CY2019 12/01/2020 Agreement ATTACHMENT D.6
COUNTY ADMR9STRATOR
CONTRACT SUMMARY FORM FOR CONTRACTS CTS LESS THAN$50,000.00
Contract with: " ,� Contract #
Effective Date: See Agreement
Expiration late: See Agreement
Contract se/Description:
ent o ent service a with o i- e o vrovides A - d l 95
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California. h .� onp1gym who 'd in California_iforni d faun is
required.
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Contract Manager. Ervan Cook 4458 = Employee Services/Stota#1
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CONTRACT COSTS
Total Dollar Value of Contract: $2000.E C t Yeas F'artiora• $2 •00
(must less ta,an SO,dt€t4) (If mt►Itiyear nt#Iran +
requims BOCC apgroval,unless the
Total contract amount witt amendment: $600 totd cumulative am,cunt is Tess 4�
5tDi000.41i).
Budgeted?Yes N e o�_ Codes:502-080 5303 10
Grant: $ - - -CountyMatch:
ADDMONALCOSTS
Estimated Ongoing Costs:$ N/A iyr For:
at included in dollm vie abc►ve} (e. .maintenance,utilities, 'm torial,salaries,etc.}
CONTRACTREVIEW
Changes Date Out
Date In DepartmentNee Digitally signed by Bryan Coo
dead Yes x a ''e Date:2021.0125 21:57:54-05' '
Risk Mannement YesEj No[D V— v
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County Attorney Yes ]No � ��^
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Comments:
Page 70 of 7
DocuSign Envelope ID:6915B241-CD72-4766-88CB-99A52FADCDEE
AMENDMENT TO THE UNIVERSAL SERVICE AGREEMENT
This Amendment ("Amendment") is by and between Worxtime, LLC (a wholly owned subsidiary of TALX
Corporation and hereinafter shall be referred to as "Worxtime") and Monroe County Board of County
Commissioners ("Client"), and is effective as of December 1, 2020 ("Effective Date"). This Amendment is
entered into with the express agreement that except as addressed herein, all terms, conditions and stipulations
contained in the Universal Service Agreement between Worxtime and Client, with an Effective Date of January 1,
2019, (the "Agreement") shall remain in full force and effect and without any change or modification whatsoever.
For the purposes of this Amendment, all capitalized terms used herein and not otherwise defined shall have the
meaning set forth in the Agreement.
WHEREAS, the parties desire to amend their Agreement, as set forth herein and hereby reaffirm and
ratify each of the terms and conditions in the Agreement.
NOW, THEREFORE, in consideration of the premises and mutual covenants set forth herein, and for
other valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree to
amend the Agreement as follows:
Amendments to Schedule A-ACA Tracking and Reporting Service dated January 1,2019
1. Schedule A, Exhibit 1 —Fees—the following shall be added:
State Mandate Reporting Subscription:
The State Mandate Reporting Subscription will be invoiced annually the month after production. Any fees for
subsequent transmissions will be invoiced monthly after utilization.
nnual Fixed-Fee Description Purchased Unit Annual
* Price Fee
State Mandate Reporting Yes See below
New Jersey-Filing Transmittal Service(includes 2 filing
transmissions); Subsequent transmissions will be invoiced at No N/A N/A
$1,000/each
District of Columbia-Filing Transmittal Service(includes 2 filing
transmissions); Subsequent transmissions will be invoiced at No N/A N/A
$1,000/each
California-Filing Transmittal Service(included 2 filing
transmissions); Subsequent transmission will be invoiced at Yes $2,000 $2,000
$1,000/each
Rhode Island-Filing Transmittal Service(included 2 filing
transmissions)„Subsequent transmission will be invoiced at No N/A N/A
$1,000/each
Total Annual Fixed-Fees $2,000
*Selecting "No" for any location above only applies to the Reporting Subscriptions purchased
under this Amendment; and shall not affect any Reporting Subscriptions previously purchased by
Client under any prior agreement or amendment.
All fees for the State reporting services will be adjusted annually in accordance with the rate in Schedule A,
Exhibit 1 —Fees.
2. Schedule B,Service Description Overview—the following shall be added:
State Mandate Reporting
Description
The State Mandate Reporting Service is designed to transmit Client's Data to the specified state per the
instructions based on individual state requirements.
Service Delivery Tasks
Worxtime will perform the following tasks in the delivery of this service:
Transmit Tax Form 1094-C/1095-C Data elements according to the distribution requirement(s) defined by
the state(s) selected in Exhibit 1 -Fees.
November 19,2020 Template Worxtime State Reporting Amendment Page 1 of 2
DocuSign Envelope ID:6915B241-CD72-4766-88CB-99A52FADCDEE
Assumptions
1. Client understands that for Worxtime to transmit to individual state entities, Client must have
completed the implementation of Services and have uploaded all required Data.
2. Worxtime will charge Client as noted in Exhibit 1 - Fees for each subsequent transmission to the
state(s) if additional transmissions are required.
Client Purchase Orders If the use of a Purchase Order("PO")or similar ordering document is required by Client,
the following information must be provided as part of the Agreement. Failure to include this information reflects
Client's agreement that a PO shall not be required by Client. Client shall provide notice of any PO changes no
less than ninety (90) days prior to the expiration of the current PO. No additional terms and conditions shall be
included in the PO unless expressly agreed to in writing by the Parties. If there is a conflict between language in
the PO and the Agreement, the Agreement shall control. Client shall send the PO's to
purchaseorders@equifax.com.
PO Number(or similar) PO Contact
PO Amount
(does not limit or otherwise
impact any minimum ordering $ Name:
obligations or purchase per timeframe
commitments specified in the
Agreement)
PO Effective Dates From: Phone:
(does not impact the Effective
Date(s)or Term(s) specified in
the Agreement) To: Email:
Miscellaneous: Other Terms. Neither this Amendment nor the Agreement can be amended or otherwise
modified, except as agreed to in writing by each of the parties authorized representatives hereto.
Effect of Amendment: Entire Agreement. This Amendment together with the parties Agreement (and any
attachments, addenda, and supplements thereto) shall be the complete and exclusive statement of the
Agreement between the parties as to the subject matter of the Agreement, and shall be binding upon each of the
parties hereto, their respective successors and to the extent permitted their assigns. All prior negotiations,
discussions and understandings between the parties are fully merged into the Agreement and amendments
thereto. In the event of a conflict between the terms and conditions hereof, and the terms and conditions of the
Agreement,the specific terms and conditions set forth in the Amendment shall govern.
This Amendment is accepted and agreed to by the following authorized representatives of the parties and each
person signing below represents and warrants that he or she has the necessary authority to bind the principal set
forth below.
IN WITNESS WHEREOF,the parties have executed this Amendment effective as of the Effective Date above.
Monroe County Board of County Worxtime, LLC, a wholly owned
CLIENT: Commissioners subsidiary of TALX Corporation
ADDRESS: 1100 Simonton St ADDRESS: 11432 Lackland Road
Key West, FL 33040 AiowsoVO 63146
Signed By: - Signed By:
Printed Name: Roman Gastesi Printed Name: Craig Beck
Title: County Administrator Title: VP, Strategy and Execution
Date: January 27, 2021 1 Date: '16 PST
Digitally signed by Cynthia L.Hall
Approved as to form and content: /�/ry,�+�Y'/�^��t o MoON:cn=Cynthia LHall,
(V . nroe County 80CC.ou.
Monroe County Attorneys Office .mad=hall
qigmhiaptnonroecountyJLg-.
November 19,2020 Template vvorM,me 1b .ppAjpS& endment Page 2 of 2