Common use of Contract Identification Clause in Contracts

Contract Identification. All insurance certificates must state this Contract's number and title. The Contractor must disclose to the County the amount of any deductible or self-insurance component of any of the required policies. With the County’s approval, the Contractor may satisfy its obligations under this section by self-insurance for all or any part of the insurance required, provided that the Contractor can demonstrate sufficient financial capacity. In order to do so, the Contractor must provide the County with its most recent actuarial report and a copy of its self-insurance resolution. The County may request additional information to determine if the Contractor has the financial capacity to meet its obligations under a deductible and may require a lower deductible, that funds equal to the deductible be placed in escrow, a certificate of self-insurance, collateral, or another mechanism to guarantee the amount of the deductible and ensure protection for the County. The County’s acceptance or approval of any insurance will not relieve the Contractor from any liability or obligation imposed by the Contract Documents. The Contractor is responsible for the Work and for all materials, tools, equipment, appliances and property used in connection with the Work. The Contractor assumes all risks for direct and indirect damage or injury to the property used or persons employed in connection with the Work and for of all damage or injury to any person or property, wherever located, resulting from any action, omission, commission or operation under the Contract or in connection in any way whatsoever with the Work. The Contractor’s insurance shall be the primary non-contributory insurance for any work performed under this Contract. The Contractor is as fully responsible to the County for the acts and omissions of its subcontractors and of persons employed by them as it is for acts and omissions of persons whom the Contractor employs directly.

Contract Identification. All insurance certificates must state this Contract's number and title. The Contractor must disclose to the County the amount of any deductible or self-insurance component of any of the required policies. With the County’s approval, the Contractor may satisfy its obligations under this section by self-insurance for all or any part of the insurance required, provided that the Contractor can demonstrate sufficient financial capacity. In order to do so, the Contractor must provide the County with its most recent actuarial report and a copy of its self-insurance resolution. The County may request additional information to determine if the Contractor has the financial capacity to meet its obligations under a deductible and may require a lower deductible, ; that funds equal to the deductible be placed in escrow, ; a certificate of self-insurance, ; collateral, ; or another mechanism to guarantee the amount of the deductible and ensure protection for the County. The County’s acceptance or approval of any insurance will not relieve the Contractor from any liability or obligation imposed by the Contract Documents. The Contractor is responsible for the Work and for all materials, tools, equipment, appliances and property used in connection with the Work. The Contractor assumes all risks for direct and indirect damage or injury to the property used or persons employed in connection with the Work and for of all damage or injury to any person or property, wherever located, resulting from any action, omission, commission or operation under the Contract or in connection in any way whatsoever with the Work. The Contractor’s insurance shall be the primary non-contributory insurance for any work performed under this Contract. The Contractor is as fully responsible to the County for the acts and omissions of its subcontractors and of persons employed by them as it is for acts and omissions of persons whom the Contractor employs directly.

Contract Identification. All insurance certificates must state this Contract's number and title. The Contractor must disclose to the County the amount of any deductible or self-insurance component of any of the required policies. With the County’s approval, the Contractor may satisfy its obligations under this section by self-insurance for all or any part of the insurance required, provided that the Contractor can demonstrate sufficient financial capacity. In order to do so, the Contractor must provide the County with its most recent actuarial report and a copy of its self-insurance resolution. The County may request additional information to determine if the Contractor has the financial capacity to meet its obligations under a deductible and may require a lower deductible, ; that funds equal to the deductible be placed in escrow, ; a certificate of self-insurance, ; collateral, ; or another mechanism to guarantee the amount of the deductible and ensure protection for the County. The County’s acceptance or approval of any insurance will not relieve the Contractor from any liability or obligation imposed by the Contract Documents. The Contractor is responsible for the Work and for all materials, tools, equipment, appliances and property used in connection with the Work. The Contractor assumes all risks for direct and indirect damage or injury to the property used or persons employed in connection with the Work and for of all damage or injury to any person or property, wherever located, resulting from any action, omission, commission or operation under the Contract or in connection in any way whatsoever with the Work. The Contractor’s insurance shall be the primary non-contributory insurance for any work performed under this Contract. The Contractor is as fully responsible to the County for the acts and omissions of its subcontractors and of persons employed by them as it is for acts and omissions of persons whom the Contractor employs directly. WITNESS these signatures: THE COUNTY BOARD OF ARLINGTON MEDICAL EVALUATION SPECIALISTS, LLC DBA COUNTY, VIRGINIA MES SOLUTIONS AUTHORIZED AUTHORIZED SIGNATURE: SIGNATURE: NAME: ▇▇▇▇▇▇ ▇. ▇▇▇▇▇ TITLE: Procurement Officer 7/26/2022 DATE: ▇▇▇ ▇▇▇▇▇▇▇ NAME: TITLE: Senior Vice President 7/26/2022 DATE: 1. Provide a nationwide network of Board-certified physicians who carry medical professional liability/medical malpractice per Virginia Code, who will review medical records, perform in-person medical evaluations, provide a report of their findings and complete the County's disability form (see Attachments A and B). At a minimum, the network must include psychologists, psychiatrists, physicians and/or surgeons in the following areas: orthopedics, neurology, ophthalmology, cardiology, oncology, pulmonology, urology and nephrology. 2. Provide a Metro-DC area network of Board-certified physicians, who carry medical professional liability/ medical malpractice insurance in accordance with Virginia Code, to perform functional capacity exams. 3. Select a network provider, relevant to the employee's medical condition and who has not treated the employee previously, within a reasonable distance (within a 50-mile radius) from the employee's home or work location. Select a non-network provider, if no network provider is available within a reasonable distance of the employee's home or worksite. When possible, providers listed on the County's Workers' Compensation panel should be avoided to ensure an independent evaluation. 4. Schedule appointments with selected provider(s) within 3-5 days of the County's request. 5. Provide notification of the appointment to the employee/retiree. This includes sending written notification to the employee/retiree that must include the following information: a. Name, address, and telephone number of the provider b. Date and time of the appointment c. Name and telephone number where employee must call to confirm appointment d. Any "no show" fees will be paid by the employee/retiree. Additionally, the vendor must send appointment reminders 10 business days prior to the appointment, unless the initial notification is within that same time frame. 6. Provide the County with an estimated cost of the services within 1 business day of scheduling an appointment. Any additional testing costs must be pre-approved by the County. 7. Act as a liaison between the County and the provider to ensure quality and timely responses throughout the process. 8. Provide a secure electronic method for the County to upload medical documentation prior to the appointment. Upon receipt of the documents, generate an electronic confirmation of documents received. 9. Forward the employee's medical information, job description, required questions (see Attachment C), and, if applicable, the County's disability form (Exhibit E and F) to the provider prior to the employee's/retiree's appointment. 10. Confirm via email to the County that the employee/retiree attended the appointment. 11. Receive and review the provider's report for quality and completeness within 10 business days of the appointment. Reports should not contain typographical errors. 12. Ensure all reports include: a. Statements that indicate the physician reviewed the employee's medical records and the employee's job description. b. A summary of the in-person exam and the provider's findings/conclusion. c. Explanatory responses to the required questions (Exhibit G) 13. Provide billing invoices that must include the name of the employee/retiree and the name of the provider. The costs must be itemized to include cost for exam, cost for chart review, and cost for additional tests. This Business Associate Agreement is hereby entered into between Medical Evaluation Specialists, LLC dba MES Solutions (hereafter referred to as “Business Associate”) and the County Board of Arlington County, Virginia (hereafter referred to as “Covered Entity” or “County”) (collectively “the parties”) and is hereby made a part of any Underlying Agreement for goods or services entered into between the parties.

Contract Identification. All insurance certificates must state this Contract's number and title. The Contractor must disclose to the County the amount of any deductible or self-insurance component of any of the required policies. With the County’s approval, the Contractor may satisfy its obligations under this section by self-insurance for all or any part of the insurance required, provided that the Contractor can demonstrate sufficient financial capacity. In order to do so, the Contractor must provide the County with its most recent actuarial report and a copy of its self-insurance resolution. The County may request additional information to determine if the Contractor has the financial capacity to meet its obligations under a deductible and may require a lower deductible, that ; funds equal to the deductible be placed in escrow, ; a certificate of self-insurance, ; collateral, ; or another mechanism to guarantee the amount of the deductible and ensure protection for the County. The County’s acceptance or approval of any insurance will not relieve the Contractor from any liability or obligation imposed by the Contract Documents. The Contractor is responsible for the Work and for all materials, tools, equipment, appliances appliances, and property used in connection with the Work. The Contractor assumes all risks for direct and indirect damage or injury to the property used or persons employed in connection with the Work and for of all damage or injury to any person or property, wherever located, resulting from any action, omission, commission commission, or operation under the Contract or in connection in any way whatsoever with the Work. The Contractor’s insurance shall be the primary non-contributory insurance for any work performed under this Contract. The Contractor is as fully responsible to the County for the acts and omissions of its subcontractors and of persons employed by them as it is for acts and omissions of persons whom the Contractor employs directly.. WITNESS these signatures: THE COUNTY BOARD OF ARLINGTON COMMUNITY RESIDENCES, INC. DBA CRI COUNTY, VIRGINIA AUTHORIZED AUTHORIZED SIGNATURE: SIGNATURE: NAME: ▇▇. ▇▇▇▇▇▇ ▇. Lewis NAME: TITLE: Purchasing Agent TITLE: ▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇▇ President/CEO DATE: 10/7/2021 DATE: 10/7/2021 EXHIBIT A SCOPE OF SERVICES‌ The Contractor is responsible for the following:

Contract Identification. All insurance certificates must state this Contract's number and title. The Contractor must disclose to the County the amount of any deductible or self-insurance component of any of the required policies. With the County’s approval, the Contractor may satisfy its obligations under this section by self-insurance for all or any part of the insurance required, provided that the Contractor can demonstrate sufficient financial capacity. In order to do so, the Contractor must provide the County with its most recent actuarial report and a copy of its self-insurance resolution. The County may request additional information to determine if the Contractor has the financial capacity to meet its obligations under a deductible and may require a lower deductible, ; that funds equal to the deductible be placed in escrow, ; a certificate of self-insurance, ; collateral, ; or another mechanism to guarantee the amount of the deductible and ensure protection for the County. The County’s acceptance or approval of any insurance will not relieve the Contractor from any liability or obligation imposed by the Contract Documents. The Contractor is responsible for the Work and for all materials, tools, equipment, appliances and property used in connection with the Work. The Contractor assumes all risks for direct and indirect damage or injury to the property used or persons employed in connection with the Work and for of all damage or injury to any person or property, wherever located, resulting from any action, omission, commission or operation under the Contract or in connection in any way whatsoever with the Work. The Contractor’s insurance shall be the primary non-contributory insurance for any work performed under this Contract. The Contractor is as fully responsible to the County for the acts and omissions of its subcontractors and of persons employed by them as it is for acts and omissions of persons whom the Contractor employs directly.. WITNESS these signatures: THE COUNTY BOARD OF ARLINGTON ARLINGTON VOA, ALR OPERATING, INC. COUNTY, VIRGINIA AUTHORIZED AUTHORIZED SIGNATURE: SIGNATURE: NAME: ▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇ NAME: ▇▇▇▇▇ ▇▇▇▇▇ TITLE: PURCHASING AGENT TITLE: EXECUTIVE VP OF HEALTHCARE OPERATIONS DATE: DATE:

Contract Identification. All insurance certificates must state this Contract's ’s number and title. The Contractor must disclose to the County county the amount of any deductible or self-insurance component of any of the required policies. With the County’s approval, the Contractor may satisfy its obligations under this section by self-insurance for all or any part of the insurance required, provided that the Contractor can demonstrate sufficient financial capacity. In order to do so, the Contractor must provide the County with its most recent actuarial report and a copy of its self-self- insurance resolution. The County may request additional information to determine if the Contractor has the financial capacity to meet its obligations under a deductible and may require a lower deductible, ; that funds equal to the deductible be placed in escrow, ; a certificate of self-insurance, ; collateral, ; or another mechanism to guarantee the amount of the deductible and ensure protection for the County. The County’s acceptance or approval of any insurance will not relieve the Contractor from any liability or obligation imposed by the Contract Documents. The Contractor is responsible for the Work and for all materials, tools, equipment, appliances appliances, and property used in connection with the Work. The Contractor assumes all risks for direct and indirect damage or injury to the property used or persons employed in connection with the Work and for of all damage or injury to any person or property, wherever located, resulting from any action, omission, commission or operation under the Contract or in connection in any way whatsoever with the Work. The Contractor’s insurance shall be the primary non-contributory insurance for any work performed under this Contract. The Contractor is as fully responsible to the County for the acts and omissions of its subcontractors and of persons employed by them as it is for acts and omissions of persons whom the Contractor employs directly.

Contract Identification. All insurance certificates must state this Contract's number and title. The Contractor must disclose to the County the amount of any deductible or self-insurance component of any of the required policies. With the County’s approval, the Contractor may satisfy its obligations under this section by self-insurance for all or any part of the insurance required, provided that the Contractor can demonstrate sufficient financial capacity. In order to do so, the Contractor must provide the County with its most recent actuarial report and a copy of its self-insurance resolution. The County may request additional information to determine if the Contractor has the financial capacity to meet its obligations under a deductible and self-insured retention. The County may require a lower deductible, that self-insured retention due to the financial stability of the Contractor. Those funds equal to the deductible delta of the self-insured retention may be requested to be placed in escrow, a certificate of self-insurance, ; collateral, ; or another mechanism to guarantee the amount of the deductible retention and ensure protection for the County. If the Contractor does not agree to comply with any such request, the Contractor shall notify the County, and the County may elect to terminate this Agreement. The County’s acceptance or approval of any insurance will not relieve the Contractor from any liability or obligation imposed by the Contract Documents. The Contractor is responsible for the Work and for all materials, tools, equipment, appliances appliances, and property used in connection with the Work. The Contractor assumes all risks for direct and indirect damage or injury to the property used or persons employed in connection with the Work and for of all damage or injury to any person or property, wherever located, resulting from any action, omission, commission commission, or operation under the Contract or in connection in any way whatsoever with the Work. The Contractor’s insurance shall be the primary non-contributory insurance for any work performed under this Contract. The Contractor is as fully responsible to the County for the acts and omissions of its subcontractors and of persons employed by them as it is for acts and omissions of persons whom the Contractor employs directly.

Contract Identification. All insurance certificates must state this Contract's number and title. The Contractor must disclose to the County the amount of any deductible or self-insurance component of any of the required policies. With the County’s approval, the Contractor may satisfy its obligations under this section by self-insurance for all or any part of the insurance required, provided that the Contractor can demonstrate sufficient financial capacity. In order to do so, the Contractor must provide the County with its most recent actuarial report and a copy of its self-insurance resolution. The County may request additional information to determine if the Contractor has the financial capacity to meet its obligations under a deductible and may require a lower deductible, that ; funds equal to the deductible be placed in escrow, ; a certificate of self-insurance, ; collateral, ; or another mechanism to guarantee the amount of the deductible and ensure protection for the County. The County’s acceptance or approval of any insurance will not relieve the Contractor from any liability or obligation imposed by the Contract Documents. The Contractor is responsible for the Work and for all materials, tools, equipment, appliances appliances, and property used in connection with the Work. The Contractor assumes all risks for direct and indirect damage or injury to the property used or persons employed in connection with the Work and for of all damage or injury to any person or property, wherever located, resulting from any action, omission, commission commission, or operation under the Contract or in connection in any way whatsoever with the Work. The Contractor’s insurance shall be the primary non-contributory insurance for any work performed under this Contract. The Contractor is as fully responsible to the County for the acts and omissions of its subcontractors and of persons employed by them as it is for acts and omissions of persons whom the Contractor employs directly.. WITNESS these signatures: THE COUNTY BOARD OF ARLINGTON COMMUNITY RESIDENCES, INC. DBA CRI COUNTY, VIRGINIA AUTHORIZED AUTHORIZED SIGNATURE: SIGNATURE: NAME: ▇▇. ▇▇▇▇▇▇ ▇. Lewis NAME: ▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇▇ TITLE: Purchasing Agent TITLE: President and CEO DATE: 10/8/2021 DATE: 10/8/2021 EXHIBIT A SCOPE OF SERVICES‌ The Contractor is responsible for the following:

Contract Identification. All insurance certificates must state this Contract's number and title. The Contractor must disclose to the County the amount of any deductible or self-insurance component of any of the required policies. With the County’s approval, the Contractor may satisfy its obligations under this section by self-insurance for all or any part of the insurance required, provided that the Contractor can demonstrate sufficient financial capacity. In order to do so, the Contractor must provide the County with its most recent actuarial report and a copy of its self-insurance resolution. The County may request additional information to determine if the Contractor has the financial capacity to meet its obligations under a deductible and may require a lower deductible, ; that funds equal to the deductible be placed in escrow, ; a certificate of self-insurance, ; collateral, ; or another mechanism to guarantee the amount of the deductible and ensure protection for the County. The County’s acceptance or approval of any insurance will not relieve the Contractor from any liability or obligation imposed by the Contract Documents. The Contractor is responsible for the Work and for all materials, tools, equipment, appliances and property used in connection with the Work. The Contractor assumes all risks for direct and indirect damage or injury to the property used or persons employed in connection with the Work and for of all damage or injury to any person or property, wherever located, resulting from any action, omission, commission or operation under the Contract or in connection in any way whatsoever with the Work. The Contractor’s insurance shall be the primary non-contributory insurance for any work performed under this Contract. The Contractor is as fully responsible to the County for the acts and omissions of its subcontractors and of persons employed by them as it is for acts and omissions of persons whom the Contractor employs directly. WITNESS these signatures: THE COUNTY BOARD OF ARLINGTON ▇▇▇▇ ▇▇▇▇▇▇ MACHT, INC. COUNTY, VIRGINIA AUTHORIZED AUTHORIZED SIGNATURE: SIGNATURE: ▇▇▇▇▇ ▇▇▇▇▇▇ NAME: ▇▇. ▇▇▇▇▇▇ ▇. LEWIS NAME: TITLE: PURCHASING AGENT TITLE: Principal DATE: 10/19/2022 DATE: 10/19/2022 EXHIBIT A SCOPE OF SERVICES‌ The Contractor shall be solely responsible for any Work performed under this Contract by its consultants, associates, or subcontractors.