Exclusion Lists Screening. School shall screen all of its current and prospective owners, legal entities, officers, directors, employees, contractors, and agents (“Screened Persons”) against (a) the United States Department of Health and Human Services/Office of Inspector General List of Excluded Individuals/Entities (available through the Internet at xxxx://xxx.xxx.xxx.xxx), (b) the General Services Administration’s System for Award Management (available through the Internet at xxxx://xxx.xxx.gov); and (c) any applicable state healthcare exclusion list (collectively, the “Exclusion Lists”) to ensure that none of the Screened Persons are currently excluded, debarred, suspended, or otherwise ineligible to participate in Federal healthcare programs or in Federal procurement or nonprocurement programs, or have been convicted of a criminal offense that falls within the ambit of 42 U.S.C. § 1320a-7(a), but have not yet been excluded, debarred, suspended, or otherwise declared ineligible (each, an “Ineligible Person”). If, at any time during the term of this Agreement any Screened Person becomes an Ineligible Person or proposed to be an Ineligible Person, School shall immediately notify Hospital of the same. Screened Persons shall not include any employee, contractor or agent who is not providing services under this Agreement. Signatures on following page Doctors Hospital of Manteca, Inc. dba Doctors Hospital of Manteca By: _ Name: Xxxxxxxx Xxxxxx, FACHE Title: Chief Executive Officer Date: Address: 0000 X. Xxxxx Xxxxxx Xxxxxxx, XX 00000 Xxxxxx-Las Positas Community College By: _ Name: Xxxxxxx X. Xxxxxxx Title: Vice Chancellor, Business Services Date: Address: 0000 Xxxxxx Xxxx Dublin, CA 94568 Attn: Xxxxxxx X. Xxxxxxx Vice Chancellor, Business Services EXHIBIT A STATEMENT OF RESPONSIBILITY For and in consideration of the benefit provided the undersigned in the form of experience in evaluation and treatment of patients of Doctors Hospital of Manteca (“Hospital”), the undersigned and his/her heirs, successors and/or assigns do hereby covenant and agree to assume all risks of, and be solely responsible for, any injury or loss sustained by the undersigned while participating in the Program operated by Xxxxxx-Las Positas Community College District (“School”) at Hospital unless such injury or loss arises solely out of Hospital’s gross negligence or willful misconduct. Dated this day of _ , 20 . Program Participant Witness EXHIBIT B
Appears in 1 contract
Samples: Affiliation Agreement
Exclusion Lists Screening. School shall screen all of its current and prospective owners, legal entities, officers, directors, employees, contractors, and agents (“Screened Persons”) against (a) the United States Department of Health and Human Services/Office of Inspector General List of Excluded Individuals/Entities (available through the Internet at xxxx://xxx.xxx.xxx.xxx), (b) the General Services Administration’s System for Award Management (available through the Internet at xxxx://xxx.xxx.gov); and (c) any applicable state healthcare exclusion list (collectively, the “Exclusion Lists”) to ensure that none of the Screened Persons are currently excluded, debarred, suspended, or otherwise ineligible to participate in Federal healthcare programs or in Federal procurement or nonprocurement programs, or have been convicted of a criminal offense that falls within the ambit of 42 U.S.C. § 1320a-7(a), but have not yet been excluded, debarred, suspended, or otherwise declared ineligible (each, an “Ineligible Person”). If, at any time during the term of this Agreement any Screened Person becomes an Ineligible Person or proposed to be an Ineligible Person, School shall immediately notify Hospital of the same. Screened Persons shall not include any employee, contractor or agent who is not providing services under this Agreement. Signatures on following page Doctors Hospital Xxxxx Hospitals Limited d/b/a The Hospitals of Manteca, Inc. dba Doctors Hospital of Manteca Providence By: _ Name: Xxxxxxxx Xxxxxx, FACHE X. Xxxxxx Title: Market Chief Executive Officer Date: Address: 0000 X. Xxxxxx Xxxxxx Xx Xxxx, Xxxxx Xxxxxx Xxxxxxx, XX 00000 Xxxxxx-Las Positas Community College Canutillo Independent School District By: _ Name: Xxxxxxx X. Xxxxxxx Xxxxxxxx Xxxxx Title: Vice Chancellor, Business Services Superintendent Date: Address: 0000 Xxxxxx Xxxxxxxx Xxxx DublinXx Xxxx, CA 94568 Attn: Xxxxxxx X. Xxxxxxx Vice Chancellor, Business Services Xxxxx 00000 EXHIBIT A STATEMENT OF RESPONSIBILITY For and in consideration of the benefit provided the undersigned in the form of experience in evaluation and treatment of patients of Doctors Hospital of Manteca (“Hospital”), the undersigned and his/her heirs, successors and/or assigns do hereby covenant and agree to assume all risks of, and be solely responsible for, any injury or loss sustained by the undersigned while participating in the Program operated by Xxxxxx-Las Positas Community College District (“School”) at Hospital unless such injury or loss arises solely out of Hospital’s gross negligence or willful misconduct. Dated this day of _ , 20 . Program Participant Witness EXHIBIT B
Appears in 1 contract
Samples: Affiliation Agreement
Exclusion Lists Screening. School shall screen all of its current and prospective owners, legal entities, officers, directors, employees, contractors, and agents (“Screened Persons”) against (a) the United States Department of Health and Human Services/Office of Inspector General List of Excluded Individuals/Entities (available through the Internet at xxxx://xxx.xxx.xxx.xxx), (b) the General Services Administration’s System for Award Management (available through the Internet at xxxx://xxx.xxx.gov); and (c) any applicable state healthcare exclusion list (collectively, the “Exclusion Lists”) to ensure that none of the Screened Persons are currently excluded, debarred, suspended, or otherwise ineligible to participate in Federal healthcare programs or in Federal procurement or nonprocurement programs, or have been convicted of a criminal offense that falls within the ambit of 42 U.S.C. § 1320a-7(a), but have not yet been excluded, debarred, suspended, or otherwise declared ineligible (each, an “Ineligible Person”). If, at any time during the term of this Agreement any Screened Person becomes an Ineligible Person or proposed to be an Ineligible Person, School shall immediately notify Hospital of the same. Screened Persons shall not include any employee, contractor or agent who is not providing services under this Agreement. Signatures on following page Doctors Hospital of Manteca, Inc. dba Doctors Hospital of Manteca XXXXX HOSPITALS LIMITED D/B/A THE HOSPITALS OF PROVIDENCE By: _ Name: Xxxxxxxx Xxxxxx, FACHE X. Xxxxxx Title: Market Chief Executive Officer Date: Address: 0000 X. Xxxxxx Xxxxxx Xx Xxxx, Xxxxx Xxxxxx Xxxxxxx, XX 00000 Xxxxxx-Las Positas Community College CANUTILLO INDEPENDENT SCHOOL DISTRICT By: _ Name: Xxxxxxx X. Xxxxxxx Xxxxxxxx Xxxxx Title: Vice Chancellor, Business Services Superintendent Date: Address: 0000 Xxxxxx Xxxxxxxx Xxxx DublinXx Xxxx, CA 94568 Attn: Xxxxxxx X. Xxxxxxx Vice Chancellor, Business Services Xxxxx 00000 EXHIBIT A STATEMENT OF RESPONSIBILITY For and in consideration of the benefit provided the undersigned in the form of experience in evaluation and treatment of patients of Doctors Hospital of Manteca (“Hospital”), the undersigned and his/her heirs, successors and/or assigns do hereby covenant and agree to assume all risks of, and be solely responsible for, any injury or loss sustained by the undersigned while participating in the Program operated by Xxxxxx-Las Positas Community College District (“School”) at Hospital unless such injury or loss arises solely out of Hospital’s gross negligence or willful misconduct. Dated this day of _ , 20 . Program Participant Witness EXHIBIT B
Appears in 1 contract
Samples: Affiliation Agreement
Exclusion Lists Screening. School shall screen all of its current and prospective owners, legal entities, officers, directors, employees, contractors, and agents (“Screened Persons”) against (a) the United States Department of Health and Human Services/Office of Inspector General List of Excluded Individuals/Entities (available through the Internet at xxxx://xxx.xxx.xxx.xxx), (b) the General Services Administration’s System for Award Management (available through the Internet at xxxx://xxx.xxx.gov); and (c) any applicable state healthcare exclusion list (collectively, the “Exclusion Lists”) to ensure that none of the Screened Persons are currently excluded, debarred, suspended, or otherwise ineligible to participate in Federal healthcare programs or in Federal procurement or nonprocurement programs, or have been convicted of a criminal offense that falls within the ambit of 42 U.S.C. § 1320a-7(a), but have not yet been excluded, debarred, suspended, or otherwise declared ineligible (each, an “Ineligible Person”). If, at any time during the term of this Agreement any Screened Person becomes an Ineligible Person or proposed to be an Ineligible Person, School shall immediately notify Hospital of the same. Screened Persons shall not include any employee, contractor or agent who is not providing services under this Agreement. Signatures on following page Doctors Hospital Medical Center of MantecaModesto, Inc. dba Doctors Hospital of Manteca Medical Center: By: _ Name: Xxxxxxxx Xxxxxx, FACHE Xxxxxx Xxxx Title: Chief Executive Officer Date: Address: 0000 X. Xxxxx Xxxxxxx Xxxxxx Xxxxxxx, XX 00000 Xxxxxx-Las Positas Community College District dba Las Positas College: By: _ Name: Xxxxxxx X. Xxxx Xxxxxxx Title: Vice Chancellor, Business Services Date: Address: 0000 Xxxxxx Xxxx DublinXxxxxx, CA 94568 Attn: Xxxxxxx X. Xxxxxxx Vice Chancellor, Business Services Xx 00000 EXHIBIT A STATEMENT OF RESPONSIBILITY For and in consideration of the benefit provided the undersigned in the form of experience in evaluation and treatment of patients of Doctors Hospital of Manteca Medical Center (“Hospital”), the undersigned and his/her heirs, successors and/or assigns do hereby covenant and agree to assume all risks of, and be solely responsible for, any injury or loss sustained by the undersigned while participating in the Program operated by Xxxxxx-Las Positas Community College District (“School”) at Hospital unless such injury or loss arises solely out of Hospital’s gross negligence or willful misconduct. Dated this day of _ , 20 . Program Participant Witness EXHIBIT BB CONFIDENTIALITY STATEMENT The undersigned hereby acknowledges his/her responsibility under applicable federal law and the Agreement between Las Positas College (“School”) and Doctors Medical Center (“Hospital”), to keep confidential any information regarding Hospital patients and proprietary information of Hospital. The undersigned agrees, under penalty of law, not to reveal to any person or persons except authorized clinical staff and associated personnel any specific information regarding any patient and further agrees not to reveal to any third party any confidential information of Hospital, except as required by law or as authorized by Hospital. The undersigned agrees to comply with any patient information privacy policies and procedures of the School and Hospital. The undersigned further acknowledges that he or she has viewed a videotape regarding Hospital’s patient information privacy practices in its entirety and has had an opportunity to ask questions regarding Hospital’s and School’s privacy policies and procedures and privacy practices. Dated this day of _ , 20 . Program Participant
Appears in 1 contract
Samples: Affiliation Agreement
Exclusion Lists Screening. School shall screen all of its current and prospective owners, legal entities, officers, directors, employees, contractors, and agents (“Screened Persons”) against (a) the United States Department of Health and Human Services/Office of Inspector General List of Excluded Individuals/Entities (available through the Internet at xxxx://xxx.xxx.xxx.xxx), (b) the General Services Administration’s System for Award Management (available through the Internet at xxxx://xxx.xxx.gov); and (c) any applicable state healthcare exclusion list (collectively, the “Exclusion Lists”) to ensure that none of the Screened Persons are currently excluded, debarred, suspended, or otherwise ineligible to participate in Federal healthcare programs or in Federal procurement or nonprocurement programs, or have been convicted of a criminal offense that falls within the ambit of 42 U.S.C. § 1320a-7(a), but have not yet been excluded, debarred, suspended, or otherwise declared ineligible (each, an “Ineligible Person”). If, at any time during the term of this Agreement any Screened Person becomes an Ineligible Person or proposed to be an Ineligible Person, School shall immediately notify Hospital of the same. Screened Persons shall not include any employee, contractor or agent who is not providing services under this Agreement. Signatures on following page Doctors Hospital Medical Center of MantecaModesto, Inc. dba d/b/a Doctors Hospital of Manteca Medical Center By: _ Name: Xxxxxxxx Xxxxxx, FACHE Xxx Xxxxxxxxxxxx Title: Chief Executive Officer President Date: Address: 0000 X. Xxxxx Xxxxxxx Xxxxxx XxxxxxxModesto, XX 00000 CA 95352 Xxxxxx-Las Positas Community College District d/b/a Xxxxxx College and/or Las Positas College By: _ Name: Xxxxxxx X. Xxxxxxx Title: Vice Chancellor, Business Services Date: Address: 0000 Xxxxxx Xxxx Xxxx., 0xx Floor Dublin, CA 94568 Attn: Xxxxxxx X. Xxxxxxx Vice Chancellor, Business Services EXHIBIT A STATEMENT OF RESPONSIBILITY For and in consideration of the benefit provided the undersigned in the form of experience in evaluation and treatment of patients of Doctors Hospital of Manteca Medical Center (“Hospital”), the undersigned and his/her heirs, successors and/or assigns do hereby covenant and agree to assume all risks of, and be solely responsible for, any injury or loss sustained by the undersigned while participating in the Program operated by Xxxxxx-Las Positas Community College District dba Xxxxxx College and/or Las Positas College (“School”) at Hospital unless such injury or loss arises solely out of Hospital’s gross negligence or willful misconduct. Dated this day of _ , 20 . Program Participant Witness EXHIBIT B
Appears in 1 contract
Samples: Affiliation Agreement
