Agenda Item
i. Contract Renewal and Ratification- Medical Review Officer Services- Caduceus USA Medical Services, LLC - Contract Renewal #4 of 4 (Not to Exceed $200,000)
Summary: Presented by: Mr. Erick Hofstetter, Chief Operating Officer, Division of Operations
Request: It is requested that the DeKalb County Board of Education approve the contract renewal (and ratification) with Caduceus USA Medical Services, LLC for an additional year through June 30, 2025, for a not to exceed amount of $200,000 for occupational medical services. This is the fourth and final (#4 of 4) one (1) year renewal option.
Why: Renewal of the contract with Caduceus USA Medical Services, LLC will ensure compliance with Federal Motor Carrier Safety Administration's (FMCSA) regulation of Drug and Alcohol Testing 49 CFR 382 and the Georgia Department of Education's physical requirements. This ensures that safety-sensitive positions such as DCSD school bus drivers are in compliance with State and Federal regulations.
Approval of the contract renewal meets Strategic Goal Area 6: Organizational Excellence
Details: On June 8, 2020, the Board of Education approved the contract award with Caduceus USA Medical Services, LLC to provide occupational medical services through one vendor. Previously, the services were provided by three (3) separate vendors.
This is the fourth and final (#4 of 4) one (1) year renewal option remaining on the contract.
Financial impact: Occupational medical services will be charged from charge code 100.2700.530000.00011.7100.1320.8012.040.0000, for a not to exceed amount of $200,000.
Contact: Mr. Erick Hofstetter, Chief Operating Officer, Division of Operations, 678-676-1447
Mr. Bernando C. Brown, Director Student Transportation, Division of Operations, 678.875.0090
Effective: Upon Board Approval
Status: Approved by the Office of Legal Affairs
DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 6/28/2024
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(ies) must have ADDITIONAL INSURED provisions or 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).
CONTACT
PRODUCER
NAME: Casey Carpenter
Sterling Seacrest Pritchard, Inc. PHONE FAX
2500 Cumberland Pkwy Se (A/C, No, Ext): 770-635-0444 (A/C, No):
E-MAIL
Ste 400 ADDRESS: ccarpenter@sspins.com
Atlanta GA 30339 INSURER(S) AFFORDING COVERAGE NAIC #
License#: 70726 INSURER A : The Doctor's Co.
INSURED CADUOCC-01
INSURER B :
Caduceus Occupational Medicine, LLC
535 North Central Avenue INSURER C :
Hapeville GA 30354 INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: 1082131230 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 SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
DAMAGE TO RENTED
CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
PRO-
POLICY JECT LOC PRODUCTS - COMP/OP AGG $
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
(Ea accident)
ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY (Per accident)
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS' LIABILITY STATUTE ER
Y/N
ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A Professional Liability - 1247020 7/1/2024 7/1/2025 Each Claim: $1,000,000
Claims Made Aggregate: $3,000,000
Retroactive Date: 07/01/2002
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
See Attached...
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
FOR INFORMATIONAL PURPOSES
USA AUTHORIZED REPRESENTATIVE
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: CADUOCC-01
LOC #:
ADDITIONAL REMARKS SCHEDULE Page 1 of 1
AGENCY NAMED INSURED
Sterling Seacrest Pritchard, Inc. Caduceus Occupational Medicine, LLC
535 North Central Avenue
POLICY NUMBER Hapeville GA 30354
CARRIER NAIC CODE
EFFECTIVE DATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
Schedule of Named Insureds:
Caduceus Telemed, LLC; Retroactive Date: 02/01/2018
Robin R Armenia DO; Retroactive Date: 01/01/2021
Brandon Dawkins MD; Retroactive Date: 06/27/2016
Stephen A Dawkins MD; Retroactive Date: 07/01/2002
Sateesh R Devagupthapu MD; Retroactive Date: 05/01/2023
Kelly Dixon-Martin, MD; Retroactive Date: 7/5/2023
Eric H Gruenberger MD; Retroactive Date: 03/03/2023
Rita Livingston, MD; Retroactive Date: 3/11/2024
Judith L Tharp MD; Retroactive Date: 09/30/2019
Schedule of Additional Insureds:
Work Comp Surgeons LLC; Retroactive Date - 10/01/2018
Karen Beach, NP - Retroactive Date: 8/15/2001
Binh Bui-Oliver, NP - Retroactive Date: 2/3/2014
Demetrius Steele, NP - Retroactive Date: 11/27/2017
Esther Iwotor, NP - Retroactive Date: 4/11/2022
Judith Klingensmith, NP - Retroactive Date: 8/31/2022
Steve Munoz, PA - Retroactive Date: 6/26/2023
Annette Sanders, NP - Retroactive Date: 6/1/2022
Krishna Tah, PA - Retroactive Date: 8/22/2022
Herretta Pickens, NP - Retroactive Date: 5/23/2023
Shantorius Stacks, NP - Retroactive Date: 5/23/2023
Sequoyah Brown, NP- Retroactive Date: 1/22/2024
Rima Momin, PA - Retroactive Date: 6/5/2024
Jessica Vargas, NP- Retroactive Date - 6/17/24
Malachi Hutto, PA- Retroactive Date - 6/10/24
Additional Insureds share in the Limits of Liability with Caduceus Occupational Medicine, LLC (Named Insured).
Course and Scope Limitation: Sateesh R Devagupthapu MD; Eric H Gruenberger MD; Kelly Dixon-Martin, MD
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD