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HomeMy WebLinkAbout11128Docusign Envelope ID: E91A8FC9-B8FO-4BE1-B30A-D7D6D89A81EA ORDINANCE NO. 11128 AN ORDINANCE APPROVING A MEMORANDUM OF UNDERSTANDING BETWEEN THE CITY OF PUEBLO, A COLORADO MUNICIPAL CORPORATION AND PUEBLO COMMUNITY HEALTH CENTER INC., A COLORADO NON- PROFIT CORPORATION FOR THE PROVISION OF PRIMARY HEALTH CARE SERVICES AT THE PUEBLO HOMELESS SHELTER AND AUTHORIZING THE MAYOR TO EXECUTE SAID CONTRACT BE IT ORDAINED BY THE CITY COUNCIL OF PUEBLO, that: SECTION 1 The Memorandum of Understanding ("MOU") effective March 1, 2026, between the City of Pueblo, a Colorado municipal corporation and Pueblo Community Health Center Inc., a Colorado non-profit corporation, having been approved as to form by the City Attorney is hereby approved. The Mayor is authorized to execute and deliver the MOU in the name of the City and the City Clerk is directed to affix the seal of the City thereto and attest same. SECTION 2. The officers and staff of the City are authorized and directed to perform any and all acts consistent with this Ordinance and the attached MOU which are necessary or desirable to effectuate the transactions described therein. SECTION 3. This Ordinance shall become effective on the date of final action by the Mayor and City Council. Action by City Council: Introduced and initial adoption of Ordinance by City Council on February 23, 2026. Final adoption of Ordinance by City Council on March 9, 2026. DocuSigned by: President of City Council Docusign Envelope ID: E91A8FC9-B8FO-4BE1-B30A-D7D6D89A81EA Action by the Mayor: C7 Approved on 03/10/2026 ❑ Disapproved on based on the following objections: Action by City Council After Disapproval by the Mayor: ❑ Council did not act to override the Mayor's veto. ❑ Ordinance re -adopted on a vote of on Mayor ❑ Council action on failed to override the Mayor's veto. President of City Council ATTEST ;CerTm,12�2410- ned by: ,WIAn P01,6 t t Deputy City Docusign Envelope ID: E91A8FC9-B8FO-4BE1-B30A-D7D6D89A81EA City Clerk's Office Item # R5 of 1111--PUEBLO colDorado Background Paper for Proposed Ordinance COUNCIL MEETING DATE: March 9, 2026 TO: President Mark Aliff and Members of City Council CC: Mayor Heather Graham VIA: Vince Petkosek, Deputy City Clerk FROM: Carla Sikes, City Attorney SUBJECT: AN ORDINANCE APPROVING A MEMORANDUM OF UNDERSTANDING BETWEEN THE CITY OF PUEBLO, A COLORADO MUNICIPAL CORPORATION AND PUEBLO COMMUNITY HEALTH CENTER INC., A COLORADO NON-PROFIT CORPORATION FOR THE PROVISION OF PRIMARY HEALTH CARE SERVICES AT THE PUEBLO HOMELESS SHELTER AND AUTHORIZING THE MAYOR TO EXECUTE SAID CONTRACT SUMMARY: Attached is an Ordinance approving a Memorandum of Understanding between the City of Pueblo and Pueblo Community Health Center Inc. ("PCHC") for the provision of health services at the Pueblo Homeless Shelter. PREVIOUS COUNCIL ACTION: On December 23, 2024 City Council by Ordinance No. 10865 approved an Operating Agreement with SafeSide Recovery for the operation of the Homeless Shelter. BACKGROUND: The City owns the property located at 710 W. 4th Street, Pueblo, Colorado and 728 W. 4th Street, Pueblo, Colorado (collectively the "Property"). The City contracts with SafeSide Recovery to operate an ongoing and emergency homeless shelter out of the Property. It is the intent of the City that supportive services such as work programs, substance abuse treatment programs, mental health programs, and health clinics be housed within the Property and made available to the unhoused and impoverished population of the community. PCHC already provides health care services at the Pueblo Homeless Shelter on a temporary basis. It has a pop-up clinic at the Shelter; however, PCHC desires to offer quality primary care services to the homeless population at the Property on a more Docusign Envelope ID: E91A8FC9-B8FO-4BE1-B30A-D7D6D89A81EA permanent basis pursuant to the attached MOU. In exchange for offering these services to the community, the City will allow PCHC to use a portion of the Property for this purpose free of charge, continue to maintain the Property, and provide security. Either party may terminate the MOU for convenience upon notice to the other party. FINANCIAL IMPLICATIONS: The City already provides utilities and maintenance for the Property. No additional costs are anticipated for this MOU. BOARD/COMMISSION RECOMMENDATION: Not applicable to this Ordinance. STAKEHOLDER PROCESS: Not applicable to this Ordinance. ALTERNATIVES: If this Ordinance is not approved, PCHC will not provide more permanent primary health care services at the Pueblo Homeless Shelter. RECOMMENDATION: Approve the Ordinance. ATTACHMENTS: 1. CITY OF PUEBLO SHELTER MEMORANDUM OF UNDERSTANDING Docusign Envelope ID: AC39EB18-OAB1-4226-8037-52115F7554DD MEMORANDUM OF UNDERSTANDING THIS Memorandum of Understanding ("MOU") made this 1St day of March, 2026, by and between the CITY OF PUEBLO, a Colorado municipal corporation ("CITY") and PUEBLO COMMUNITY HEALTH CENTER INC, a Colorado Non -Profit Corporation ("PCHC"). WHEREAS, CITY owns the real property located at 710 W. 4th Street, Pueblo, Colorado and 728 W. 4th Street, Pueblo, Colorado (collectively the "Property"); WHEREAS, CITY contracts with SafeSide Foundation, a Colorado nonprofit corporation to operate an ongoing and emergency homeless shelter out of the Property; WHEREAS, it is the intent of the CITY that supportive services such as work programs, substance abuse treatment programs, mental health programs, and health clinics be housed within the Property and made available to the unhoused and impoverished population of the community; WHEREAS, this use of the Property works to prevent homelessness and facilitate the self-sufficiency of the population served; and, WHEREAS, CITY desires PCHC to offer quality primary care services ("Services") to the homeless population at its Property pursuant to this MOU; and, WHEREAS, the required approval, clearance and coordination have been accomplished from and with appropriate authorities; WHEREAS, as of this date the execution of this Agreement, PCHC meets all statutory and regulatory requirements for entering into this Agreement. NOW THEREFORE, it is hereby agreed that: SECTION 1 TERM & TERMINATION 1.1 Term: This agreement may commence on March 1, 2026, although the Agreement may have been executed by the parties on a different date and shall be for a period of three years from the commencement date and may be renewed for successive terms. 1.2 Termination: Either CITY or PCHC may terminate this Agreement at any time with or Page 1 of 11 Docusign Envelope ID: AC39EB18-OAB1-4226-8037-52115F7554DD without cause by giving at least sixty (60) days prior written notice of termination and specifying the effective date of the termination, thereof at least sixty (60) days before the effective date of such termination. 1.3 This Agreement may be terminated by either party for cause. If either party is in default hereunder, the non -defaulting party shall provide written notice describing the default to the non -defaulting party. If the defaulting party does not correct such default within twenty-one (21) days after receipt of said notice, or if the default cannot be corrected within said twenty-one (21) day period and the defaulting party fails to commence action to correct within said period and thereafter diligently pursue corrective action, the non -defaulting party may terminate this Agreement upon an additional seven (7) days written notice to the defaulting party. SECTION 2 OPERATING MODEL 2.1 PCHC will operate the Services on the Property according to its Comprehensive Primary Care Model in accordance with prevailing professional standards and best practices. 2.2 PCHC will operate the Services in accordance with the Patient Handbook that explains patient's rights and responsibilities and contains information about utilizing PCHC's services. 2.3 PCHC will operate the Services on the Property in compliance with applicable laws and regulations pertaining to the Public Health Service Act 330, Health Resources Services Administration (HRSA) funding and the Federally Qualified Health Center program. This includes the PCHC Board of Directors retaining authority, responsibility, and approval of the services provided as well as monitoring and complying with HRSA requirements. 2.4 PCHC will operate the Services in accordance with its policies, procedures and operating systems, including compliance with the standards of Accreditation Association for Ambulatory Health Care (AAAHC) and the Federal Torts Claims Act. 2.5 To provide patients with access to comprehensive services and benefits and to provide for professional malpractice coverage, all patients receiving Services on the Property will be patients of PCHC and enrolled as such. Patient health records will be the property of PCHC. SECTION 3 ROLE OF CITY 3.1 CITY will provide adequate space and fixtures on the Property for the provision of the Services. Maintenance and repairs of the Property will be performed by CITY. Capital Page 2 of 11 Docusign Envelope ID: AC39EB18-OAB1-4226-8037-52115F7554DD improvements shall be the responsibility of CITY and made at the discretion of the CITY. 3.2 The cost of access to and monthly recurring cost of utilities, including water, electric and natural gas for the Property and space in which the Services will be provided will be paid by CITY. 3.3 CITY will provide general janitorial services for the Property and space in which the Services will be provided sufficient to enable PCHC to meet its infection control policies. (PCHC will implement infection control measures that are more than what a lay janitor would provide.) 3.4 CITY, in coordination with PCHC, will provide necessary and adequate tele- communications infrastructure, including high speed internet access and telephone systems. PCHC may, at its cost, provide additional internet lines. 3.5 City will be responsible for providing Security for the Property. Security shall include routine patrolling of the Property including the space in which the Services will be provided and while the Services are operating, and responding to calls for assistance by PCHC Services Staff. City may contract with third parties to provide such security for the Property. SECTION 4 ROLE OF PCHC 4.1 Staffing: 4.1.1 All staff providing Services shall be employed by PCHC and under the supervision and direction of PCHC management. PCHC will provide a primary care provider (i.e., nurse practitioner, physician assistant or physician), medical assistant(s), enrollment specialist, case manager and a behavioral health provider who is able to offer substance abuse treatment services. 4.1.2 PCHC's Chief Operations Officer will be the executive in charge of Services and implementation of this MOU. 4.1.3 PCHC's personnel policies and compensation system will be in effect for PCHC employees and implemented for all Services. 4.1.4 PCHC staff will observe Property rules and CITY building and safety policies. 4.2 Services Hours and Appointment Scheduling: 4.2.1 PCHC will deliver Services according to a schedule commensurate with the need Page 3 of 11 Docusign Envelope ID: AC39EB18-OAB1-4226-8037-52115F7554DD and demand of the patient population. The onset of Services will be provided one, half -day per week, in the afternoon. The schedule will be adjusted based on activity and upon mutual agreement of the CITY and PCHC. 4.2.2 PCHC will use its scheduling system and policies, including offering walk-in appointments. 4.3 Responsibility and Supervision of Patient Care: 4.3.1 PCHC's Chief Medical Officer shall direct the implementation of Services policies, systems, compliance with AAAHC requirements and other matters affecting provider staff and patient care. 4.3.2 Patient care will be directed by providers contracted with or otherwise employed by PCHC, within the context of PCHC's clinical policies. 4.4 Patient Records, HIPAA, Patient Privacy and Consent for Treatment: 4.4.1 Patient health records will be maintained by PCHC in accordance with its policies and procedures, which include HIPAA compliance. 4.4.2 The PCHC staff responsible for the Services will adhere to HIPAA laws at all times. 4.4.3 PCHC will implement and provide a HIPAA compliant treatment consent form. 4.4.4 All matters pertaining to patient privacy shall follow PCHC's privacy practices and policies. 4.5 Ancillary and Support Services: 4.5.1 Laboratory services will be referred to PCHC's contracted provider, unless a patient is required to utilize another provider. 4.5.2 Radiological services will be referred to local providers, including Parkview Medical Center and St. Mary -Corwin Medical Center, based on facility appointment access best for the patient. 4.5.3 Pharmacy services will be provided by PCHC through its existing pharmacies and through existing referral practices. Patients are free to use the pharmacy of their choice. PCHC will offer prescriptions on a sliding fee scale basis for eligible patients. 4.5.4 Specialty physician care will be arranged through existing community referral practices and in the interest of patient care. Page 4 of 11 Docusign Envelope ID: AC39EB18-OAB1-4226-8037-52115F7554DD 4.5.5 Dental care will be provided by PCHC. 4.5.6 Obstetrical and Gynecological care will be provided by PCHC. 4.5.7 Behavioral health will be provided by PCHC. 4.5.8 Infectious control measures (including biohazard waste control and disposal), other than general janitorial services will be provided by PCHC. 4.6 Inpatient Care: PCHC will arrange for inpatient care at local hospitals. PCHC will provide obstetrical call through PCHC physicians and midwives. 4.7 Information Systems: PCHC operates a centralized management information system and will operate its Services using these resources. 4.8 Supplies: Purchasing supplies and non -capital equipment will be performed and paid for by PCHC. 4.9 Expenses: PCHC will be responsible for expenses associated with supplies, laboratory, radiology, pharmacy, and contractual services necessary to operate the Services including liability and business insurance and administrative overhead. SECTION 5 FINANCIAL MATTERS 5.1 PCHC provides access to care regardless of a patient's financial ability to pay or insurance coverage status. PCHC will work with all patients to assist them in obtaining coverage for which the patient may be eligible. PCHC accepts Medicaid, Medicare, and most private health insurance plans. Patients will be made aware of the sliding fee discount program and eligibility for discounts based on income and family size. 5.1.1 PCHC will bill third party payers for all services when applicable. CITY waives any right, title or interest in or to any reimbursement from a third -party payer. 5.2 PCHC and CITY are collaborating to provide health care services to the homeless population and contributing to the effort within their respective financial resources, and there are no fees or reimbursement expected from either party as part of this MOU. SECTION 6 COLLABORATIVE COORDINATION 6.1 Coordination: PCHC and CITY will designate a point of contact for the administration of this MOU. Page 5 of 11 Docusign Envelope ID: AC39EB18-OAB1-4226-8037-52115F7554DD 6.1.1 For CITY: Melissa Cook, Director Department of Housing and Citizen Services (719) 553-2849; mcook@pueblo.us 6.1.2 For PCHC: Donald E. Moore, PCHC Chief Operations Officer (719) 543-8718 ext. 139; dmoore@pueblochc.org 6.2 Patient Complaints: Most patient concerns will be managed to resolution at the point of service by on -site staff. In the event a patient wants to pursue a matter further, the patient will be referred to PCHC's Patient Advocate. The Patient Advocate system manages the complaint to resolution. Depending on the nature of the complaint, resolution may involve the Chief Medical or Dental Officer or a member of executive management. 6.2.1 CITY's point of contact for complaints concerning the Services will be the PCHC Patient Advocate. 6.2.2 Clients who are abusive towards PCHC staff performing Services may be barred from receiving Services from PCHC at the Property. PCHC will inform City of all incidents that result in a discontinuation of Services. 6.3 Patient dismissal 6.3.1 PCHC may end their relationship with the patient for any reason deemed harmful to the treatment relationship or for patient non-compliance with PCHC policies. Patients may also be discharged from the practice when the patient's behavior is a safety concern or places PCHC or its staff at risk. 6.3.2 Prior to discharge, a patient will be granted due process, including access to an appeal. The Patient Advocate will be the point of contact for this step. 6.3.3 Due to confidentiality PCHC will not involve CITY in the discharge process or decision. With the patient's permission, PCHC can discuss the circumstances of the dismissal with CITY. 6.3.4 The management representatives of PCHC and CITY will meet as necessary to monitor MOU implementation and compliance. SECTION 7 CONFLICT RESOLUTION 7.1 Conflict resolution will be handled by the following process: 7.1.1 Conflicts are to be resolved through open and honest communication at the staff level. Page 6 of 11 Docusign Envelope ID: AC39EB18-OAB1-4226-8037-52115F7554DD 7.1.2 Services and patient care concerns shall be forwarded to the Chief Operations Officer of PCHC who will involve PCHC's Chief Medical Officer when a conflict involves independent clinical practice. SECTION 8 LEGAL AUTHORITY 8.1 PCHC warrants that it possesses the legal authority to enter into this Agreement and that it has taken all actions required by its procedures, bylaws, and applicable law to exercise that authority, to lawfully authorize its undersigned signatory to execute this Agreement, and to bind PCHC to its terms. The person executing this Agreement on behalf of PCHC warrants that such person has full authorization to execute this Agreement. 8.2 CITY warrants that it possesses the legal authority to enter into this Agreement and that it has taken all actions required by its procedures, bylaws and applicable law to exercise that authority, to lawfully authorize its undersigned signatory to execute this Agreement, and to provide the Property for this use and purpose. The person executing this Agreement on behalf of CITY warrants that such person has full authorization to execute this Agreement. 8.3 PCHC certifies that no member of its Board of Directors, no employee and no individual or entity providing services under this Agreement has been debarred or prohibited from participation in any Federal, State or Local healthcare funding program. SECTION 9 CONFLICT OF INTEREST 9.1 PCHC shall maintain written standards governing the performance of its Board of Directors and employees engaged in the award and administration of contracts. No employee, officer, or agent of PCHC shall participate in the selection, or the award or the administration of a contract or subcontract supported by State or Federal funds if a conflict of interest, real or apparent, would be involved SECTION 10 LIABILITY INSURANCE/FIDELITY COVERAGE 10.1 During the term of this Agreement, and any extension hereof, PCHC agrees that it will keep in force an insurance policy or policies, issued by a company authorized to do business in Colorado, in the minimum amounts specific below unless specifically waived herein and show proof of insurance upon request of CITY. In the event of cancellation of any such coverage, PCHC shall immediately notify CITY of such cancellation. Page 7 of 11 Docusign Envelope ID: AC39EB18-OAB1-4226-8037-52115F7554DD 10.1.1 Standard Workman's Compensation and Employer's Liability as required by State statute including occupational disease, covering all employees at the worksite. 10.1.2 General Liability combined single limit $1,000,000.00. Any aggregate limit will not be less than $1,000,000.00. 10.1.3A11 licensed professionals providing services in their professional capacity shall be deemed employees of the Federal Government by contract with PCHC, as a Federally Qualified Health Center, and shall be covered by the Federal Tort Claims Act. PCHC shall maintain gap coverage and general liability insurance in sufficient amounts to cover any loss not covered by the Federal Tort Claims Act. 10.2 PCHC certifies that, at the time of entering into this MOU, it has currently in effect all necessary licenses, certifications, approvals, insurance and permits required to properly perform the services covered by this Agreement. PCHC warrants that it will maintain all necessary licenses, certifications, approvals, insurance and permits required to properly perform this Agreement. Additionally, all employees of the PCHC performing services under this Agreement shall hold the required licenses or certification to perform their responsibilities. Any revocation, withdrawal or non-renewable of necessary licenses, certifications, approvals, insurance or permits required for PCHC to properly perform this Agreement shall be grounds for immediate termination of this Agreement by CITY for default. SECTION 11 RECORDS MAINTENANCE AND REPORTING 11.1 All patient records, documents, communications, and other materials created by PCHC which contain the protected health information of the patient shall be the property PCHC. Using proper and authorized procedures, CITY shall be granted reasonable access upon request to the records created by PCHC. All records created by CITY shall remain the property of CITY. Using proper and authorized procedures, reasonable access to CITY records shall be granted to PCHC. Compliance with Federal and State law with respect to patients' protected health information shall rest with the custodian of the record. PCHC and CITY shall maintain a complete file of all records, documents, communications, and other written materials which pertain to the operation of programs or the delivery of services under this Agreement and shall maintain such records for a period of six years after the date of the termination of this Agreement or final payment hereunder, whichever is later, or for such further period as may be necessary to resolve any matters which may be pending. 11.2 PCHC and CITY each agree to comply with the applicable provisions of the Administrative Simplification section of the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), as amended, and the requirements of any regulations promulgated Page 8 of 11 Docusign Envelope ID: AC39EB18-OAB1-4226-8037-52115F7554DD thereunder, including, without limitation, the federal privacy regulations as contained in 45 CFR Parts 160 and 164 (the "Federal Privacy Regulations") and the federal security regulations as contained in 45 CFR Part 164 (the "Federal Security Regulations"). PCHC and CITY each agree not to use or further disclose any protected health information, as defined in 42 U.S.C. § 1320d and 45 CFR §64.501(collectively, the "Protected Health Information"), concerning a patient other than as permitted or required by this Agreement or otherwise authorized under HIPAA, as amended. As permitted under HIPAA, the parties hereby agree, that by virtue of this Agreement, as it relates to the provision of Services, they are an "organized health care arrangement" for purposes of meeting the Federal Privacy Regulations and the authorized use and disclosure of Protected Health Information thereunder. SECTION 12 INDEMNIFICATION 12.1 PCHC agrees that, to the extent provided by law, PCHC shall indemnify, defend and hold harmless the City, its officers, employees and agents, from and against any and all loss, damage, injuries, claims, cause or causes of action, or any liability whatsoever resulting from, or arising out of, or in connection with the its obligations, the Services, or actions under this MOU caused, in whole or part, by any willful or negligent error, omission or act or a failure to observe any applicable standard of care by PCHC or any person employed by it. To the extent damages are covered by insurance, PCHC agrees to waive all rights of subrogation against the City, its subsidiary, parent, associated and/or affiliated entities, successors, or assigns, its elected officials, trustees, employees, agents, and volunteers for losses arising from the Services or work performed by PCHC on the Property. The indemnification obligation shall survive the expiration or termination of this MOU. SECTION 13 LITIGATION 13.1 Unless otherwise provided, PCHC shall promptly notify CITY if PCHC learns of any litigation or notice of claim concerning services provided under this Agreement in which it is a party Defendant. PCHC, after being served with a Summons, Complaint, or other pleading in a notice of case which involves services provided under this Agreement, and which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document to the CITY representative designated in this MOU. SECTION 14 NOTICES 14.1 Any notice or demand required under this Agreement will be in writing; will be personally served or sent by certified mail, return receipt requested, postage prepaid, or by a recognized overnight carrier which provides proof of receipt; and will be sent to the addresses below. Either party may change the address to which notices are sent by sending written notice of such change of address to the other party. Page 9 of 11 Docusign Envelope ID: AC39EB18-OAB1-4226-8037-52115F7554DD For CITY: Mayor's Office One City Hall Place Pueblo, CO 81003 Attn: Mayor Heather Graham or Successor For PCHC: Donald Moore, Chief Executive Officer Pueblo Community Health Center 110 E Routt Avenue Pueblo, CO 81004 SECTION 15 MISCELLANEOUS 15.1 Compliance with Laws. If any law or regulation is enacted, modified, or judicially interpreted so that this Agreement would be found not to comply with such law or regulation, this Agreement will terminate immediately upon either party's receipt of notice of termination from the other party or appropriate amendments to this Agreement shall be entered into by the parties. 15.2 Assignment. No assignment or transfer by PCHC of this MOU or any part thereof will be recognized unless such assignment has had the prior written approval of the City, which may be granted or withheld at the sole discretion of the City. Such written approval by the City, if given, shall not relieve the PCHC of the obligations under the terms of this MOU. 15.3 Independent Contractor. PCHC understands and agrees that PCHC and its employees, agents, servants, or other personnel are not City employees. PCHC shall be solely responsible for payment of salaries, wages, payroll taxes, unemployment benefits or any other form of compensation or benefit to the PCHC or any of its employees, agents, servants or other personnel for the Services performed on the Property pursuant to this MOU, whether it is of a direct or indirect nature. Further in that regard, it is expressly understood and agreed that for such purposes neither PCHC nor PCHC's employees, agents, servants or other personnel performing the Services on the Property shall be entitled to any City payroll, insurance, unemployment, worker's compensation, retirement or any other benefits whatsoever. 15.4 Third Parties. It is expressly understood and agreed that enforcement of the terms and conditions of this MOU, and all rights of action relating to such enforcement, shall be strictly reserved to the Parties hereto, and nothing contained in this MOU shall give or allow any such claim or right of action by any other or third person or entity on such MOU. It is the express intention of the Parties hereto that any person or entity, other than the Parties to this MOU, receiving services or benefits under this MOU shall be deemed to be incidental beneficiaries only. 15.5 No Waiver Governmental Immunity. Nothing in this Agreement shall be construed or Page 10 of 11 Docusign Envelope ID: AC39EB18-OAB1-4226-8037-52115F7554DD interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections, or other provisions, contained in the Colorado Governmental Immunity Act, §24-10-101, et seq., C.R.S. 15.6 No Multi -Year Fiscal Obligation on City. This MOU is expressly made subject to the limitations of the Colorado Constitution. Nothing herein shall constitute, nor deemed to constitute, the creation of a debt or multi -year fiscal obligation or an obligation of future appropriations by the City Council of Pueblo, contrary to Article X, § 20 Colorado Constitution or any other constitutional, statutory or charter debt limitation. Notwithstanding any other provision of this MOU, with respect to any financial obligation of the City which may arise under this MOU in any fiscal year after 2026, in the event the budget or other means of appropriations for any such year fails to provide funds in sufficient amounts to discharge such obligation, such failure shall not constitute a default or breach of this MOU, including any sub -agreement, attachment, schedule, or exhibit thereto, by the City. PCHC and CITY have acknowledged their understanding of, and agreement to, the mutual promises written above by executing this Agreement. PUEBLO COMMUNITY HEALTH CENTER AM DocuSigned by: � b Donald Moore, Chief Executive Officer Date: 03/11/2026 CITY OF PUEBLO By: Signed by: Heather Graham, Mayor Date: 03/10/2026 Page 11 of 11