location(s) covered operations has been completed; or s) desig- i nated above. 2. That portion of your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. I 1 1 CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 'I II Appendix B: CGL Additional Insured Endorsements 429 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: '1 COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations it i;i Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section 11 — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property dam- age" caused, in whole or in part, by your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products- completed operations hazard ". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1