CY2016 1st Amendment 01/31/20171
County of Monroe
..
Flori ne �
Monroe County
Board of County Commissioners
Office of the County Administrator
The Historic Gato Cigar Factory
1100 Simonton Street, Suite 205
Key West, FL 33040
(305) 292 -4441 — Phone
(305) 292 -4544 - Fax
MEMORANDUM
BOARD OF COUNTY COMMISSIONERS
Mayor George Neugent, District 2
Mayor Pro Tern David Rice, District 4
Heather Carruthers, District 3
Danny L. Kolhage, District 1
Sylvia J. Murphy, District 5
TO: Pamela Hancock — Executive Assistant
FROM: Lindsey Ballard, Aide to County Administrator
DATE: March 24, 2017
SUBJECT: Small Contracts for your records
These small contract are for your records only.
Enclosures:
✓Xerox— 1 Copy
N/ Coastal Systems International, Inc. — 1 Copy
✓Worxtime LLC — 1 Copy of each Contract
Advanced Data Solutions, Inc. — 1 Copy — 1 �+
arI1 J7
Thank you,
Lindsey
Monroe County Purchasing Policy and Procedures
ATTACHMENT D.6
COUNTY ADMINISTRATOR
CONTRACT SUMMARY FORM FOR CONTRACTS LESS THAN $50,000.00
Contract with: Worxtime LLC Contract #
Effective Date: January 1 2016
Expiration Date: December 31, 2016
Contract Purpose/Description:
Approval of Amendment to 2016 Service Agreement with Worx0ma LLC covering calendar year 2016, t o
engage orx4me o ass Monroe county ccomp ance o ce . ,.. ; e , Aa
requirements y prepa n g afia milling torm I Uft allgli5ief mp . ees ancl
reel or
ca en d ar year
Contract is Original Agreement Contract Amendment/Extension Renewal
Contract Manager: Maria Gonzalez 4448 Em io ee Services/Stop #1
(Name) (Ext.) (Department/Stop #)
CONTRACT COSTS
Total Dollar Value of Contract: $ 8640 Current Year Portion: $
(must be less than $50,000) (If multiyear agreement then
requires BOCC approval, unless the
total cumulative amount is less than
$50,000.00).
Budgeted? Yes&( No ❑ Account Codes: 502 - 08002 530310 -
Grant: $ - - - -
County Match: $ - - - -
ADDITIONAL COSTS
Estimated Ongoing Costs: $ /yr For:
Not included in dollar value above e.. maintenance, utilities, janitorial, salaries, etc.
CONTRACT REVIEW
Changes Date Out
Date In Needed Iewer
Department Head Yes❑ No
Risk Management �S 7 Yes❑ No ❑? o
2 �13�1 1
O.M.B. /Purchasing Yes❑ No[� 3/ In
County Attorney Yes ❑No ®
Comments:
Page 67 of 70
AMENDMENT TO
2016 SERVICE AGREEMENT
THIS AMENDMENT ( "Amendment') TO THE SERVICE AGREEMENT DATED APRIL 21, 2016
( "Agreement') is entered into as of thisU of January , 2017, by and between WORXTIME LLC, a Georgia
limited liability company ( "Worxtime ") and Monroe County Board of County Comissioners ( "You," "Your" or
"Customer "). Any defined terms used herein that are not specifically defined herein shall have the same meaning as
set forth in the Agreement.
WHEREAS, Worxtime and Customer entered into that certain Agreement, dated April 21, 2016 ( "Agreement'), with
respect to the Worxtime program and certain services; and
WHEREAS, through an inadvertent oversight, the parties failed to clarify on Exhibit A to the Agreement that the
County wished for Worxtime to do the mailing of the 1095C form to plan members; and
WHEREAS, Worxtime and Customer agree to amend the Agreement in order to clarify that this fulfillment function will
be performed by Worxtime for the CY 2016 forms.
NOW THEREFORE, in consideration of the mutual promises and covenants contained herein and in the Agreement,
Worxtime and Customer hereby agree as follows:
1. Mailing of Forms 1095C Worxtime agrees to mail 1095C forms to all benefit eligible employees
for calendar year 2016 and employees who have been offered coverage during calendar year
2016. The determination as which employees are to be mailed 1095C forms and to what address
such forms will be mailed shall be based on the data provided by You;
2. Monroe County Board of County Comissioners agrees to pay $3.00 per mailed 1095C form to
Worxtime, LLC for this service;
3. The Quantity is to be determined and will be determined after confirmation of Eligible
Employees.
4. An Amended Exhibit A to the Agreement is attached hereto and shall serve as a replacement for
the Exhibit A originally attached to the Agreement. In all respects, it shall supersede the original
Exhibit A.
5. Except as expressly amended hereby, all the remaining provisions of the Subscription
Agreement shall remain in full force and effect.
The parties hereby agree and consent to the terms and conditions of these Amendments to the
stated Service Agreement and acknowledge such by executing the Amendments below.
Executed by
Customer: Monroe County Board of County
Coggsi
Signature:
Printed Name:
Title:
Date
Signed:
1100 Simonton Street
Address: Room 268
Key West, FL 33040
MONROE COUNTY ATTOHNty
RM'
071
A 20VED AS T
YNTHIA L. ALL
ASSISTANT COUNTY ATTORNEY
Date /- If -�c�► fi
Accepted By: Worxtime LLC
Signature:
flame: Tearle D. Bagwell
Managing Partner
11-5/10 -
360B Quality Circle
Address: Suite 220
Huntsville, AL 35806
Approved by NAA
EXHIBIT A
SERVICE AGREEMENT FEES
Invoice to:
Monroe County Board of County Commissioners
1100 Simonton St., Room 268
Key West, FL 33040
Set-up Fee
$0.00 - Renewal
PEPM Per Employee, Per month fee rate
$0.00
Estimated Months Measured
PEPM fees are applicable to all month(s) measured.
** Actual measurement Dates will be determined during
The first month to be measured shall be: January of
implementation
2016.
Signature:
The final month measured shall be: December of 2016.
Biling Cycle
Annual
Estimated Number of Employees to be Measured
1200
Estimated Annual Cost
$8640
Training Cost
Included at no Cost
Form 1095C Fullfilment Fees (printing, mailing, etc.)
Quantity TBD @ $3.00 per mailed 1095C form
Approval:
** Client selects Worxtime to perform this service:
Attest:
® Yes No
Multiple EINs: 5 additional EIN's - Renewal
$0.00 Renewal
Multiple Payrolls may result in additional fees.
Reformatting Fees (Files shall be provided to Worxtime
in a file format designated by Worxtime, otherwise a
reformatting fee will apply.) $495
Executed by:
Monroe_Qow9ty Board of
Accepted by:
Worxtime LLC
Co C ner
Signature:
__-
Signature:
-
Printed Name:
UJ r' i � a,
Printed Name:
Title:
�y
Title:
M g P er
Approval:
Attest:
KEVIN MADOK, Clerk
By: Deputy Clerk
MONR.OE COUNTY ATTORNEY
APPROVED AS TO FORA:
CYNTHIA L. HALL
ASSISTANT COUNTY ATTORNEY
Date / - // - a-G 1 "-t