Backup Documents 12/01/2009 Item #16E2
16[2
MEMORANDUM
Date:
January 12, 2010
To:
Lyn Wood, Contract Specialist
Purchasing Department
From:
Teresa Polaski, Deputy Clerk
Minutes and Records Department
Re:
Contract #09-5343 "Blueprint for Wellness Services"
Contractor: Quest Diagnostics, Inc.
Attached is an original change order, referenced above (Item #16E2)
approved by the Board of County Commissioners on December 1, 2009.
The second original document will be held in the Minutes and Records
Department with the Official Records of the Board.
If you should have any questions please contact me at 252-8411.
Thank you.
Attachment
ITEM NO.:
FILE NO.:
ROUTED TO:
DO NOT WRITE ABOVE THIS LINE
REQUEST FOR LEGAL SERVICES
Date: Ek......llloer 1,2009 9tL/,lU_cU(f 0 I ;}OIO
To: Office of the County Attorney
Attention: Scott Teach
From: Lyn M. Wood, C.P.M., Contract specialistJ... ~.../
Purchasing Department, Extension 2667 ,"PM
,
Re: Agreement: #09-5343 "Blueprint for Wellness Services"
Contractor: Quest Diagnostics, Inc.
BACKGROUND OF REQUEST:
16E2
DATE RECEI\,(ED:
\.,'; i II-.!..._
i-',i'
- r"" L' ') 5
\':!!.' .;-j (\1 \.,- 1-
,. 0 vJ'.
1rCVv~ ~l;~
fLJ: ~ ~
:\-rJ
CA-r .(bt.. l---~. Y>
DlU.. '/1"2.) ,0 ~ ~ '
J //1 ))0
sP-1.
J
~
This item was approved by the BCC on December 1, 2009,
Agenda Item 16.E.2.
This item was previously submitted.
ACTION REQUESTED:
Agreement review and approval.
OTHER COMMENTS:
Scott, please forward to the Chairman of the BCC for signature after
approval. If there are any questions concerning the document, please contact
me. Purchasing would appreciate notification when the documents exit your
office. Thank you.
NA JJ~
\\\\.\ \0
C: Karen Eastman, Human Resources
MEMORANDUM
J6E2
TO:
FROM:
Ray Carter
Risk Management Department
Lyn M. Wood, C.P.M., Contract Specialist f~v
Purchasing Department ) -\ U
.Q~C8I'ReClr 1, 2ggg~ g(1<./1U{ ,j...1jj (, I Clo i ()
Review of Insurance for Agreement: #09-5343 "Blueprint for
Wellness Services"
Contractor: Quest Diagnostics, Inc.
DATE:
RE:
This item was approved by the BCC on December 1, 2009, Agenda Item
16.E.2.
Please review the Insurance Certificates for the above-referenced agreement.
If everything is acceptable, please forward to the County Attorney for further
review and approval. Also, will you advise me when it has been forwarded.
Thank you. If you have any questions, please contact me at extension 2667.
DATE REcrrVED
JAN 0 7 2010
RISK MANAGEMENT
dod/LW
It ';:1' /it nJ~
. REcr~
s:::~ 2 2009... '\ ,
ISK Ml~EMENl
f;~<1 ~. v<:lR (~c;;f
C: Karen Eastman, Human Resources
~~&
t(t 110
~:Y"
~
mausen 9
16E2
From:
Sent:
To:
Cc:
Subject:
RaymondCarter
Friday, January 08, 2010 4:06 PM
LynWood
EastmanKaren; mausen_g; walkeU
Contract 09-5343 "Blueprint for Wellness Services"
Alii have approved the Certificate(s) of Insurance provided by Quest Diagnostics, Inc. for contract 09-5343. The contract
will now be forwarded to the County Attorney's Office for their review.
Thank you,
Ray
~~
Manager Risk Finanace
Office 239-252-8839
Cell 239-821-9370
Under Florida Law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send
electronic mail to this entity. Instead, contact this office by telephone or in writing.
1
.www.sunbiz.org - Department of State
Page 1 of2
16 2
Home
Contact Us
E-Filing Services
Document Searches
Forms
Help
Previous on List
Next on List Return To List
IEntity Name Search
Submit I
Events
Name Historv
Detail by Entity Name
Foreign Profit Corporation
QUEST DIAGNOSTICS INCORPORATED
Filing Information
Document Number F95000000131
FEIIEIN Number 161387862
Date Filed 01/09/1995
State DE
Status ACTIVE
Last Event NAME CHANGE AMENDMENT
Event Date Filed 12/31/1996
Event Effective Date NONE
Principal Address
3 GIRALDA FARMS
MADISON NJ 07940
Changed 04/07/2009
Mailing Address
3 GIRALDA FARMS
MADISON NJ 07940
Changed 04/07/2009
Registered Agent Name & Address
CORPORATION SERVICE COMPANY
1201 HAYS STREET
TALLAHASSEE FL 32301-2525 US
Name Changed: 10/26/2009
Address Changed: 10/26/2009
Officer/Director Detail
Name & Address
Title CEOD
MOHAPATRA, SURYA N
3 GIRALDA FARMS
MAOISON NJ 07940
Title T
O'KEEF, ROBERT F
3 GIRALDA FARMS
MADISON NJ 07940
http://www.sunbiz.org/scripts/cordet.exe?action=DETFIL&in'L doc _ number=F95000000... 10/28/2009
www.sunbiz.org - Department of State
.
Title S
O'SHAUGHNESSY, WilLIAM J JR
3 GIRAlDA FARMS
MADISON NJ 07940
Annual Reports
Report Year Filed Date
2007 04/21/2007
2008 04/28/2008
2009 04/07/2009
Document Images
04/07!2"QQ~ -- ANNUAL REPORT
04/28/2008 -- ANNUALBEpORT
04/21/2007 -- ANNUAL REPORT
03/16/2006 ,,_ANNUAL REPORT
04/WL2QQ~--AN~UAlREpORT
0610312004=ANN UAL REPORT
0810a/2003 =~I\MJ]tCh~ng!1
06/06/2003=ANNUA.L. R.EPORT
0_6L15/2002"" AW,LUALREEQRL
04/23/2001 ANNUAL REPORT
04/26/2000 = ANNUAL REPORT
05/10/1~~9 =ANNUAL REPORT
04/22./1998 -- ANNUAL_REPORT
06/05/1997,- ANNUAL REPORT
05/QJL19.9Q=ANN UI\LJiE P.o.RT
OJI09.!l99.6.=DOCUM1JHSPR.loB_1O-.1Jl.9Z
Page 2 of2
16 2
View im~ge in PDF format
View image in PDF format
View image in PDF format
View image in PDF format
View image in PDF format
View image in PDFforrnat
View image in PDF format
View image in PDF format
View image in PDF format
View image in PDF format
View image in PDF format
View image in PDF format
View image in PDF format
Note: This is not offici~1 record. See documents if question or confiict
PreviQlJs on List
Events
NameJ-iJ"tQry
N.ext on List Return To Li,.t
IEntity Name Search
SUbmit I
I Home I Contact us I Document Searches I E-Filing Services I Forms I Help I
Copyright and Privacy Policies
Copyright @ 2007 State of Florida, Department of State.
http://www,sunbiz.org/scripts/cordet.exe?action~DETFIL&in~ doc nwnber=F95000000... 10/28/2009
.... Quest
~ Diagnostic~
16E2
CERTIFICATE OF SECRETARY
I, William J. O'Shaughnessy, Jf., Secretary of Quest Diagnostics Incorporated, a
corporation organized under the laws of the State of Delaware (the "Company") do
hereby certify the individual whose name appears below is authorized in the name and on
behalf of the Company to enter into Blueprint for Wellness Agreements, and to execute
and deliver such documents in connection therewith:
NAME
TITLE
Steven L. Burton
Vice President, Health and Wellness Services
IN WITNESS WHEREOF, I have hereunto set my hand this 20th day of
November, 2009,
tJ~
William
Secretary
State of New Jersey }
County of Morris }
Subscribed and sworn to before me this 20th day of November, 2009
By:
-1MIWH't
..... ......
.... II IN .....
... (',- . IIU....... 1,. ."
RLS# D1-hu..- tJ{ '101
CHECKLIST FOR REVIEWING CONTRACTS
Entity Name: r:PlItsr O/II&JVOSTICS IIU~ClfVJtJv2.lrnb
Insurance
Insurance Certificate attached?
Insured registered in Florida?
Contract # &/or Project referenced on Certificate?
Certificate Holder name correct (BCC)?
Commercial General Liability
General Aggregate Required $ I.....' L.
Products/CompVOp Required $
Personal & Advert Required $
Each Occurrence Required $
FirelProp Damage Required $
Automobile Liability
Bodily Inj & Prop Required $ f \ \ I'-
Workers Compensation ~
Each accident Required $ '"( iI. 't
Disease Aggregate Required $ 5 ",t <;.
Disease Each Empl Required $ 1-'
Umbrella Liability
Each Occurrence Provided $ S' 1\.1.1 L
Aggregate Provided $ , .
Does Umbrella sufficiently cover any underinsured portion?
Professional Liability
Each Occurrence Required $ I......., L
Per Aggregate Required $ ...., t..
Other Insurance
Each Occur Type:~ 'S
~\t.
County required to be named as additional insured?
County named as additional insured?
Entity name correct on contract?
Entity registered with FL Sec. of State?
../ Yes
~Yes
V Yes
~Yes
~Yes
-->..<::::.Yes
Provided $
Provided $
Provided $
Provided $ '2. I\.{ 1 L-
Provided $
Provided $__
Provided $ 2. "^ \ L
Provided $ l \
Provided $ · I
16E2
No
No
No
_No
No
No
Exp. Date .;II
Exp. Date
Exp. Date
Exp. Date 1:/.131
Exp. Date
r Ii)
Exp Date
Exp Date
Exp Date
Exp Date
Izl3,IIO
"
.,
ExpDate~
Exp Date "
_J<:::::...Yes
Provided $ S lA, L
Provided $ "
Required $ S'N) &60
Indemnification
Does indemnification meet County standards?
Is County indemnifying other party?
Performance Bond
Bond requirement referenced in contract?
If attached, expiration date ofbond
Does dollar amount match contract?
Agent registered in Florida?
Provided $
-.L Yes
~Yes
~Yes
_Yes
_Yes
Signature Blocks
Correct executor name in signature block?
Correct title of executor?
Executor authorized to sign for entity?
Proper number of witnesses/notary?
Authorization for executor to sign, if necessary:
Chairman's signature block?
Clerk's attestation signature block?
County Attorney's signature block?
Attachments
Are all required attachments included?
Yes
Yes
NC'iA/l-l2.'C.b
rUTlFI~~
./ Yes
~Yes
-----",=-Yes
v Yes
OF stUf-r>4ll-y"
--<<::::.Yes
.....-Yes
V'Yes
V' Yes
_No
Exp. Date 1?13l{1t>
Exp. Date "
Exp Date ~
No
_No
_No
~No
_No
_No
_No
No
No
_No
_No
_No
_No
No
Revie~e~ Initials: ~
Date: dh ~ID
04-COA-6103 /222
QUEST DIAGNOSTICS INCORPORATED
LETTER OF AGREEMENT
FOR BLUEPRINT FOR WELLNESSTM SERVICES
QUEST DIAGNOSTICS INCORPORATED, ("QUEST DIAGNOSTICS")
agrees to provlda Blueprlntfor Wellness TN Services to:
l6E 21
Customer Name Collier County Government
corDorate name)
NIA
Subcontract name
Customer ContactlTitle Karen Eastman, Wellness Programs Mgr, OR
Jeff Walker, Risk Management Director
Customer Contact Information Collier County Government
Street Address 3301 East Tamiami Trail, Bide. D
City Naples
State, Zip FL 34112
Phone Number Karen Eastman 239-252-8906 OR Jeff Walker 239-252-6092
Emall Address kareneastma~collieraov,net OR JeffWalkertmcolliereov.net
Program Name/Account #(s) "INVEST IN YOUR HEALTH"
Total # of Participants Eligible and Number of Participants eligible: _Based on age eligible criteria, and
employees> 50 years of age
Estimated % participation Expected % Participation: 80 %
Requested Date(s) and Location(s) ~ List of locations for CCG is attached.
of Event ~ Primary location (same address as above, with -1,000
(Date(s) to be confirmed by BFW participants would like to begin BFW events on 1/20/09 for 2
Staff. weeks, then complete all locations by March 31s'.
List each individual location and # of
eligible participants at each),
Note than an "Event" is considered a
health fair/screening at one location
1F0r a fixed, uninterrupted period of
ime,
Event Staffing Commitment .: ~ Three (3) weeks before each Event
Wellness Specialist will confirm with
he customer the number of .Staffing Commitments finalized less than three (3) weeks require
participants, event hours and prior approval and will be assessed additional charges as set forth in
schedule event staffing three weeks Section 1 of the Terms of Service, below.
orior to each event date.
2009: Health-Plan-eligible employees of CCG total - 2,200
Eligibility Criteria for Participation 2010: Age-based, Health-Plan-eligible employees of CCG -1,200
(e.g" employees only, spouses, etc,) 2011: Age-based, Health-Plan-eligible employees of CCG + eligible,
active spouses -2,200
2012: Final events take place Jan-March, 2012
Services Requested Personal Laboratory Report Solution
Program modules & pricing, below)
BFW LOA rev. 11/07
1
16[2
Laboratory Tests Included: Heart: Total cholesterol, HDL, calculated LDL, triglycerides,
calculated cholesterol/HDL ratio (Note: no cardio-CRP as requested)
Thyroid: TSH-Thyroid Stimulating Hormone, and Free T4
Kidneys: BUN, creatinine, BUN/creatinine ratio
Bone: Calcium
Liver: Albumin, total protein, globulin, A/G ratio, Alkaline
Phosphatase, AL T, AST, total & direct bilirubin, and GGT
Pancreas: Glucose
~hole Body: Chloride, potassium, sodium
Pancreas: Hemoglobin A 1 c
Blood: CBC Hemogram
Lunas: Cotinine (blood sample)
PSA (Males> or = 40) (Yes or No) NO
specifv if other than Males> or = 40)
HRA (on-line, paper or both) HRA - Both
Specimen Collection: On-site Events & Remote PSC Collection Kits
(On-site Events, Remote/PSCs,
other)
Medical Authority (PWN Physician Quest Diagnostics will provide medical authority via PWN-
Dr Customer-supplied) Physician's Wellness Network.
Biometric Measurement Data Height, Weight, BMI, Blood/Pressure, Waist, Hip, WaisVHip Ratio
Requested:
Describe Customer reQuirement)
Participation in BFW-PWR is a key "qualifying step" for health-plan-
Participant Incentive eligible employees to increase coverage from "Basic" to "Select" or
Premium" without increasing their contribution to the health plan,
Incentive Criteria BFW-Personal Wellness Report to include HRA
On Line Registration Key CCG
Wellness Program Participant ID1 CCG Employee ID # - this change occurred 10/2/08
~hen spouses are added in 2011 they will use the employee ID + S
Participant ID; Define unique ~or Spouse.
Participant ID requested as it will
~ppear in the Customer eligibility
"ile(emplovee ID, SSN, Etc.)
Disclosure of Particioant Data in ~ Do not send PWR data to Meritain (health plan) at this time.
Identifiable Format (i.e., disclosure ~ CCG identified data should go to CHP-Community Health
Iof data other than the aggregate de- Partners weekly.
identified statistical report provided to ~ CCG request that aU printed BFW-PLR printed reports be made
Customer): available to CHP so the CHP Health Advocates can review lab
and HRA results with each participant during their one-on-one
Define Customer requested Result counseling sessions.
Reporting to participant or other 3rd ~ All mailed PWRs should ship in bulk to:
parties. Attn: Sandy Theobald
(e.g., third party disease Community Health Partners
management or weUness provider) 851 5th Ave. North, Suite 201
Disclosure of identifiable participant Naples, FL 34102
data requires a written directive from ~ CCG prefers no participant results be available on-line at any
he Customer containing specific time.
elements, and must be received prior
o any release of PHI to anyone other
han the participant.
BFW LOA rev. 11/07
2
De-Identified - Aggregate
Reporting:
Define requirements for De-Identified >
aggregate reporting breakout and
parties to receive the reporting.
Eligibility File of Participants:
Define contact that will provide the
ligibility file and target date for
delivery
n eligibility file is required where
BFW scheduling and/or an HRA
component is provided,
Note: Will participation be allowed if
mployee and/or spouse is not
included in the eligibility file?
Program estimated start date(s)
Program estimated end date(s)
BFW LOA rev. 11107
16f2
> Exact Reporting TBD - includes program aggregate report and
weekly participation reports.
CCG would like the standard Aggregate Report following the
events (predicted to last through March 31, 2009, and about 1
month to allow some ees to visit a Quest Diagnostics PSC, After
that time, additional BFW registrations should be new
employees.
> They would like to get weekly Participant participation reports
showing those employees that have had BFW collected, CCG
will sort by Dept. or Cost Center to determine where they need
more communication to encourage participation.
> In subsequent years they want cohort reports that demonstrate
chan es over rior ear, stratified b De t. or Cost Ctr,
Eligibility File to be Provided By:
lice Toppe 239-252-8966 and James(Jim) Young of Collier County
Government
> Only names in the eligibility file are allowed to participate in
Blueprint for Wellness. CCG will send updated eligibility file
(monthly) for the 39 months of the program.
> First eligibility file is due about Nov, 1, 2008. Beginning in 2011
spouses will be included.
arget Date for Year 2 Eligibility File: TBD
> Events Jan 1 - Mar 31, 2009, then as needed for new ees
throughout the year until Dec.31, 2009
> Events in 2010 will be limited to an age-based group, followed by
new employees,
> Events in 2011 will be limited to an age-based group and
spouses, and will be followed by new employees,
> Events in 2012 will include employees, spouses and may be age
based.
> Client reserves the right to adjust dates and scope of services by
year with ample advance notice to BFW,
Program will end annually on Dec. 31St, and the complete
ro ram will end on March 31, 2012
3
erm of the Letter of Agreement:
(mm-dd-yy - mm-dd-yy)
Copies of electric invoices (as a convenience only) to:
>> Keith Wilson; keith.wilson@.meritain.com
>> Victoria Krenik: victoria.krenik meritain.com
nnually - through March 31, 2012 (39 months)
[ ] One Year [lOne-time Event (check one box)
X 39 Months - Jan 1, 2008 - March 31, 2012.
BFW Pro ram Module sand Pricin
Other comments or requirements:
ustomer BUlin Account
Invoices should be sent to CCG (email preferred but not required) for
Billing Arrangements: payment:
If other than bill to "Customer" please>> Alice Toppe: 239-252-8966 or alicetoppe@.collieraov.net
etail and provide billing contact >>Claire Wilson: 239-252-6120 or clairewilson@.collieraov.net
Alice Toppe OR Claire Wilson
Collier County Government
3301 Tamiami Trail, Bldg D
Naples, FL 34112
Monthl :39 months
R an Van Horn
. .
BLUEPRINT FOR WELLNESS SERVICE PRODUCT NAME PRICE PER EMPLOYEE
. I
f d but t
. d
PROGRAMS OR COMPONENTS
r ram details and s cial r uirements should be noted
>> Participant Registration and Scheduling, online and by phone
>> Physician Oversight provided throughout program
>> BFW Specialist assigned as key contact throughout program
>> On-Site Collection Events.
>> Remote Collection Kits provided to employees unable to attend events
>> Bio-Metric Measures (Height, Weight, B/P, BMI, Waist & Hip circumference)
>> Personal Wellness Report for every participant
>> Health Management Data Feed provided to vendors you select.
>> Heart: Total chol, HDL, calc LDL, triglycerides, calc chol/HDL ratio (NO CRP)
>> Thyroid: TSH-Thyroid Stimulating Hormone, and Free T4
>> Kidneys: BUN, creatinine, BUN/creatinine ratio
>> Bone: Calcium
>> Liver: Alb, total protein, globulin, A/G ratio, Alk Phos, AL T, AST, total &
direct bilirubin, and GGT
>> Pancreas: Glucose
>> Whole Body: Chloride, K, Na++
>> Pancreas: Hemoglobin A1c
>> Blood: CBC Hemogram
>> Lun s: Cotinine blood sam Ie
aist circumference, Hip circumference, Waist/Hip Ratio
TOTAL Price/Participant
Note: This price is for 2010 Program. The 3n:t and 4th year (Jan, 2011 & Jan-
Mar 2012 ma be sub.ect to a rice increase u to but not exceed in 4%,
SPECIAL PROGRAMS OR EVENT ARRANGEMENTS
(program details and special requirements should be noted)
All lab tests Included
Included
129.50
PRICE PER PROGRAM
OR EVENT
BFW LOA rev. 11107
4
.. \:It .~
In the event Collier County Government requests additional services not set forth
bove, the arties shall mutuall a ree u on services and ricin .
BLUEPRINT FOR WELLNESS CUSTOM PROGRAMS
FULLY DETAIL
end invoices to: Alice Toppe and Claire Wilson at CCG
>> Alice Toppe: 239-252-8966 or alicetoooeailcollieraov.net
>> Claire Wilson: 239-252-6120 or clairewilsonailcollieraov.net
>> Addresses listed above
PRICE PER PROGRAM
OR EVENT
Included
BFW LOA rev. 11107
5
Terms of Service:
16E2
1. BFW SERVICES: In accordance with the program-specific details listed above, Ouest Diagnostics agrees to
provide the Blueprint For Wellness™ ("BFW") Services as further set forth herein, The BFW Services
provided by Ouest Diagnostics are as follows:
a. Registration and Scheduling of participants (if selected by Customer): offered via online access or by
calling a toll-free wellness scheduling number.
b. Provision of all supplies and test kits necessary to provide BFW Services.
c. Collection Services to obtain/collect all specimens from participants at an "Event", Additional charges will
apply when:
(i) Paramedical examiner is required to collect specimens between the hours of 9:00 PM and 6:00 AM
Monday-Saturday and between the hours of 6:00 PM Saturday and 6:00 AM Monday (additional
charge of $30 per hour, per examiner applies).
(ii) Staffing of the Event is requested less than three (3) weeks prior to the Event (additional $7 per-
participant charge),
(iii) Staffing is requested in advance for Events with fewer than 20 participants (a "Small Group Event"):
. Home or office visit to collect specimens from one participant: $95~ per visit
. Small Group Events with 10 or fewer participants (based upon a 1-2 hour event, with one
examiner): $140..
. Small Group Events with 11-19 participants (based upon a 1-2 hour event, with one or two
examiners as determined by Ouest Diagnostics)): $240..
. ~the surcharges specified above are added in addition to BFW per-participant charges for
BFW Services, If additional staffing is requested for a Small Group Event, an additional $60
per hour/per examiner charge will be assessed,
. Depending on the number of Actual Participants who participate in the Small Group Event,
Customer will be assessed either the Small Group surcharges listed above, or the per-
participant charges for at least 20 Participants, whichever amount is lower.
(iv) Paramedical examiner is required to travel more than fifty (50) miles each way to/from the Event from
the ExamOne office where the paramedical examiner is based (additional $,47/mile over 50 miles
to/from Event). If an ovemight stay is required, Customer will be billed actual lodging/food expenses.
d. Based upon the specific Program components selected by Customer, includes collection of biometric data,
shipment of specimens to the testing laboratory, and testing of laboratory specimens.
e. Release of test results to an Authorized Provider and if authorized, directly to participants, Customer will
also receive a report detailing aggregate de-identified statistics, Additional or reprinted reports may be
provided for an additional charge,
1. THIRD PARTY WELLNESS/DISEASE MANAGEMENT PROVIDER
COMMUNITY HEALTH PARTNERS (CHP)
2, WELL SOURCE - Wellness Provider
Customer has directed Ouest Diagnostics to release participant test results or other identifiable health
information to third party disease management or wellness providers. Customer represents and warrants
that (i) it has provided the appropriate notice to participants in its HIPAA Notice of Privacy Practices to
allow such a disclosure, (ii) the provision of identifiable participant data is consistent with the Notice (iii)
access to identifiable participant data will be limited to only those employees who require access to the
data for the proper performance of their duties on behalf of Customer's third party disease management or
wellness provider receiving the data on its behalf is acting in its capacity as a "Business Associate" of
Customer.
2, PAYMENT TERMS: Customer agrees to pay Quest Diagnostics for services as set forth herein within thirty
(30) days of date of invoice, and Customer agrees not to submit (or request Quest Diagnostics to submit) any
claim, bill or other request for reimbursement to any insurer, Managed Care Organization, Govemment health
program, fund, or to any other person or entity. Ouest Diagnostics reserves the right to add a charge of the
lesser of one and one-half percent (1 %%) per month, or the maximum rate the law permits, on all amounts
thirty (30) or more days past due.
BFW LOA rev. 11107
6
16f2
.3. MEDICAL AUTHORITY: Customer acknowledges and agrees that only a person who is authorized under
applicable state/federal law to order those clinical laboratory tests included in the Blueprint For Wellness 1M
producl ("Testing") shall order all Testing (such person shall be referred to as an "Authorized Provider"),
a. In the event Customer provides such Authorized Provider themselves, Customer represents and warrants
that the Authorized Provider meets all state/federal laws applicable to the ordering of Testing, Alternately,
in the event Customer elects to have Quest Diagnostics arrange for an Authorized Provider, Quest
Diagnostics shall represent and warrant that this Authorized Provider meets all state/federal laws
applicable to the ordering of Testing,
b. Quest Diagnostics shall report laboratory results only to such Authorized Provider, unless such Authorized
Provider gives permission for Quest Diagnostics to release the lab results to such employee participants
as desired. If Customer is providing such Authorized Provider, the requirement to allow release of results
directly to the participant must be included in Customer's contract with such Authorized Provider.
c. The Authorized Provider is responsible for contacting participants in the event of alert, critical, and
significantly out-of-normal range laboratory resu~s.
d. While the Authorized Provider may set his/her own alert values, critical ranges are not modifiable,
e. The Authorized Provider may be required to forward test results to the participant's personal physician,
4. NO-SHOW, MINIMUM, AND CANCELLATION CHARGES:
At least three (3) weeks prior to an Event, Customer and Quest Diagnostics will finalize a Staffing Commitment
("Staffing Commitment") which allows Quest Diagnostics to schedule staffing for the Event based upon the
number of expected participants and length of the Event. At the point the Staffing Commitment is finalized,
Customer will be responsible for paying no-show, minimum, and cancellation charges,
a, No-Show Charges: No-Show Charges will not apply if at least 90% of the Expected Participants
participate in the Event ("Actual Participation Rate"), The term "Expected Participants" means the
number of participants that were expected to participate at the time the Staffing Commitment is
finalized (including scheduled participants and expected walk-in participants). For all Events where the
Actual Participation Rate is less than 90%, Customer will be charged a No-Show Charge of $20 per
participant until the Actual Participation Rate is equivalent to 90%.
For example: If an Event is held for 100 Expected Participants and there are 80 Actual Participants,
Customer will be charged a No-Show Charge of $20 for 10 Participants. [100 Expected Participants x
90% No-Show Threshold] = 90 , and [90 minimum required participants - 80 Actual Participants] x $20
= $200 No-Show Penalty.
b, Minimum Event Participation and Hourly Participant Flow: Unless a Small Group Event is arranged in
advance, Quest Diagnostics will only schedule and staff Events with a minimum of 20 Expected
Participants and where at least 10 participants per hour can be processed by a specimen collector. For
purposes of this section, "Event" means one wellness screening/health fair held at a single location. For
an Event that is expected to have less than 20 Expected Participants, Customer may make arrangements
in advance for Quest Diagnostics to staff for a Small Group Event. Small Group Event charges are further
described in Section 1 and are assessed to Customer to equip, staff and manage the Small Group Event.
c. Cancellation Charges: If an Event is cancelled after the Staffing Commitment has been finalized,
Customer shall be responsible for paying $20.00 for each Expected Participant. Postponement of an
Event is equivalent to a Cancellation.
5. LEGISLATIVE/REGULATORY CHANGE: In the event federal or state legislative and/or regulatory changes
impact Quest Diagnostics' clinical reference laboratory business, Quest Diagnostics will retain the right, upon
prior written notice to Customer, to immediately amend this agreement to fully comply with any legislative or
regulatory changes. All other modifications or amendments to this agreement will not be binding unless
reduced to writing and signed by the parties hereto.
6. TERMINATION: This agreement will take effect on the date it is fully executed by both parties and may be
renewed on an annual basis upon mutual agreement of the parties for two additional one (1) year periods.
Customer will provide Quest Diagnostics with sixty (60) days advanced written notice of its intent to renew.
BFW LOA rev. 11107
7
16r ?'
7, INDEMNIFICATION: Not to exceed the maximum extent permitted by Florida law, Quest Diagnostics 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 negligence, recklessness, or intentionally wrongful conduct of Quest Diagnostics
or anyone employed or utilized by the Quest Diagnostics in the performance of this Agreement. 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. The
provisions of this paragraph shall survive termination of this Agreement. This section does not pertain to
any incident arising from the sole negligence of Collier County,
8. INSURANCE: Quest Diagnostics shall agree to maintain the following insurance coverage during the
course of this agreement. Quest Diagnostics may utilize a program of self insurance for all or any portion
of the minimum limits required to be carried,
TYPE LIMITS (Check)
X Workers' Compensation Statutory Limits of Florida Statutes 440 and Federal Government Statutory Limits
and ReQuirements
X Emolover's Liabilitv X $500,000 $1,000,000
X Commercial General $500,000 per occurrence X $1,000,000 per occurrence bodily injury and
Liability (Occurrence Form) bodily injury and property property damage
patterned after the current damage
ISO form with no limiting
endorsements,
X Professional Liability X $1,000,000 per occurrence $2,000,000 per occurrence
Insurance $1,000,000 aaaregate $2,000,000 aggregate
Collier County Board of County Commissioners shall be named as the Certificate Holder, NOTE-The "Certificate
Holde~' should read as follows:
Collier County
Board of County Commissioners
Naples, Florida
No County Division, Department, or individual name should appear on the Certificate, No other format will be
acce-.-~I . Thirty (30) Days Cancellation Notice required on Agreements exceeding 6 months. The contract name and number
shall be included on the certificate of insurance.
Collier County must be named as "ADDITIONAL INSURED" on the Insurance Certificate for Commercial General
Liability.
9. ENTIRE AGREEMENT: This Agreement constitutes the entire understanding between the parties regarding
the subject matter hereof and supersedes all prior understandings, arrangements and agreements relating to
the subject matter hereof, '
10, INDEPENDENT CONTRACTORS: It is expressly understood and agreed by the parties hereto that Quest
Diagnostics and Customer will at all times be and act as independent contractors,
11. TRADEMARKS: Neither party shall use the trademark, trade name, or service mark of the other party for any
purpose without the prior written consent of the other party, however, Customer authorizes the use of its name
and/or logo as a participant in the Blueprint for Wellness program.
BFW LOA rev. 11107
8
16E2
IN WITNESS WHEREOF, Quest Diagnostics Incorporated and Collier County have each, respectively, by an
authorized person or agent, hereunder set their hands and seals on the date and year first written above.
y:
~
~ - ------
. ,~-~~
Witnes~-
,/ ~~L~
Witness Signature
i\ssi~ta' It County At r ey
D.)C7~
S '"" tl- {<. I-u.. e L,
Print Name
BFW LOA rev. 11/07
TY COMMISSIONERS
Y, FL /
h~ ~;j4-j?
a, Chairman
By:
'7" L. ~~ TIN
Typed/Printed Name Here with Title
'-J(- Hfll''7'H AN'? IAI(LLNE~S.
'So€~la:
Item # llo~.;1
9
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 \^JHICH 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
N~~ ADD'~ TYPE OF INSURANCE POLICY NUMBER POLICYEFFECTlVE I POLlCYEXPIRATlON LIMITS
LTR INSR OATE (MMlOOIYYYY) , DATE (MMlOOIYYYY)
A 'GENERAL LIABILITY "$2,000,000 SELF INSURED 12/31/2009 12/31/2010 EACH 0 URRENCE 2 000 000
DAMAGE TO RENTED
rMMERCIAL GENERAL LIABILITY 'RETENTION'" PREMISES{Ea occurrencel $
CLAIMS MADE D OCCUR MED EXP (Anyone person) $
,~I PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
GENERAL AGGREGATE LIMIT APPLIES PER PRODUCTS -COM PlOP AG I$;
in PRO- n
' POLICY JEeT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
$
rJ ANY AUTO (EaaCcidenl)
, ALL O\flJ1\lED AUTOS BODILY INJURY $
R SCHEDULED AUTOS (Per person)
HIRED AUTOS BODILY INJURY $
1 NON-Q\fIJ1\lED AUTOS (Per accident) I
'--j PROPERTY DAMAGE $
l (Per accident)
GARAGE LIABILITY AUTOONLY-EAACCIDENT $ I
H ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: $
AGG
D ,I EXCESS / UMBRELLA LIABILITY 8124655 12/31/2009 12/31/2010 EACH OCCURRENCE $ 5,000,000
e OCCUR ~ CLAIMS MADE I AGGREGATE $
$
~1' DEDUCTIBLE I $
RETENTION $ .
B I WORKE~S_~OMPENSAnONAND ,ITC2JUB'266T3523-TIL-09 (DED) 12/31/2009 12/31/2010 X I\rVCSTATU- 10Jb'-
B EMPLOYERS' LIABILITY TRJUB~266T3535-TIL-09 (RETRO) 12/31/2009 12/31/2010 ~L. EACH ACCIDENT $ 2,000,000
' ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N I
I OFFICER/MEMBER EXCLUDED? [E::J ~.L, DISEASE - EA EMPLOYE $ 2,000,000
kMandalorp in NHJ If ~es, describe under J I ~L DISEASE - POLICY LIMIT $ 2,000,000 I
PECIAL ROVI 10 S below
OTHER : 112/31/2010 I $5,000,000 (SIR)
A PROFESSIONAL L1AB. I SELF-INSURED RETENTION 12/31/2009
CLAIMS MADE I I
i
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS I
RE: BLUEPRINT FOR WELLNESS SERVICES - CONTRACT #00000105
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS IS INCLUDED AS AN ADDITIONAL INSURED.
1
, , .,.....
IM2-
-?"""\ ---- - -- -- - -- - -- -- - I
ACORi:! CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY)
~ 01/05/2010
PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION
MARSH USA INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
ATTN: JANET T. NORMAN HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1166 AVENUE OF THE AMERICAS ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
NEW YORK, NY 10036
37986 -MAIN-09-10 XXX INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Quest Diagnostics Incorporated
QUEST OIAGNOSTICS INCORPORATED AND
ITS WHOLLY OWNED SUBSIDIARIES INSURER 8: Travelers Prop. Casualty Co. Of America 25674
3 GIRALDA FARMS INSURER C: N/A N/A
MADISON, NJ 07940
INSURER D: Lexington Insurance Company 19437
INSURER E.
~
COVERAGES
CERTIFICATE HOLDER
NYC-003942183-26
CANCELLATION
COLLIER COUNTY BOARD OF COUNTY
COMMISSIONERS
3301 TAMIAMI TRAIL EAST
BOARD OF COUNTY COMMISSIONERS
NAPLES, FL 34112
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND
UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
A~fTt\~~lim~lPI~~ENTATlVE --u{~ --l/J,j;.t
Marla Nicholson ......->;;;;:-
ACORD 25 (2009/01)
@1998-2009ACORDCORPORATION,AIIRights Reserved
The ACORD name and logo are registered marks of ACORD
16E2
IMPORTANT
If the certificate holder is an ADDITIONAL INSUREO, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized
representative or producer, and the certificate holder, nor does it affirmatively or negatively amend,
extend or alter the coverage afforded by the policies listed thereon.
Acord 25 (2009/01)