ECC Board of Trustees

Executive Summary

Date: April 28, 2016

Subcommittee: Consent Agenda

Agenda Item: Affiliation Agreements requested by the ECC Division of Health Sciences with the Clinical Sites of Associated Physicians of WNY, P.C.; Aurora Optometric Group; and Heritage Christian Services, Inc.

This item is for: For Board's Approval Backup Documentation: Attached to this document

Background Information:

In order to provide students with needed competencies and standards of proficiency required for

degree completion, the ECC Health Sciences Division requests clinical Affiliation Agreements with the

sites: Associated Physicians of NY, P.C.; Aurora Optometric Group; and Heritage Christian Services, Inc.

Reasons for Recommendation:

To provide students access to required clinical, technical and educational experience and training

directly related to the successful completion of curricula.

Fiscal Implications:

Required course(s) for student graduation.

Consequences of Negative Action:

Students would not have access to required clinical learning experiences.

Steps Following Approval:

Review and approval by the ECC legal counsel.

Contact Information If Any Questions:

Richard C. Washousky, Executive Vice President of Academic Affairs, North Campus

Phone: (716) 851-1500 / E-Mail: washousky@ecc.edu

Patrick J. Wiles, Associate Vice President of Health Sciences, North Campus

Phone: (716) 851-1901 / Email: wiles@ecc.edu

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Erie Community College Affiliation Agreement This agreement is made as ofthis 4th day of March, 2016, by and between ERIE

COMMUNITY COLLEGE, an educational institution part of a municipal corporation of the State of

New York, namely, the County of Erie [hereinafter referred to as "ECC"], and ASSOCIATED

PHYSICIANS OF WNY, P.C., an individual, partnership, limited liability company, corporation or

other organization doing business in the State of New York [hereinafter referred to as the "HOST"].

WITNESSETH

WHEREAS, ECC and the HOST are desirous of developing a program pursuant to which

ECC students may make use of some or all of the HOST's facilities for the purpose of enabling said

students to gain field clinical, technical and educational experience and training directly related to

and/or required for successful completion of the ECC courses or programs in which the students are

enrolled, and

WHEREAS, the HOST is willing to afford assigned ECC students access to the HOST's

facilities for such purpose, upon the terms and conditions set forth herein, and to accept said students

without regard to sex, race, color, disability, national and ethnic origin, age, sexual orientation,

religion or creed.

NOW, THEREFORE, ECC and the HOST, in consideration of the covenants contained

herein, hereby mutually agree and intend to be legally bound as follows:

1. The HOST will afford assigned ECC students access to the HOST's facilities, at the

location(s) identified in the Appendix(ces) annexed hereto, for the purpose of enabling said students to

gain field clinical, technical and educational experience and training directly related to and/or required

for successful completion of the ECC courses or programs in which the students are enrolled. Such

access shall include one or more meeting rooms or conference areas for the assigned ECC students

and the ECC faculty/instructors designated in the Appendix (ces).

Page I of 6

. • ! I

2. The HOST will make known to the designated ECC faculty/instructors all rules,

regulations and procedures of the HOST to be applicable to the assigned ECC students and ECC will

be responsible for ensuring that the assigned ECC students are informed as to such policies and of

their need to comply with same. The information provided by the HOST and explained by ECC

Faculty/Instructors to ECC Students will include information relevant to the HOST's policies and

procedures with regard to the Health Insurance Portability and Accountability Act (HIP AA).

3. The HOST will have the right to require the removal of any assigned ECC student or

designated ECC faculty/instructor who fails to comply with the HOST's rules, regulations and

procedures or whose condition or conduct jeopardizes the well-being or safety of any patient or

employee of the HOST or any other person.

4. ECC will instruct the assigned students as to their ethical and legal obligations relative to

confidentiality and to respect and preserve the presumptively confidential nature of all information

which the students may obtain while gaining field clinical, technical and educational experience and

training at the HOST's facilities, whether obtained from patients/significant others, another student,

any staff or records of the HOST or otherwise. ECC will include in this instruction of the students

specific reference to HIPP A and any special requirements of HIPP A relative to the student's training

at the HOST's facility.

5. ECC's designated faculty/instructors and assigned students shall not be deemed employees

of the HOST nor shall any monetary consideration be paid by or to the HOST relative to the field

clinical, technical and educational experience and training provided under this Agreement.

6. ECC will neither publish nor cause to be published any material related to the field clinical,

technical and educational experience and training provided under this Agreement without prior written

approval of the HOST.

7. The HOST will have the right to limit the number ofECC students who may be assigned

to participate in the field clinical, technical and educational experience and training to be provided

under this Agreement.

Page 2 of 6

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8. The designee ECC faculty/instructors and the HOST designee will jointly agree, as

indicated in the Appendix( ces ), in advance of each semester or other applicable student training

rotation, as to the number of students to be assigned by ECC and accepted by the HOST and as to the

specific dates, hours and facilities for upcoming field clinical, technical and educational experience

and training.

9. Except as otherwise specifically provided herein, including Appendix(ces), neither ECC

nor the HOST shall be financially responsible for expenses incurred by the assigned ECC students,

including, but not limited to, all housing, meals and transportation to and from ECC and/or the

HOST's facilities.

10. Insofar as may be required under applicable law or regulation, ECC will see to it that

every assigned ECC student has undergone a physical examination of sufficient scope so as to ensure

that the said students do not assume their duties at the HOST's facilities unless free from any health

impairment which poses a risk to patients or otherwise interferes with the performance of said duties.

11. The HOST will make emergency medical care available to any designated ECC faculty or

instructor or assigned ECC student who may become ill or incapacitated or who may be injured while

at the HOST's facilities. Said faculty, instructors and students shall be responsible for seeking and

obtaining all other emergency medical care.

12. ECC, through the county of Erie is largely self-insured with regard to automobile liability,

general liability, medical malpractice liability and workers' compensation matters. In the event that

the HOST receives notice of any claim arising out of or related to the field clinical, technical and

educational experience and training provided under this Agreement, the HOST will immediately give

notice thereof to ECC, through its designated faculty/instructor.

Page 3 of 6

_,.,,.

13. Notwithstanding its largely self-insured status, ECC does maintain a School Policy for

Healthcare Provider Students which affords $1 million each claim/$3 million aggregate professional

liability insurance coverage to those ECC students, and their ECC faculty and advisors, who provide

healthcare-related services. Where healthcare-related services are provided by assigned ECC students

at the HOST's facilities, ECC will cause an insurance certificate evidencing such coverage to be

issued to the HOST and will keep such coverage in place so long as ECC students are assigned to the

HOST's facilities.

14. During all time periods when ECC students are assigned to the HOST's facilities, the

HOST will maintain in force and effect policies of general liability, automobile liability, professional

liability and workers' compensation insurance. The HOST will also provide ECC with evidence of

such insurance coverages, on ACORD or equivalent insurance certificate forms, and copies of said

insurance certificates will be attached to this Agreement.

15. The HOST agrees to defend, indemnify and hold harmless ECC, to include the County of

Erie, and its agents and employees from and against all claims, damages, losses or causes of action

arising out of or resulting from actions or omissions, materials provided, services rendered or other

performance of or by the HOST, its agents, employees or volunteers, pursuant to this Agreement.

ECC, to include the County of Erie, agrees to defend, indemnify and hold harmless the HOST and its

agents and employees from and against all claims, damages, losses and causes of action arising out of

or resulting from actions or omissions, materials provided, services rendered or other performance of

or by ECC, its agents, employees or volunteers, pursuant to this Agreement.

16. With regard to any field clinical, technical and educational experience and training

involving the provision by assigned ECC students ofhealthcare services to patients:

A. The HOST will maintain overall supervision of all such patient care, including any

required medical direction.

B. A professional staff member ofthe HOST may intervene in such patient care at any time

and any manner deemed necessary, as dictated by the circumstances, so as to safeguard patient(s),

including without limitation the issuance of emergency medical direction to the ECC student(s) or

the resumption by the HOST of the provision of such care to patient(s).

Page 4 of 6

C. ECC students will be instructed to immediately request guidance and direction from

either a professional staff member of the HOST or an ECC faculty/instructor where the

student becomes unsure as to how to proceed with the care of a patient or where a patient's

condition appears to the student to require the immediate attention of a professional staff

member of the HOST.

D. The designated ECC faculty/instructors will provide orientation to the HOST's profess­

ional staff relative to the courses or programs in which the assigned ECC students are enroll­

ed and the students' previous field clinical, technical and educational experience and training.

E. The professional staff of the HOST will provide orientation to the designated ECC

faculty/instructors, and to the assigned ECC students, including without limitation the

HOST's procedures as to fire and safety evacuation, body substance isolation, safe use of

tools and equipment, permitted entry and exit points for the HOST's facilities, available locker

or changing rooms, restricted or prohibited access areas and any requirements as to attire or the

display of photo or other identification.

17. ECC and the HOST agree that each will comply with all applicable laws, rules, and

regulations with respect to the performance of this Agreement.

18. Except as may otherwise be set forth in the Appendix(ces), and unless sooner terminated

as set forth in paragraph "19", this Agreement will commence as of the date first written above, will

continue in full force and effect for a period of one (1) year and will thereafter continue in full force

and effect until terminated as set forth in said paragraph "19".

19. This Agreement may be terminated by either party for any reason upon ninety (90) days

prior written notice addressed to the other as set forth Appendix, provided, however, that no such

termination on the part of the HOST shall take effect prior to the conclusion of the student training

rotation during which such notice of termination is given.

20. This Agreement may be modified only upon the further mutual consent of ECC and the

HOST and then only by means of another writing, approved and executed in a similar fashion to the

approval and execution of this Agreement.

Page 5 of 6

21. This Agreement shall be governed by and construed in accordance with the laws of the

State of New York. The illegality or non-enforceability of any provision of this Agreement shall not

affect the validity of remaining provisions.

22. This Agreement supersedes all prior understandings and agreements between the parties,

both written and oral.

23. This Agreement may not be assigned in whole or in part without the prior written consent

of the parties.

ERIE COMMUNITY COLLEGE

By: Jack Quinn ECC President

Date: ----------------------

STATE OF NEW YORK COUNTY OF ERIE

ASSOCIA1ED PH~~~~NS 0~ WNY, P.C.

By: / -r ' .,-<.J · ;_xt?i/ -JJ~'> .· i rvc .. "cy.T· P-2-ters, f'-\;\:),, V. fh's•o-\en.+-

Date: 3 / ,)..yj lb

On the day of , before me personally came Jack Quinn, to me known to be the individual described in, and who, executed, the foregoing instrument and acknowledge that he executed the same.

p

I I Date '

APPROVED AS TO FORM:

By:

Executive Vice President, Legal Affairs

Date Doc.# -------------------

APPROVED AS TO CONTENT:

~e-t&f.~ arcm T. Bermel, D.M., M.S., MLS (ASCP), CMA

Professor/Department Head

Date

Page 6 of 6

Erie Community College Affiliation Agreement

This agreement is made as of this lOth day of March, 2016, by and between ERIE

COMMUNITY COLLEGE, an educational institution part of a municipal corporation of the State of

New York, namely, the County of Erie [hereinafter referred to as "ECC"], and Aurora Optometric

Group, 980 West Maple Court, Elma, NY 14059, an individual, partnership, limited liability

compaily, corporation or other organization doing business in the State ofNew York [hereinafter

referred to as the "HOST"].

WITNESSETH

WHEREAS, ECC and the HOST are desirous of developing a program pursuant to which

ECC students may make use of some or all of the HOST's facilities for the purpose of enabling said

students to gain field clinical, technical and educational experience and training directly related to

and/or required for success:fiJl completion of the ECC courses or progra..ms in which the students are

enrolled, and

WHEREAS, the HOST is willing to afford assigned ECC students access to the HOST's

facilities for such purpose, upon the terms and conditions set forth herein, and to accept said students

without regard to sex, race, color, disability, national and ethnic origin, age, sexual orientation,

religion or creed.

NOW, THEREFORE, ECC and the HOST, in consideration of the covenants contained

herein, hereby mutually agree and intend to be legally bound as follows:

1. The HOST will afford assigned ECC students access to the HOST's facilities, at the

location( s) identified in the Appendix( ces) annexed hereto, for the purpose of enabling said students to

gain field clinical, technical and educational experience and training directly related to and/or required

for successful completion of the ECC courses or programs in which the students are enrolled. Such

Page 1 of 6

. '

,,, ____ .. ,, ... , .... , ____________________________________ _

access shall include one or more meeting rooms or conference areas for the assigned ECC students

and the ECC faculty/instructors designated in the Appendix ( ces ).

2. The HOST will make known to the designated ECC faculty/instructors all rules,

regulations and procedures of the HOST to be applicable to the assigned ECC students and ECC will

be responsible for ensuring that the assigned ECC students are informed as to such policies and of

their need to comply with same. The information provided by the HOST and explained by ECC

Faculty/Instructors to ECC Students will include information relevant to the HOST's policies and

procedures with regard to the Health Insurance Portability and Accountability Act (HIP AA).

3. The HOST will have the right to require the removal of any assigned ECC student or

designated ECC faculty/instructor who fails to comply with the HOST's rules, regulations and

procedures or whose condition or conduct jeopardizes the well-being or safety of any patient or

employee of the HOST or any other person.

4. ECC will instruct the assigned students as to their ethical and legal obligations relative to

confidentiality and to respect and preserve the presumptively confidential nature of all information

which the students may obtain whiie gaining fieid ciinicai, technicai and educationai experience and

training at the HOST's facilities, whether obtained from patients/significant others, another student,

any staff or records of the HOST or otherwise. ECC will include in this instruction of the students

specific reference to HIPP A and any special requirements of HIPP A relative to the student's training

at the HOST's facility.

5. ECC's designated faculty/instructors and assigned students shall not be deemed employees

of the HOST nor shall any monetary consideration be paid by or to the HOST relative to the field

clinical, technical and educational experience and training provided under this Agreement.

6. ECC will neither publish nor cause to be published any material related to the field clinical,

technical and educational experience and training provided under this Agreement without prior written

approval of the HOST.

Page 2 of 6

. '

111111111111111111111111111 Ill 1111.11 •• 1 •• _, ______________________ _

7. The HOST will have the right to limit the number ofECC students who may be assigned

to participate in the field clinical, technical and educational experience and training to be provided

under this Agreement.

8. The designee ECC faculty/instructors and the HOST designee will jointly agree, as

indicated in the Appendix( ces ), in advance of each semester or other applicable student training

rotation, as to the number of students to be assigned by ECC and accepted by the HOST and as to the

specific dates, hours and facilities for upcoming field clinical, technical and educational experience

and training.

9. Except as otherwise specifically provided herein, including Appendix(ces), neither ECC

nor the HOST shall be financially responsible for expenses incurred by the assigned ECC students,

including, but not limited to, all housing, meals and transportation to and from ECC and/or the

HOST's facilities.

10. Insofar as may be required under applicable law or regulation, ECC will see to it that

every assigned ECC student has undergone a physical examination of sufficient scope so as to ensure

that the said students do not assume their duties at the HOST's facilities unless free from any health

impairment which poses a risk to patients or otherwise interferes with the performance of said duties.

11. The HOST will make emergency medical care available to any designated ECC faculty or

instructor or assigned ECC student who may become ill or incapacitated or who may be injured while

at the HOST's facilities. Said faculty, instructors and students shall be responsible for seeking and

obtaining all other emergency medical care.

12. ECC, through the county of Erie is largely self-insured with regard to automobile liability,

general liability, medical malpractice liability and workers' compensation matters. In the event that

the HOST receives notice of any claim arising out of or related to the field clinical, technical and

educational experience and training provided under this Agreement, the HOST will immediately give

notice thereof to ECC, through its designated faculty/instructor.

13. Notwithstanding its largely self-insured status, ECC does maintain a School Policy for

Healthcare Provider Students which affords $1 million each claim/$3 million aggregate professional

Page 3 of 6

liability insurance coverage to those ECC students, and their ECC faculty and advisors, who provide

healthcare-related services. Where healthcare-related services are provided by assigned ECC students

at the HOST's facilities, ECC will cause an insurance certificate evidencing such coverage to be

issued to the HOST and will keep such coverage in place so long as ECC students are assigned to the

HOST's facilities.

14. During all time periods when ECC students are assigned to the HOST's facilities, the

HOST will maintain in force and effect policies of general liability, automobile liability, professional

liability and workers' compensation insurance. The HOST will also provide ECC with evidence of

such insurance coverages, on ACORD or equivalent insurance certificate forms, and copies of said

insurance certificates will be attached to this Agreement.

15. The HOST agrees to defend, indemnify and hold harmless ECC, to include the County of

Erie, and its agents and employees from and against all claims, damages, losses or causes of action

arising out of or resulting from actions or omissions, materials provided, services rendered or other

performance of or by the HOST, its agents, employees or volunteers, pursuant to this Agreement.

ECC, to include the County of Erie, agrees to defend, indemnify and hold harmless the HOST and its

agents and employees from and against aii ciaims, damages, iosses and causes of action arising out of

or resulting from actions or omissions, materials provided, services rendered or other performance of

or by ECC, its agents, employees or volunteers, pursuant to this Agreement.

16. With regard to any field clinical, technical and educational experience and training

involving the provision by assigned ECC students ofhealthcare services to patients:

A. The HOST will maintain overall supervision of all such patient care, including any

required medical direction.

B. A professional staff member of the HOST may intervene in such patient care at any time

and any manner deemed necessary, as dictated by the circumstances, so as to safeguard patient(s),

including without limitation the issuance of emergency medical direction to the ECC student(s) or

the resumption by the HOST of the provision of such care to patient(s).

C. ECC students will be instructed to immediately request guidance and direction from

either a professional staff member of the HOST or an ECC faculty/instructor where the

student becomes unsure as to how to proceed with the care of a patient or where a patient's

Page 4 of 6

--------···-~-1-llll------------------------------------

.. condition appears to the student to require the immediate attention of a professional staff

member of the HOST.

D. The designated ECC faculty/instructors will provide orientation to the HOST's profess­

ional staff relative to the courses or programs in which the assigned ECC students are enroll­

ed and the students' previous field clinical, technical and educational experience and training.

E. The professional staff of the HOST will provide orientation to the designated ECC

faculty/instructors, and to the assigned ECC students, including without limitation the

HOST's procedures as to fire and safety evacuation, body substance isolation, safe use of

tools and equipment, permitted entry and exit points for the HOST's facilities, available locker

or changing rooms, restricted or prohibited access areas and any requirements as to attire or the

display of photo or other identification.

17. ECC and the HOST agree that each will comply with all applicable laws, rules, and

regulations with respect to the performance of this Agreement.

18. Except as may otherwise be set forth in the Appendix( ces ), and unless sooner terminated

as set forth in paragraph "19", this Agreement will commence as of the date first written above, will

continue in full force and effect for a period of one ( 1) year and will thereafter continue in full force

and effect until terminated as set forth in said paragraph "19".

19. This Agreement may be terminated by either party for any reason upon ninety (90) days

prior written notice addressed to the other as set forth Appendix, provided, however, that no such

termination on the part of the HOST shall take effect prior to the conclusion of the student training

rotation during which such notice of termination is given.

20. This Agreement may be modified only upon the further mutual consent ofECC and the

HOST and then only by means of another writing, approved and executed in a similar fashion to the

approval and execution of this Agreement.

21. This Agreement shall be governed by and construed in accordance with the laws of the

State of New York. The illegality or non-enforceability of any provision of this Agreement shall not

affect the validity of remaining provisions.

Page 5 of 6

< '

22. This Agreement supersedes all prior understandings and agreements between the parties,

both written and oral.

23. This Agreement may not be assigned in whole or in part witl;10ut the prior written consent

of the parties.

ERIE COMMUNITY COLLEGE

By: Jack Quinn ECC President

Date: ---------------------

STATE OF NEW YORK COUNTY OF ERIE

~ I I

Date: · .. 3/ f ~ { / ~

On the day of , before me personally came Jack Quinn, to me known to be the individual described in, and who, executed, the foregoing instrument and acknowledge that he executed the same.

Notary Public

APPROVED AS TO FORM:

By:

Date Doc.# __________________ _

Page 6 of 6

"' ··-· "'" ' ' ',,, ___ _ _......,...r_~ __ ........ ,_ ..... ---·· .. -· ACORD

8

CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDIYYYYI

~ 11/11/2015

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 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 ~2~I~CT Michele Steiner James F. Collins Agency, Inc. ~g_N:o. Exll:. (716) 652-4203

1 FAX .. llAIC, Noj: (716) 652-4205

~DMD~~ss: shelly@ jamesfcoliins. c:;;~ 450 Olean Road

PO Box 669 INSURER(S) AFFORDING COVERAGE ; NAIC. East Aurora NY 14052 INSURER A :Merchants Mutual ,23329 INSURED INSURER .. B: Aurora Optometric Group Pc II\ISI.J..Rf:f't C:

' 980 West Maple Court INSURERD: i .~!I~U.ItE:It. !: .. :. i

Elma NY 14059-9397 INSURERF: COVERAGES CERTIFICATE NUMBER·2015 master 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.

~~.r:r TYPE OF INSURANCE ~~~:~1~:! POUCY NUMBER , POLICY EFF 1 ,~g~J~~~~ . LIMITS

l;,t_Lc~~MERCIAL GENE~'::~_ lABILITY I ! : EACH occuRRENCE r 1 j DAMAGE-TO "R"EI'iTED

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f- j ·-·--· : PERSONAL & ADV INJURY i $

f-~E~'L AGGR~GATE LIMIT APr"'_l:I~,S PER ' GENERAL AGGREGATE 1

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,AND EMPLOYERS' LIABILITY !ANY PROPRIETOR/PARTNER/EXECUTIVE ,'f ~~~ i OFFICER/MEMBER EXCLUDED? ~ :I N I A ! (Mandatory In NHI :If yes, describe under !DESCRIPTION OF OPERATIONS below I

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: 11/19/2015 111/19/2016 BODILY INJURY (Per accident) $

PROPERTY DAMAGE ' [Per eccident) I $

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AGGREGATE !

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; $ , PER : , OTH· ; STATUTE ' ER

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' E L DISEASE • EA EMPLOYE~ $

E L DISEASE • POLICY LIMIT i $

DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarl<s Schedule, may be attached If mora space Is required)

2,000,000

500,000

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included

4,000,000

4,000,000

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Professional Liability applies for Dr. Richard O'Connor, Dr. Keith Del Prince, Dr. Shawn Clancy, Dr. Patricia Miller, Dr. Amy Suda and Dr. Katie L Del Prince at any location

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

Erie Comminuty College North Campus THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

& Erie County ACCORDANCE WITH THE POLICY PROVISIONS.

Attn Janet Arcara 6205 Main Street AUTHORIZED REPRESENTATIVE

Williamsville, NY 14221 ~a~ Michele Steiner/95

© 1988-2014 ACORD CORPORATION. All rights reserved.

ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD IN~n?a; t'>n'JAf\1,

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'

Erie Community College Affiliation Agreement

This agreement is made as of this 25th day of February, 2016 by and between ERIE

COMMUNITY COLLEGE, an educational institution part of a municipal corporation ofthe State of

New York, namely, the County of Erie [hereinafter referred to as "ECC"], and Heritage Christian

Services, Inc. 349 W. Commercial Street, East Rochester, NY 14445, an individual, partnership,

limited liability company, corporation or other organization doing business in the State ofNew York

[hereinafter referred to as the "HOST"].

WITNESSETH

WHEREAS, ECC and the HOST are desirous of developing a program pursuant to which

ECC students may make use of some or all of the HOST's facilities for the purpose of enabling said

students to gain field clinical, technical and educational experience and training directly related to

and/or required for successful completion of the ECC courses or programs in which the students are

enrolled, and

WHEREAS, the HOST is willing to afford assigned ECC students access to the HOST's

facilities for such purpose, upon the terms and conditions set forth herein, and to accept said students

without regard to sex, race, color, disability, national and ethnic origin, age, sexual orientation,

religion or creed.

NOW, THEREFORE, ECC and the HOST, in consideration of the covenants contained

herein, hereby mutually agree and intend to be legally bound as follows:

1. The HOST will afford assigned ECC students access to the HOST's facilities, at the

location(s) identified in the Appendix(ces) annexed hereto, for the purpose of enabling said students to

gain field clinical, technical and educational experience and training directly related to and/or required

for successful completion of the ECC courses or programs in which the students are enrolled. Such

Page 1 of 6

.. access shall include one or more meeting rooms or conference areas for the assigned ECC students

and the ECC faculty/instructors designated in the Appendix (ces).

2. The HOST will make known to the designated ECC faculty/instructors all rules,

regulations and procedures of the HOST to be applicable to the assigned ECC students and ECC will

be responsible for ensuring that the assigned ECC students are informed as to such policies and of

their need to comply with same. The information provided by the HOST and explained by ECC

Faculty/Instructors to ECC Students will include information relevant to the HOST's policies and

procedures with regard to the Health Insurance Portability and Accountability Act (HIP AA).

3. The HOST will have the right to require the removal of any assigned ECC student or

designated ECC faculty/instructor who fails to comply with the HOST's rules, regulations and

procedures or whose condition or conduct jeopardizes the well-being or safety of any patient or

employee of the HOST or any other person.

4. ECC will instruct the assigned students as to their ethical and legal obligations relative to

confidentiality and to respect and preserve the presumptively confidential nature of all information

which the students may obtain while gaining field clinical, technical and educational experience and

training at the HOST's facilities, whether obtained from patients/significant others, another student,

any staff or records of the HOST or otherwise. ECC will include in this instruction of the students

specific reference to HIPPA and any special requirements ofHIPPA relative to the student's training

at the HOST's facility.

5. ECC's designated faculty/instructors and assigned students shall not be deemed employees

of the HOST nor shall any monetary consideration be paid by or to the HOST relative to the field

clinical, technical and educational experience and training provided under this Agreement.

6. ECC will neither publish nor cause to be published any material related to the field clinical,

technical and educational experience and training provided under this Agreement without prior written

approval ofthe HOST.

Page 2 of 6

.. 7. The HOST will have the right to limit the number ofECC students who may be assigned

to participate in the field clinical, technical and educational experience and training to be provided

under this Agreement.

8. The designee ECC faculty/instructors and the HOST designee will jointly agree, as

indicated in the Appendix( ces ), in advance of each semester or other applicable student training

rotation, as to the number of students to be assigned by ECC and accepted by the HOST and as to the

specific dates, hours and facilities for upcoming field clinical, technical and educational experience

and training.

9. Except as otherwise specifically provided herein, including Appendix(ces), neither ECC

nor the HOST shall be financially responsible for expenses incurred by the assigned ECC students,

including, but not limited to, all housing, meals and transportation to and from ECC and/or the

HOST's facilities.

10. Insofar as may be required under applicable law or regulation, ECC will see to it that

every assigned ECC student has undergone a physical examination of sufficient scope so as to ensure

that the said students do not assume their duties at the HOST's facilities unless free from any health

impairment which poses a risk to patients or otherwise interferes with the performance of said duties.

11. The HOST will make emergency medical care available to any designated ECC faculty or

instructor or assigned ECC student who may become ill or incapacitated or who may be injured while

at the HOST's facilities. Said faculty, instructors and students shall be responsible for seeking and

obtaining all other emergency medical care.

12. ECC, through the county of Erie is largely self-insured with regard to automobile liability,

general liability, medical malpractice liability and workers' compensation matters. In the event that

the HOST receives notice of any claim arising out of or related to the field clinical, technical and

educational experience and training provided under this Agreement, the HOST will immediately give

notice thereof to ECC, through its designated faculty/instructor.

13. Notwithstanding its largely self-insured status, ECC does maintain a School Policy for

Healthcare Provider Students which affords $1 million each claim/$3 million aggregate professional

Page 3 of 6

..

,,._,,_,,,,,,.,, _____________________ _ liability insurance coverage to those ECC students, and their ECC faculty and advisors, who provide

healthcare-related services. Where healthcare-related services are provided by assigned ECC students

at the HOST's facilities, ECC will cause an insurance certificate evidencing such coverage to be

issued to the HOST and will keep such coverage in place so long as ECC students are assigned to the

HOST's facilities.

14. During all time periods when ECC students are assigned to the HOST's facilities, the

HOST will maintain in force and effect policies of general liability, automobile liability, professional

liability and workers' compensation insurance. The HOST will also provide ECC with evidence of

such insurance coverages, on ACORD or equivalent insurance certificate forms, and copies of said

insurance certificates will be attached to this Agreement.

15. The HOST agrees to defend, indemnify and hold harmless ECC, to include the County of

Erie, and its agents and employees from and against all claims, damages, losses or causes of action

arising out of or resulting from actions or omissions, materials provided, services rendered or other

performance of or by the HOST, its agents, employees or volunteers, pursuant to this Agreement.

ECC, to include the County of Erie, agrees to defend, indemnify and hold harmless the HOST and its

agents and employees from and against all claims, damages, losses and causes of action arising out of

or resulting from actions or omissions, materials provided, services rendered or other performance of

or by ECC, its agents, employees or volunteers, pursuant to this Agreement.

16. With regard to any field clinical, technical and educational experience and training

involving the provision by assigned ECC students ofhealthcare services to patients:

A. The HOST will maintain overall supervision of all such patient care, including any

required medical direction.

B. A professional staff member of the HOST may intervene in such patient care at any time

and any manner deemed necessary, as dictated by the circumstances, so as to safeguard patient(s),

including without limitation the issuance of emergency medical direction to the ECC student(s) or

the resumption by the HOST ofthe provision of such care to patient(s).

C. ECC students will be instructed to immediately request guidance and direction from

either a professional staff member of the HOST or an ECC faculty/instructor where the

student becomes unsure as to how to proceed with the care of a patient or where a patient's

Page 4 of 6

.. condition appears to the student to require the immediate attention of a professional staff

member of the HOST.

D. The designated ECC faculty/instructors will provide orientation to the HOST's profess­

ional staff relative to the courses or programs in which the assigned ECC students are enroll­

ed and the students' previous field clinical, technical and educational experience and training.

E. The professional staff of the HOST will provide orientation to the designated ECC

faculty/instructors, and to the assigned ECC students, including without limitation the

HOST's procedures as to fire and safety evacuation, body substance isolation, safe use of

tools and equipment, permitted entry and exit points for the HOST's facilities, available locker

or changing rooms, restricted or prohibited access areas and any requirements as to attire or the

display of photo or other identification.

17. ECC and the HOST agree that each will comply with all applicable laws, rules, and

regulations with respect to the performance of this Agreement.

18. Except as may otherwise be set forth in the Appendix( ces ), and unless sooner terminated

as set forth in paragraph "19", this Agreement will commence as ofthe date first written above, will

continue in full force and effect for a period of one (1) year and will thereafter continue in full force

and effect until terminated as set forth in said paragraph "19".

19. This Agreement may be terminated by either party for any reason upon ninety (90) days

prior written notice addressed to the other as set forth Appendix, provided, however, that no such

termination on the part ofthe HOST shall take effect prior to the conclusion of the student training

rotation during which such notice of termination is given.

20. This Agreement may be modified only upon the further mutual consent ofECC and the

HOST and then only by means of another writing, approved and executed in a similar fashion to the

approval and execution of this Agreement.

21. This Agreement shall be governed by and construed in accordance with the laws of the

State of New York. The illegality or non-enforceability of any provision of this Agreement shall rtot

affect the validity of remaining provisions.

Page 5 of 6

22. This Agreement supersedes all prior understandings and agreements between the parties,

both written and oral.

23. This Agreement may not be assigned in whole or in part without the prior written consent

of the parties.

ERIE COMMUNITY COLLEGE

By: Jack Quinn

ECC President Date: ----------------------

STATE OF NEW YORK COUNTY OF ERIE

Name of Site

Heritage Christian Services, Inc . .

B= ~resident & CEO

Date: ...3/1 I/ I b ----~~L-~--------

On the day of , before me personally came Jack Quinn, to me known to be the individual described in, and who, executed, the foregoing instrument and acknowledge that he executed the same.

Notary Public

Da'te

APPROVED AS TO FORM:

By: Kristin Klein-Wheaton

Executive Vice President, Legal Affairs

Date Doc.# ------------------

Page 6 of 6

Evelyn Post- unn. Department Chair .

2- jz_5/ I/:, Date

HOST Heritage Christian Services, Inc. 349 W. Commerical St. East Rochester, NY 14445

HOST FACILITIES/LOCATIONS:

Allwood Drive 3/31/93 Katrecia 58 Allwood Drive Dellaporta Rochester, NY 14617 338-9167

Fax 266-4232 Baird Road Sapphire Buckner 2209 Baird Road 385-6258 Penfield, NY 14526 Fax 385-6176 Bnffa1o Road Tiffany Tolbert 4466 Buffalo Road 594-1550 N. Chili, NY 14514 Fax 594-4828 Chili Ave. Shawanda Batzing 3897 Chili Avenue 889-1472 Churchville, NY 14428 Fax 889-1478 Claire Court Apt. Jared Cooper 5570 South Park Ave. Box 716-649-9805 200 Fax 716-649-9806 Hamburg, NY 14075 Clover Street Sarah Scheffelaar 600 Clover Street 288-6772 Rochester, NY 14610 Fax 288-4896

Dickinson Road Elizabeth 306 Dickinson Road Williams-Webster, NY 14580 Velasquez

787-1804 East Ave Colleen Benson 730 East Avenue 716-434-1487 Lockport, NY 14094 716-434-1489 Evergreen Apt Karen Schnaufer 3273 Hemlock Hills Dr. 315-986-7239 Macedon, NY 14502 Fax 315-986-4958

Fairport Road Jerry Gaebel 299 Fairport Road 586-4171 E. Rochester, NY 14445 Fax 586-2911

Five Mile Line Jennifer Clark 2035 Five Mile Line Rd 385-1911 Penfield, NY 14526 Fax 385-1796 Gates Greece Shawn James 517 Gates Greece 426-7676 TownlineRd Fax 426-7677 Rochester, NY 14606 Goodburlet Joe Borelli 390 Goodburlet Road 334-2025 Henrietta, NY 14467 Fax 334-9314 Groton Parkway Apt. Sarah Palermo 90 Groton Parkway 334-9828 Rochester, NY 14623 Fax 334-7756

I 111.11·--------------~~--·--•L!B'--

APPENDIX

TO

ECC AFFILIATION AGREEMENT

Hoover Road 6274 Hoover Road Sanborn, NY 14132

Jefferson Ave. Apt. 498 Jefferson Avenue Fairport, NY 14450 Jennifer Lane 548 Klem Road Webster, NY 14580 Keller Road 10996 Keller Road Clarence, NY 14031 Kentucky Crossing 80 Kentucky Crossing Rochester, NY 14612

Landsdowne 46 Landsdowne Lane Rochester, NY 14618

Larwood 2 Larwood Drive Rochester, NY 14618

Latona 450 Latona Road Rochester, NY 14626 Osage 5 Osage Trail Spencerport, NY 14559

Oxbow 860 Oxbow Lane Lewiston, NY 14092

Peppermint 99 Peppermint Drive Rochester, NY 14615 Phillips Rd. 390 Phillips Rd. Webster, NY 14580

PineHill 5 Pinehill Drive Pittsford, NY 14534 P1ankRoad 1 1435 Plank Road Webster, NY 14580

ERIE COMMUNITY COLLEGE Occupational Therapy Assistant Dept. 6205 Main Street Williamsville, NY 14221

Evelyn R. Post-Dunn, Department Head Occupational Therapy Assistant. Dept. 6205 Main St., Williamsville, NY 14221 (716) 851-1320 /dunne@ecc.cdu

Robin Stefanski Ransom Rd. Rachele Gugliuzza 716-731-2264 1140 Ransom Rd. 716-684-7177 Fax 716-731-2237 Lancaster, NY 14086 Fax 716-684-0004

Cindy Robertson Robin Hood Caroline Laursen 388-5199 1346 Robin Hood Lane 265-1967 Fax 388-5197 Webster, NY 14580 Fax 216-9941 Meredith Laffin Sa1tRoad Felipe Rios 671-4362 1103 Salt Road 217-9196 Fax 671-9303 Webster, NY 14580 Fax217-9411 Vince Edgerton Schlegel Road Bianca Richards 716-741-3681 1452 Schlegel Road 265-0480 Fax 716-741-4361 Webster, NY 14580 Fax 265-9562 Nate Klingebiel Scribner Road Jessica Blake 225-8708 140 I Scribner Road 671-7436 Fax 225-4088 Penfield, NY 14526 Fax 671-6501

Chris Palermo Selkirk Nicole Bennett 385-7536 234 Selkirk Drive 716-693-0676 Fax 385-6561 N. Tonawanda, NY Fax 716-693-6056

14120 Chris Palermo Sbanlee Lucy Arseneau 461-9165 698 Shanlee Drive 217-9285 Fax 461-9777 Webster, NY 14580 Fax 217-8678

Christina Forte Shoecraft 2 Joan Levato 723-8306 1450 Shoecraft Rd. 671-0246 Fax 723-8671 Penfield, NY 14526 Fax 670-0662 Karen Zampatori Shoecraft 1 Shayla Johnson 585-293-1614 1500 Five Mile Line 787-9531 Fax 585-293-0618 Road Fax 787-9519

Penfield, NY 14526 Greg Stenzil South Forest Apt. Karol Kowalski 716-754-7213 356 South Forest Road 716-626-1687 Fax 716-754-8143 Williamsville, NY Fax 716-626-1688

14221 Katrecia Dellaporta State Road Joan Levato 581-0533 1305 State Road 872-0031 Fax 581-0835 Webster, NY 14580 Fax 872-6304 Tommy Walsh State Road II Kerry Hart 265-2677 1008 State Road 872-6703 Fax 265-2687 Webster, NY 14580 Fax 872-5127

Bethann Selice Stone Road Audrey Khabursky 385-0851 454 Stone Road 586-5340 Fax 264-0829 Pittsford, NY 14534 Fax 249-9628 Lysah Bagley Stony Point Stephanie Arendas 217-9484 2982 Stony Point Road 716-773-1388 Fax 217-9485 Grand Island, NY Fax 716-773-1389

14072

Page 1 of 3

Hard Road Lindsey Lawler Plank Road 2 Bethann Selice Sweet Home Apt. Nicole Christopher 686 Hard Road 787-0220 1150 Plank Road 872-9244 3414 Sweet Home 716-564-2064 Webster, NY 14580 Fax 787-0028 Webster, NY 14580 Fax 872-9216 Road 716-564-2306

Amherst, NY 14228 Heim Road Justin Eberle Portland Rachel Palmesano Tonawanda Creek Kelly Horschel 16HeimRoad 716-689-1090 221 0 Portland A venue 266-3830 4441 Tonawanda 716-692-3136 Williamsville, NY 14221 Fax 716-689-1091 Rochester, NY I 46 I 7 Fax 266-3831 CreekN Fax 716-692-3137

N. Tonawanda, NY 14120

High Street Ext. Deb Brown Railroad Mills Road Akira Sims Wall Road Michael Schaeffer 363 High Street Extension 223-5642 128 Railroad Mills Road 218-0706 1189 Wall Road 872-4406 Fairport, NY 14450 Fax 223-5695 Pittsford, NY 14534 Fax 218-4385 Webster, NY 14580 Fax 872-0019 Hillrise Drive Doug Bowes Ransom Rd. Rachele Gugliuzza Webster Road Sarah Plantenberg I 71 Hillrise Drive 377-5918 1138 Ransom Rd. 716-684-3338 229 Webster Road 265-3189 Penfield, NY 14526 Fax 377-4746 Lancaster, NY 14086 Fax 716-684-9998 Webster. NY 14580 Fax 265-9143 Westside Drive Shanon Eadie Fresh Link Day Hab Robbie Lyman Twelve Corners Day Brad Sheffield I 127 Westside Drive 426-7894 1345 Penfield Center Road 872-1406 Hab 461-4529 Rochester, NY I 4624 Fax 426-7794 Penfield, NY 14526 Fax 872-6678 1200 S. Winton Road Fax # 256-0898

Rochester, NY I 4618 Westside Drive Shanon Eadie Goodrich Day Hab Judy Cate-Smithers Visitor Center Day DanLista I 129 Westside Drive 247-1683 5375 Old Goodrich Road 716-741-3909 Hab 349-2090 X 4512 Rochester, NY 14624 Fax 247-1678 Clarence, NY 14032 Fax 716-741-3694 700 Colby Street

Spencerport, NY 14559

Whalen Road Doug Bowes Klem Bakery Day Hab Stacy Waite Webster Day Hab DeAnna Stupia 785 Whalen Road 248-0517 855 Klem Road 671-9628 671-9207 (fax) 550 Webster Road 585-752-1752 Penfield, NY 14526 Fax 248-3849 Webster, NY 14580 To order: 671-8802 Webster, NY 14580 Whiting Street Michael Nguti Lapham Park Day Hab Beth Nardi 36 Whiting Street 716-695-3109 I 0 Lapham Park Day Hab 265-4555 RESPITE & OTHER RESPITE & OTHER N. Tonawanda, NY 14120 Fax 716-695-1786 Webster, NY 14580 Fax 265-0693 Willow Avenue Kelly Horschel Life Center Day Hab Laura Vatalaro Respitelodge Vanessa Shattuck 576 Willow Avenue 716-692-5795 1025 Commons Way 487-3509 214 Chestnut Ridge 889-0772 N. Tonawanda, NY 14120 Fax 716-743-8566 Rochester, NY 14623 Fax 487-3511 Road Fax 889-0768

Rochester, NY I 4624 Winton Road Kathleen Schlafer Main St Day Hab Laura Kempton Respitewood Sarah Vogt 1208 South Winton Rd. 271-3293 170 Main St. 716-695-9578 133 I Schlegel Road 265-3331 Rochester, NY 14618 Fax 271-3692 Tonawanda, NY 14150 Fax 716-695-9613 Webster, NY 14580 Fax 265-1353 Winton Road Apt. Kathleen Schlafer Mendon Day Hab Debra St. Denis Respite Creek Kara Scourby 1210 South Winton Road 461-8349 3914 Clover Street 334-6170 Monroe I Boces 249-7201 Rochester, NY 14618 Fax 473-0072 Honeoye Falls, NY 14472 Fax 321-0414 41 O'Connor Road

Fairport, NY 14450 Woodsboro Farms Teresa Johnston Nine Mile Point Jessica Rykowski Respite Friends (after Kristen LaRocca 1149 Woodsboro Farms 872-9533 (Downstairs) 377-5232 school) 754-7791 Webster, NY 14580 Fax 872-6246 1885 Nine Mile Point Rd Fax 377-5226 1025 Commons Way

Penfield, NY 14526 Rochester, NY 14623 Yorktown Drive Teresa Johnston Penfield Point Day Hab Jennifer Hyde Sarah Ferguson, 260-2194 33 Yorktown Drive 670-9478 1885 Nine Mile Point Road 377-5228 Director 967-0178 Webster, NY 14580 Fax 670-9479 Penfield, NY 14526 Fax 377-1705 Jen Shortino- Intake 203-7229

Upstairs Kristen Kramer Prog. oord.

Perinton Day Hab Pete Wills Expressive Suzanne Rounding DAYHABS DAYHABS 6511 Pittsford Palmyra Road 752-7078 Beginnings 340-2077

Fairport, NY 14450 Fax 223-7404 875 Commons Way Fax 272-0975 Rochester, NY 14623

Blossom Road Day Hab Bridget Hart Piano Works Day Hab Jennifer Hyde Heritage Hollow Janet Van Staalduinen 805 Blossom Rd. Phone& Fax 349 W. Commercial St. 340-5736 287 Route 28 315-357- 2054 Rochester, NY 14610 482-4852 #1700 Fax 340-5738 Inlet, NY 13360 Fax 315-357-4747

E. Rochester, NY 14445 Cayuga Day Hab Jessica Hunt Pioneer Day Hab Francis Lagona Little Valley 2140 Cayuga Dr. Ext. 716-731-4850 9324 Lake Shore Road Cell: 716-352-2625 9639 Route 242 716-938-6138 Niagara Falls, NY 14304 Fax: 716-731- Angola, NY 14006 2•• #: 716-549-1420 Little Valley, NY

4860 14755 Challenger Day Hab Mike Pilato Rodwell Lodge LuAnn Lanzatella Pieters Family Life Andrew Little, Director 5733 Tonawanda Creek 716-625-8401 100 Hubbell Road 352-4657 Center 487-3500 Lockport, NY 14094 Fax 716-625-8401 Spencerport, NY 14559 Fax 352-6998 1025 Commons Way Fax 487-3527

Rochester, NY 14623 Colby Bakery Day Hab Jessica Cutcliffe Salt Road Day Hab Trish Lewis Salt Road Stables Lorrie Renker 1994 Colby Street 637-0750 1103 Salt Road 872-4344 1103 Salt Road 872-2540 Brockport, NY 14420 Fax 637-4032 Webster, NY 14580 Fax 872-4847 Webster, NY 14580 Fax 872-4847

Order 637-3379 East Rochester United Ester Garcia Sanborn Day Hab Andy Pluff Second Thought Anna Pravato Methodist Church Day 248-0703 3520 Saunders Settlement 716-216-4782 349 W. Commercial St. 340-5730 Hab Fax 248-0698 Rd. Phone&Fax E. Rochester, NY 357 Fairport Road S~bOID.NY 14132 14445 East Rochester, NY 14445 Ellicott Creek Day Hab Lisa Jones Springdale Farm Day Hab Terry Demar Springdale Farm Farm Office: 352-5315 1000 Ellicott Creek Road 716-694-4091 696 Colby Street 352-0101 696 Colby Street Farm Fax: 349-9276 Tonawanda, NY 14150 Fax 716-694-3591 Spencerport, NY 14559 Fax 349-9276 Spencerport, NY

14559 Ellison Day Hab Lezlie Singleton St. Stephens Day Hab Brenda Carrasquillo Visitor Center Dan Pieters 1135 Empire Blvd 288-1061 7 50 Wehrle Drive 716-256-8368 700 Colby Street 349-2090 ext 4500 Rochester, NY 14609 Fax 288-1068 Buffalo, NY 14225 Spencerport, NY

14559

Page 2 of 3

•

Eimgrove Day Hab Kristin Harmer 247-7581

Transition to Work Sue Dennie WNY Main Office Rocheie Page I 500 Spencerport Road Rochester, NY I 4606

Reformed Lutheran Church 662-3527 3790 Commerce Court 716-743-2020 Fax 247-6058 I I I N. Chestnut Street

I4604 #800 Fax 716-743-1838 N. Tonawanda, NY 14120

WNYCiub Adventure 1000 Ellicott Creek Road Tonawanda, NY 14150

Rebecca Rayter 716-694-4091

Any written notice to be given either by the HOST to ECC or by ECC to the HOST, and any exchange of written communications, shall be directed and addressed, at minimum, to the persons and to the non e-mail mailing addresses first listed below.

Marisa Geitner, President & CEO Heritage Christian Services, Inc. 349 W. Commercial St. East Rochester, NY 14445

Evelyn R. Post-Dunn, Department Head Occupational Therapy Assistant. Dept. 6205 Main St. Williamsville, NY 14221 (716) 851-1320 /dunnc@ecc.edu

ANTICIPATED ASSIGNED STUDENT ROTATION NUMBERS, DATES & HOURS:

Fall Semester: [8J Start/End Dates: Variable Hours: Variable

Spring Semester: [8J Start/End Dates: Variable Hours: Variable

APPAREL, INSTRUMENTS OR OTHER ITEMS SUPPLIED BY STUDENTS/ECC

Page 3 of 3

Other: [8J Winter Session Other: [8J Summer Session Dates: Variable Hours: Variable

APPAREL, INSTRUMENTS OR OTHER ITEMS SUPPLIED BY HOST

HERICHR-01 KSWEERS

ACORD" CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNYYY)

~ 1/26/2016

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 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 License# BR-904760 ~2~~~cT Kathy Sweers Lawley-Andolina-Verdi, LLC rlJgN:o Extl: 1 (585) 454-1600 I rffc No): 1 (866) 211-4683 30 North Union Street Rochester, NY 14607 ~oMDA~~ss: ksweers@lawleyinsurance.com

INSURER(S) AFFORDING COVERAGE NAIC#

INSURERA:Philadelphia Indemnity Ins Co 18058 INSURED INSURER B:

Heritage Christian Services, Inc. INSURERC:

349 W Commercial St., Ste 2795 INSURERD: East Rochester, NY 14445 INSURERE:

INSURERF:

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 TYPE OF INSURANCE 7~~~ ~~ ~~~~JEM~~ , ~~g~~%MVv1 LIMITS LTR POLICY NUMBER A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000

r---:J CLAIMS-MADE 0 OCCUR X PHPK1431244 12/31/2015 12/31/2016 ~~~~~~~?E~~u~~nce) 100,000 $

x See Oth Cov MED EXP (Any one person) $ 5,000 -

PERSONAL & ADV INJURY $ 1,000,000 ~

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000

=j_ DPRO- D PRODUCTS- COMP/OP AGG $ 3,000,000 POLICY JECT LOG

OTHER: $

AUTOMOBILE LIABILITY fE~~~~~~~~~INGLE LIMIT $ 1,000,000

A ---=-X ANYAUTO PHPK1431244 12/31/2015 12/31/2016 BODILY INJURY (Per person) $

- ALLOWNED B SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS - NON-OWNED rp~?~ci~d~t~AMAGE HIRED AUTOS AUTOS $ -

I l $

UMBRELLA LIAB M OCCUR EACH OCCURRENCE $ 20,000,000

A ~ EXCESS LIAB CLAIMS-MADE PHUB524339 12/31/2015 12/31/2016 AGGREGATE $ 20,000,000

OED I X I RETENTION $ 10,000 $ WORKERS COMPENSATION I PER I I OTH-AND EMPLOYERS' LIABILITY STATUTE ER

YIN ANY PROPRIETOR/PARTNER/EXECUTIVE D 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 $

DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) RE: For the purpose of supporting ECC students under an affiliation agreement Certificate holder is additional insured for general liability on a primary & non contributory basis as required by written contract.

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

County of Erie and Erie Community College THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

4041 Southwestern Blvd ACCORDANCE WITH THE POLICY PROVISIONS.

Orchard Park, NY 14127 AUTHORIZED REPRESENTATIVE

l i=LU-1vt ~

© 1988-2014 ACORD CORPORATION. All rtghts reserved.

ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD