HomeMy WebLinkAboutRequest to Purchase - RenewGRANT COUNTY
COMMISSIONERS AGENDA MEETING REQUEST FORM
(Must be submitted to the Clerk of the Board by 12:00pm on Thursday)
REQUESTING DEPARTMENT: Renew
REQUEST SUBMITTED BY.. Sarah Nelson
DATE: 1 /23/24
PHONE: 509-765-9239
CONTACT PERSON ATTENDING ROUNDTABLE:Dell Anderson
CONFIDENTIAL INFORMATION: ®YES El NO
DAgreement / Contract
D Bids / RFPs / Quotes Award
El Computer Related
El Facilities Related
*Invoices / Purchase Orders
ElMinutes
1:1 Policies
7 Recommendation
[]Tax Levies
DAP Vouchers
013id Opening Scheduled
[:]County Code
F-1 Financial
DGrants — Fed/State/County
El Ordinances
El Proclamations
OProfessional Serv/Consultant
OThank You's
OAppointment / Reappointment
OARPA Related
E-1 Boards / Committees
D Budget
F Emergency Purchase
El Employee Rel.
El Funds
11 Hearing
Ell -eases
E] MOA / MOU
El Out of State Travel
El Petty Cash
ORequest for Purchase
0 Resolution
0 Support Letter
E]Surplus Req.
[]Tax Title Property
E1WSLCB
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Request to approve insurance quote from Admiral Insurance Company for Medical
Professional Liability Insurance coverage for Kyleigh Sanchez, ARNP
Total Cost - $5,360.25 from Fund 108.150.00-0000-564004600
DATE OF ACTION:_1 C 50.7-4 DEFERRED OR CONTINUED TO:
APPROVE: DENIED ABSTAIN
D1:
D2:
D3: T-11
INET --IED
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C -,RANT COUNTYcomifw,,Qmw
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a Berkley Company
A.M. Best Rating: A+ (Superior)
Subject: GRANT COUNTY
DBA: RENEW - GRANT BEHAVIORAL
HEALTH AND WELLNESS
Date: 01/08/2024
Financial Size Category: XV
Reference: 049GJW 002
Renewal Of: E0000059092-01
Carrier: Admiral Insurance Company
Minimum Retained Premium: 25% Minimum Retained at Inception
This quotation will expire on 02/08/2024 This quotation may not include all terms and conditions requested.
FM5110 (07/20) Page 1 of 2
QUOTE
Coverage Medical Professional Liability
(Claims
Made)
Business Service: Outpatient community health clinic providing
mental health counseling and medication management ONLY
Limits of Liability:
Professional Liability (PL) Each Claim
$1,000,000
Aggregate
$3,000,000
Sexual Abuse Each Claim
$100,000
Aggregate
$300,000
Claim Expenses Aggregate Limit
$1,000,000
Additional Coverages:
ier�r wirer r
Each Claim
Aggregate
Network Security & Data Privacy Liability
$1,000,000
$1,000,000
First Party Privacy Breach Expenses
$100,000
$100,000
Media Activities
$25,000
$25,000
Regulatory Wrongful Acts
$25,000
$25,000
H I PAA
License Defense
$250, 000
$5,000
$250,000
$25,000
Peer Review Expenses
$5,000
$25,000
Subpoena Assistance
$5,000
$5,000
Reimbursement of Lost Wages or Earnings
$500
$5,000
Reputation Protection Coverage
$5,000
$5,000
Emergency Evacuation Expenses
$25,000
$25,000
Patient Property Damage
$500
$500
Policy Aggregate Limit: $3,000,000
PL Deductible: $2,500
Per Claim - Including Expenses
PL Retroactive Date: 02/08/2023
Premium: $5,000
Flat Rate
Minimum Retained Premium: 25% Minimum Retained at Inception
This quotation will expire on 02/08/2024 This quotation may not include all terms and conditions requested.
FM5110 (07/20) Page 1 of 2
i% % i /
two.
Grant County
PO Box 37
Ephrata, WA 98823
% $ 51360.25
Invoice#647788
E0000059092-02
/
Please detach and return with payment
Thank ank ou
Customer: Grant County
Policy #E0000059092-02 02/08/2024-02/08/2025
Admiral Insurance Company
647788 02/08/2024 Renew policy
Professional Liability - Renew policy
Stamping Fee
5,000.00
Broker Fee
5.25
Surplus Lines Tax
250.00
105.00
PAYMENT DUE UPON RECEIPT. THANK YOU FOR YOUR
BUSINESS! If you have any questions please feel free to
contact our office directly.
Due Date: 2/8/2024
5,360.25
om
Thank
9. i.a n n You
Trask Insurance
Attn: Acct West 2 PO Box 1788
(509)765-0241 % ��� -%
Grand Rapids, MI 49501-1788
mail@traskinsurance.com 01/23/2024