Burbank Unified School District Special Education Department
REPORT TO THE BOARD TO:
Members of the Board of Education
FROM:
Tom Kissinger, Assistant Superintendent, Instructional Services
PREPARED BY:
Tom Kissinger, Assistant Superintendent, Instructional Services
SUBMITTED BY:
Teri Smith, Administrative Secretary
DATE:
October 5, 2017
SUBJECT:
Approval of Agreement with Nova Southeastern University for Speech Language Communication Program
Background: The purpose of the Speech Language and Communication Programs is to provide students with experience in the field through practice in schools and classes. Students will be assigned to these speech and language interns, within the District. Pursuant to the provisions of Section 1095 of Education Code, the governing board is authorized to enter into agreements with any university or college accredited by the State Board of Education as a teacher education institution.
Discussion/Issues: This program builds a relationship with Nova Southeastern University – Speech Language and Communication Program, which expands the pool of speech and language therapists prepared to work on the field. The District will provide experience through programs already established at school sites. Fiscal Impact: None Recommendation: Tom Kissinger, Assistant Superintendent, Instructional Services, recommends that the Board of Education approve the Clinical Affiliation Agreement with Nova Southeastern University for Speech Language and Communication Disorders Clinic, effective, January 1, 2018 through June 30, 2019, and that authority to sign the service agreements be exercised pursuant to BUSD-AR 3314, as presented.
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CERTIFICATE OF LIABILITY INSURANCE
06/26/2017
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 NAME: PHONE (A/C, No, Ext): 1-877-945-7378 E-MAIL ADDRESS:
[email protected] PRODUCER
Willis Insurance Services of Georgia, Inc. c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA
FAX (A/C, No):
1-888-467-2378
INSURER(S) AFFORDING COVERAGE INSURER A :
INSURED
NAIC #
37974
Mt. Hawley Insurance Company
INSURER B :
Nova Southeastern University, Inc. Attn: Elizabeth Guimaraes, Director of Risk Management 3301 College Avenue Ft. Lauderdale, FL 33314
INSURER C : INSURER D : INSURER E : INSURER F :
CERTIFICATE NUMBER: W2763973
COVERAGES
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 LTR
ADDL SUBR INSD WVD
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFF POLICY EXP (MM/DD/YYYY) (MM/DD/YYYY)
COMMERCIAL GENERAL LIABILITY CLAIMS-MADE
OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER: PROPOLICY LOC JECT
LIMITS
EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence)
$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
PRODUCTS - COMP/OP AGG
$ $
OTHER: COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person)
AUTOMOBILE LIABILITY
ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY
$
SCHEDULED AUTOS NON-OWNED AUTOS ONLY
$ $
BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident)
$ $
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
EXCESS LIAB
CLAIMS-MADE
AGGREGATE
$
DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below
A
$ PER STATUTE
Y/N
Professional Liability
OTHER
E.L. EACH ACCIDENT
N/A
$
E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT
N
N
MMP0000146
$
07/01/2017 07/01/2018 Per Claim Limit
$1,000,000
Aggregate Limit
$3,000,000
Deductible
$250,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
This policy provides coverage for all employees, faculty, and students of the above named insured only when they are working for or training under the auspices of Nova Southeastern University.
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.
Nova Southeastern University, Inc. Attn: Risk Management Dept. (VPF) 3301 College Avenue Fort Lauderdale, FL 33314
ACORD 25 (2016/03)
AUTHORIZED REPRESENTATIVE
© 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 14760204 BATCH: 362591
11.
COUNTERPARTS AND SIGNATURES
This Agreement may be executed in counterparts, each of which will be deemed original, but all of which together shall constitute one and the same agreement. Scanned, photocopied and facsimile signatures shall be deemed original signatures. The parties represent and warrant that the person signing on behalf of the party has authority to sign as its representative.
IN WITNESS WHEREOF, the parties have executed this Agreement as of the date first set forth below.
BURBANK UNIFIED SCHOOL DISTRICT
NOVA SOUTHEASTERN UNIVERSITY, INC.
By:
________________________
By:
Title:
________________________
Title:
Date: ________________________
Date: ________________________________
6 NSU Affiliation Agreement Educational Settings Nov. 2016
________________________________ Stanley H. Wilson, P.T., Ed.D. Dean, College of Health Care Sciences