Scope of Work - Nevada Department of Employment, Training and ...

ATTACHMENT AAScope of WorkGeneral ServicesVendors providing services under this contract agree to provide general services to anapplicant or eligible client of the Vocational Rehabilitation Division (Division). Servicesmay include, but are not limited to:• Computer technical services;• Business plan development;• Recreation services assessment;• Benefits Planner;• Scribe Services.The purpose and expectation of the service is to facilitate program participation foreligible clients to achieve employment.Referrals -Accepted referrals for service will result in scheduled service delivery no more than ten(10) business days from date of referral. Any extenuating circumstances preventing thereferred service by the vendor will be documented in writing, or email, andcommunicated by telephone to the referring counselor/Agency within five (5) businessdays.Invoicing –All services must be pre-authorized by the Division according to the establishedMedicaid fee schedule or best negotiated price. Invoices must be submitted within fifteen(15) business days of the provided service, include the appropriate Medicaid procedurecode, or CPT code, if applicable, and a description of the services. Services providedwithout prior authorization will not be paid by the Division. Payment may be delayed ifthe invoice is not submitted correctly, and/or the required reports are not submitted;vendors will not receive payment for claims submitted after 90 days from the date of theservice.Licensure and Credentials -Vendors must provide evidence of a Nevada State Business License in good standingwith the State of Nevada Secretary of State’s office. The individual providing the servicesmust be qualified and maintain necessary certifications, training, and all appropriateinsurances and licenses required in their field. Out of state vendors must provide evidenceof a Nevada State Business License in good standing with the State of Nevada Secretaryof State’s office, and must be licensed and qualified in their discipline per theiraccreditation and licensure in the state that the service is provided. The State of Nevadawill not utilize the services of any non-licensed vendor.Revised: 09/17/13Approved: 12/13/12

ATTACHMENT BBINSURANCE SCHEDULEGENERAL SERVICESINDEMNIFICATION CLAUSE:Contractor shall indemnify, hold harmless and, not excluding the State's right to participate, defend the State, itsofficers, officials, agents, and employees (hereinafter referred to as “Indemnitee”) from and against all liabilities,claims, actions, damages, losses, and expenses including without limitation reasonable attorneys’ fees and costs,(hereinafter referred to collectively as “claims”) for bodily injury or personal injury including death, or loss ordamage to tangible or intangible property caused, or alleged to be caused, in whole or in part, by the negligent orwillful acts or omissions of Contractor or any of its owners, officers, directors, agents, employees or subcontractors.This indemnity includes any claim or amount arising out of or recovered under the Workers’ Compensation Law orarising out of the failure of such contractor to conform to any federal, state or local law, statute, ordinance, rule,regulation or court decree. It is the specific intention of the parties that the Indemnitee shall, in all instances, exceptfor claims arising solely from the negligent or willful acts or omissions of the Indemnitee, be indemnified byContractor from and against any and all claims. It is agreed that Contractor will be responsible for primary lossinvestigation, defense and judgment costs where this indemnification is applicable. In consideration of the award ofthis contract, the Contractor agrees to waive all rights of subrogation against the State, its officers, officials, agentsand employees for losses arising from the work performed by the Contractor for the State.INSURANCE REQUIREMENTS:Contractor and subcontractors shall procure and maintain until all of their obligations have been discharged,including any warranty periods under this Contract are satisfied, insurance against claims for injury to persons ordamage to property which may arise from or in connection with the performance of the work hereunder by theContractor, his agents, representatives, employees or subcontractors.The insurance requirements herein are minimum requirements for this Contract and in no way limit the indemnitycovenants contained in this Contract. The State in no way warrants that the minimum limits contained herein aresufficient to protect the Contractor from liabilities that might arise out of the performance of the work under thiscontract by the Contractor, his agents, representatives, employees or subcontractors and Contractor is free topurchase additional insurance as may be determined necessary.A. MINIMUM SCOPE AND LIMITS OF INSURANCE: Contractor shall provide coverage with limits ofliability not less than those stated below. An excess liability policy or umbrella liability policy may be usedto meet the minimum liability requirements provided that the coverage is written on a “following form”basis.1. Commercial General Liability – Occurrence Form• General Aggregate $2,000,000• Products – Completed Operations Aggregate $1,000,000• Personal and Advertising Injury $1,000,000• Each Occurrence $1,000,000a. The policy shall be endorsed to include coverage for physical/sexual abuse and molestation.b. The policy shall be endorsed to include the following additional insured language: “The Stateof Nevada, Rehabilitation Division, 1370 S. Curry St., Carson City, NV 89703”, shall benamed as an additional insured with respect to liability arising out of the activities performedby, or on behalf of the Contractor.”2. Automobile Liability –Bodily Injury and Property Damage for any owned, hired, and non-owned vehicles used in theperformance of this Contract.• Combined Single Limit $1,000,000a. The policy shall be endorsed to include the following additional insured language: “The Stateof Nevada, Rehabilitation Division, 1370 S. Curry St., Carson City, NV 89703”, shall benamed as an additional insured with respect to liability arising out of the activities performedPage 1 of 3Revised: 09/17/13Approved: 04/03/13

ATTACHMENT BBINSURANCE SCHEDULEGENERAL SERVICESby, or on behalf of the Contractor, including automobiles owned, leased, hired or borrowed bythe Contractor".b. This requirement shall not apply when a contractor or subcontractor has declared they are nottransporting clients by executing the appropriate DETR, Rehabilitation, Intent to Transportform.3. Worker’s Compensation and Employers’ LiabilityWorker’s Compensation Statutory Employers’ Liability• Each Accident $100,000• Disease – Each Employee $100,000• Disease – Policy Limit $500,000a. Policy shall contain a waiver of subrogation against the State of Nevada.b. This requirement shall not apply when a contractor or subcontractor is exempt under NRS,and when such contractor or subcontractor executes the appropriate sole proprietor waiverform.4. Professional Liability (Errors and Omissions Liability)The policy shall cover professional misconduct or lack of ordinary skill for those positions definedin the Scope of Services of this contract.• Each Claim $1,000,000• Annual Aggregate $2,000,000a. In the event that the professional liability insurance required by this Contract is written on aclaims-made basis, Contractor warrants that any retroactive date under the policy shallprecede the effective date of this Contract; and that either continuous coverage will bemaintained or an extended discovery period will be exercised for a period of two (2) yearsbeginning at the time work under this Contract is completed.5. Fidelity Bond or Crime Insurance• Bond or Policy Limit $100,000a. The bond or policy shall include coverage for all directors, officers, agents and employees ofthe Contractorb. The bond or policy shall include coverage for third party fidelity and name the State ofNevada and their clients as loss payee where as their interests may appear.c. The bond or policy shall include coverage for extended theft and mysterious disappearance.d. The bond or policy shall not contain a condition requiring an arrest and conviction.e. Policies shall be endorsed to provide coverage for computer crime/fraud.B. ADDITIONAL INSURANCE REQUIREMENTS: The policies shall include, or be endorsed to include,the following provisions:1. On insurance policies where the State of Nevada is named as an additional insured, the State of Nevadashall be an additional insured to the full limits of liability purchased by the Contractor even if thoselimits of liability are in excess of those required by this Contract.2. The Contractor's insurance coverage shall be primary insurance and non-contributory with respect toall other available sources.Page 2 of 3Revised: 09/17/13Approved: 04/03/13

ATTACHMENT BBINSURANCE SCHEDULEGENERAL SERVICESC. NOTICE OF CANCELLATION: Each insurance policy required by the insurance provisions of thisContract shall provide the required coverage and shall not be suspended, voided or canceled except afterthirty (30) days prior written notice has been given to the State, except when cancellation is for nonpaymentof premium, then ten (10) days prior notice may be given. Such notice shall be sent directly toState of Nevada Department of Employment, Training and Rehabilitation, Attn: Provider Agreement, 1370S. Curry Street, Carson City, NV 89703.D. ACCEPTABILITY OF INSURERS: Insurance is to be placed with insurers duly licensed or authorizedto do business in the state of Nevada and with an “A.M. Best” rating of not less than A- VII. The State inno way warrants that the above-required minimum insurer rating is sufficient to protect the Contractor frompotential insurer insolvency.E. VERIFICATION OF COVERAGE: Contractor shall furnish the State with certificates of insurance(ACORD form or equivalent approved by the State) as required by this Contract. The certificates for eachinsurance policy are to be signed by a person authorized by that insurer to bind coverage on its behalf.All certificates and any required endorsements are to be received and approved by the State before workcommences. Each insurance policy required by this Contract must be in effect at or prior tocommencement of work under this Contract and remain in effect for the duration of the project. Failure tomaintain the insurance policies as required by this Contract or to provide evidence of renewal is a materialbreach of contract.All certificates required by this Contract shall be sent directly to State of Nevada Department ofEmployment, Training and Rehabilitation, Attn: Provider Agreement, 1370 S. Curry Street, Carson City,NV 89703. The State project/contract number and project description shall be noted on the certificate ofinsurance. The State reserves the right to require complete, certified copies of all insurance policiesrequired by this Contract at any time.F. SUBCONTRACTORS: Contractors’ certificate(s) shall include all subcontractors as additional insuredsunder its policies or Contractor shall furnish to the State separate certificates and endorsements for eachsubcontractor. All coverages for subcontractors shall be subject to the minimum requirements identifiedabove.G. APPROVAL: Any modification or variation from the insurance requirements in this Contract shall bemade by the Attorney General’s Office or the Risk Manager, whose decision shall be final. Such actionwill not require a formal Contract amendment, but may be made by administrative action.IN WITNESS WHEREOF, the parties hereto have caused this Contract to be signed and intend to be legallybound thereby.Authorized Signature Date TitleSignature – State of Nevada Date TitlePage 3 of 3Revised: 09/17/13Approved: 04/03/13

ATTACHMENT BBBRIAN SANDOVALGOVERNORREHABILITATIONDIVISIONFRANK WOODBECKDIRECTORMAUREEN COLEADMINISTRATORINTENT TO TRANSPORTI, , and employees, if any; will transportPrint Full NameVocational Rehabilitation clients for the purpose of providing services as described in thescope of work. I understand that by doing so I am required to maintain automobileliability for any owned, hired, and non-owned vehicles used for the intent of transportingclients.The policy shall be endorsed to include the following additional insured language: “TheState of Nevada shall be named as an additional insured with respect to liability arisingout of the activities performed by, or on behalf of the Vendor, including automobilesowned, leased, hired or borrowed by the Vendor”I further understand that any individual transporting clients on my behalf who is notacting as an employee, must meet the vendor requirements and all appropriatedocumentation must be submitted for approval to:DETR/Rehabilitation DivisionAttn: Michele Killian1370 S. Curry StreetCarson City, NV 89703-5146Phone: (775) 684-4107Fax (775) 684-4184mlkillian@nvdeter.orgI, , will NOT transport clients, I understand that IPrint Full Nameam not to transport Vocational Rehabilitation clients at any time, and I further understandthat any individual transporting clients on my behalf must meet the vendor requirementsand all appropriate documentation must be submitted for approval to:DETR/Rehabilitation DivisionAttn: Michele Killian1370 S. Curry StreetCarson City, NV 89703-5146Phone: (775) 684-4107Fax (775) 684-4184mlkillian@nvdeter.orgIndependent Contractor’s Signature Date Independent Contractor’s TitleRev.12/05/2012

ATTACHMENT CCFEE SCHEDULEProviders must provide detailed fixed prices for all costs associated with the responsibilities and relatedservices. This applies to all providers wherein the service is not contained in the State of Nevada’sMedicaid Rate Schedule or an established fee schedule in the Scope of Work.The fee schedule shall include the provider’s name, service description, rate and fees associated with theservice and any additional associated costs. Additional pages may be attached if necessary.Contact InformationProvider Representative:Business Name:Telephone Number:Email:Service DescriptionRate/Feehourly daily milestone other _______________hourly daily milestone other _______________hourly daily milestone other _______________hourly daily milestone other________________hourly daily milestone other _______________hourly daily milestone other _______________hourly daily milestone other _______________Associated CostsDescriptionRate/FeeThe fee schedule is only valid upon the Administrator of Vocational Rehabilitation’s approval.Administrator’s SignatureDateRevised: 01/10/2013