Employee Assist. Prog. Agree. Mercy
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MEMORANDUM
October 27. 2006
TO:
The Honorable Mayor and City Council Members
FROM:
Michael C. Van Milligen, City Manager
SUBJECT: Agreement with Mercy Medical Center to Provide Employee Assistance
Program Services
Personnel Manager Randy Peck is recommending approval of an agreement with
Mercy Medical Center to provide employee assistance services to the City of Dubuque
employees and their family members. The annual fee will $5.830 effective July 1, 2006.
which is a $530 increase over the previous year fee schedule.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
f!'lJ k, AL
Michael C. Van Milligen
MCVM/jh
Attachment
cc: Barry Lindahl. City Attorney
Cindy Steinhauser, Assistant City Manager
Randy Peck, Personnel Manager
D'i:i~~E
~c/de-~
Memorandum
October 20, 2006
FROM:
Michael C. Van Milligen
City Manager
Randy Peck J1 ()
Personnel Manager I'll
TO:
SUBJECT: Agreement with Mercy Medical Center to provide Employee Assistance
Program Services
I have attached an agreement with Mercy Medical Center to provide employee assistance
services to City of Dubuque employees and their family members. The annual fee will be
$5,830 dollars effective July 1, 2006, and it represents an increase of $530 dollars over the
previous year fee schedule. The City of Dubuque has had an Employee Assistance Program
since 1989. This is the fourth increase in their fee since 1991. The last increase occurred in
Fiscal Year 2004. The annual fee can be financed within the approved Fiscal Year 2007
budget and it will be in effect through June 30, 2007. The Agreement has been reviewed by
City Attorney Barry Lindahl and he has found it acceptable. I recommend that the Agreement
be approved. I request that the City Council approve a motion authorizing you to sign the
Agreement.
If you have any questions, please feel free to call.
RP:bf
Enclosure
AGREEMENT
EMPLOYEE ASSISTANCE PROGRAM
The Mercy Medical Center Employee Assistance Program (EAP) agrees to provide the following
services to the City of Dubuque:
1. Emplovee Services. These services shall include:
A. Assessment, evaluative counseling, referral, case management and follow-up for all
employees and their family members.
B. There is no set limit of the number of sessions allowed for each client, but will be
determined by the counselor and parties involved based on a need basis. All
sessions involving the client and EAP are at no charge to the employee. Any charge
from another provider other than EAP will be the responsibility of the employee or
his/her insurance.
C. In the case of employees who are referred by the employer, when a threat of
disciplinary action accompanies referral, follow-up services will be provided. Follow-
up will be for a period of time determined by the parties involved and will consist of
the following:
. monthly meeting between the employee and the EAP counselor
. weekly contact with any agency the employee is referred to for the
duration of his/her involvement at that agency.
. monthly contact with the supervisor who made the referral. This contact
will not involve disclosure of information as to the nature of the
employee's problem or recommended treatment. It will serve to inform
the supervisor as to the level of the employee's involvement and progress
being made in dealing with the identified problem(s).
2. Utilization Review Services.
Mercy Medical Center EAP shall provide, on at least an annual basis, statistical data
relevant to the utilization of the EAP by employees and their family members. This data
shall reflect the number of employees and their family members who have used the
program voluntarily and formally, as well as a breakdown of the types of problems dealt
with. This data will be statistical in nature and will not include the names of any
employees or their family members using the program.
3. Fees.
Mercy Medical Center EAP shall be paid at the rate of $11.00 per year times the number
of full and part-time employees of the City of Dubuque as indicated in the following
calculation. Full-time employee is herein defined as any employee working thirty-two
(32) hours or more per week.
$11.00
x 530
=$5,830.00
Per Employee
Number of Full-time and Part-time Employees
Annual Fee
4. Manner of Payment.
The fee shall be paid to the Mercy Medical Center EAP on an annual basis.
5. Reyision/TerminationfEffective Date.
The terms of this agreement go into effect on July 1, 2006. This agreement may be
modified by either party by mutual consent on thirty (30) day written notice of intent to
revise the agreement. Either party wishing to terminate this agreement must give thirty
(30) days written notice to other party.
6. Insurance.
During the term of this agreement, Mercy Medical Center EAP shall maintain insurance
as set forth in the attached Insurance Schedule C.
7. Indemnification.
Mercy Medical Center agrees to defend, indemnify and hold the City of Dubuque
harmless from and against any and all claims arising out of Mercy's negligent
performance of this agreement.
Signed this _ day of
,2006
Signed this
day of
,2006
Russell M. Knight
President and Chief Executive Officer
Mercy Medical Center
Michael C. Van Milligen
City Manager
City of Dubuque
Revised 6/2006
INSURANCE SCHEDULE C
INSURANCE REQUIREMENTS FOR PROFESSIONAL SERVICES TO THE
CITY OF DUBUQUE
1. All policies of insurance required hereunder shall be with an insurer authorized to do
business in Iowa. All insurers shall have a rating of A better in the current A.M. Best
Rating Guide.
2. All policies of insurance shall be endorsed to provide a thirty (30) day advance
notice of cancellation to the City of Dubuque, except for 10 day notice for non-
payment, if cancellation is prior to the expiration date. This endorsement supersedes
the standard cancellation statement on the Certificate of Insurance.
3. shall furnish a signed Certificate of Insurance to the City of
Dubuque, Iowa for the coverage required in Paragraph 6 below. Such Certificates
shall include copies of the following endorsements:
a) Commercial General Liability policy is primary and non-contributing.
b) Commercial General Liability additional insured endorsement.
c) Governmental Immunities Endorsement.
shall also be required to provide Certificates of Insurance
of all subcontractors and all sub-sub contractors who perform work or services
pursuant to the provisions of this contract. Said certificates shall meet the same
insurance requirements as required of
4. Each certificate shall be submitted to the contracting department of the City of
Dubuque.
5. Failure to provide minimum coverage shall not be deemed a waiver of these
requirements by the City of Dubuque. Failure to obtain or maintain the required
insurance shall be considered a material breach of this agreement.
6. Contractor shall be required to carry the following minimum coverage/limits or
greater if required by law or other legal agreement:
a) COMMERCIAL GENERAL LIABILITY
General Aggregate Limit
Products-Completed Operations Aggregate Limit
Personal and Advertising Injury Limit
Each Occurrence Limit
Fire Damage limit (anyone occurrence)
Medical Payments
$2,000,000
$1,000,000
$1,000,000
$1,000,000
$ 50,000
$ 5,000
10f2
June 2005
INSURANCE SCHEDULE C (Continued)
INSURANCE REQUIREMENTS FOR PROFESSIONAL SERVICES TO THE
CITY OF DUBUQUE
This coverage shall be written on an occurrence form, not claims made form. All
deviations or exclusions from the standard ISO commercial general liability form CG
0001 or Business owners BP 0002 shall be clearly identified. Form CG 25 04 03 97
'Designated Location (s) General Aggregate Limit' shall be included.
Governmental Immunity endorsement identical or equivalent to form attached.
Additional Insured Requirement:
The City of Dubuque, including all its elected and appointed officials, all its
employees and volunteers, all its boards, commissions and/or authorities and
their board members, employees and volunteers shall be named as an additional
insured on General Liability including "ongoing operations" coverage equivalent
to ISO CG 20100704.
b) Automobile $1.000.000 combined sinale limit.
c) WORKERS COMPENSATION & EMPLOYERS LIABILITY
Statutory for Coverage A
Employers Liability:
Each Accident
Each Employee Disease
Policy Limit Disease
$ 100,000
$ 100,000
$ 500,000
$1,000,000
d) PROFESSIONAL LIABILITY
e) UMBRELLA/EXCESS LIABILITY .
'Coverage and/or limit of liability to be determined on a case-by-case basis by
Finance Director.
Completion Checklist
o Certificate of Liability Insurance (2 pages)
o Designated Location(s) General Aggregate Limit CG 25 04 03 97
D Additional Insured CG 20 10 07 04
D Governmental Immunities Endorsement
20f2
June 2005
APOBQ. CERTIFICATE OF LIABILITY INSURANCE
t ,",OOu"",, (5&3)S56-027Z FAX (563)556-4425
IN!;URANCE AGENCY
STREET AlIDIlE5S
. TrY , STATE, ZIP COllE
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Street Ad4ress
City, State, .Zip Cocle
UAl1iHMWOD/Y\"VYJ
112/2tlj2ooS
THIS CERTIACI\TE IS ISSUED AS A MA.TTER OF INFQRMA:r.aN
ONLY AND CONFERS NO RIGHTS UPON THE CERT!
HOLDER. THIS CERTIACA:rE DOES NOT AMEND,
AI. TER THE COVERAGE AfFORDED ElYTHE POUC
,
!INSURERS A.FFORDING COVERAGE
IlN$tJIWl.A Thsul'ance ~ny
1- lNSURER.S~
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rINSURFRC:
NAIC#
THe POLICY PeRIOO1NDICAT-eG, NOTWITJ-1STAAOOl<
TOWHICH THIS CERTIfiCATe MAY BE ISSUED OR
l THe TERMS, EXClUSIONS AND COND11lONS OF S\)c~
Ut;lllTS
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I
EACH-o<"~
"O~~t()~RetlIJEO
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GtiI~RAL.~GATE
pRODUCTS."OOMPf()PA((jG:
t!"'c
CoMi:W'Ci.:!I)'~!iGl'E LIMIT
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BOO!.L'lINJURY
(per~)
BOhitY1I!UURV
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PROPS'tTYOAW\AGE
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5iIONAt. lIAlllUTY
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FLLOISEASE POUCYLlfA!T $
$1,000,000
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""'1i~"&FDwl''ll''"atlEl.OCis~'~m~i4rar(l~Al''mII~POW:ID INCL ONGOING &< COMPlETED
TiIONS COVERAGE EQUlVILANT ~ ISO CG 201{l 9704 " CG 2037 0704. GENERAL lIABILITY POUCY IS PRDlAIlY
NON-<'.ONTRIBUTING. roRliI CG 2.04 03117 "DeSXOliIATED lOCATIONS" GENERAL UAllIUTY AGGREGATE lIMJT SHAtJ.. lIE
LODED. GOVERNMENTAL IMMUHIl'lES ENDORSEMENT IS INClUDED. All,pO/.JUES OF INSURANCE SHAll BE ENOORSllIl
o PROVIDE TIfIIlTY (~O) OAY -I\I:lVANCE fIIllUCE OF CANCEt.lAUOIrI TO mE CITY OF OOBUQtfE.
Tt
$itO'~~~()f:~~~DE$CRI8EOPOUCfES R.CAHCW.~D'~lHE
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CITY OF DUBUQUE
CITY HAll
50 W. 13TH STREET
OUBUOOE, lA 52001
AUTHOJtIZ1WREPM.SeH1'A'T1ViI
ACORD $(20011081
teACOAD c.nRPORATtnN-1!UtR
,.
IMPORTANT
lfSUBROGAT10l'l ISWAlVED. sub' ., 'an~
require an eodOl'$emenl. A statement on1his certl1lcaie'
holder in 1ieu of sUCh sndOl'$ement(s).
, 'be .....dorsed. A state<<nent
endorsement(s).
iill'/. certain policie,s may
!(} the certificate
If the certificate holder is an ADDITIONAL
on this ceftificate does,not romer rig
The Certificate of Im;uranoe on the reverse $ide
the isslJing nlsurer(S). aut!lorized representative .
<lfIirmatlvely.or negatlvelyamend. extend or slte
COIlslilutea pontracl betwleen
e certifICate I1oIder, oor does.Jt
by the policies listed thIereon.
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.. ROllCY NUMEER:
COMME!\!:'lAL GENERAL LlABIUTY
CS 25 040397
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY,
DESIGNATED LOCA TION(S)
GENERAL AGGREGATE LIMIT
This endor:sement modffi~ insurance provided LInder
Designated Location{s):
COMMERCIAL GENEAAL UABILITY C
, ^ -' ,~~!
ANY AND ALL COV~~FiBLOCATIONB
:'::;~':_:"_:::/-:~:2~:--
ornement will be shown in the DeClarations
(if nO en
as appo
appears above, information required to coinpl~lll'
. endorsemenl) . ,
,
A. FQl' all ~ms wh insured becomes legally
obllgatecl. to caused
.~ 'lle$" A .(SECT!
I), a II m caUSlldby
cie rO C.(SE:CTI0N J),
ca . t6 operationS at a singIe'
d!!Signated '1 shown In the Schedule","
aballe: ..
1. A separate Oes' Locatlon General'"
e limit iell to each designated:" .
and . Is equal to the' '
~ the nellll Aggregate Limit'
$h the Oedarations.
%.. The 'Oesignated Locaticln General Aggregate
Liinllis the most we Will pay for tile sum of all'
damages unper COveRAGE A. elOcept dam-
ages because of "bodily injury" or 'property
damage' incluDed in the ilrcclt:tcls:cornpleted
operations hsurd', anc! for mediCal expen_
under COVERAGE C regartlJess of the" num-
ber of:
a. "jnsurecls;
b. Claims made or .sults" brought or
c. Persons or o~nizatiol1$ making claims
or bringing "suits".' "
ny payment& madl:!uncler COveRJ\GE A
for damages or tmcIer COVSRA&e:: C "for
medical expenses shall ~ce 'll1e oesig- .
nated Loaallon General Aggregate Umlt for
that designated 'ocation'. 5ucb pa}'l:nelltS
shall not reduce tile General
shown in the De<;\ar.lticm; 11Dr
duce any other Oesignated Lo
Aggregate limit for any ,
"location' shown in the SclledUle ~,
4. The nmlts shown in tile DeclaraflOll$ fot Eacll
Occurrence" Fire Damage and MedlcaJ ex-
pense continue to apply. However, instead qf
bei"ll subjacl to the General Aggreg!ilte Umlt
shown in the Declarations. SU5iil.llmlls Will be
subjlild. 10 the applicable Oeslf;lnated t.ocation
General Aggregate Limit.
,,"
S <:P'E <'<<:iC:'.'IMEN
' "~-,' ! -" ":;:_.- '.; - -
"::' " -," . -: L, "'~ ' - '- - - ::
. "
C.G Z5 04 03 97
Copyright, Insurance Services Office, Inc., 1996
Page 1 ofZ tI
t I ~-.. A.
. .
POLlCY NUMBER:
COMMERCIAL GENERAL LIABILITY
CG 20 10 0704
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITiONAL INSURED OWNERS, lESSEES OR
CONTRACTORS ERSON OR
o
This endorsement modifies insurance provided \J
COMMERCIAL GENERAL LIABILITY COVERAGE P.
:>
ratlons
Information uiredto oomolete this Schedule If notit1~ ~bo~;will he shown in the Cleclarations.
A.
espect to the insurance afforded to 1Ilese
. nal insureds. the follOwing additional exclu-' .
sions al'Ply: .
This insurance does not apply to "bodily injury" Of
"property damage" occLlning after:
1. All wer~. including malerials. pans or equip-
ment furnished in connection with such WIil/l(.
on (Qther than service, malnlenance
or be performed by or on behalf at
I insul'ed(s) at the location of 1I1e
. lions .has been completed; Of
. of "your worJ( out at which the
age aniles has been put to its In-
tended y any person or organization other
than another contraelor Of subconlraelor en-
gaged in performing operations for a princlpal
as a part of the same projeel.
11 II - Who Is An Insured is amende
. . as an addllional insured the person(s
organization(s) shown in the Schedule, but only
Yfith respecl'to Iiabifrty for "bodily injury", "property
damage" or "personal and advertising injury"
caused, in whole or in part, by:
1. Your acts or omisSions; or
2. The acts Of omissions of those acting on your
behalf;
in the performance of your ongoing operations fQr .
the additional insured(s} at the location(s) desig-
nated above.
SPECI.~
N
CG 20 10 07 04
elso Properties,lnc" 2004
Pag. 1 of 1
D
. .
CITY OF DUBUQUE, IOWA
GOVERNMENTAL IMMUNITIES ENDORSEMENT
1.
Nonwaiver of Governmentallmmunitv. The insurance carrier expressly agrees and
states that the purchase of this policy and the including of the City of Dubuque, Iowa
as an Additional Insured does not waive any of the defenses of governmental
immunity available to the City of Dubuque, Iowa under Code of Iowa Section 670.4
as it is now exists and as it may be amended from time to time.
2.
Claims Coveraae. The insurance carrier further agrees that this policy of insurance
shall cover only those claims not subject to the defense of governmental immunity
under the Code of Iowa Section 670.4 as it now exists and as it may be amended
from time to time. Those claims not subject to Code of Iowa Section 670.4 shall be
covered by the terms and conditions of this insurance policy.
3.
Assertion of Government Immunitv. The City of Dubuque, Iowa shall be responsible
for asserting any defense of governmental immunity, a'nd may do so at any time and
shall do so upon the timely written request of the insurance carrier.
4.
Non-Denial of Coveraae. The insurance carrier shall not deny coverage under this
policy and the insurance carrier shall not deny any of the rights and benefits
accruing to the City of Dubuque, Iowa under this policy for reasons of governmental
immunity unless and until a court of competent jurisdiction has ruled in favor of the
defense(s) of governmental immunity asserted by the City of Dubuque, Iowa.
No Other Chanqe in Policv. The above preservation of governmental immunities shall
not otherwise change or alter the coverage available under the policy.
SPECIMEN
1 of 1
June 2005