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HomeMy WebLinkAboutPsychologie Clinique S.C. CITY OF OSHKOSH LEGAL DEPARTMENT 215 CHURCH AVENUE, P.O. BOX 1130, OSHKOSH, WI 54903-1130 PHONE: (920) 236-5115 FAX(920) 236-5106 LETTER OF TRANSMITTAL To: Psychologie Clinique SC Date: March 4, 2014 130 E. Walnut Street, Suite 410 Project: N/A Green Bay, WI 54301 From: Carol Marchant, Admin. Assistant Re: Employment Psychological Attn: Valerie De Lain Assessments Agreement Please find: ® Attached ❑ Under Separate Cover ❑ Copy of Letter ® Agreement ❑ Amendment ❑ Report ❑ Agenda El Meeting Notes ❑ Photos ❑ Mylars ❑ Change Order ❑ Plans ❑ Specifications ❑ Estimates ❑ Diskette ❑ Zip Disk ❑ Other Quantity Description 1 Original of the Agreement for Employment Psychological Assessments These are being transmitted as indicated below: ❑ For Approval ® For Your Use ❑ As Requested ❑ For Review&Comment Remarks: cc: City Clerk (original) Human Resources (copy) City Attorney (copy) RECEIVED OR p 2-°4 ,SpFFid CI TY CLEF AGREEMENT / p THIS AGREEMENT, made on the / 0 day of February, 2014, by and between the CITY of OSHKOSH, hereinafter referred to as CITY, and Psychologie Clinique, S.C., 130 E. Walnut Street, Suite 410, Green Bay, WI 54301, hereinafter referred to as the CONSULTANT. WITNESSETH: That the CITY and the CONSULTANT, for the consideration hereinafter named, enter into the following Agreement for CONSULTANT to provide post-conditional offer of employment psychological assessments on an as needed basis for the CITY. ARTICLE I. CONSULTANT'S REPRESENTATIVE A. The contact person designated for the CONSULTANT for purposes of this Agreement shall be: Valerie De Lain, PhD B. Dr. DeLain shall personally perform all assessments and shall oversee the provision of all reports or other documents required or requested under this Agreement. ARTICLE II. CITY REPRESENTATIVE The CITY shall assign the following individual to manage this Agreement: Ms. Sue Brinkman, HR Manager ARTICLE III. SCOPE OF WORK The CONSULTANT shall provide post-conditional offer of employment psychological assessments on an as needed basis for CITY. The Assessments shall include at least the following methods: Clinical Interview Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Personality Assessment Inventory (PAI) California Personality Inventory (CPI) Collateral Information provided by the City of Oshkosh (Employment Application, Background Report, and other assessment reports) Page 1 of 4 CONSULTANT shall provide a verbal report within 24 hours of assessment followed up by a written report within one week of assessment. The signed written report should contain at least the following: Method of Assessment Relevant Background Information Behavioral Observations and Evaluation Procedures Test Results/Emotional Stability and Suitability of Employment Summary and Recommendations The CONSULTANT may provide additional products and/or services if such products/services are requested in writing by the Authorized Representative of the CITY. ARTICLE IV. STANDARD OF CARE The standard of care applicable to CONSULTANT's Services will be the degree of skill and diligence normally employed by professional CONSULTANTs or consultants performing the same or similar Services at the time said services are performed. ARTICLE V. CITY RESPONSIBILITIES The CITY shall schedule post-conditional offer of employment psychological assessments by phone with Valerie De Lain, PhD. ARTICLE VI. PAYMENT The CITY shall pay to the CONSULTANT four hundred fifty dollars ($450.00) per report. The amount of this fee shall not change for the term of this Agreement. The CONSULTANT shall submit itemized monthly statements for services. The CITY shall pay the CONSULTANT within 30 calendar days after receipt of such statement. If any statement amount is disputed, the CITY may withhold payment of such amount and shall provide to CONSULTANT a statement as to the reason(s) for withholding payment. Additional Costs. Costs for additional services shall be negotiated and set forth in a written amendment or addendum to this Agreement signed by both parties. Additional costs shall be billed and paid in the same manner as provided above. Page 2 of 4 ARTICLE VII. CONSULTANT TO HOLD CITY HARMLESS The CONSULTANT covenants and agrees to protect and hold the City of Oshkosh, its officials and employees harmless against all actions, claims, and demands which may be to the proportionate extent caused by or result from the intentional or negligent acts of the CONSULTANT, its agents or assigns, or employees, related however remotely to the performance of this Agreement or be caused or result from any violation of any law or administrative regulation, and shall indemnify or refund to the CITY all sums including court costs, attorney fees, and punitive damages which the CITY may be obliged or adjudged to pay on any such claims or demands within thirty (30) days of the date of the CITY's written demand for indemnification or refund for those actions, claim, and demands caused by or resulting from intentional or negligent acts as specified in this paragraph. ARTICLE VIII. INSURANCE The CONSULTANT agrees to abide by the attached City of Oshkosh Insurance Requirements for Professional Services. ARTICLE IX. TERM This Agreement shall commence upon the date indicated in the first paragraph herein and shall terminate on December 31, 2014 unless terminated earlier by one of the parties as provided in Article X. ARTICLE X. TERMINATION A. For Cause. If the CONSULTANT shall fail to fulfill in timely and proper manner any of the obligations under this Agreement, the CITY shall have the right to terminate this Agreement by written notice to the CONSULTANT. In this event, the CONSULTANT shall be entitled to compensation for any satisfactory work completed. B. For Convenience. The CITY may terminate this Agreement at any time by giving written notice to the CONSULTANT no later than 30 calendar days before the termination date. If the CITY terminates under this paragraph, then the CONSULTANT shall be entitled to compensation for any satisfactory work performed to the date of termination. Page 3 of 4 ARTICLE XI. AMENDMENTS/ADDENDUMS This document and any specified attachments contain all terms and conditions of the Agreement and any alteration thereto shall be invalid unless made in writing, signed by both parties and incorporated as an amendment or addendum to this Agreement. ARTICLE XII. NO THIRD-PARTY BENEFICIARIES This AGREEMENT gives no rights or benefits to anyone other than CITY and CONSULTANT and has no third-party beneficiaries. In the Presence of: CONSULTANT PSYCHOLOGIE CLINIQUE, S.C. By: AT 4 • Vq. !♦.r _ , alerie De Lain, Managing Member (Seal of Consultant if a Corporation.) CITY OF OSHKOSH Wc L Ci By: 471>°'1444 (Witness) Mark A. Rohloff, City Manager •OA w And: Cf./6 7 j) ►�itness) Pamela R. Ubrig, City Clerk APPROVED: I hereby certify that the necessary provisions ' have been made to pay the liability which which will accrue under this Agreement. 11P-11, /Li& littio ity Atto‘"M 4\Ade) \/30(\ailt. City Comptr er AGie �' Page 4 of 4 ACOREP CERTIFICATE OF LIABILITY INSURANCE 0402/0 3"'"' 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 CONTACT NAME:Trust Risk Management Services,Inc. Trust Risk Management Services,Inc.doing business in Wias Potomac PHONE (NC 9 9 (AIC,No,Est):877.637.9700 (AIC,No►: 877.251.5111 Risk Management Services,Inc. EMA9. 1791 Paysphere Circle ADDRESS:infoelrustrn s.00m Chicago,IL 60674 INSURER(S)AFFORDING COVERAGE NAIC X INSURER A:ACE American Insurance Company 22667 INSURED INSURER B: Psychologie Clinique,S.C. INSURER C: 130 E Walnut St Ste 410 Green Bay,WI 54301 4231 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 ADDL SUER POUCY EFF POUCY EXP LTR TYPE OF INSURANCE INSR WVD POUCY NUMBER (MIA/DO/WY) IMMIDDIYW) UMITS GENERAL LIABILITY EACH OCCURRENCE $ — COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES(Ea occurrence) CLAIMS MADE OCCUR MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEN'SETML AGGREGATE LIMIT APPUES PRODUCTSS€COMP/OP AGO $ PRO- $ POLICY JECT II LOC AUTOMOBILE LIABILITY COMBINED SINGLE UMIT $ (Ea accident) _ ANY AUTO BODILY INJURY(Per Person) $ ALL OWNED SCHEDULED — $ AUTOS _AUTOS BODILY INJURY(Per accident) HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ — EXCESS LIAR CLAIMS-MADE AGGREGATE DED RETENTION$ $ WORKERS COMPENSATION I WC STATU 0TH- $ AND EMPLOYERS LIABILITY YIN TORY UMITS ER ANYPROPRIETORIPARTNER/EXECUTIVE N/A E.LEACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L DISEASE-EA EMPLOYEE $ (Mandatory InNH) If yes,describe under $ DESCRIPTION OF OPERATIONS ow E.L DISEASE-POLICY UMIT bel Psychologists Professional 68G22318196 05/23/2013 05/23/2014 Each incident $1,000,000 A Liability Annual aggregate $3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DEUVERED IN ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATIVE ACORD25(2010105) A© 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD