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Backup Documents 07/07/2015 Item #16E1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP RECSIa0 ACCOMPANY ALL ORIGINAL DOCUMENTS SENT T zARD OF COUNTY COMMISSIONERS OFFICE FOR SIGN T jut 2 2.015 coXIIORNEY PiNx RotrriNtSUP likwitifirWriCaurement Services to the Office Initials Date Following Addressee(s) (In routing order) 1. Risk Management Risk 7721)/(`� 2. County Attorney Office County Attorney Office 2i WS 3. BCC Office Board of County �D Commissioners \M// —1\-zZ\‘S 4. Minutes and Records *Please provide Clerk of Court's Office an electronic copy to Procurement l2� r1(2z(15 4=35f"` 5. Return to Procurement Services Procurement Services Division Contact: Diana De Leon PRIMARY CONTACT INFORMATION Name of Primary Diana De Leon for Sandra Herrera Phone Number 252-8375 Procurement Staff July 17,2015 Contact and Date Agenda Date Item was July 7,2015 d Agenda Item Number 16.E.1 1/ Approved by the BCC Type of Document Contract Number of Original 1 Attached Documents Attached PO number or account N/A Solicitation/Contract 15-6505 HealthCare number if document is Number/Company Impact to be recorded Name INSTRUCTIONS & CHECKLIST Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not appropriate. (Initial) Applicable) 1. Does the document require the chairman's original signature? DD 2. Does the document need to be sent to another agency for additional signatures? If yes, N/A provide the Contact Information(Name;Agency;Address; Phone)on an attached sheet. 3. Original document has been signed/initialed for legal sufficiency. (All documents to be signed by the Chairman,with the exception of most letters,must be reviewed and signed by the Office of the County Attorney. 4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A Office and all other parties except the BCC Chairman and the Clerk to the Board 5. The Chairman's signature line date has been entered as the date of BCC approval of the N/A document or the final negotiated contract date whichever is applicable. 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's DD signature and initials are required. 7. In most cases(some contracts are an exception),an electronic copy of the document and DD this routing slip should be provided to the County Attorney's Office before the item is input into SIRE. 8. The document was approved by the BCC on the date above and all changes made 0 A p.CI during the meeting have been incorporated in the attached document. The County Attorney's Office has reviewed the changes,if applicable. 9. Initials of attorney verifying that the attached document is the version approved by th= ' BCC, all changes directed by the BCC have been made, and the document is ready f.. the Chairman's signature. _4 .-, 16E1Ann P. Jennejohn From: Ann P.Jennejohn Sent: Thursday,July 23, 2015 12:03 PM To: DeLeon, Diana Subject: Contract#15-6505 w/HealthCare Impact Associates, LLC Attachments: Contract#15-6505 (#16E1 July 7, 2015 BCC Meeting).pdf Hi Diana, A copy of Contract #15-6505 w/HealthCare Impact Associates, LLC., approved by the Board on July 7, 2015 (#16E1) is attached for you records. Thank you! Ann Jennejohn, Deputy Clerk Clerk of the Circuit Court Clerk of the Value Adjustment Board Collier County Minutes & Records Dept. 239-252-8406 239-252-8408 (Fax) 1 Pgt of Minnesota Business and Lien System, Office of the Minnesota Secretary of State Business Record Details » Minnesota Business Name HealthCare Impact Associates L. L. C. Business Type MN Statute Limited Liability Company(Domestic) 322B File Number Home Jurisdiction 491063700027 Minnesota Filing Date Status 5/29/2012 Active/In Good Standing Renewal Due Date Registered Office Address 12/31/2015 Baker Technology Plaza 6121 Baker Road Ste 104 Minnetonka, MN 55345 USA Registered Agent(s) Manager (Optional) None provided Andrew Brown 3600 Westview Drive Deephaven, MN 55391 USA Principal Executive Office Address 3600 Westview Drive Deephaven, MN 55391 USA Comments HealthCare Impact Associates, LP Filing History Filing History Select the item(s)you would like to order: Order Selected Copies https://mblsportal.sos.state.mn.us/Business/SearchDetails?filingGuid=9099c337-fba9-e 111... 7/17/2015 Page 2 of 2 16E1 ❑ Filing Date Filing Effective Date ❑ 5/29/2012 Original Filing-Limited Liability Company(Domestic) ❑ 8/29/2013 Registered Office and/or Agent- Limited Liability Company(Domestic) D 3/20/2015 Registered Office and/or Agent- Limited Liability Company(Domestic) 0 4/21/2015 Consent to Use of Name-Limited Liability Company (Domestic) O 4/21/2015 Consent to Use of Name-Limited Liability Company (Domestic) Copyright 2015 I Secretary of State of Minnesota I All rights reserved https://mbl sportal.sos.state.mn.us/Business/SearchDetails?filingGuid=9099c3 3 7-fba9-e 111... 7/17/20 15 16E1 HEALTH e ® Clarity. Compliance.Control. SOFTWARE AND SERVICE AGREEMENT ("Master Agreement") ff This Agreement is made on the day of V clt_ , 2015 (the "Effective Date") by and between HealthCare Impact Associates, LLC ("HIA"), & Minnesota limited liability company with primary office at 6121 Baker Road, Suite 104, Minneapolis, MN 55345, and Collier County, a political subdivision of the State of Florida ("Employer" or "the County"), with an office at 3299 Tamiami Trail E., Suite 303, Naples, Florida 34112. WHEREAS, HIA is the developer and exclusive owner of an Affordable Care Act management information system known as Health E(fx)® (which, together with its accompanying documentation and other materials, shall be referred to hereafter as the "Software" or"Service"); and WHEREAS, as further described on the proposal provided to Employer, dated April 15, 2015 and attached hereto as Exhibit A (the "Proposal") the Software: (1) aggregates and analyzes raw employer data received from Employer source systems, including payroll, HRIS, time and attendance and benefits administration; (2) complies with applicable regulations of the Affordable Care Act as of the date of its implementation, and is designed to maintain compliance to subsequent regulation changes as introduced; (3) measures, reports, and alerts on employee medical benefits eligibility and plan affordability compliance under the Affordable Care Act; (4) provides employer management reporting, compliance reporting, and employee notifications and federal reporting; and (5) enables complex data modeling and analytics (when the analytics module is purchased) to assess and evaluate risk, cost, and strategies related to an employer's medical benefits program; and WHEREAS, Employer wishes to license and use the Software and HIA services for the price and on the terms set forth herein; NOW, THEREFORE, in consideration of the mutual covenants and premises herein contained, the parties hereto agree to the terms and conditions of this Agreement (also called "Master Agreement"). 1. Term and Termination. This Agreement shall become effective upon the date the Board of County Commissioners approves ("Effective Day") and shall be for thirty-six (36) months beginning on the Effective Date, at the end of which time it may be renewed for additional twelve (12) month periods until terminated by (1) mutual agreement of the parties, (2) the Employer upon ninety (90) days' notice to HIA, or (3) as otherwise provided herein. All services and products provided prior to termination shall be paid for in full, upon receipt of a proper invoice and upon approval by the Risk Management Director, or his designee, and in compliance with Chapter 218, Fla. Stats., otherwise known as the "Local Government Prompt Payment Act". Provisions of this Agreement which by their terms are intended to survive the termination of this Agreement, including but not limited to Sections 5, 6, 7, and 9, shall survive termination of this Agreement. 1 SSA SUBSCRIPTION(041515) 16E1 2. Services: License. Subject to the terms of this Agreement and in exchange for the fees below, HIA will provide to Employer the services described on the Proposal and purchased by Employer, including the grant of a non-exclusive non-transferable, license to use the Software as set forth more particularly in the End User Software License and Warranty Agreement ("EULA"), which is attached hereto as Appendix A and incorporated by reference herein. 3. Fees: Employer shall pay fees as follows: a. Implementation Fee. The Implementation Fee is a one-time non-refundable fee securing the implementation schedule and include set-up, system configuration, data file(s) integration and testing, hosting and deployment, and standard training. b. Software and Service Fees. In addition to the Implementation Fee, Employer shall pay an annual Software and Service Fee for the Health E(fx) Compliance Module. Employer will be provided access to and use of the Health E(fx)® Analytics Module for a period of three (3) months (the "Trial Period") from the "Go-Live" date free of charge, at which time additional fees for continued use will apply (as shown in the Applicable Software and Service Fees table below). Employer has the right to cancel access and use of Analytics Module upon written notice up to ten (10) days in advance of the end of the Trial Period. All fees associated with the Annual Software and Service Fees are in effect for a period of three (3) years from Agreement date, subject to an annual 4% adjustment at the start of years two and three. "Go-Live" shall begin when the Employer's system is moved to production subsequent to Employer's documented acceptance sign-off, which sign-off shall not be unreasonably withheld. Support and maintenance Services shall be governed by the Support and Service Level Agreement, which is attached hereto as Appendix B and incorporated by reference. c. Applicable Software and Service Fees: Item s Pea �,� Implementation Fee $9,200 Compliance Module $11,000 annually Optional Analytics Module Three months free use; $3,500 annually 1094-C Generation and Filing $3,500 1095-C Generation 2 SSA SUBSCRIPTION(041515) 16E1 Additional Services *Managed Services PEPM $1.25 One Time Set Up Fee - $1,150 Standard Print and Mail Per Form - $0.92 1095 Forms Fulfillment Combined Print and Electronic Portal Per Form - $1.30 Annual Portal License Fee $1,725 Unlimited User Seats Included d. Basis For Fees. I. Fees are based on implementation of standard Software functionality and include implementation of current month and historical data testing, and validation of the data feeds from Employer source systems identified in the proposal data form provided by Employer ("Data Form") appended to this Agreement as Appendix C, and using secure data acquisition processes integral and proprietary to the Software. Implementation requires timely tendering of required source data to maintain implementation schedule. II. Historical data load is included provided historical data is provided to HIA in the agreed data specification ("Implemented Data Files") established between Employer and HIA during implementation. III. A one-time historical data load is included in the Implementation Fee. If additional support is required and/or historical data must be reloaded due to errors or changes caused by Employer, additional fees may apply and are subject to a written scope change document, upon prior approval by the Employer. IV. Additional consulting resulting from additional requests not included in licensing or which are not identified in the Employer Data Form (Appendix C), or changes that are made to Employer's data feeds subsequent to Go-Live, shall be invoiced at $235 for compliance and client services, and $175 per hour for technical services. Such costs are in addition to the fees set forth in sections 3a, 3b and 3c above and will be documented as a scope change for Employer's approval before work is undertaken. 3 SSA SUBSCRIPTION(041515) (53 16E1 e. Invoicing. Payment will be made upon receipt of a proper invoice and upon approval by the Risk Management Director, or his designee, and in compliance with Chapter 218, Fla. Stats., otherwise known as the "Local Government Prompt Payment Act". The Implementation Fee is due upon execution of this Agreement. The Annual Subscription Software and Service Fees shall be invoiced after Go-Live acceptance. f. Travel Costs. Requested travel, if any, shall be requested in advanced and approval by the Risk Management Director is required. Requested travel will incur costs in addition to the Implementation Fee and Software and Support Fees. Travel expenses will include all travel time that is in addition to training time, and shall be reimbursed as per Section 112.061 Fla. Stats. Reimbursements shall be at the following rates: Mileage $0.445 per mile Breakfast $6.00 Lunch $11.00 Dinner $19.00 Airfare Actual ticket cost limited to tourist or coach class fare Rental car Actual rental cost limited to compact or standard-size vehicles Lodging Actual cost of lodging at single occupancy rate with a cap of no more than $150.00 per night Parking Actual cost of parking Taxi or Airport Actual cost of either taxi or airport Limousine limousine g. Print and Fulfillment Services. Managed print and electronic fulfillment is available at Employer's request. Print and mail fulfillment services are not included in fees above and shall be invoiced in addition to the other fees in this Section 3. The Software is integrated with industry-leading third party tax form vendors. An addendum will be executed should managed print and electronic services be requested. 4. Interest charges. In addition to the default remedies available at law and in this Agreement, any past due amounts will accrue monthly interest in accordance to Fla. Stat. §218.74 and payable upon receipt of a proper invoice and upon approval by the Risk 4 0 SSA SUBSCRIPTION(041515) l6Ei Management Director, or his designee, and in compliance with Chapter 218, Fla. Stats., otherwise known as the "Local Government Prompt Payment Act". 5. Confidentiality. HIA and Employer agree that each party may have access to, or become acquainted with confidential information about the other, including customer information and methods and means of the operation of the business. Each party shall keep said confidential information ("Confidential Information") of the other party in confidence and shall not use, copy, reveal, report, publish, disclose, transfer or otherwise make it available, directly or indirectly, without the prior written consent of the other party. The parties agree that all employee information provided by Employer to HIA hereunder, including through its use of the Software is "Confidential Information" and that all aspects of the Software (including but not limited to its functionality and design) and documentation related thereto, are likewise deemed Confidential Information. Each party agrees to: (a) maintain the confidentiality of all Confidential Information using at least the degree of care and security as it uses to maintain the confidentiality of its own Confidential Information, and in no event less than a reasonably degree of care, and (b) not use the other's Confidential Information except in accordance with this Agreement. In the event that HIA wishes to disclose Employer's Confidential Information to one of its agents or subcontractors (including service providers), it may do so only if that agent or service provider has a need to know such Confidential Information in order for HIA to perform its obligations under this Agreement, and the agent, subcontractor, or service provider acknowledges that the Confidential Information is subject to protection hereunder. Information shall not be considered confidential under this Section that: (i) is publicly known prior to or after disclosure hereunder other than through acts or omissions attributable to the recipient or its employees or representatives; (ii) as demonstrated by prior written records, is already known to the recipient at the time of disclosure hereunder; (iii) is disclosed in good faith to the recipient by a third party having a lawful right to do so; (iv) is the subject of written consent of the party which supplied such information authorizing disclosure; or (v) is required to be disclosed by law; provided that the recipient shall give the disclosing party reasonable notice in writing prior to disclosing such information in order to facilitate seeking a protective order or other appropriate remedy from the proper authority. Notwithstanding the foregoing, if the parties have previously executed an agreement concerning confidentiality and non-disclosure, and any of those terms directly conflict with the terms in this Section 5, the most restrictive and protective term will prevail. HIA shall have the right to communicate Employer use of the Software. 6. Data Security. As noted in the EULA, which is attached as Appendix A to this Agreement, HIA has implemented and maintains an information security program that incorporates administrative, technical, and physical safeguards designed to ensure the security, confidentiality, and integrity of Personal Information (as defined below) in compliance with applicable laws, including without limitation the requirements contained in the Massachusetts Code of Regulations, 201 CMR Sections 17.00 et. seq. For purposes of this Agreement, the term "Personal Information" shall mean 1) information that is not lawfully available to the public 2) in any medium provided by Employer to HIA, or collected or processed by HIA on Employer's behalf, 3) that identifies or could reasonably be used to identify any natural person, including without limitation a person's first and last name or first initial and last name, in combination with one or more of the following: social security number or other third-party issued identifier such as a state identification number, driver's license number or passport number, and financial information, including credit card or bank account information. 5 SSA SUBSCRIPTION(041515) bJ 16E1 7. HIPAA Compliance. HIA agrees to comply with all applicable laws relating to the privacy, transmission and security of individually identifiable personal data, including individually identifiable health care information and, to execute a Business Associate Agreement attached hereto as Exhibit "B." 8. Ownership of Data. All right, title and interest in the data used and/or submitted by Employer in connection with the Software ("Data") is owned by Employer and may not be used, disclosed, transferred, assigned, sold or published by HIA without Employer's prior, express, written permission. HIA will not publish or sell Data or Personal Information or employee-specific information or otherwise use any Data or Personal Information for any purpose other than as strictly necessary to provide the Software and services to Employer. 9. Indemnification. HIA shall indemnify and hold harmless Collier County, its officers and employees from any and all liabilities, damages, losses and costs, including, but not limited to, reasonable attorneys' fees and paralegals' fees, to the extent caused by the intentionally wrongful conduct of HIA or anyone employed by HIA in the performance of this Agreement or damages resulting from any claim by any third party, including amounts incurred pursuant to resolution or settlement agreements with government agencies (cumulatively, each a "Claim"), arising out of: (a) any material breach by HIA of Section 5 (Confidentiality) or Section 6 (Data Security), or (b) any determination that any of the Software or Services (or any portion thereof) infringes a third party's patents, or infringes or misappropriates, as applicable, such third party's copyrights, trademarks, trade secrets or other intellectual property or proprietary rights. This indemnification obligation shall not be construed to negate, abridge or reduce any other rights or remedies which otherwise may be available to an indemnified party or person described in this paragraph. This section does not pertain to any incident arising from the sole negligence of Collier County. 9.1 The duty to defend under this Section 9 is independent and separate from the duty to indemnify, and the duty to defend exists regardless of any ultimate liability of the HIA, County and any indemnified party. The duty to defend arises immediately upon presentation of a claim by any party and written notice of such claim being provided to HIA. HIA's obligation to indemnify and defend under this Section 9 will survive the expiration or earlier termination of this Agreement until it is determined by final judgment that an action against the County or an indemnified party for the matter indemnified hereunder is fully and finally barred by the applicable statute of limitations. 10. Non-Solicitation of Employees. During the term of this Agreement and for one (1) year thereafter, each party agrees that it will not induce or attempt to influence any employee, subcontractor, or agent of the other party to (1) terminate his/her or its relationship with the other party, or (2) enter into any employment or other business relationship with any other person firm or entity. 11. Independent Contractor. HIA is at all times an independent contractor and nothing in this Agreement is intended, or construed, to create between Employer and HIA an agency, joint venture or partnership relationship. Except as specifically set forth herein, neither party may act on behalf of the other. 12. Insurance. At all times during the term of this Agreement, HIA will maintain insurance policies as set forth below, and will cause Employer to be named as an additional insured. 6 SSA SUBSCRIPTION(041515) 16E1 Insurance shall be obtained from insurers authorized to transact the relevant type of insurance business in the state in which work is to be performed, and shall have an A.M. Best rating of no less than "A-", and an A.M. Best Financial Size Category of at least VII, with at least the following provisions, coverages and limits: 1. Worker's Compensation Statutory limits in accordance with all applicable state and federal laws, applicable in states where work is to be performed: Employer's Liability Each accident $ 500,000 Disease (policy limit) $ 500,000 Disease (each employee) $ 500,000 2. Commercial General Liability (including Contractual Liability Insurance coverage based on the following minimum limits): General Aggregate $2,000,000 Products/Completed Operations Aggregate $2,000,000 Advertising Injury and Personal Injury Aggregate Limit $1,000,000 Each Occurrence $1,000,000 Medical Expenses $ 10,000 3. Umbrella liability (which shall be excess and following form with respect to underlying coverage requirements and limits, with a minimum limit of): Each Occurrence $3,000,000 Aggregate $3,000,000 4. Technology Errors & Omissions Liability. The definition of"professional services" under this policy shall cover the scope of work being performed under this Agreement. The policy shall provide minimum limits of liability as follows: Each claim $3,000,000 Aggregate $3,000,000 13. IRS Reporting Only. If Employer has opted to use only the IRS reporting functions of the Software, Employer shall bear any and all liability associated with the determination of eligibility, affordability, and the compliance data it provides to HIA that is used in fulfilling IRS reporting data requirements. When reporting only is chosen, HIA is unable to audit employer data, and therefore must depend on and assume the correctness and accuracy of employer provided and determined compliance information critical to the IRS reports, including eligibility and affordability of offer of coverage. 14. Default. Failure by either party to perform as agreed upon in this Agreement shall be a default. Prior to initiating any legal action or termination of this Agreement, the non- defaulting party shall give written notice of the default to the other party. If the default is not cured within ten (10) days of delivery of the notice, the non-defaulting party may, at its option, terminate this Agreement, including Employer's rights under the EULA. In the event of a failure to make payment when due, HIA may suspend and/or terminate service to 7 SSA SUBSCRIPTION(041515) 16E1 Employer. Termination of this Agreement by HIA does not relieve Employer of the obligation to make immediate payment of all outstanding amounts owing to HIA by Employer. As set forth above, the County may terminate said agreement for cause. 15. Notices. Any notices given pursuant to this Agreement will be in writing, delivered to the addresses set forth below (unless change by notice) and will be effective upon receipt as documented via a return receipt or courier service. To Employer: Collier County 3311 Tamiami Trail E. Naples, FL 34112 Attn: Jeff Walker, Risk Management Director Telephone No: 239-252-8461 Facsimile No: 239-252-8048 To HIA: Contract Management HealthCare Impact Associates, LLC Baker Technology Plaza 6121 Baker Road, Suite 104 Minnetonka, MN 55345 16. Modification of Agreement. Any modification of this Agreement shall be binding only if evidenced in writing, and signed by each party. 17. Invalidity. Should any part of this Agreement for any reason be declared invalid, such declaration shall not affect the remaining portions of this Agreement, which shall remain in full force and effect as if this Agreement had been executed without the invalid portion thereof. 18. Headings. The division of this Agreement into sections and subparagraphs and the insertion of headings are for the convenience of reference only and shall not affect the construction or interpretation of this Agreement. 19. Assignment. The Agreement may not be assigned by either party without the prior express written consent of the other; such consent will not be unreasonably withheld. See Appendix A. 20. Force Majeure. Neither party shall be liable or deemed in default for any delay or failure in performance of any part of this Agreement to the extent that such delay or failure is caused by the occurrence of any event beyond the reasonable control of such party, including without limitation, fire, flood, strikes and other industrial disturbances, accident, embargo, act of the government, war, terrorism or national emergency requirement, act of God, act of the public enemy, electrical, internet, or telecommunication outage that is not caused by the obligated party. 21. Governing Law. This Agreement shall be governed in all respects by the laws of Florida without regard to its conflicts of laws rules. 22. Entire Agreement. This Agreement together with Exhibit A, Exhibit B and the Appendices hereto contains the entire agreement between the parties hereto and supersedes all prior 8 SSA SUBSCRIPTION (041515) 16E1 agreements, arrangements, negotiations and understandings between the parties hereto relating to the subject matter hereof. 23. Counterparts. This Agreement may be executed in counterparts, delivered by facsimile transmission or as a .pdf attachment to an email. (Signature Page to Follow) 9 SSA SUBSCRIPTION(041515) 006'3 16E1 IN WITNESS WHEREOF, the parties hereto, have each, respectively, by an authorized person or agent, have executed this Agreement on the date and year first written above. BOARD OF COUNTY COMMISSIONERS ATTEST: COLLIER COUNTY, FLORIDA Dwight E. Brock, Clerk of Courts _l By I ) ' _ 1; ,0.. . By / cap__ Tim Nance, Chairman Dated: �S (SWf t • to Chairman's signature only. HealthCare Impact Associates, LLC (\AL 3t.41, By: < '.y/�-- Signature First Witness Car 1-e, 5 106 TType/print witness name di)E44V QS- t30-^✓j Type/print signature and titleT , ! 1 Second Witness Kelm SIn eeVict rt TType/print witness nameT Approved as to Form and Legality: oe94,..g/I AAsst�p ounty Attorney � Print Name Attachments: Item# NEL Exhibit A- Proposal Exhibit B- Business Associate Agreement Agenda Appendix A- End User License Agreement Date Appendix B-Support and Service Level Agreement �� Appendix C- Employer Data Form Date --r--r�-�� Recd �1 iah Deputy• � 10 SSA SUBSCRIPTION(041515) 16EL DATE(MM/ ) AWRE, CERTIFICATE OF LIABILITY INSURANCE 07/15/2015 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 CONTACT Willis of Minnesota, Inc. NAME: c/o 26 Century Blvd PHONE FAX IA/C.No.Ext1:1-877-945-7378 (A/C,No):1-888-467-2378 P.O. Box 305191 E-MAIL Nashville, TN 372305191 USA ADDRESS:certificates@willis.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Federal Insurance Company 20281 INSUREDHealthcare Impact Associates, LLC DBA Health E (fx) INSURER B: Baker Technology Plaza INSURER C: 6121 Baker Road, Suite 104 Minnetonka, MN 55345 INSURER D INSURER E: _INSURER F: COVERAGES CERTIFICATE NUMBER:W1032741 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 ADDL SUBR POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) IMMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 1,000,000 A MED EXP(Any one person) $ 10,000 99485256 04/26/2015 04/26/2016 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- POLICY JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident) $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS _ AUTOS (Per accident) A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE _ $ 3,000,000 EXCESS LIAB CLAIMS-MADE 79894821 04/26/2015 04/26/2016 AGGREGATE $ 3,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN X STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N N/A 71749195 08/01/2014 08/01/2015 E.L.EACH ACCIDENT $ 500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 A Errors & Omissions 99485256 04/26/2015 04/26/2016 $3,000,000 Limit $25,000 Deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Umbrella Policy Follows Form. Collier County Government is included as an Additional Insured as respects to General Liability, as required by written contract. 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. AUTHORIZED REPRESENTATIVE Collier County Government 3299 Tamiami Trail E., Suite 303 {��/ Maples, FL 34112 �1 C'/- ©1988-2014 ACORD CORPORATION. All rights reserved. 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WHEREAS, Covered Entity and Business Associate have entered into, or plan to enter into, an arrangement pursuant to which Business Associate may provide services for Covered Entity that require Business Associate to access, create and use Protected Health Information ("PHI")that is confidential under state and/or federal law; and WHEREAS, Covered Entity and Business Associate intend to protect the privacy and provide for the security of PHI disclosed by Covered Entity to Business Associate, or collected or created by Business Associate, in compliance with the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191 ("HIPAA"), and the regulations promulgated there under, including, without limitation, the regulations codified at 45 CFR Parts 160 and 164 ("HIPAA Regulations"); the Health Information Technology for Economic and Clinical Health Act, as incorporated in the American Recovery and Reinvestment Act of 2009, and its implementing regulations and guidance issued by the Secretary of the Department of Health and Human Services (the "Secretary") (the "HITECH Act"); and other applicable state and federal laws, all as amended from time to time, including as amended by the Final Rule issued by the Secretary on January 17, 2013 titled "Modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules under the Health Information Technology for Economic and Clinical Health Act and the Genetic Information Nondiscrimination Act; Other Modifications to the HIPAA Rules"; and WHEREAS, the HIPAA Regulations require Covered Entity to enter into an agreement with Business Associate meeting certain requirements with respect to the Use and Disclosure of PHI, which are met by this Agreement. NOW, THEREFORE, in consideration of the mutual promises contained herein and the exchange of information pursuant to this Agreement,the parties agree as follows: 1. Definitions. Capitalized terms used herein without definition shall have the meanings ascribed to them in the HIPAA Regulations or the HITECH Act, as applicable unless otherwise defined herein. 2. Obligations and Activities of Business Associate. a. Permitted Uses and Disclosures. Business Associate shall only Use or Disclose PHI for the purposes of(i) performing Business Associate's obligations under Exhibit A of this Agreement ("Exhibit A") and as permitted by this Agreement; or (ii) as permitted or Required By Law; or (iii) as otherwise permitted by this Agreement. Business Associate shall Page 1 of 10 16E1 not Use or further Disclose PHI other than as permitted or required by this Agreement or as Required By Law. Further, Business Associate shall not Use or Disclose PHI in any manner that would constitute a violation of the HIPAA Regulations or the HITECH Act if so used by Covered Entity, except that Business Associate may Use PHI (i) for the proper management and administration of Business Associate; and (ii) to carry out the legal responsibilities of Business Associate. Business Associate may Disclose PHI for the proper management and administration of Business Associate, to carry out its legal responsibilities or for payment purposes as specified in 45 CFR § 164.506(c)(1) and (3), including but not limited to Disclosure to a business associate on behalf of a covered entity or health care provider for payment purposes of such covered entity or health care provider, with the expectation that such parties will provide reciprocal assistance to Covered Entity, provided that with respect to any such Disclosure either: (i) the Disclosure is Required By Law; or (ii) for permitted Disclosures when Required By Law, Business Associate shall obtain a written agreement from the person to whom the PHI is to be Disclosed that such person will hold the PHI in confidence and will not use and further disclose such PHI except as Required By Law and for the purpose(s) for which it was Disclosed by Business Associate to such person, and that such person will notify Business Associate of any instances of which it is aware in which the confidentiality of the PHI has been breached. b. Appropriate Safeguards. Business Associate shall implement administrative, physical and technical safeguards that(i) reasonably and appropriately protect the confidentiality, integrity and availability of electronic PHI that it creates, receives, maintains or transmits on behalf of Covered Entity; and (ii)prevent the Use or Disclosure of PHI other than as contemplated by Exhibit A and this Agreement. c. Compliance with Security Provisions. Business Associate shall: (i) implement and maintain administrative safeguards as required by 45 CFR § 164.308, physical safeguards as required by 45 CFR § 164.3 10 and technical safeguards as required by 45 CFR § 164.3 12; (ii) implement and document reasonable and appropriate policies and procedures as required by 45 CFR § 164.3 16; and (iii) be in compliance with all requirements of the HITECH Act related to security and applicable as if Business Associate were a "covered entity," as such term is defined in HIPAA. d. Compliance with Privacy Provisions. Business Associate shall only Use and Disclose PHI in compliance with each applicable requirement of 45 CFR § 164.504(e). Business Associate shall comply with all requirements of the HITECH Act related to privacy and applicable as if Business Associate were a "covered entity," as such term is defined in HIPAA. To the extent Business Associate is to carry out one or more of Covered Entity's obligation(s) under Subpart E of 45 CFR Part 164, Business Associate shall comply with the requirements of Subpart E that apply to Covered Entity in the performance of such obligation(s). e. Duty to Mitigate. Business Associate agrees to mitigate, to the extent practicable and mandated by law, any harmful effect that is known to Business Associate of a Use or Disclosure of PHI by Business Associate in violation of the requirements of this Page 2 of 10 16E1 Agreement. f. Encryption. To facilitate Business Associate's compliance with this Agreement and to assure adequate data security, Covered Entity agrees that all PHI provided or transmitted to Business Associate pursuant to Exhibit A shall he provided or transmitted in a manner which renders such PHI unusable, unreadable or indecipherable to unauthorized persons, through the use of a technology or methodology specified by the Secretary in the guidance issued under section 13402(h)(2) of the HITECH Act. Covered Entity acknowledges that failure to do so could contribute to or permit a Breach requiring patient notification under the HITECH Act and further agrees that Business Associate shall have no liability for any Breach caused by such failure. 3. Reporting. a. Security Incidents and/or Unauthorized Use or Disclosure. Business Associate shall report to Covered Entity a successful Security Incident or any Use and/or Disclosure of PHI other than as provided for by this Agreement or permitted by applicable law within a reasonable time of becoming aware of such Security Incident and/or unauthorized Use or Disclosure (but not later than five (5) days thereafter), in accordance with the notice provisions set forth herein. Business Associate shall take (i) prompt action to cure any such deficiencies as reasonably requested by Covered Entity, and (ii) any action pertaining to such Security Incident and/or unauthorized Use or Disclosure required by applicable federal and state laws and regulations. If such successful Security Incident or unauthorized Use or Disclosure results in a Breach as defined in the HITECH Act, then Covered Entity shall comply with the requirements of Section 3.b below. b. Breach of Unsecured PHI. The provisions of this Section 3.b are effective with respect to the Discovery of a Breach of Unsecured PHI occurring on or after September 23, 2009. With respect to any unauthorized acquisition, access, Use or Disclosure of Covered Entity's PHI by Business Associate, its agents or subcontractors, Business Associate shall (i) investigate such unauthorized acquisition, access, Use or Disclosure; (ii) determine whether such unauthorized acquisition, access, Use or Disclosure constitutes a reportable Breach under the HITECH Act; and (iii) document and retain its findings under clauses (i) and (ii). If Business Associate Discovers that a reportable Breach has occurred, Business Associate shall notify Covered Entity of such reportable Breach in writing within five (5) days of the date Business Associate Discovers such Breach. Business Associate shall be deemed to have discovered a Breach as of the first day that the Breach is either known to Business Associate or any of its employees, officers or agents, other than the person who committed the Breach, or by exercising reasonable diligence should have been known to Business Associate or any of its employees, officers or agents, other than the person who committed the Breach. To the extent the information is available to Business Associate, Business Associate's written notice shall include the information required by 45 CFR § 164.410(c). Business Associate shall promptly supplement the written report with additional information regarding the Breach as it obtains such information. Business Associate shall cooperate with Covered Entity in meeting Covered Entity's obligations under the HITECH Act with respect to such Breach. Page 3 of 10 C.b 16E1 4. Business Associate's Agents. To the extent that Business Associate uses one or more subcontractors or agents to provide services under Exhibit A, and such subcontractors or agents receive or have access to PHI, Business Associate shall sign an agreement with such subcontractors or agents containing substantially the same provisions as this Agreement. 5. Rights of Individuals. a. Access to PHI. Within ten (10) days of receipt of a request by Covered Entity, Business Associate shall make PHI maintained in a Designated Record Set available to Covered Entity or, as directed by Covered Entity, to an Individual to enable Covered Entity to fulfill its obligations under 45 CFR § 164.524. Subject to Section 5.b below, (i) in the event that any Individual requests access to PHI directly from Business Associate in connection with a routine billing inquiry, Business Associate shall directly respond to such request in compliance with 45 CFR § 164.524; and (ii) in the event such request appears to be for a purpose other than a routine billing inquiry, Business Associate shall forward a copy of such request to Covered Entity and shall fully cooperate with Covered Entity in responding to such request. In either case, a denial of access to requested PHI shall not be made without the prior written consent of Covered Entity. b. Access to Electronic Health Records. If Business Associate is deemed to use or maintain an Electronic Health Record on behalf of Covered Entity with respect to PHI, then, to the extent an Individual has the right to request a copy of the PHI maintained in such Electronic Health Record pursuant to 45 CFR § 164.524 and makes such a request to Business Associate, Business Associate shall provide such individual with a copy of the information contained in such Electronic Health Record in an electronic format and, if the Individual so chooses, transmit such copy directly to an entity or person designated by the Individual. Business Associate may charge a fee to the individual for providing a copy of such information, but such fee may not exceed Business Associate's labor costs in responding to the request for the copy. The provisions of 45 CFR § 164.524, including the exceptions to the requirement to provide a copy of PHI, shall otherwise apply and Business Associate shall comply therewith as if Business Associate were the "covered entity," as such term is defined in HIPAA. At Covered Entity's request, Business Associate shall provide Covered Entity with a copy of an Individual's PHI maintained in an Electronic Health Record in an electronic format and in a time and manner designated by Covered Entity in order for Covered Entity to comply with 45 CFR § 164.524, as amended by the HITECH Act. c. Amendment of PHI. Business Associate agrees to make any amendment(s) to PHI in a Designated Record Set that Covered Entity directs or agrees to pursuant to 45 CFR § 164.526 at the request of Covered Entity or an Individual, and in the time and manner designated by Covered Entity. d. Accounting Rights. This Section 5.d is subject to Section 5.e below. Business Associate shall make available to Covered Entity, in response to a request from an Individual, information required for an accounting of disclosures of PHI with respect to the Page 4 of 10 16E1 Individual, in accordance with 45 CFR § 164.528, incorporating exceptions to such accounting designated under such regulation. Such accounting is limited to disclosures that were made in the six (6) years prior to the request and shall not include any disclosures that were made prior to the compliance date of the HIPAA Regulations. Business Associate shall provide such information as is necessary to provide an accounting within ten (10) days of Covered Entity's request. Such accounting must he provided without cost to the Individual or to Covered Entity if it is the first accounting requested by an Individual within any six (6) month period; however, a reasonable, cost-based fee may be charged for subsequent accountings during that period if Business Associate informs Covered Entity and Covered Entity informs the Individual in advance of the fee, the Individual is afforded an opportunity to withdraw or modify the request and charging such fee is not otherwise contrary to law. Such accounting obligations shall survive termination of this Agreement and shall continue as long as Business Associate maintains PHI. e. Accounting of Disclosures of Electronic Health Records. The provisions of this Section 5.e shall be effective on the date specified in the HITECH Act. If Business Associate is deemed to use or maintain an Electronic Health Record on behalf of Covered Entity, then, in addition to complying with the requirements set forth in Section 5.d above, Business Associate shall maintain an accounting of any Disclosures made through such Electronic Health Record for Treatment, Payment and Health Care Operations, as applicable. Such accounting shall comply with the requirements of the HITECH Act. Upon request by Covered Entity, Business Associate shall provide such accounting to Covered Entity in the time and manner specified by Covered Entity and in compliance with the HITECH Act. Alternatively, if Covered Entity responds to an Individual's request for an accounting of Disclosures made through an Electronic Health Record by providing the requesting Individual with a list of all business associates acting on behalf of Covered Entity, then Business Associate shall provide such accounting directly to the requesting Individual in the time and manner specified by the HITECH. Act. f. Agreement to Restrict Disclosure. If Covered Entity is required to comply with a restriction on the Disclosure of PHI pursuant to Section 13405 of the HITECH Act, then Covered Entity shall, to the extent necessary to comply with such restriction, provide written notice to Business Associate of the name of the Individual requesting the restriction and the PHI affected thereby. Business Associate shall, upon receipt of such notification, not Disclose the identified PHI to any health plan for the purposes of carrying out Payment or Health Care Operations, except as otherwise required by law. Covered Entity shall also notify Business Associate of any other restriction to the Use or Disclosure of PHI that Covered Entity has agreed to in accordance with 45 CFR § 164.522. 6. Remuneration and Marketing. a. Remuneration for PHI. This Section 6.a shall be effective with respect to exchanges of PHI occurring six (6) months after the date of the promulgation of final regulations implementing the provisions of Section 13405(d) of the HITECH Act. On and after such date, Business Associate agrees that it shall not, directly or indirectly, receive remuneration in exchange for any PHI of Covered Entity except as otherwise permitted by the HITECH Act. b. Limitations on Use of PHI for Marketing Purposes. Business Associate Page 5 of 10 ®-L)‘ 16E1 shall not Use or Disclose PHI for the purpose of making a communication about a product or service that encourages recipients of the communication to purchase or use the product or service, unless such communication: (I) complies with the requirements of subparagraph (i), (ii) or (iii) of paragraph (1) of the definition of marketing contained in 45 CFR § 164.501, and (2) complies with the requirements of subparagraphs (A), (B) or (C) of Section 13406(a)(2) of the HITECH Act, and implementing regulations or guidance that may be issued or amended from time to time. Covered Entity agrees to assist Business Associate in determining if the foregoing requirements are met with respect to any such marketing communication. 7. Governmental Access to Records. Business Associate shall make its internal practices, books and records relating to the Use and Disclosure of PHI available to the Secretary for purposes of determining Covered Entity's compliance with the HIPAA Regulations and the HITECH Act. Except to the extent prohibited by law, Business Associate agrees to notify Covered Entity of all requests served upon Business Associate for information or documentation by or on behalf of the Secretary. Business Associate shall provide to Covered Entity a copy of any PHI that Business Associate provides to the Secretary concurrently with providing such PHI to the Secretary. 8. Minimum Necessary. To the extent required by the HITECH Act, Business Associate shall limit its Use, Disclosure or request of PHI to the Limited Data Set or, if needed, to the minimum necessary to accomplish the intended Use, Disclosure or request, respectively. Effective on the date the Secretary issues guidance on what constitutes "minimum necessary" for purposes of the HIPAA Regulations, Business Associate shall limit its Use, Disclosure or request of PHI to only the minimum necessary as set forth in such guidance. 9. State Privacy Laws. Business Associate shall comply with state laws to extent that such state privacy laws are not preempted by HIPAA or the HITECH Act. 10. Termination. a. Breach by Business Associate. If Covered Entity knows of a pattern of activity or practice of Business Associate that constitutes a material breach or violation of Business Associate's obligations under this Agreement, then Covered Entity shall promptly notify Business Associate. With respect to such breach or violation, Business Associate shall take reasonable steps to cure such breach or end such violation, if possible. If such steps are either not possible or are unsuccessful, upon written notice to Business Associate, Covered Entity may terminate its relationship with Business Associate. b. Breach by Covered Entity. If Business Associate knows of a pattern of activity or practice of Covered Entity that constitutes a material breach or violation of Covered Entity's obligations under this Agreement, then Business Associate shall promptly notify Covered Entity. With respect to such breach or violation, Covered Entity shall take reasonable steps to cure such breach or end such violation, if possible. If such steps are either not possible or are unsuccessful, upon written notice to Covered Entity, Business Entity may terminate its relationship with Covered Entity. Page 6 of 10 J 16E1 c. Automatic Termination. This Agreement will automatically terminate, without any further action by the parties hereto, at such time as there are no longer any Service Agreements by and between the parties hereto. d. Effect of Termination. Upon termination of this Agreement for any reason, Business Associate shall either return or destroy all PHI, as requested by Covered Entity, that Business Associate or its agents or subcontractors still maintain in any form, and shall retain no copies of such PHI. If Covered Entity requests that Business Associate return PHI, such PHI shall be returned in a mutually agreed upon format and timeframe. If Business Associate reasonably determines that return or destruction is not feasible, Business Associate shall continue to extend the protections of this Agreement to such PHI, and limit further uses and disclosures of such PHI to those purposes that make the return or destruction of such PHI not feasible. If Business Associate is asked to destroy the PHI, Business Associate shall destroy PHI in a manner that renders the PHI unusable, unreadable or indecipherable to unauthorized persons as specified in the HITECH Act. 11. Amendment. The parties acknowledge that state and federal laws relating to data security and privacy are rapidly evolving and that amendment of this Agreement may be required to ensure compliance with such developments. The parties specifically agree to take such action as is necessary to implement any new or modified standards or requirements of HIPAA, the HIPAA Regulations, the HITECH Act and other applicable laws relating to the security or confidentiality of PHI. Upon the request of Covered Entity, Business Associate agrees to promptly enter into negotiation concerning the terms of an amendment to this Agreement incorporating any such changes. 12. No Third Party Beneficiaries. Nothing express or implied in this Agreement is intended to confer, nor shall anything herein confer, upon any person other than Covered Entity, Business Associate and their respective successors or assigns, any rights, remedies, obligations or liabilities whatsoever. 13. Effect on Underlying Arrangement. In the event of any conflict between this Agreement and any underlying arrangement between Covered Entity and Business Associate, the terms of this Agreement shall control. 14. Survival. The provisions of this Agreement shall survive the termination or expiration of any underlying arrangement between Covered Entity and Business Associate. 15. Interpretation. This Agreement shall he interpreted as broadly as necessary to implement and comply with HIPAA, the HIPAA Regulations and the HITECH Act. The parties agree that any ambiguity in this Agreement shall be resolved in favor of a meaning that complies and is consistent with such laws. 16. Governing Law. This Agreement shall be construed in accordance with the laws of the State of Florida. Page 7 of 10 rJ 16E1 17. Notices. All notices required or permitted under this Agreement shall be in writing and sent to the other party as directed below or as otherwise directed by either party, from time to time, by written notice to the other. All such notices shall be deemed validly given upon receipt of such notice by certified mail, postage prepaid, facsimile transmission, e-mail or personal or courier delivery: If to Covered Entity: Collier County Government Center 3311 Tamiami Trail E. Naples, FL 34112 Attn: Risk Management Director Telephone no: 239-252-8461 Facsimile no: 239-252-8048 If to Business Associate: Contract Management HealthCare Impact Associates, LLC Baker Technology Plaza 6121 Baker Road, Suite 104 Minnetonka, MN 55345 Telephone no: 612-225-4492 18. Indemnification. The Business Associate shall indemnify and hold harmless Covered Entity and any of Covered Entity's affiliates, directors, officers, employees and agents from and against any claim, cause of action, liability, damage, cost or expense (including reasonable attorney's fees) arising out of or directly relating to any non-permitted disclosure of Protected Health Information or other breach of this Agreement by Business Associate or any affiliate, director, officer, employee, agent or subcontractor of Business Associate. 19. Miscellaneous. a. Severability. In the event that any provision of this Agreement is adjudged by any court of competent jurisdiction to be void or unenforceable, all remaining provisions hereof shall continue to be binding on the parties hereto with the same force and effect as though such void or unenforceable provision had been deleted. b. Waiver. No failure or delay in exercising any right, power or remedy hereunder shall operate as a waiver thereof; nor shall any single or partial exercise of any right, power or remedy hereunder preclude any other further exercise thereof or the exercise of any other right, power or remedy. The rights provided hereunder are cumulative and not exclusive of any rights provided by law. c. Entire Agreement. This Agreement constitutes the entire agreement between the parties hereto relating to the subject matter hereof, and supercedes any prior or Page 8 of 10 J 16E1 contemporaneous verbal or written agreements, communications and representations relating to the subject matter hereof. d. Counterparts, Facsimile. This agreement may be signed in two or more counterparts, each of which shall be deemed an original and all of which taken together shall constitute one and the same instrument. A copy of this Agreement bearing a facsimile signature shall be deemed to be an original. (signature page to follow) Page 9 of 10 16E1 IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be signed as of the date first set forth above. COVERED ENTITY: BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA By: ,w�CA-- -- /, e alker, Director of Risk Management First Witness: BUSINESS ASSOCIATE: L(t tiA Signature HealthCare Impact Associates, LLC ��Cjii tompp-' S iitoa4 By: r Print Name: Print Name: i J,2G / R-Ol-ii ni Second Witness: i I L 111 g A AL,_ Title: la S-i i,Df�,-✓ •Signature g k slr,e7ekavI Print Name: As to Form and Legality: --%-.15 f- ei,...4 L Aesitternrcounty Attorney DP)9, , Page 10 of 10 ( -:).- 16E1 HEALTH ee. Clarity.Compliance.Control. APPENDIX A: End User Software License and Warranty Agreement PLEASE READ THE FOLLOWING TERMS AND CONDITIONS CAREFULLY, THEY APPLY UPON YOUR EXECUTION OF THE SOFTWARE AND SERVICE AGREEMENT (THE "AGREEMENT") TO WHICH THIS IS APPENDED AND GOVERN YOUR USE OF THE HEALTH E(FX) SOFTWARE (HEREINAFTER "SOFTWARE"). THIS LICENSE IS NOT A SALE. TITLE, OWNERSHIP, PROPRIETARY AND INTELLECTUAL PROPERTY RIGHTS TO THE SOFTWARE AND DERIVATIVE PRODUCTS, ACCOMPANYING MATERIALS AND ALL SERVICES RELATED THERETO REMAIN THE EXCLUSIVE PROPERTY OF HEALTHCARE IMPACT ASSOCIATES, LLC ("LICENSOR", "WE" OR "OUR"). LICENSEE SHALL BE REFERRED TO AS "YOU" OR "YOUR". 1. Grant of License Subject to the terms of the Agreement, Licensor grants You a limited, non-exclusive, non-transferable, non-assignable license to use the Software and such associated documentation and technical materials as may be available on the date Effective Date of the Master Agreement. This license also extends to any enhancements that We may choose to release. Any enhancements or other modifications to the Software will be made at Our sole discretion; if upgrades or changes are made, they will be communicated to You and You may have the opportunity to use them as provided in the Master Agreement. Your license to use the Software will be automatically revoked if the Master Agreement is terminated or as described herein. 2. Ownership And Warranty (a) At all times and for all purposes, We will be the sole and exclusive owner of the Software. Nothing in the Agreement or any other document You receive will result in any transfer of any ownership in the Software to You. Because We are the exclusive owner of the Software, we also retain the right to make any changes. Nothing in the Agreement, this license, or any other document You receive will grant You the right to make any changes to the Software. No modifications, additions or deletions may be made to the Software by You. In the event You violate this provision and unlawfully create any derivative work, You agree that title to such derivative work remains with Us. In the event that You or anyone working for You creates a derivative work based on the Software, You must immediately advise us of this fact and take immediate steps to turn over to Us all documentation, code, and all copies of the derivative work in any form. You may not distribute, publicly display, reverse engineer, decompile, disassemble or otherwise try to discover the Source Code for the Software. 1 !3)End-User License Agreement(041515) 16E1 (b) There are fields in the Software that are customizable. This fact does not grant You any ownership in the Software. In the event that We (or any party we authorize) undertake any customizations or augmentations for You (which would be the subject of a separate agreement), those customizations or augmentations will always be Our exclusive property. Under no circumstances will customizations (or augmentations) and any related documentation be construed as a work made for hire, and no ownership rights shall be transferred to or created in You or any third party. You will not own resale or marketing rights. You also have the obligation to ensure that unauthorized third parties do not violate Our ownership rights. (c) In the event any part of the Software were ever determined to be a work made for hire, You hereby agree to convey all claims of ownership and authorship that arise from such a determination to Us. (d) We warrant that: (i) We have legal title and rights of ownership in the Software and have full power and authority to grant You a license to use it; (ii) to the best of Our knowledge, the use of the Software will in no way constitute an infringement or other violation of any patent, copyright, trade secret, trademark, or other proprietary right of any third party; and (iii) as set forth in Section 6 of the Master Agreement, Our company and the Software complies with applicable data security laws, including the requirements of the Massachusetts Code of Regulations, 201 CMR Sections 17.00 et seq. (iv) the Software calculates and reports according to the requirements applicable to Employers of the Affordable Care Act (ACA), and as also described in the Proposal appended to the Master Agreement as Exhibit A. This warranty is dependent on You meeting Your data tender obligations to Us. 3. Assignment or Transfer of Rights You may not transfer or sub-license Your license. You may not resell Your license nor provide access to the Software to parties that are not specifically authorized to use it by Us. 4. Termination Unauthorized use, copying, or transfer of the Software, or portions or derivative products, or the accompanying materials or failure to comply with the above restrictions will result in automatic and immediate termination of this license and will make available to Licensor other legal remedies. Your obligations of confidentiality do not end upon termination of the Master Agreement. 2 End-User License Agreement(041515) a`� 16E1 5. Data Security (a) Data Security Safeguards. We have implemented and maintain an information security program that incorporates administrative, technical, and physical safeguards designed to ensure the security, confidentiality, and integrity of Personal Information (as defined in the Master Agreement) in compliance with applicable laws, including without limitation the requirements contained in the Massachusetts Code of Regulations, 201 CMR Sections 17.00 et. seq. (b) Data Security Breach. We will notify you promptly and in no event later than five (5) business days following our discovery of a Data Security Breach (defined below) and shall (i) undertake an investigation of such Data Security Breach and (ii) reasonably cooperate with you in connection with such investigation, including by providing you with a summary of the results of our investigation; (iii) not make any public announcements relating to such Data Security Breach without your prior written approval, which shall not be unreasonably withheld; and (iv) take all necessary and appropriate corrective action reasonably possible on our part to prevent a recurrence of such Data Security Breach (the costs of such action shall be paid as set forth in the next subsection). For purposes of this Agreement, the term "Data Security Breach" shall mean any of the following occurring in connection with Personal Information (provided that you have sent the Personal Information to us through the secure transfer protocols we provide to You) in connection with your use of the Software: (a) the loss or misuse of Personal Information; (b) disclosure to, or acquisition, access or use by, any person not authorized to receive Personal Information, other than in circumstances in which the disclosure, acquisition, access or use is made in good faith and within the course and scope of the employment with Us or other professional relationship with Us and does not result in any further unauthorized disclosure, acquisition, access or use of Personal Information. (c) Remediation of a Data Security Breach. The remediation required above may include without limitation (a) development and delivery of notices to you of individuals whose Personal Information may have been affected; (b) investigation and resolution of the causes and impacts of the Data Security Breach; and (c) such other measures that we may mutually determine and agree in writing are reasonable and commensurate with the nature and level of severity of the Data Security Breach. In the event that the Data Security Breach was a result of action or inaction by Us, or the failure of the Software to comply with the data security measures notes in this Section 5, then we will be solely responsible for the costs and expenses of all remediation measures we take. If, on the other hand, the Data Security Breach was a result of Your actions or inactions, then we will invoice You for our assistance in our remediation efforts. 6. Limited Warranty and Disclaimer PROVIDED THAT ANY AND ALL MODIFICATIONS TO THE SOFTWARE HAVE BEEN MADE EXCLUSIVELY BY US, OR AUTHORIZED BY US, WE WARRANT THAT 3 End-User License Agreement(041515) ,a� 1 6 E 1 THE SOFTWARE WILL OPERATE IN SUBSTANTIAL CONFORMITY WITH THE DESCRIPTION IN THE MASTER AGREEMENT, INCLUDING THE PROPOSAL, FOR THE TERM OF THE LICENSE. NOTWITHSTANDING THE FOREGOING THIS WARRANTY IS VOIDABLE AS SET FORTH IN SECTION 2(d)(iv) ABOVE. EXCEPT AS OTHERWISE SET FORTH HEREIN, WE DISCLAIM ALL OTHER WARRANTIES, EITHER ORAL OR WRITTEN, EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE. WE MAKE NO WARRANTY THAT THE SOFTWARE IS ERROR FREE, THAT ALL ERRORS IN THE SOFTWARE WILL BE CORRECTED, THAT THE SOFTWARE WILL OPERATE IN CONJUNCTION WITH ANY OTHER PROGRAMS (UNLESS SOLD TO YOU BY US TO OPERATE WITH THIS SOFTWARE) OR THAT THE SOFTWARE'S FUNCTIONALITY WILL MEET YOUR REQUIREMENTS. The duration of any implied warranties is limited to the period stated above. Our entire liability shall not exceed the coverage available to You under the insurance policies required in the Master Agreement. Notwithstanding the foregoing, Our warranty obligations are expressly contingent upon You: a) notifying Us of a warranty claim within ten (10) days after having actual or constructive knowledge of the same; b) providing sufficient detail of the facts associated with a warranty claim in writing so as to allow Us to reasonably reproduce any alleged defects and errors in the Software, or demonstrate to Us such defect or error; c) providing Us with sufficient information in order to verify that any error or defect is solely attributable to the Software; and d) agreeing that any corrections to the Software shall be performed only by Us. We reserve the right, without notice, to supersede versions of the Software with newer versions, which may add, modify, or eliminate functionality of earlier versions. Such newer versions may be provided by Us as warranty replacements. 7. Limitation of Liability NOTWITHSTANDING ANYTHING TO THE CONTRARY IN THE MASTER CONTRACT, IN NO EVENT SHALL WE BE LIABLE FOR ANY INCIDENTAL DAMAGES, INCLUDING BUT NOT LIMITED TO LOSS OF DATA, LOST PROFITS, LOST GOODWILL, COST OF COVER OR OTHER SPECIAL OR INDIRECT DAMAGES ARISING FROM THE USE OF THE SOFTWARE, HOWEVER CAUSED AND ON ANY THEORY OF LIABILITY, WHETHER IN CONTRACT OR TORT, INCLUDING, WITHOUT LIMITATION, NEGLIGENCE AND INDEPENDENT OF ANY FAILURE OF ESSENTIAL PURPOSE OF THE LIMITED WARRANTY AND REMEDIES PROVIDED HEREIN. THIS DISCLAIMER SHALL APPLY WHETHER OR NOT WE HAVE BEEN APPRISED OF THE POSSIBLITY OF SUCH DAMAGES. IN NO EVENT 4 End-User License Agreement(041515) 16E1 SHALL OUR AGGREGATE LIABILITY FOR DAMAGES IN CONNECTION WITH THIS AGREEMENT EXCEED THE AMOUNTS AVAILABLE TO YOU THROUGH THE INSURANCE POLICIES MANDATED IN THE MASTER AGREEMENT. The parties acknowledge that the limitations set forth in this Agreement are integral to the amount of fees levied in connection with the Master Agreement and that, were We to assume any further liability other than as set forth herein, such fees would be set substantially higher. 8. Data While We will ensure that our Software complies with data security laws, You also have a responsibility to safeguard your data and Personal Information. While We verify, validate, audit and alert on data we receive from You, since We acquire the needed source data from You, You are responsible for the source data we receive, and for using the information the Software generates in a proper manner and as designed. You acknowledge that We shall not be liable for any errors, omissions, delays, or losses caused by You or Your agents, including the consequences of untimely, incomplete, incorrect or unusable data. You are also responsible for complying with all local, state, and federal laws pertaining to the use and disclosure of any data. 9. General The laws of the State of Florida will govern this Agreement. Licensor: HealthCare Impact Associates, LLC, 6121 Baker Road, Suite 104, Minnetonka, MN 55345. 5 End-User License Agreement(041515) 0 16E1 HEALTH e ® Clarity. Compliance.Control. APPENDIX B: Support and Service Level Agreement 1.0 Maintenance Services. Commencing on the Effective Date and during the term of Master Agreement, HIA shall provide Employer with the following maintenance services ("Maintenance Services"): 1.1 Defect Correction. When Employer reports a suspected Defect in the Service or Software (the "Service Offering") to HIA, HIA shall attempt to recreate the suspected Defect based upon information provided by Employer. If the Defect is confirmed, HIA shall implement a Correction into the Service Offering and provide Employer a Correction. For the purpose herein, a "Defect" is a material failure of the Service Offering to operate substantially in accordance with this Agreement, which failure is attributable exclusively to Licensor or the Software. A "Correction" means, without limitation, workarounds, support releases, component replacements, patches and/or documentation changes, as HIA deems reasonably appropriate. 1.2 Technical Support and Communications. Employer may report problems and seek assistance regarding Employer's use of the Service Offering. Employer can report problems or request service using HIA's online issue reporting and tracking tool. HIA shall respond to Employer's requests for Technical Support as defined in the response tables in section 3.0 below. Technical Support is available 7:00 a.m. to 6:00 p.m. CST Monday through Friday, excluding holidays. 1.3 System Updates: The availability and intent to release a Software version update is communicated to the Employer at least one month in advance of the date of the intended release. Preliminary product release notes will be provided for the Employer to access pending updates; Employer will have the option to opt-out of the update process. Should Employer wish to opt-out of the update process, it must inform the Company of its decision prior to the release date. In the event that Employer does not update to a new version of the Software, future updates will not be offered to Employer. 1.4 Maintenance Scheduling: Scheduled maintenance will be communicated to the Employer at least one (1) day in advance. Standard downtime for any scheduled maintenance is less than four (4) hours. Maintenance is scheduled to be before 7:00 a.m. CST and after 7:00 p.m. (CST) (i.e. off working hours) whenever possible. The foregoing notwithstanding, when it is in the interest of the Employer, any emergency threat can be addressed without notice of maintenance scheduling. Maintenance downtime shall not be included against the calculation of system uptime warranties or service credits. 1.5 Data Back-up: Employer data backup is scheduled nightly and occurs automatically. Employer acknowledges that data back up, regardless of frequency (i.e. if Employer request more frequent data back-up than once nightly), will limit access to system for brief periods. System downtime for data back up shall not be included against the calculation of system uptime warranties or related service credits. 1.5 Additional Charges: Technical support and service level warranties apply to priority P1, P2, P3, and P4 issues described in Section 3.0 below. P5 requests, if not associated with a technical 1 Support and Service Level Agreement(041515) 16E1 performance or standard system functionality will be subject to review and may be subject to additional costs, upon prior notice and approval by the Employer. 2.0 System Access and Service Level Warranties: HIA warrants that the Service target of ninety-nine point 5 percent uptime (99.5%) will be met, or HIA will be subject to service credit penalties as described in section 3.0 and 4.0 below. This warranty will not apply to any downtime that occurs as a result of any fault of Employer or as a result of failure of or problems in Employer's equipment, any Employer power or utility problems, any problems in Employer's network, or any other problems or causes for which HIA is not responsible. Maintenance periods do not impact uptime measurements. Measurement of performance will be monthly via HIA's reporting tool to measure downtime every 15 minutes during the intended 24 hour, 7 day per week operational period and percentage downtime will be calculated by dividing the number of"unavailable" measurements by the total number of measurements throughout the month. 3.0 Technical Support- Issue Prioritization, Response Time, and Resolution: Technical support shall be provided to Employer by HIA subject to prioritization of requests and response, engagement and resolution times as follows: 3.1 Priority Support Issues Rating Groups - Definition: P1 System is down: no functionality is available. Major functional element is unavailable. (i.e. One or more dashboards or P2 Employee Search function (all EES) or All Reports) Partial functionality unavailable. (i.e. Employee search for one or more P3 employees, 1 or more reports unavailable.) Unusual results from functional areas. (i.e. Dashboards, Reports, Employee P4 search.) All other requests (may incur additional charges if not related to technical performance or standard system functionality, and may be subject to P5 additional documentation and client approval.) 3.2 Time to Respond*: Issue to Respond: P1 15 minutes P2 30 minutes P3 1 hour P4 4 hours P5 Best Effort 2 C.) Support and Service Level Agreement(041515) 16E1 3.3 Time to Engage*: Time to Engage P1 30 minutes P2 1 hour P3 4 hours P4 8 hours P5 Mutual a•reement 3.4 Time to Resolve*: Time to Reso[ O P1 2 hours P2 4 hours P3 16 hours P4 32 hours P5 Mutual Agreement Suspected Defect Best Effort (*Times to respond, engage and resolve technical support issues within HIA's technical support hours of operation between 7:00 a.m. and 6:00 p.m. CST.) 4.0 Service Credit Formula: The Employer may request review and audit of system availability and performance of this Support and Service Level Agreement. If deficiencies are found Service Credits shall be applied to reduce the Service Fees owed by Client to HIA in the subsequent month under the terms of this Agreement. Such Service Credits will be applied against the Services provided by HIA to Client, as defined in the table below. For the duration of the Master Agreement, HIA will use the SLA's and Service Credit formula herein to compute on a monthly basis any Service Credits owed to Client. If HIA fails to provide a timely response to each Issue Rating Group within the allotted times in a given month, then Client shall receive a Service Credit based upon the failure(s) for each Issue Rating Group to meet the time to respond, time to engage, and time to resolve criteria in the calendar month as listed in the "Service Credit" table below. Each Service Credit percentage represents a deduction of said percentage from the monthly fee Client is obligated to pay HIA for support services. \ \\\ Service Credit°l\ moo:. 0-3 0 4-6 2 7-9 4 10- 12 6 13- 16 8 17-20 10 3 0 Support and Service Level Agreement(041515) H EALTH e 1bE1 Clarity. Compliance. Control. PROPOSAL DATA FORM ORGANIZATIONAL INFORMATION Client Legal Name Street Address City State Zip Code Type of Organization (Corporation, LLC, Non-Profit, etc.) Formed under the laws of which state? Security&Hierarchy Structure Industry (Le. Location Managers) O Decentralized User Access O Central User Access Reporting Control Group Common Ownership w/multiple FEINs=Single Number of FEINs O Single O Multiple EMPLOYEE POPULATION INFORMATION Benefit Eligible Total Employee Count Employee Count (Including PTNariable) Turnover Rate HR SYSTEMS INFORMATION Can you produce historical data that reflects employee Payroll Vendors/Versions HRIS status?*See below. O Yes O No Benefits Administration Vendor Time&Attendance Vendor Benefits Plan Year Other HR Systems `For example:If I was a part-time administrator 3 months ago and today I am FT will historical data reflect my true status each month? .„.., , ., ,. ,., Z, , 0/v. ....-..... , ve„„,, .7 Q. 0 '... ...:- , (11 , lit4" 1. * (1) t4.4 E sz intsC:i........4).: N7: ' = 1'':::"-' \,... ... 1,,,....„ (13 v.' 4--.1 0 CI ..„„. *es (13 QS 117 (,) Z J Z .C3 < E C),.. 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E o m o ° > L C c "T 1l \ 0 a s O '° • 'C 'i rn rn -0 E o - 4 rn Cr) CI) ° CI m o�o E aa)i 2 v cr,I a� rn Cr)- rn o o f c o W C. p I I 1 I 0 o o N v a o W Q 0 0 0 0 c) o O o o a ° N aa)) '5_ E �1 W Ln O 0 Q O OO ^ o U V a) .O �° N cM Lc' O O °-O C.2 ° o. M N c Q C� O 0 O �, W x L ° • >. E a) g o E �? E 1p m a a— ° rn v w I a' E a— o LU = a a� E w Z o ., N i J Ps PPE7. -tAx c: 1 6 E HEALTH e PROPOSAL DATA FORM Clarity. Compliance. Control. ORGANIZATIONAL INFORMATION Client Legal Name Street Address City State Zip Code Type of Organization (Corporation, LLC, Non-Profit,etc.) Formed under the laws of which state? Security&Hierarchy Structure Industry (i.e.Location Managers) O Decentralized User Access O Central User Access Reporting Control Group Common Ownership wl multiple FEINs=Single Number of FEINs O Single O Multiple EMPLOYEE POPULATION INFORMATION Benefit Eligible Total Employee Count Employee Count (Including PT/Variable) Turnover Rate I I I I I HR SYSTEMS INFORMATION Can you produce historical data that reflects employee Payroll VendorsNersions HRIS status?'See below. I I O Yes O No Benefits Administration Vendor Time&Attendance Vendor I I I Benefits Plan Year Other HR Systems I I I 'For example:If I was a part-time administrator 3 months ago and today I am FT will historical data reflect my true status each month? ,a� IØE1 Agenda Item No. �� Agenda Item Topic AcCp- Da'a. t\ (For Public Comment,list topic) Meeting Date: Name: Dr Incefil J' iZ Address:TO d 3L11< 4-/.620g, ka pi 31--/(07- 1 Representing/Petitioner: Other: COLLIER COUNTY ORDINANCE NO.2003-53,AS AMENDED BY ORDINANCE 2004-05 AND 2007-24,REQUIRES THAT ALL LOBBYIST SHALL,BEFORE ENGAGING IN ANY LOBBYING ACTIVITIES(INCLUDING,BUT NOT LIMITED TO,ADDRESSING THE BOARD OF COUNTY COMMISSIONERS),REGISTER WITH THE CLERK TO THE BOARD AT THE BOARD MINUTES AND RECORDS DEPARTMENT YOU ARE LIMITED TO THREE(3)MINUTES FOR YOUR COMMENTS AND ARE TO ADDRESS ONLY THE CHAIR PUBLIC COMMENT IS NOT INTENDED TO BE A FORUM FOR SELF-PROMOTION. PUBLIC COMMENT SPEAKERS WHO ENGAGE IN ADVERTISING THEIR BUSINESS,PERSONAL POLITICKING OR OTHER FORMS OF SELF-PROMOTION WILL BE ASKED TO LEAVE THE PODIUM. PLACE COMPLETED FORM ON THE TABLE TO THE LEFT OF THE DAIS-PLEASE PRINT CLEARLY I' l