2. 05/01/2020 Agreement ATTACHMENT D.6
COUNTY ADMINISTRATOR
CONTRACT SUMMARY FORM FOR CONTRACTS LESS THAN$50,000.00
Contract with: 1 " Contract#
Effective Date: See Agreement
Contract Purpose/Description: Expiration Date: See Agreement
ftisint 5 AsIggiates AgEjeMog bCjWC2n er f ServicesInc.and Monroe Couft
&bAudling Qf P ! ' roeC Butfits
Department.
BContract is `'`" """ ` i,. B ' ' Contract Am
Contract Manager: Brvan Cook 4458 Employee Services/Stop#1
ame xt. epartmen top
CONTRACT COSTS
FTotalDollar Value of Contract: Zero Current Year Portion• $ Z"
$50.000) Billable services or multiyear agreement then Billable services
processed on requires BOCC approval,unless the Processed on
separate contract. 101.11 C111114ilat4o aniount Is Icss that) separate contract.
s,t►.onatalt.
Budgeted? Yes® Nc[] XMunt Codes:502-08002-5303 10
Grant: $ - - - -
County Match:
ADDITIONAL COSTS
Estimated Ongoing Costs: $ NIA /yr For:
Not included in dollar vatue above e. .maintenance,utilities,'anitorial,salaries,etc.)
CONTRACT REVIEW
Changes Date Out
Date In Needed R ewe
Department Head 6/3/2020 Yes®No® *, 6/3/2020
Risk Management 06-5-2020 YesEl Noo 06-5-2020
O.M.B./Purchasing 6 0 Yes❑NoE] Ch#-6Wwta18r6ckeZL 6/5/2020
County Attorney 6-5-2020 Yes❑No �. 6-$-20
26
Comments:
1, oun mints or
Page 70 of 73
BUSINESS ASSOCIATE AGREEMENT
This Business Associate Agreement ("Agreement") is entered into on Mayl, 2010(the
"Effective Date"), by and between Monroe County Board of County Commissioners) on behalf
of the Group Health and Welfare Plans of Monroe County Board of County Commissioners
"Covered Entity") and Gallagher Benefit Services, Inc. ("Business Associate').
RECITALS:
WHEREAS, Covered Entity and Business Associate mutually desire to outline their
individual responsibilities with respect to the use and/or disclosure of Protected Health
Information ("PHP) as mandated by the Privacy Rule promulgated under the Administrative
Simplifications subtitle of the Health Insurance Portability and Accountability Act of 1996
("HIPAA") including all pertinent regulations issued by the U.S. Department of Health and
Human Services as outlined in 45 C.F.R. Parts 160, 162 and 164 ("HIPAA Privacy Rides
and/or Security Standards").and
WHEREAS, Covered Entity and Business Associate understand and agree that the
HIPAA Privacy Rules and Security Standards requires the Covered Entity and Business
Associate enter into a Business Associate Agreement which shall govern the use and/or
disclosure of PHI and the security of PHI and ePHI.
NONV, THEREFORE, the parties hereto agree as follows:
1. Definitions. When used in this Agreement and capitalized, the following terms
have the foilov ing meanings:
(a) "Breach" shall have the same meaning as the term "Breach" in 45 C.F.R.
516-4.402.
(b) "Electronic Protected Health Information" or "ePHI' shall mean
Protected Health Information transmitted by electronic media or maintained in
electronic media.
(c) "Individual" shall have the same meaning as the term "Individual" in 45
C.F.R. 5160.103 and shall include a person %%ho qualifies as a personal representative
in accordance with 45 C.F.R. §164.502(g).
(d) "Privacy Rule" shall mean the Standards for Privacy of Individua I
Identifiable Health Information as set forth at 45 C.F.R. Parts 160 and 164 Subparts A
and E.
(e) "Protected Health Information" or "PHT' shall have the same meaning
as the term "protected health information" in 45 C.F.R. 5 160.103, limited to the
information created or received by Business Associate from or on behalf of Covered
Entity.
Gallagher Business Associate Agreement
050920I4
by the Secretary to conduct an investigation with respect to PHI received from the
Covered Entity. 4
(g) Business Associate agrees to document an)° disclosures of PHI that are
not excepted under 45 C.F.R. § 164.528(a)(1) as would be required for Covered Entity
to respond to a request by an Individual for an accounting of disclosures of PHI in
accordance with 45 C.F.R. § 164.528,
(h) Business Associate agrees to provide to Covered Entity or an Individual,
in a time and manner designated by Covered Entity, information collected in accordance
with paragraph (g) above, to permit Covered Entity to respond to a request by an
Individual for an accounting of disclosures of PHI in accordance with 45 C.F.R.
§ 164,528,
(i) Business Associate agrees to use or disclose PHI pursuant to the request
of Covered Entity: provided, however, that Covered Entity shall not request Business
Associate to use or disclose PHI in any manner that,�%ould not be permissible under the
Privacy Rule if done by Covered Entity.
3. Permitted Uses and Disclosures of PH[ by Business Associate.
(a) Business Associate may use or disclose PHI to perform functions,
activities or services for, or on behalf of, Covered Entity provided that such use or
disclosure would not violate the Privacy Rule if done by Covered Entity.
(b) Business Associate may use PHI for the proper management and
administration of Business Associate and to carry out the legal responsibilities of
Business Associate.
(c) Business Associate may disclose PHI for the proper management and
administration of Business Associate and to carry out the legal responsibilities of
Business Associate if:
(i) such disclosure is Required by Law, or
(ii) Business Associate obtains reasonable assurances from the person to
whom the information is disclosed that such information will remain
confidential and used or further disclosed only as Required by Law or
for the purposes for which it was disclosed to the person, and the person
agrees to notify Business Associate of any instances of which it is aware
that the confidentiality of the information has been breached.
(d) Business Associate shall limit the PHI to the extent practicable, to the
limited data set or if needed by the Business Associate, to the minimum necessary to
accomplish the intended purpose of such use,disclosure or request subject to exceptions
set forth in the Privacy Rule.
Gallagher Business Associate Agreement
05092014
Pace 3 of 9
(e) Business Associate agrees to immediately notify Covered Entity upon
discovery of any Breach of Unsecured Protected Health Information (as defined in 45
C.F.R. §§ 164.402 and 164.410) and provide to Covered Entity, to the extent available
to Business Associate. all information required to permit Covered Entity to comply with
the requirements of 45 C.F.R. Part 164 Subpart D.
(f) Covered Entity agrees and understands that the Covered Entity is
independently responsible for the security of all PHI in its possession (electronic or
otherwise), including all PHI that it receives from outside sources including the
Business Associate.
6. Term and Termination.
(a) Term. This Agreement shall be effective as of the Effective Date and
shall remain in effect until the Business Associate relationship with the Covered Entity
is terminated and all PHI is returned, destroyed or is otherwise protected as set forth in
Section 6(d).
(b) Termination for Cause by Covered Entity'. Upon Covered Entity's
kno«ledge of a material breach by Business Associate, Covered Entity shall provide an
opportunity for Business Associate to cure the breach. If Business Associate does not
cure the breach within 30 days from the date that Covered Entity provides notice of such
breach to Business Associate, Covered Entity shall have the right to immediately
terminate this Agreement and the underlying services agreement between Covered
Entity and Business Associate.
(c) Termination by BusinessAssociate. This Agreement may be terminated
by Business Associate upon 30 days prior written notice to Covered Entity in the event
that Business Associate, actin; in good faith, believes that the requirements of any law.
legislation, consent decree.judicial action, governmental regulation or agency opinion,
enacted, issued, or other�%ise effective after the date of this Agreement and applicable
to PHI or to this Agreement, cannot be met by Business Associate in a commercially
reasonable manner and without significant additional expense.
(d) Effect of Termination. Upon termination of this Agreement for any
reason. at the request of Covered Entity, Business Associate shall return or destroy all
PHI received from Covered Entity. or created or received by Business Associate on
behalf of Covered Entity. Business Associate shall not retain any copies of the PHI
unless return or destruction is deemed infeasible. If the return or destruction of PHI is
infeasible, Business Associate shall 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 infeasible, for so long as Business Associate maintains such PHI.
For purposes of illustration only and not to limit the set of circumstances that could
potentially make return or destruction infeasible, it would be infeasible for Business
Associate to return or destroy certain PHI that is part of work product that must be
Gallagher Business Associate Agreement
OJ091014
Page 5 of
facsimile transmission. (iii) sent by overnight courier, or(iv) sent by registered mail or certified
mail. return receipt requested. postage prepaid.
If to the Covered Entity:
Monroe County Board of County
Commissioners
1100 Simonton Street
Key West. FL 33040
If to the Business Associate:
Gallagher Benefit Services. Inc.
2255 Glades Road. Suite 200E
I� Boca Raton. FL 3343J
11. R_egulaton References.
A reference in this Agreement to a section in the Privacy Rule means the referenced
section or its successor, and fbi- -v%hich compliance is required.
12. Headiny-s and Captions.
The headings and captions of the �ariOus subdivisions of the Agreement are for
convenience of reference only° and %4 ill in no «ay modify or affect the meaning or construction
of any of the terms, or provisions hereof.
13. Entire Agreement,
This Agreement sets forth the entire understanding of the parties %%ith respect to the
subject matter set forth herein and supersedes, all prior agreements. arrangements and
communications. whether oral or N%ritten, pertaining to the subject matter hereof.
14. Binding Effect.
The provisions of this Agreement shall be binding upon and shall inure to the benefit of
both Parties and their respective successors and assigns.
15. No Waiver of Rig hts Po►►-ers and Remedies.
No failure or delay by a party hereto in exercising any right, power or remedy under this
Agreement, and no course of dealing between the parties hereto, will operate as a waiver of any
Calla®her Business Associate Agreement
056-M 14
Page 7of9
BUSINESS ASSOCIATE:
GALLAGHER BENEFIT SERVICES, INC.
By:
Name: .f d'c P ,E, — — —
Title: A c Lt € rez ide,j
COVERED ENTITY:
M N 1 \11 a M (- M ` ,1)
By: 202-0
Name:
Title: CpL41
'
t,
Gallagher Business Associate Agreement
M91414
Page 9of9
OATE(MMICON"Mn
ACORd°
CERTIFICATE OF LIABILITY INSURANCE 1002019
THIS CERTIFICATE IB ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGIFM UPON THE CERTIFICATE MOLDER.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 pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed.
H 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 corder rl hts to the cerdflcats holder In lieu of such endorsem s.
PROGUOMt DIrett All Inquiries to Emil
Arthur J.Gallagher Risk Management Services,Inc. I FAX
300 S.Riverside Plaza,SWte 1500
Chimp IL 60606 Chi CeTtIficamanifincom
INsu A"ORDNG COVERAGE NAIC r
NSUMRA:Arch fnaurance Cornpenv 11150
GallagherSURER Benefit SeMoes,Inc ARTHJGA11 R a:ACE 6 Ces Insurance Cc 20M
2286 Glades Road SLdte 200E IN c:Arch hidemnl InaurmiCe Co many 30530
Boca Reton,FL 33431 D
COVERAGES CERTIFICATE NUMBER:17175WM 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, NOTVATHSTANDING 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 CONOITIONS OF SUCH POLICIES.LsIUTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INXR L7RrnaoFwaualNa LwM
A X COMMERCIAL GENERALUABILITY Y 410PP4931412 14MMO19 10H12020 EACH OCCURRENCE 31LOW.000
CLA IAWAAOE EXI OCCUR I a 1,000.000
A DPF OVED RISK MANAGEMENT 6- 2020 µEDUP on. $10000
PERSONAL A AOV INJURY $1 000 000
OENL AGGREGATE UMIT APPLIES PER.nn GENERALAGOREGATE S 3,000,000
RPOLICY LOC PRODUCTS-COMPIOP AGG $3,000 000
WHER, t
A AUTOMOBM.ELAGLrIV 41CA841KM12 ) 10/112019 10J1R020 $3,000.000
X ANY AUTO 41CAE4939012 AtA) 10J7�019 1011Q020 BODILY INJURY(Pwpwm) S
OWNED SCC4EEgDULED BODILY ft1w o wdoodwo) S
X HIRED
AS p ONLY M
AHOlM01MVED S
AUTOS ONLYAUTOS ONLY
S
S JX UMBRELLA Luc N OCCUR XOO G46920%9 003 1011=19 10M12020 EACH OCCURRENCE a 3.000,000
eXCE $I" CLAOAS•MADE AGGREGATE $5,00,000
DID I X I 9610MOL2UMS
A WORRERSCOMPENSATION 41WDWMi12(AQS) 10HI2019 10M12020 X
C ANDEWLaYBIWLIAGILITY Y N 44V+IC10a01a12(NY,TX.CO.KY. 1011r2019 10/1/2020
ANYPROPRIETOWPARTNERiE%ECUIIVE 1 N MIA ) EL.EACHACCIOENT 31.000.000
OFFICERIMEMBEREXCLUDED? �I,����
(MWwdory M NMI E,L.DISEASE-EA EMPLOYEE $1 000 000
if d.Cra.UrAw
IDESCRIPTION C Et.DISEASE-POLICY LIMIT S 1 000 000
naocR TM OFOPERATMSI LOCATWW JVEHICLEa fACDMe�Ot,AddlBwur RrrrrMa BchMrY,my br aldehrd M man spaais ri1{nlr�
General Llattillly:
General Aggregate Per Location Subject to$10 MO PolcCyy eg regate.
Monroe County Board of Commissioners Is AddlUo Inured on the Gw wal U&Wty policy perform 0060598 00 0410 etMched as required by
wilien conked pumuent to andaubJect to the policys terms.ddnMwm.Conditions and excInlom.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Monroe County Board of County Commissioners ACCORDANCE WITH THE POLICYPRQNISIONS.
MITI:Natalie Maddox
1100 Simonton Street AUTHOFM TATWa
Key Wgst FL 33040 �/,�✓
f�✓� 01988.201a ACORD CORPORATION. All rights reserved.
ACORD 25(20111103) The ACORD name and logo are registered marks of ACORD
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSURED
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
LICIOUR LIABILITY FORM
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE FORM
SECTION II — WHO IS AN INSURED is amended to include as an additional insured the person or
organization who is required under a written contract with you to be Included as an insured under this
policy, but only with respect to liability arising out of your operations or premises owned by or rented to
YOV
All other terms and conditions of this policy remain unchanged,
Endorsement Number:
Policy Number: 41GPP49M1I2
Named Insured:ARTHUR J GALLAGHER&COMPANY
This endorsement is effective on the inception date of this Policy unless otherwise stated herein:
Endorsement Effective Date: 10M12019
00 GLO596 00 04 10 Page 1 of 1