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2nd Amendment 01/18/2017KEVIN MADOK, CPA MONROE COUNTY CLERK OF THE CIRCUIT COURT & COMPTROLLER DATE: January 10, 2017 TO: Maria Fernandez - Gonzalez Sr. Benefits Administrator FROM: Pamela G. Hancoc( eputy Clerk SUBJECT: January 18tH BOCC Meeting Attached are two duplicate originals of Item C10 approval of an Amendment No. 2 to Pharmacy Benefit Management Services Agreement with Envision Pharmaceutical Services, LLC to extend the agreement to December 31, 2017. Should you have any questions, please feel free to contact me at ext. 3130. Thank you. cc: County Attorney Finance File AMENDMENT NO.2 TO PHARMACY BENEFIT MANAGEMENT SERVICES AGREEMENT This Amendment No. 2 (this "Amendment "), is entered into by and between Envision Pharmaceutical Services, LLC ( "Envision "), and Monroe County Board of County Commissioners ( "Plan Sponsor "). BACKGROUND Envision and Plan Sponsor are parties to a Pharmacy Benefit Management Services Agreement dated October 1S 2011 (the "Agreement "), under which Envision provides PBM Services to Plan Sponsor; and The parties desire to amend the Agreement, and therefore Envision and Plan Sponsor agree as follows: I. The term of the Agreement shall extend to December 31S 2017. 2. Financial performance guarantees for Contract Year 2016 will include all Claims from October 1S 2016 through December 31 st, 2017. 3. This Amendment shall be effective January 1 2017 ( "Effective Date "). 4. All other terms or provisions of the Agreement not modified by this Amendment or any other amendments or addenda shall remain unchanged. IN WITNESS WHEREOF, Envision and Plan Sponsor have executed this Amendment as4theT- Effective Date above. ' `' r- r. rn For ENVISION: For PLAN SPONSOR: w BY• ti By:- �v Gibbs, Pharm D. Mayo George Neugent I/ 18 i 7 t ercial & Managed Markets Print Name & Title BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA e OK, CLERK MONRO G UNTYATTORNEY BY: ,c, AP OV1 = Deputy Cl irk CYNTHIA L. HALL ASSISTA T (,;OUNTY ATTORN Y /Monroe County BOC Am. 2 113016 © Envision Pharmaceutical Services, LLC Page 1 of 1 oRn CERTIr OF LIABILITY INSURgl'',rE THIS CERTIFICATE IS ISSUED AS A MATTER QF 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 RE PRESENTATIVE O R PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) 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 MARSH USA INC. 501 MERRI T 7 NORWALK, CT 068566010 Aft Nonriak a*ueslQmalsh.00m INSURED EnWslon PhamlacedW Holdings, U.0 2181 East Aurora Road, Suits 201 TWnsblNQ, OH 44087 COVERAGES CERTIFICATE NUMBER: NYC•008227067.09 REVISION N UMBER:4 Allied Wald Assurenca Company, Inc. Trawlers Properly casualty Co. of Arnerica NIA The Trawler IndemNN Company DATE 12rJ0M16 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, I SR TYPH OF INSURANCE LILY NUMBER ERR Y LIMITS A X COMMERCIAL GENERAL LIABILITY 0309359/ 01101/2017 0110112018 EACH OCCURRENCE S 5 ° 000,000 CLAIMS4AADE [i] OCCUR AM RENTED S 500.000 of Marsh USA Inc. MED EXP one $ Nancy Kalbfell vxa�e ti ,, �o.at� sat PERSONAL& AOV INJURY $ 5,000,000 GEN1. AGGREGATE LSAIT APPLIES PER. GENERAL AGGREGATE S 5,000.000 X POLICY ❑ ,IE& ❑ LOC PRODUCTS - COMPIOP AGG $ 5 °000,000 OTHER: S B AUTOMO91LEL1AWLITY C2JCAP•8049X072.17 41!01/2017 011018018 Boo 1 $ 5.000,000 X ANY AUTO BODILY INJURY (Per person) $ A OV ED... A�OS ED BODILY INJURY (Pa acckh d) S NON -OWNED PR ERTY S HIRED AUTOS AUTOS S UMBRELLA LIAB OCCUR EACH OCCURRENCE S 1AGGREGATE S EXCESS LIAR CLAJM54MOE DEO I I RETENTION$ 5 B WORKERS COMPENSATION TC2JUB- 7412L10A -11 (ADS) 0110112017 1 1 1 X ER D AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE Y TRKliB 7442L111.17 (AZ MA) 01!01/2017 0110112018 E.L EACH ACCIDENT S 2,000,000 B Y F �dM l ary in NHS EXCLUDED? ❑ NIA 8 7442112317(OH 1M) 01101/2017 0110112018 E.L. DISEASE - EA EMPLOYE s 2 . E.L. DISEASE - POLICY LIMIT $ 2,000,000 Iyes describe under DESdRIP RATIONS below 75cewWC A HeaMrare Facilles 309.3594 0110112017 011018018 SEE ATTACHED Medkel Professional Liability (CLAIMS MADE) SEE ATTACHED DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, nay be attached N more apace ft required) G- 147167. 899 (*06) Monroe County Board of County Commissioners is induded as additional Insured where reWhed by written watract with rasped to General LlaAty. E T q AP 11 L CERTIFICATE HOLDER CANCELLATION MOmos County Board of County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Con"Mioner THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1100 Slatonlon SL, Suite 2.268, ACCORDANCE WITH THE POLICY PROVISIONS. Ivey west FL 33010 AUTHORU:ED REPRESENTATIVE of Marsh USA Inc. Nancy Kalbfell vxa�e ti ,, �o.at� sat ®198 &2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD