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HomeMy WebLinkAboutItem C17 COUNTY of MONROE BOARD OF COUNTY COMMISSIONERS Mayor Michelle Lincoln,District 2 The Florida Keys Mayor Pro Tem David Rice,District 4 a e Craig Cates,District 1 e' Tames K. Scholl,District 3 � Holly Merrill Raschein,District 5 Regular Meeting January 28, 2026 Agenda Item Number: C17 26-0234 BULK ITEM: DEPARTMENT: Employee Services TIME APPROXIMATE: N/a STAFF CONTACT: Natalie Maddox, Senior Administrator Benefits and HIPAA Privacy Officer AGENDA ITEM WORDING: Approval of a Fourth Amendment to an agreement with Quantum Health Solutions to provide Employee Assistance Program(EAP) services to all benefit-eligible employees in the BOCC and Constitutional Offices, extending retroactively to January 17, 2026. The current agreement will by three (3) years with no change in terms, services, or cost $74,400 over three years. ITEM BACKGROUND: Approval of a three-year contract renewal with Quantum Health Solutions for Employee Assistance Program(EAP) services, some of which include: work problems; stress and depression; alcohol/drug dependency; living with anxiety; marital problems; family relationships; personal growth; emotional problems; legal and financial matters. Counseling services for company managers and employer support services when dealing with complex work situations is included in scope of service. The most recent Request for Proposals (RFP) for Employee Assistance Program (EAP) services was issued in 2014, and Quantum was the selected provider. The Agreement has been renewed since that time. PREVIOUS RELEVANT BOCC ACTION: 11/15/2022: BOCC granted approval of 3rd Amendment. 05/20/2020: BOCC granted approval of 2nd Amendment. 01/18/2017: BOCC granted approval of 1st Amendment. 05/21/2014: BOCC granted approval of original agreement. INSURANCE REQUIRED: Yes CONTRACT/AGREEMENT CHANGES: Approval of Fourth Amendment with Quantum Health Solutions (EAP). The term of the agreement is extended by three (3) years with no chang to terms, services, or cost. STAFF RECOMMENDATION: Approval DOCUMENTATION: Fourth Amendment Certificate(s) of Insurance EAP Brochure Renewal Offer Third Amendment Second Amendment First Amendment Original Agreement FINANCIAL IMPACT: Effective Date: January 17, 2026 Expiration Date: January 17, 2029 Fund 502-Group Insurance Fund; Cost Center: 08002—Group Insurance Operations Total Dollar Value of Contract: $74,400 over three years Total Cost to County: $74,400 Current Year Portion: Budgeted: Yes Source of Funds: Primarily Ad Valorem CPI: N/A Indirect Costs: N/A Estimated Ongoing Costs Not Included in above dollar amounts: Revenue Producing: N/A If yes, amount: N/A Grant: N/A County Match: N/A C 17. Approval of a Fourth Amendment to an agreement with Quantum Health Solutions to provide Employee Assistance Program (EAP) services to all benefit-eligible employees in the BOCC and Constitutional Offices, extending retroactively to January 17, 2026. The current agreement will by three (3)years with no change in terms, services, or cost $74,400 over three years. FOURTH AMENDMENT TO MONROE COUNTY CONTRACT FOR PROFESSIONAL SERVICES FOR EMPLOYEE ASSISTANCE PROGRAM THIS FOURTH AMENDMENT ("Fourth Amendment"), entered into on January 28, 2026, is by and between Monroe County (hereinafter called the "County") and Quantum Health Solutions of Florida, Inc. (hereinafter the "Contractor") (collectively, the "Parties"). WHEREAS, on June 1 , 2014, the Parties entered into an agreement for the provision of professional services for employee assistance ("Agreement"); and WHEREAS, the Agreement was extended on January 18, 2017 by a First Amendment ("First Amendment") to extend the term of the Agreement by three years from the Effective Date of the First Amendment; and WHEREAS, the Agreement was extended on January 17,2020 by a Second Amendment ("Second Amendment") to extend the term of the Agreement by three years from the Effective Date of the First Amendment; and WHEREAS, the Agreement was extended on January 16, 2022 by a Third Amendment ("Third Amendment") to extend the term of the Agreement by three years from the Effective Date of the First Amendment; and WHEREAS, the County would like to renew and extend the Agreement beyond its current term; and WHEREAS, the Contractor has provided rates with no cost increase for the renewal as defined within this Amendment and Exhibit A, Scope of Services, and has offered to have the rates remain constant for an additional three (3) years; WHEREAS, the Parties now desire to amend the Agreement by three (3) years on the terms and conditions offered by the Contractor; and WHEREAS, it is necessary to revise additional clauses within the Agreement in order to comply with recently enacted statutory contract language changes. NOW THEREFORE, the Parties agree to the following changes: 1. Paragraph 3.1 of the Agreement, as amended by Paragraph 3 of the Third Amendment, is revised to read as follows: The term of this Agreement, as amended, is extended from January 17, 2026 and renewed for an additional three (3) years, to run through January 17, 2029. Monroe County's performance and obligations to pay under this Fourth Amendment remain contingent upon annual appropriation by the Monroe County Board of County Commissioners. 1 2. The last sentence of Section 8, Records, is revised to read as follows: IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS, GAELAN JONES, AT (305) 292-3470, p .jl,)rrrecordsLa-)imoriroecoLjn..yfl.,gov; c/o Monroe County Attorneys Office, 1111 12 t" St., Suite 408, Key West, FL 33040. 3. E-verify Requirement (required by F.S. 448.095): Every public employer, contractor, and subcontractor shall register with and use the E-Verify system to verify the work authorization for all newly hired employees. By entering in this Agreement, the vendor certifies that it registers with and uses the E-Verify system. If the contractor enters into a contract with a subcontractor, the subcontractor must provide the contractor with an affidavit stating that the subcontractor does not employ, contract with, or subcontract with an unauthorized alien. The contractor shall maintain a copy of such affidavit for the duration of the contractor. 4. Scrutinized companies (F.S. 287.135): This contract is terminable at the option of the awarding body if the company is found to have been placed on the Scrutinized Companies That Boycott Israel List as that term is defined in F.S. 287.135 or is engaged in the boycott of Israel. 5. Human Trafficking (F.S. 787.06): Whenever a contract is executed, renewed, or extended between a nongovernmental entity and a governmental entity, the nongovernmental entity must provide an affidavit signed by an officer or a representative of the nongovernmental entity under penalty of perjury, attesting that the nongovernmental entity does not use coercion for labor or for services. A copy of the affidavit is attached. 6. Foreign Entities Affidavit (F.S. 287.138): a. Beginning 1/1/2024, a governmental entity may not accept a bid or proposal from, or enter into a contract with, an entity which would grant the entity access to individual personal identifying information ("Pil") unless the entity provides an affidavit signed by an officer or representative under penalty of perjury attesting that the entity does not meet any of the criteria in F.S. 287.138(2)(a)-(c): • Entity owned by a country of concern (China, Russia, Iran, North Korea, Venezuela, Syria) • Controlling interest by government of foreign country of concern; • Entity organized under the laws of or has principal place of business in foreign country of concern. 2 b. Beginning 7/1/2025, a governmental entity cannot renew a contract with an entity which would grant the access to PII unless the entity provides the affidavit. c. Beginning 7/1/2025, a governmental entity cannot extend or renew a contract with an entity meeting the above criteria if the contract would give access to P 11 to that entity. The affidavit is attached. In all other respects, the terms and conditions of the Agreement between the Parties, as amended by the Fourth Amendment, remain in full force and effect. IN WITNESS HEREOF, this Fourth Amendment has been executed by the duly authorized representatives of the Parties, each of whom has full authority to enter into this Fourth Amendment. For the County: (SEAL) MONROE COUNTY BOARD OF Attest: Kevin Madok, Clerk COUNTY COMMISSIONERS By: By: Deputy Clerk Mayor Date: For the Contractor: QUANTUM HEALTH SOLUTIONS OF FLORIDA, INC. By: Anthony Riccio, President Date: January 7, 2026 Approved as to form and legal sufficiency: Monroe County Attorney's Office 1-15-2026 3 AFFIDAVIT ATTESTING TO NONCOERCIVE CONDUCT FOR LABOR OR SERVICES EntityNendor Name: �&AV4.r 1454-6,1W � Vendor FEIN: L 3 Vendor's Authorized Representative: I " (Name and Title) Address: e,/6 73P v j if- _-�> -_- City: 221a:92n 92 s State: Zip: 7=:L 3 4-7 Phone Number: 411� 0o.-4 o'loa!:7, x- Z-LI Email Address: c Coc+5• 60^0\ As a nongovernmental entity executing, renewing, or extending a contract with a government entity, Vendor is required to provide an affidavit under penalty of perjury attesting that Vendor does not use coercion for labor or services in accordance with Section 787.06, Florida Statutes. As defined in Section 787.06(2)(a), coercion means: 1. Using or threating to use physical force against any person; 2. Restraining, isolating, or confining or threating to restrain, isolate, or confine any person without lawful authority and against her or his will; 3. Using lending or other credit methods to establish a debt by any person when labor or services are pledged as a security for the debt, if the value of the labor or services as reasonably assessed is not applied toward the liquidation of the debt, the length and nature of the labor or service are not respectively limited and defined; 4. Destroying, concealing, removing, confiscating, withholding, or possessing any actual or purported passport, visa, or other immigration document, or any other actual or purported government identification document, of any person; 5. Causing or threatening to cause financial harm to any person; 6. Enticing or luring any person by fraud or deceit; or 7. Providing a controlled substance as outlined in Schedule I or Schedule II of Section 893.03 to any person for the purpose of exploitation of that person. As a person authorized to sign on behalf of Vendor, I certify under penalties of perjury that Vendor does not use coercion for labor or services in accordance with Section 787.06. Additionally, Vendor h s reviewed Section 787.06, Florida Statutes, and agrees to abide by same. Certified By. , who is authorized to Agn on behalf the bove referenced company. Authorized Signa Pre: Print Name: "R)ex.4", Title: fx �GJ i y�. 1�_s�; r►... 4 FOREIGN ENTITIES AFFIDAVIT F.S. 287.138 � of the c� of �� 4*+12r-- accordin to law on ty � 1 .._. 9 my oath, and4inder penalty of perjury, depose and say that: a. I am G G of the firm of 42iAdni�� .. S ("Entity"), the bidder making the Proposal for the project described in the Request for Proposals for Ailvywc /::?wG and that I executed the said proposal with full authority to do so; b. In accordance with section 287.138, Florida Statutes, the Entity is not owned by the government of a Foreign Country of Concern, as that term is defined in F.S. 287.138, is not organized under the laws of nor has its Principal Place of Business in a Foreign Country of Concern, and the government of a Foreign Country of Concern does not have a Controlling Interest in the entity. c. The statements contained in this affidavit are true and correct, and made with full knowledge that Monroe County relies upon the truth of the statements contained in this affidavit in awarding contracts for said project. (§(9nature) Date: TO :Z STATE OF: mo 4' COUNTY OF: Subscribed and sworn to (or affirmed) before me, by means of hysical presence or 0 online rota ization, an I g (date) by n u A (name of aff[ t}. Re/She is personally known to me or has produce --J r-e 0 so, (type of identification) as identification. ZYM 0% THY• BLF4na _. .� Commission 9 HH 612662 y Comm.Expires Nov 14,2028 M GVWM98td ' 5 THE HARTFORD BUSINESS SERVICE CENTER THE 3600 WISEMAN BLVD HARTFORD SAN ANTONIO TX 78251 January 8, 2026 Monroe County BOCC 1100 SIMONTON ST KEY WEST FL 33040 Account Information: Ll Contact Us QUANTUM HEALTH SOLUTIONS Policy Holder Details : INC Need Help? Chat online or call us at (866)467-8730. We're here Monday- Friday. Enclosed please find a Certificate Of Insurance for the above referenced Policyholder. Please contact us if you have any questions or concerns. Sincerely, Your Hartford Service Team WLTRO05 DATE(MM/DD/YYYY) Wuuu CERTIFICATE OF LIABILITY INSURANCE 01/08/2026 THIS CERTIFICATE IS ISSUED AS A MATTER OF 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 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS 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 CONTACT USAA INSURANCE AGENCY INC/PHS NAME: PHONE (888)242-1430 FAX 65812846 (A/C,No,Ext): (A/C,No): The Hartford Business Service Center 3600 Wiseman Blvd E-MAIL San Antonio,TX 78251 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Hartford Casualty Insurance Company 29424 QUANTUM HEALTH SOLUTIONS INC INSURER B: Hartford Underwriters Insurance Company 30104 4873 PALM COAST PKWY NW UNIT 3 INSURER C: PALM COAST FL 32137-3669 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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.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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MM/DD/YYYY MM/DD/Y YYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED $300 000 PREMISES Ea occurrence) ' X General Liability MED EXP(Any one person) $10,000 A X 65 SBA TF9660 12/05/2025 12/05/2026 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,0007000 POLICY 1:1 PRO- Fx LOC PRODUCTS-COMP/OP AGG $4,000,000 JECT OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED BODILY INJURY(Per accident) AUTOS AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) F- UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- MADE AGGREGATE DED RETENTION$ WORKERS COMPENSATION X PER I I OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY Y/NE E.L.EACH ACCIDENT $1 3000,000 B PROPRIETOR/PARTNER/EXECUTIVE N/A 65 WEC GD3821 02/11/2025 02/11/2026 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $1 3000,000 DESCRIPTION OF OPERATIONS below A EMPLOYMENT PRACTICES 65 SBA TF9660 12/05/2025 12/05/2026 Each Claim Limit $5,000 LIABILITY Aggregate Limit $5,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured's Operations.Certificate holder is an additional insured per the Business Liability Coverage Form SS0008 attached to this policy. CERTIFICATE HOLDER CANCELLATION Monroe County BOCC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1100 SIMONTON ST APPROVED I� ANACEEN BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED KEY WEST FL 33040 BY IN ACCORDANCE WITH THE POLICY PROVISIONS. DATE 01•08• 6 AUTHORIZED REPRESENTATIVE WAIVER N/A YES X Auto waived per�i'1-Slavik 4ee ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1100 Virginia Drive, Suite 250 Fort Washington, PA 19034-3278 ........ ....... ....... Phone:1-888-288-3534 Fax:1-847-953-0134 Website:www.hpso.com 04/08/25 Quantum Health Solutions, Inc. 4873 Palm Coast Pkwy Nw Unit 3 Palm Coast, FL 32137 Dear Anthony Riccio: Enclosed is the replacement certificate of insurance that you requested. If you have any questions or need assistance, please call us toll free at 1-888-288-3534. Our Customer Service Representatives are available weekdays from 8:00 a.m. to 6:00 p.m., EST. Sincerely, Customer Service Enclosure Q032 Dedicated To Serving The Insurance Needs of Healthcare Providers Healthcare Providers Service Organization is a registered trade name of Affinity Insurance Services,Inc.;(AR 244489);in CA&MN,AIS Affinity Insurance Agency,Inc.(CA 0795465);in OK,AIS Affinity Insurance Services Inc.; in CA,Aon Affinity Insurance Services,Inc.,(OG94493),Aon Direct Insurance Administrators and Berkely Insurance Agency and in NY,AIS Affinity Insurance Agency. HEALTHCARE PROVIDERS SERVICE ORGANIZATION PURCHASING GROUPCNA "" b r. Certificate of 3nourance HYN!),o Priint Date: 4/08/2025 PRODUCER BRANCH IPIREIFIX POLICY NUMBER POLICY PERIOD 018098 970 IHPG 0270500214 From:. 08/08/25 to 08/08/26 at 12:01 AM Standard Time Named)Insured and Address: Program Administered by: Insurance Provided by: Quantum Health Solutions, Inc. Healthcare Providers Service Organization American Casualty Company of Reading, 4873 Palm Coast Pkwy Nw Unit 3 1100 Virginia Drive,Suite 250 Pennsylvania Palm Coast, FL 32137 Fort Washington, PA 19034-3278 151 N. Franklin Street 1-888-288-3534 1 www.hpso.com Chicago, IL 60606 Medical Specialty: Code: Alcohol/Drug Counselor Firm 80723 Excludes Cosmetic Procedures Professional Liability("PL"): X_Occurrence. Claims Made and Reported .Limits of Liability $1,000,000 each claim/ $3,000,000 aggregate PL Limits of Liability above include the following: *Healthcare Providers Services Liability *Placement Services Liability Formal IReview Board Activities Liability*Good Samaritan Services Liiabiliity Abuse and Molestation Sublimits of Liability: Damages(included within PL Limits of Liability shown above) $25,000 aggregate Defense Costs(included within PL Limits of Liability shown above) $100,000 aggregate PL Supplementary Benefits Licensure Defense Expenses Up to$200 per hour/$25,000 aggregate Licensure Proceeding Supplemental Costs $500 each insured/$500 aggregate Subpoena Assistance Costs $10,000 each subpoena/$10,000 aggregate Assault(includes workplace violence counseling) $25,000 each assault incident/$25,000 aggregate Patient First Aid Medical Expenses $10,000 aggregate Services to Animals Property Damage $10)000 aggregate Media Expense $25,000 aggregate Cyber Liability and First Party Loss(Including Privacy)—Claims Made and Reported $25,000 aggregate Defense Costs within limits Retroactive Date: 08/08/2016 Workplace Liability:Occurrence Workplace Liability Aggregate Limit of Liability $1,000,000 aggregate (included within PL Aggregate Limit of Liability,above) Bodily Injury and Property Damage (included within Workplace Aggregate, above) $1,000,000 each occurrence Personal and Advertising Injury (included within Workplace Aggregate, above) $1,000,000 any one person or entity Fire and Water Sublirnit of Liability $150,000 aggregate (included within Bodily Injury and Property Damage each occurrence Limit,above) Workplace Liability Supplementary Benefit Non-Patient Medical Expenses $25,000 each person PL and GLIWPL(as applicable)Supplementary Benefit: Proceeding Expense Reimbursement $1,000 each insured per day/$25,000 each insured per proceeding Employment Practices Liability("EPL" : Claims Made and Reported $25,000 each claim I $25,000 aggregate Defense only Retroactive Date: 08/08/2021 Total $1,542.27 Base Premium$ 1527.00 FIGA Emergency $ 15.27 APPROVED BY RISK MANAGEMENT Policy Forms and Endorsements (Please see attached list) BY � Medical Speciality is amended to include Consulting Services(CNA101460) CRATE .7.26 WAIVER N/A X YES WC provided under separate , p p /2 ...... ... ,. .. :E. ........ ..r.... cover F , r{•r.1tyyr .. ........... :..... Doug Worman,Chief Executive Officer Stathy Darcy,Secretary Keep this Certificate of Insurance in a safe place.It and proof of payment are your proof of coverage. There is no coverage in force unless the premium is paid in full.To activate your coverage,please remit premium in full by the effective date of this Certificate of Insurance. Coverage Change Date: Endorsement Date: Master Policy: 188711433 CNA101440(07-23) Page 1 0 CNA All Rights Reserved. HEALTHCARE PROVIDERS SERVICE ORGANIZATION PURCHASING GROUP CNA C ertifirate of ln5uranre H 0 Your professional liability insurance contains insuring agreements that may be written on an occurrence or a claims made and reported basis. With respect to any claims made and reported coverage such coverage applies only to claims first made against the insureds and reported to the Insurer during the policy period or any applicable extended reporting period in accordance with the provisions of this policy. Please discuss with your Program Administrator. DEFENSE WITHIN LIMITS: WHERE DEFENSE WITHIN LIMITS IS INDICATED BELOW OR BY ENDORSEMENT, THE AMOUNT OF MONEY AVAILABLE TO PAY SETTLEMENTS OR JUDGMENTS AGAINST YOU UNDER SUCH SPECIFIED COVERAGE PARTWILL BE REDUCED AND MAY BE EXHAUSTED BY DEFENSE EXPENSES,INCLUDING BUT NOT LIMITED TO FEES PAID TO ATTORNEYS TO DEFEND YOU. The application for the policy and any and all supplementary information,materials,and statements submitted therewith shall be maintained on file by us or our Program Administrator and will be deemed attached to and incorporated into the policy as if physically attached. POLICY FORMS&ENDORSEMENTS The following are the policy forms and endorsements that apply to your current professional liability policy. FORM# FORM DESCRIPTION CNA101429 (07-23) General Terms and Conditions CNA101432 (07-23) Healthcare Providers Professional Liability Coverage Part (Occurrence) CNA101436 (07-23) Workplace Liability Coverage Part CNA81753 (03-15) Coverage & Cap on Losses from Certified Acts Terrorism CNA81758FL (01-21) Notice -Offer of Terrorism Coverage & Disclosure of Premium CNA101455 (07-23) Business Owner Coverage Extension Endorsement CNA101519 (07-23) Entity Endorsement(Including Specified Procedures and Services and Office Sharing Exclusions) CNA101553 (07-23) Table of Contents- General Terms and Conditions CNA101557 (07-23) Table of Contents- Coverage Part Occurrence Form CNA101559 (07-23) Table of Contents- Employment Practices Liability Defense Only CNA101563 (07-23) Table of Contents-Workplace CNA101577 (07-23) Biometric Privacy Exclusion Endorsement CNA101512FL (07-23) Cancellation and Non Renewal Amendatory Endorsement- Florida CNA1 0 1521 FL (07-23) Amendatory Endorsement (General Terms & Conditions)- FL CNA101580 (07-23) Additional Insured Endorsement (Professional Liability) CNA62825FL (09-12) Policyholder Notice- Florida CNA62832FL (09-12) Policyholder Notice- FL CNA77863FL (02-14) Policyholder Notice- Electronic policy transmission CNA101441 (07-23) Cosmetic Procedures Exclusion Endorsement CNA101443 (07-23) Media Event Expenses Supplementary Benefits Endorsement CNA101444 (07-23) Employment Practices Liability Coverage Part(Defense Costs only) CNA101460 (07-23) Consulting Services Liability Coverage Endorsement CNA101479 (07-23) Cyber Liability and First Party Loss (Including Privacy) Endorsement CNA101501 (07-23) Agreement to Provide Notice of Cancellation PLEASE REFER TO YOUR CERTIFICATE OF INSURANCE FOR THE POLICY FORMS & ENDORSEMENTS SPECIFIC TO YOUR STATE AND YOUR POLICY PERIOD. For FL residents: The surcharge shown on the Certificate of Insurance is the FL Insurance Guaranty Association Emergency Assessment Form#:CNA101440 (07-23) Named Insured:Quantum Health Solutions, Inc. Master Policy#: 188711433 Policy#:0270500214 Page 2 CNA All Rights Reserved. A Y NEAVILIN, CPA IIIIRNRRE ,FLRR�Da CLERK OF CIRCUff COUffr & COM OL R DATE: June 17, 2014 To: Teresa Aguiar, PHR, CPM Director of Employee Services ATTN.- Christine Diaz FROM: Lindsey Ballard, D.C. VV At the May 21, 2014, Board of County Commissioner's meeting the Board granted approval and execution of Item C 11 Approval of Employee Assistance Program Contract with Quantum Health Solutions. Attached is three (3) duplicate originals of the above-mentioned for your handling. Should you have any questions please do not hesitate to contact this office. cc: County Attorney (electronic copy) Finance (electronic copy) File 500 Whitehead Street Suite 1010 PO Box 1980,Key West,FL 33040 Phone:305-295-3130 Fax:305-295-3663 3117 Overseas Highway,Marathon,FL 33050 Phone:305-289-6027 Fax:305-289-6025 88820 Overseas Highway,Plantation Key,,FL 33070 Phone:852-7145 Fax:305-852-7146 AGREEMENT MONROE COUNTY CONTRACT FOR PROFESSIONAL SERVICES FOR EMPLOYEE ASSISTANCE PROGRAM THIS AGREEMENT is made and entered into this 1st day of June, 2014, by MONROE COUNTY ("COUNTY"), a political subdivision of the State of Florida, whose address is 1100 Simonton Street, Key West, Florida 33040 and Quantum Health Solutions("CONTRACTOR"), whose address is 4873 Palm coast Parkway, NW, Unit 3, Palm Coast, FL 32137. Section 1. SCOPE OF SERVICES CONTRACTOR Shall do, perform and carry out in a professional and proper manner certain duties as described in the Scope of Services — Exhibit A--which is attached hereto and made a part of this agreement. CONTRACTOR shall provide the scope of services in Exhibit A for COUNTY. CONTRACTOR warrants that it is authorized by law to engage in the performance of the activities herein described, subject to the terms and conditions set forth in these Agreement documents. The CONTRACTOR shall at all times exercise independent, professional judgment and shall assume professional responsibility for the services to be provided. Contractor shall provide services using the following standards, as a minimum requirement: A. The CONTRACTOR shall maintain adequate staffing levels to provide the services required under the Agreement resulting from this RFP process. B. The personnel Shall not be employees of or have any contractual relationship with the county. To the extent that contractor uses subcontractors or independent contractors, this Agreement specifically requires that subcontractors and independent contractors shall not be an employee of or have any contractual relationship with County. C. All personnel engaged in performing services under this Agreement shall be fully qualified, and, if required, to be authorized or permitted under State and local law to perform such services. Section 2. COUNTY'S RESPONSIBILITIES 2.1 Provide all best available information as is required by the contractor and is mutually agreed upon. 2.2 Designate in writing a person with authority to act on the COU NTY'S behalf on all matters concerning the EAP. 2.3 Provide a schedule that is mutually agreeable to the COUNTY and CONTRACTOR. Section 3. TERM OF AGREEMENT 3.1 The initial Agreement term will be for three (3) years beginning the 1 st day of June, 2014. Monroe County's performance and obligations are contingent upon an annual appropriation by the Monroe County Board of county Commissioners. 1 Section 4. PAYMENT TO CONTRACTOR 4.1 Compensation to the Contractor is outlined in Exhibit A. 4.2 Payment will be made according to the Florida Local Government Prompt Payment Act, Section 218.70, Florida Statutes. The Provider shall submit to the County an invoice and supporting documentation in a form acceptable to the Clerk. Acceptability to the Clerk is based on generally accepted accounting principles and such laws, rules and regulations as may govern the Clerk's disbursal of funds. The Director of Employee Services will review the request, note his/her approval on the request and forward it to the Clerk for payment. Section 5. CONTRACT TERMINATION, MODIFICATION 5.1 Either party may terminate this Agreement because of the failure of the other party to perform its obligations under the Agreement. The COUNTY may terminate this Agreement with or without cause upon thirty (30) days notice to the CONTRACTOR. COUNTY shall pay CONTRACTOR for work performed through the date of termination. The Contractor must provide the Contractor with at least ninety (90) days notice of intent to terminate. 5.2 If either party desires to modify this Agreement, it shall notify the other in writing at least thirty (30) days prior to the effective date of such modification. In the case of proposed modification the party receiving the notification of the proposed modification shall itself notify the other party within ten (10) days after receipt of notice of its agreement to the proposed modification. Failure to do so shall terminate this Agreement. Section 6. CONTRACTOR'S ACCEPTANCE OF CONDITIONS A. CONTRACTOR hereby agrees that he has carefully examined the RFP, his response, and this Agreement and has made a determination that he/she has the personnel, equipment, and other requirements suitable to perform this work and assumes full responsibility therefore. The provisions of the Agreement shall control any inconsistent provisions contained in the specifications. All specifications have been read and carefully considered by CONTRACTOR, who understands the same and agrees to their sufficiency for the work to be done. Under no circumstances, conditions, or situations shall this Agreement be more strongly construed against COUNTY than against CONTRACTOR. B. Any ambiguity or uncertainty in the specifications shall be interpreted and construed by COUNTY, and its decision shall be final and binding upon all parties. C. The passing, approval, and/or acceptance by COUNTY of any of the services furnished by CONTRACTOR shall not operate as a waiver by COUNTY of strict compliance with the terms of this Agreement, and specifications covering the services. D. CONTRACTOR agrees that County Administrator or his designated representatives may visit CONTRACTOR'S facility(ies) periodically to conduct random evaluations of services during CONTRACTOR'S normal business hours. E. CONTRACTOR has, and shall maintain throughout the term of this Agreement, appropriate licenses and approvals required to conduct its business, and that it will 2 at all times conduct its business activities in a reputable manner. Proof of such licenses and approvals shall be submitted to COUNTY upon request. Section 7. NOTICES Any notice required or permitted under this agreement shall be in writing and hand delivered or mailed, postage prepaid, to the other party by certified mail, returned receipt requested, to the following: To the COUNTY: Benefits, Sr. Administrator 1100 Simonton Street, Suite 2-258 Key West, Florida 33040 To the CONTRACTOR: Quantum Health Solutions 4873 Palm Coast Parkway, NW, Unit 3 Palm Coast, FL 32137 Section 8. RECORDS Each party to this Agreement or their authorized representatives shall have reasonable and timely access to such records of each other party to this Agreement for public records purposes during the term of the agreement and for five years following the termination of this Agreement. If an auditor employed by the COUNTY or Clerk determines that monies paid to CONTRACTOR pursuant to this Agreement were spent for purposes not authorized by this Agreement, the CONTRACTOR shall repay the monies together with interest calculated pursuant to Section 55.03, of the Florida Statutes, running from the date the monies were paid to CONTRACTOR. Pursuant to Florida Statute §119.0701, Contractor and its subcontractors shall comply with all public records laws of the State of Florida, specifically to: a. Keep and maintain public records that ordinarily and necessarily would be required by Monroe County in the performance of this Agreement. b. Provide the public with access to public records on the same terms and conditions that Monroe County would provide the records and at a cost that does not exceed the cost provided in Florida Statutes, Chapter 119 or as otherwise provided by law. c. Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law. d. Meet all requirements for retaining public records and transfer, at no cost, to Monroe County all public records in possession of the contractor upon termination of this Agreement and destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure 3 requirements. All records stored electronically must be provided to Monroe County in a format that is compatible with the information technology systems of Monroe County. Section 9. EMPLOYEES SUBJECT TO COUNTY ORDINANCE NOS. 010 AND 020- 1990 The CONTRACTOR warrants that it has not employed, retained or otherwise had act on its behalf any former County officer or employee subject to the prohibition of Section 2 of Ordinance No. 010-1990 or any County officer or employee in violation of Section 3 of Ordinance No. 020-1990. For breach or violation of this provision the COUNTY may, in its discretion, terminate this agreement without liability and may also, in its discretion, deduct from the agreement or purchase price, or otherwise recover the full amount of any fee, commission, percentage, gift, or consideration paid to the former County officer or employee. Section 10. CONVICTED VENDOR By signing this agreement, CONTRACTOR represents that the execution of this Agreement will not violate the Public Entities Crime Act (Section 287.133, Florida Statutes). Violation of this section shall result in termination of this Agreement and recovery of all monies paid hereto, and may results in debarment from County's competitive procurement activities. A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a Agreement with a public entity for the construction or repair of a public building or public work, may not perform work as a CONTRACTOR, supplier, subcontractor, or CONTRACTOR under Agreement with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017 of the Florida Statutes, for the Category Two for a period of 30 months from the date of being placed on the convicted vendor list.. Section 11. GOVERNING LAW, VENUE, INTERPRETATION, COSTS AND FEES This Agreement shall be governed by and construed in accordance with the laws of the State of Florida applicable to agreements made and to be performed entirely in the State. In the event that any cause of action or administrative proceeding is instituted for the enforcement or interpretation of this Agreement, the COUNTY and CONTRACTOR agree that venue shall lie in the appropriate court or before the appropriate administrative body in Monroe County, Florida. Section 12. SEVERABI LITY If any term, covenant, condition or provision of this Agreement (or the application thereof to any circumstance or person) shall be declared invalid or unenforceable to any extent by 4 a court of competent jurisdiction, the remaining terms, covenants, conditions and provisions of this Agreement, shall not be affected thereby; and each remaining term, covenant, condition and provision of this Agreement shall be valid and shall be enforceable to the fullest extent permitted by law unless the enforcement of the remaining terms, covenants, conditions and provisions of this Agreement would prevent the accomplishment of the original intent of this Agreement. The COUNTY and CONTRACTOR agree to reform the Agreement to replace any stricken provision with a valid provision that comes as close as possible to the intent of the stricken provision. Section 13. ATTORNEY'S FEES AND COSTS The COUNTY and CONTRACTOR agree that in the event any cause of action or administrative proceeding is initiated or defended by any party relative to the enforcement or interpretation of this Agreement, the prevailing party shall be entitled to reasonable attorney's fees, and court costs, as an award against the non-prevailing party. Mediation proceedings initiated and conducted pursuant to this Agreement shall be in accordance with the Florida Rules of Civil Procedure and usual and customary procedures required by the Circuit Court of Monroe County. Section 14. BINDING EFFECT The terms, covenants, conditions, and provisions of this Agreement shall bind and inure to the benefit of the COUNTY and CONTRACTOR and their respective legal representatives, successors, and assigns. Section 15. AUTHORITY Each party represents and warrants to the other that the execution, delivery and performance of this Agreement have been duly authorized by all necessary County and corporate action, as required by law. Section 16. ADJUDICATION OF DISPUTES OR DISAGREEMENTS COUNTY and CONTRACTOR agree that all disputes and disagreements shall be attempted to be resolved by meet and confer sessions between representatives of each of the parties. If the issue or issues are still not resolved to the satisfaction of the parties, then any party shall have the right to seek such relief or remedy as may be provided by this Agreement or by Florida law. This Agreement shall not be subject to arbitration. Section 17. COOPERATION In the event any administrative or legal proceeding is instituted against either party relating to the formation, execution, performance, or breach of this Agreement, COUNTY and CONTRACTOR agree to participate, to the extent required by the other party, in all proceedings, hearings, processes, meetings, and other activities related to the substance of this Agreement or provision of the services under this Agreement. COUNTY and CONTRACTOR specifically agree that no party to this Agreement shall be required to enter into any arbitration proceedings related to this Agreement. 5 Section 18. NONDISCRIMINATION COUNTY and CONTRACTOR agree that there will be no discrimination against any person, and it is expressly understood that upon a determination by a court of competent jurisdiction that discrimination has occurred, this Agreement automatically terminates without any further action on the part of any party, effective the date of the court order. The parties agree to comply with all Federal and Florida statutes, and all local ordinances, as applicable, relating to nondiscrimination. These include but are not limited to: Title VI1 of the Civil Rights Act of 1964 (PL 88-352) which prohibits discrimination on the basis of race, color or national origin; Title IX of the Education Amendment of 1972, as amended (20 USC ss. 1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; Section 504 of the Rehabilitation Act of 1973, as amended (20 USC s. 794), which prohibits discrimination on the basis of handicaps; The Age Discrimination Act of 1975, as amended (42 USC ss. 6101-6107) which prohibits discrimination on the basis of age; The Drug Abuse Office and Treatment Act of 1972 (PL 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (PL 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; The Public Health Service Act of 1912, ss. 523 and 527 (42 USC ss. 690dd-3 and 290ee-3), as amended, relating to confidentiality of alcohol and drug abuse patient records; Title Vill of the Civil Rights Act of 1968 (42 USC ss. 3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; The Americans with Disabilities Act of 1990 (42 USC s. 1201 Note), as may be amended from time to time, relating to nondiscrimination on the basis of disability; and any other nondiscrimination provisions in any Federal or state statutes which may apply to the parties to, or the subject matter of, this Agreement. Section 19. COVENANT of NO INTEREST COUNTY and CONTRACTOR covenant that neither presently has any interest, and shall not acquire any interest, which would conflict in any manner or degree with its performance under this Agreement, and that only interest of each is to perform and receive benefits as recited in this Agreement. Section 20. CODE OF ETHICS COUNTY agrees that officers and employees of the COUNTY recognize and will be required to comply with the standards of conduct for public officers and employees as delineated in Section 112.313, Florida Statutes, regarding, but not limited to, solicitation or acceptance of gifts; doing business with one's agency; unauthorized compensation; misuse of public position, conflicting employment or contractual relationship; and disclosure or use of certain information. Section 21. NO SOLICITATION/PAYMENT The COUNTY and CONTRACTOR warrant that, in respect to itself, it has neither employed nor retained any company or person, other than a bona fide employee working solely for it, to solicit or secure this Agreement and that it has not paid or agreed to pay any person, company, corporation, individual, or firm, other than a bona fide employee working solely for it, any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach 6 or violation of the provision, the CONTRACTOR agrees that the COUNTY shall have the right to terminate this Agreement without liability and, at its discretion, to offset from monies owed, or otherwise recover, the full amount of such fee, commission, percentage, gift, or consideration. Section 22. PUBLIC ACCESS The COUNTY and CONTRACTOR shall allow and permit reasonable access to, and inspection of, all documents, papers, letters or other materials in its possession or under its control subject to the provisions of Chapter 119, Florida Statutes, and made or received by the COUNTY and CONTRACTOR in conjunction with this Agreement; and the COUNTY shall have the right to unilaterally cancel this Agreement upon violation of this provision by CONTRACTOR. Section 23. NON-WAIVER of IMMUNITY Notwithstanding the provisions of Sec. 768.28, Florida Statutes, the participation of the COUNTY and the CONTRACTOR in this Agreement and the acquisition of any commercial liability insurance coverage, self-insurance coverage, or local government liability insurance pool coverage shall not be deemed a waiver of immunity to the extent of liability coverage, nor shall any Agreement entered into by the COUNTY be required to contain any provision for waiver. Section 24. PRIVILEGES AND IMMUNITIES All of the privileges and immunities from liability, exemptions from laws, ordinances, and rules and pensions and relief, disability, workers' compensation, and other benefits which apply to the activity of officers, agents, or employees of any public agents or employees of the COUNTY, when performing their respective functions under this Agreement within the territorial limits of the COUNTY Shall apply to the same degree and extent to the performance of such functions and duties of such officers, agents, volunteers, or employees outside the territorial limits of the COUNTY. Section 25. LEGAL OBLIGATIONS AND RESPONSIBILITIES Non-Delegation of Constitutional or Statutory Duties. This Agreement is not intended to, nor shall it be construed as, relieving any participating entity from any obligation or responsibility imposed upon the entity by law except to the extent of actual and timely performance thereof by any participating entity, in which case the performance may be offered in satisfaction of the obligation or responsibility. Further, this Agreement is not intended to, nor shall it be construed as, authorizing the delegation of the constitutional or statutory duties of the COUNTY, except to the extent permitted by the Florida constitution, state statute, and case law. Section 26. NON-RELIANCE BY NON-PARTIES No person or entity shall be entitled to rely upon the terms, or any of them, of this Agreement to enforce or attempt to enforce any third-party claim or entitlement to or benefit of any service or program contemplated hereunder, and the COUNTY and the CONTRACTOR agree that neither the COUNTY nor the CONTRACTOR or any agent, officer, or employee of either shall have the authority to inform, counsel, or otherwise 7 indicate that any particular individual or group of individuals, entity or entities, have entitlements or benefits under this Agreement separate and apart, inferior to, or superior to the community in general or for the purposes contemplated in this Agreement. Section 27. ATTESTATIONS CONTRACTOR agrees to execute such documents as the COUNTY may reasonably require, to include, but not be limited to, a Public Entity Crime Statement, an Ethics Statement, and a Drug-Free Workplace Statement, Lobbying and Conflict of Interest Clause, and Non-Collusion Agreement. Section 28. NO PERSONAL LIABILITY No covenant or agreement contained herein shall be deemed to be a covenant or agreement of any member, officer, agent or employee of Monroe County in his or her individual capacity, and no member, officer, agent or employee of Monroe County shall be liable personally on this Agreement or be subject to any personal liability or accountability by reason of the execution of this Agreement. Section 29. EXECUTION IN COUNTERPARTS This Agreement may be executed in any number of counterparts, each of which shall be regarded as an original, all of which taken together shall constitute one and the same instrument and any of the parties hereto may execute this Agreement by signing any such counterpart. Section 30. SECTION HEADINGS Section headings have been inserted in this Agreement as a matter of convenience of reference only, and it is agreed that such section headings are not a part of this Agreement and will not be used in the interpretation of any provision of this Agreement. Section 31. INSURANCE POLICIES 31.1 General Insurance Requirements for other Contractors and Subcontractors. As a pre-requisite of the work governed, the CONTRACTOR shall obtain, at his/her own expense, insurance as specified in any attached schedules, which are made part of this contract. The CONTRACTOR will ensure that the insurance obtained will extend protection to all Subcontractors engaged by the CONTRACTOR. As an alternative, the CONTRACTOR may require all Subcontractors to obtain insurance consistent with the attached schedules, however CONTRACTOR is solely responsible to ensure that said insurance is obtained and shall submit proof of insurance to COUNTY. Failure to provide proof of insurance shall be grounds for termination of this Agreement. The CONTRACTOR will not be permitted to commence work governed by this contract until satisfactory evidence of the required insurance has been furnished to the COUNTY as specified below. Delays in the commencement of work, resulting from the failure of the CONTRACTOR to provide satisfactory evidence of the required insurance, shall not extend deadlines specified in this contract and any penalties and failure to perform assessments shall be imposed as if the work commenced on the specified date and time, except for the CONTRACTOR'S failure to provide satisfactory evidence. 8 The CONTRACTOR shall maintain the required insurance throughout the entire term of this contract and any extensions specified in the attached schedules. Failure to comply with this provision may result in the immediate suspension of all work until the required insurance has been reinstated or replaced and/or termination of this Agreement and for damages to the COUNTY. Delays in the completion of work resulting from the failure of the CONTRACTOR to maintain the required insurance shall not extend deadlines specified in this contract and any penalties and failure to perform assessments shall be imposed as if the work had not been suspended, except for the CONTRACTOR'S failure to maintain the required insurance. The CONTRACTOR shall provide, to the COUNTY, as satisfactory evidence of the required insurance, either: • Certificate of Insurance or • A Certified copy of the actual insurance policy. The County, at its sole option, has the right to request a certified copy of any or all insurance policies required by this contract. All insurance policies must specify that they are not subject to cancellation, non-renewal, material change, or reduction in coverage unless a minimum of thirty (30) days prior notification is given to the County by the insurer. The acceptance and/or approval of the contractor's insurance shall not be construed as relieving the contractor from any liability or obligation assumed under this contract or imposed by law. The Monroe County Board of county Commissioners, its employees and officials will be included as "Additional Insured" on all policies, except for Workers' Compensation. 31.2 INSURANCE REQUIREMENTS FOR CONTRACT BETWEEN COUNTY AND CONTRACTOR (Note: amounts of coverage are subject to change in final contract) Prior to the commencement of work governed by this contract, the CONTRACTOR shall obtain General Liability Insurance. coverage shall be maintained throughout the life of the contract and include, as a minimum: • Premises Operations • Bodily Injury Liability • Expanded Definition of Property Damage The minimum limits acceptable shall be: $1,000,000 Combined Single Limit (CSL) If split limits are provided, the minimum limits acceptable shall be: $500,000 per Person $1,000,000 per Occurrence $100,000 Property Damage 9 An Occurrence Form policy is preferred. If coverage is provided on a claims Made policy, its provisions should include coverage for claims filed on or after the effective date of this contract. In addition, the period for which claims may be reported should extend for a minimum of twelve (12) months following the acceptance of work by the County. The Monroe county Board of county commissioners shall be named as Additional Insured on all policies issued to satisfy the above requirements. 31.3 VEHICLE LIABILITY INSURANCE REQUIREMENTS Recognizing that the work governed by this contract requires the use of vehicles, the CONTRACTOR, prior to the commencement of work, shall obtain Vehicle Liability Insurance. coverage shall be maintained throughout the life of the contract and include, as a minimum, liability coverage for: ■ Owned, Non-owned, and hired vehicles The minimum limits acceptable shall be: $300,000 Combined Single Limit (CSL) If split limits are provided, the minimum limits acceptable shall be: $100,000 per Person $300,000 per Occurrence $50,000 Property Damage The Monroe County Board of County Commissioners Shall be named as Additional Insured on all policies issued to satisfy the above requirements. Coverage shall be provided by a company or companies authorized to transact business in the state of Florida. 31.4 WORKERS' COMPENSATION INSURANCE REQUIREMENTS Prior to commencement of work governed by this contract, the CONTRACTOR Shall obtain Workers' compensation Insurance with limits sufficient to respond to the applicable state statutes. In addition, the CONTRACTOR shall obtain Employers' Liability Insurance with limits of not less than: $500,000 Bodily Injury by Accident $500,000 Bodily Injury by Disease, policy limits $500,000 Bodily Injury by Disease, each employee Coverage shall be maintained throughout the entire term of the contract. 10 Coverage shall be provided by a company or companies authorized to transact business in the state of Florida. 31.5 PROFESSIONAL MEDICAL LIABILITY REQUIREMENTS Recognizing that the work governed by this contract involves the providing of professional medical and/or psychological services, the CONTRACTOR shall purchase and maintain, throughout the life of the contract, Professional Medical Liability Insurance which will respond to the rendering of, or failure to render medical professional services under this contract. The minimum limits of liability shall be: 500 000 per occurrencel1,000,000 Aggregate If coverage provided is on a claim made basis, an extended claims 9 re ortin period of four p (4) years will be required. Section 32. INDEMNIFICATION The CONTRACTOR does hereby consent and agree to indemnify, defend and hold harmless the COUNTY, its Mayor, the Board of County Commissioners, appointed Boards and Commissions, Officers, and the Employees, and any other agents, individually and collectively, from all fines, suits, claims, demands, actions, costs, obligations, attorneys fees, or liability of any kind arising out of the negligent or intentional actions of the CONTRACTOR or substantial and unnecessary delay caused by the willful nonperformance of the CONTRACTOR and shall be solely responsible and answerable for any and all accidents or injuries to persons or property arising out of its performance of this contract. The amount and type of insurance coverage requirements set forth hereunder shall in no way be construed as limiting the scope of indemnity set forth in this paragraph. Further the CONTRACTOR agrees to defend and pay all legal costs attendant to acts attributable to the sole negligent act of the CONTRACTOR. At all times and for all purposes hereunder, the CONTRACTOR is an independent contractor and not an employee of the Board of County Commissioners. No statement contained in this agreement shall be construed so as to find the CONTRACTOR or any of his/her employees, contractors, servants or agents to be employees of the Board of County Commissioners for Monroe County. As an independent contractor the CONTRACTOR shall provide independent, professional judgment and comply with all federal, state, and local statutes, ordinances, rules and regulations applicable to the services to be provided. The CONTRACTOR shall be responsible for the completeness and accuracy of its work, plan, supporting data, and other documents prepared or compiled under its obligation for this project, and shall correct at its expense all significant errors or omissions therein which may be disclosed. The cost of the work necessary to correct those errors attributable to the CONTRACTOR and any damage incurred by the COUNTY as a result of additional costs caused by such errors shall be chargeable to the CONTRACTOR. This provision shall not apply to any maps, official records, contracts, or other data that may be provided by the COUNTY or other public or semi-public agencies. 11 The CONTRACTOR agrees that no charges or claims for damages shall be made by it for any delays or hindrances attributable to the COUNTY during the progress of any portion of the services specified in this contract. Such delays of hindrances, if any, shall be compensated for by the COUNTY by an extension of time for a reasonable period for the CONTRACTOR to complete the work schedule. Such an agreement shall be made between the parties. 12 IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed on the day of Ou, , 2014. ' � ; •` �.. BOARD OF COUNTY COMMISSIONERS r 3� i l i n, CLERK OE COUNTY FLORIDA put Clerk Ma or/C airman (CORPORATE SEAL) (Name of Contractor) Quantum Health ATTEST: Solutions, Inc. By By. 4 Title 9Lc MONROE COUNTY ATTORNEY APrOVEDr XYE RM: / .YNTHIA L. ALL ASS!INTWONTY ATTORNEY Date 13 EXHIBIT A SCOPE OF SERVICES PROFESSIONAL SERVICES FOR EMPLOYEE ASSISTANCE PROGRAM (EAP) The EAP shall provide mental health assistance to County employees and their eligible dependents in the form of individual counseling services in a number of areas; pharmacologic intervention (counseling on medication management for the individual), educational group seminars, management orientation sessions, program orientation sessions, prepare reports, and other related services as set out in the Scope of Work below. The initial contract term will be for three (3) years. SCOPE OF THE WORK TO BE PROVIDED BY EAP PROVIDER At a minimum the services provided by the EAP shall be provided to all employees and their eligible dependents. County employees are the employees of the Board of County Commissioners, the Board members, the Constitutional Officers and their employees. Eligible dependents can include household members as well as dependents eligible for health care coverage such as college students. The services shall include up to eight (8) visits per individual issue. (A) Individual counseling services that include but are not limited to: • Alcohol dependency • Anxiety • Adolescent care and services • Drug abuse • Depression Family discord • Elder care • Stress • Marital and Relational conflict • Aged parent care • Compulsive Gambling • Legal Difficulties • Parenting issues • Job stress Face-to-face counseling sessions shall be available to an employee and eligible dependents during the contract term. If the sessions under the contract terms are exhausted and the problem has not been resolved, the Proposer must explain other treatment options. If the problem is not covered by the EAP, the Proposer must refer the person to a provider who can furnish the service(s) needed preferably by a provider covered under the County's health plan. 14 Evening and special appointments will be provided for clients unable to schedule during office hours. Emergency situations are handled immediately (within 24 hours) on a case-by-case basis. All other appointments will be scheduled within two days or as convenient to the client. Face to face counseling services will be made available to clients within 10 miles of driving distance of the client's home or work. Quantum will offer options for clients who prefer assistance by telephone. Quantum WebConnect will also be offered providing client accessibility to a Counselor via Internet web based video cam. B) ■ Educational group seminars (two separate sessions in each of the three locations = 6 Total) on an annual basis which will include programs within Quantum's library of topics in: o Personal Development o EAP Program Awareness and Development O Wellness Topics O Us DOT Training a organizational and Personal Development ■ Orientation group sessions providing an EAP overview at the three County locations annually, including: O Training of Managers seminars at the three county locations annually (two separate sessions in each of the three locations = 6 Total) • Providing Managers with a working understanding of EAP and employer support; Identification and referral of troubled employees; observing and documenting job performance; Warning signs of emotional distress; warning signs of drug/alcohol abuse; Management/union consultation; Proper intervention techniques; Confidentiality and the EAP referral process. O Employee Orientation seminars for all County employees at the three County locations annually (two separate sessions in each of the three locations = 6 Total) • Providing employees with a clear understanding of the scope of EAP services and the kinds of problems EAP can address; Program access and eligibility; Services available; Qualifications of staff; Confidentiality services; Counselor locations and types of sessions available; Non clinical EAP work-life benefits; and Quantum WebConnect. O The County will also have unlimited access to Quantum Employee Orientation video and Quantum Supervisory video 15 • Critical Incident Program (2 sessions annually): o Professional assistance providing a safe mechanism by which to address emotional issues related to trauma such as accidents, injuries or natural disasters. • Response on-site for structured Critical Incident Stress Management and Debriefings (CISM/D) • Individual and group sessions following the onsite C1SM/D • Referrals for those affected by the event, to EAP Counselors or clinical professionals within the medical benefit plan for continued help. Substance Abuse Professional (SAP) Services for employees who have violated Federal Department of Transportation Regulations (49 CFR Part 40): o Includes an initial audit of DOT Compliance, defining the role of the manager or supervisor, assisting the manager/supervisor with responsibilities when a Policy violation occurs, Monroe County policy and procedures review, drug-free workplace education, DOT referral procedures and effective use of Monroe County Drug testing program, and providing comprehensive in-person SAP services in accordance with DOT. Quantum SAP Responsibilities will include: • Evaluation: Monroe County contacts the Quantum SAP for referral and violation assessment. Designated Employer Representative (DER) documentation of failed drug test and any other job-related problems are conveyed. The Quantum SAP will then meet with the employee and conduct a thorough evaluation and assessment. • Referral: Based on the evaluation, the employee is referred to the appropriate level of treatment education. If dually diagnosed, the employee will also be referred to appropriate mental health treatment. • Monitor Compliance: The Quantum SAP will monitor compliance with the treatment/education provider as well as providing compliance reports to the employer. ■ Follow-up Evaluation: once Quantum receives a written documentation of treatment completion by the treatment facility or clinical provider, he/she must be seen by the Quantum SAP for follow-up evaluation. This evaluation assesses the employee's current and future treatment, including involvement with education and relapse prevention programs. • Coordination and Return to Work: The Quantum SAP will prepare employer reports and note specific information as defined by the DOT. The report will confirm compliance and return to work requirements. Coordination with Monroe County DER and MRO will occur during each phase of the process t❑ ensure DOT compliance is fulfilled. • Referrals: o Referrals to community resources in conjunction with EAP counseling for issues such as: Addiction and Recovery, Anxiety Disorders, Associations and Institutes, Attention Deficit Hyperactivity Disorder, Child Abuse and Domestic Violence, Depression, Chronic Fatigue, 16 Developmental Disorders, Eating Disorders, Personality Disorders, Suicide Awareness and Hotlines, and counseling Resources. • Fit To Work Exams: Diagnostic interviews and evaluations in the areas of mental health and substance abuse. • Legal Services: 30 —50 minute session per employee per year. Services thereafter provided at a discounted rate. ■ Financial counseling: Up to three (3) sixty minute telephonic sessions annually. Seminars will be conducted at the discretion of the county either onsite with the traditional method of presentation or via Quantum WebConnect. It is understood that Quantum WebConnect hosts custom seminars via web portal to an audience of up to 25 participants. C) The following additional services: • Additional Educational Group Seminars: Two separate sessions in each of the three locations = 5 Total on an annual basis. • WebConnect hosted seminars: 6 sessions on an annual basis. D) Other services offered by the hour if specifically requested by the County: • Additional Critical Incident Program Services: $150 per hour. • Conflict Resolution Services: Mediation process to help generate options for an agreement that works for all involved parties. coordination through management OR Human Resources and the Quantum Account Manager: $150 per hour. Service Requirements Proposer will provide a twenty-four (24) hour, seven (7) day a week toll free confidential telephone service answered by professional staff. This phone service must provide immediate assistance to the individual seeking professional help. All calls will be answered with the moniker, "Monroe county Employee Assistance Program, how may we help you". The telephone log information must be included in the quarterly report to the County. English and Spanish clinician service will be provided as needed as well as TDD for hearing impaired. Required Reports Utilization reports will be provided quarterly and will include at least the following • Initial Phone contacts Training and Critical Incident 17 Brief Phone consultations Debriefings • case Opening Data . Project management--- (e.g. Client Demographics Team building, conflict • Problem Identification — resolution, etc. personal and work performance • Contract Administrative • Clinical Contacts with Progress Services Notes • Promotional Activities • Supervisor Contacts and • Employer Support Services Consultations • Paperless Staff and Affiliate Documentation Return on Investment Report will be provided on an annual basis. Informational Materials The following printed materials will be provided to the county during the contract term: Unlimited employee brochures, wallet cards and workplace informational posters. Unlimited access to monthly editions of Quantum Frontline Supervisor newsletters and Quantum Balanced Living newsletters. Unlimited access to electronic editions of Q Notes topical/informational material. Qualifications Necessary for Provider Counselors must have current credentials, licensing, training and relative experience in their respective fields. Pharmacologic intervention must be evaluated and managed by professionals of the healing arts licensed in the State of Florida that includes this scope of practice. The EAP Provider will certify at least annually that all staff members, independent contractors, subcontracted work, if any, all service providers it uses, engages or manages, comply with Health Insurance Portability and Accountability Act (HIPAA) and HITECH privacy and Security rules. Cost Requirements All charges for services, inclusive of all travel and other expenses (there will be no reimbursable expense items): $1.25 per employee per month for the services described above in Scope of Work A & B. Additional services are priced separately below: $.25 per employee per month described above in Scope of Work C. 18 SECTION THREE: RESPONSE FORMS RESPOND TO: MONROE COUNTY BOARD OF COUNTY COMMISSIONERS c/o Purchasing Department GATO BUILDING, ROOM 2-213 1100 SIMONTON STREET KEY WEST, FLORIDA 33040 1 acknowledge receipt of Addenda No.(s) Exhibit A. Scope of Services I have included • Response Form X • Lobbying and Conflict of Interest Clause X • Non-Collusion Affidavit X • Drug Free Workplace Form X • Public Entity Crime Statement X • Local Preference Form (if applicable) NIA • A copy of the proposed invoice showing breakdown of anticipated billing X • Copy of the business tax receipt X Other documents included are fisted below: r:: %W If the applicant is not an individual (sole proprietor) please supply the following information: APPLICANT ORGANIZATION: -Quantum Health Solutions of Florida Inc. (Registered business name must appear exactly as it appears on www.sunbiz.or Any applicant other than an individual (sole proprietor) must submit a printout of the "Detail by Entity Name" screen from Sunbiz, and a copy of the most recent annual report filed with the Florida Department of State, Division of Corporations. List all charges for services, inclusive of all travel and other expenses (there will be no reimbursable expense items): Base charge for services listed in 3. Scope of the Work to be Provided by Proposer, parts A) and B): $1.25 per employee per month Additional charge(s) for services listed in 3. Scope of the Work to be Provided by Proposer, list C): $ 0.25 per employee per month (or list the individual services in C with a price for each): 30 ce Mailing Address: 4873 Palm Coast Pkw , NW Telephone: 877 747-1200 Suite 3 Fax: (973) 300-4816 Palm Coast, FL 32137 Date: 02/24/2014 Signed: Witness: AnthonyRiccio (Print Name) Executive Director (Title) STATE OF: COUNTY OF: Subscribed d sworn to ( r a ironed} before me on J ­,�444 (date)by &sea (name of affiant). He/She is personally known ,tg me or has OFoduced (type of i ntification)as identification. NOTARY PUBLIC My Commission Expires: Z- �tilfilf�f DENEAH D.BLEDSOE Notary Public-state of Florida My Comm.Expires Dec 18,2014 v Commission #EE 38456 31 LOBBYING AND CONFLICT OF INTEREST CLAUSE 4W SWORN STATEMENT UNDER ORDINANCE NO. 010-1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE Is Quantum Health Solutions of Florida, Inc. " (Company) "...warrants that he/it has not employed, retained or otherwise had act on his/her behalf any former County officer or employee in violation of Section 2 of Ordinance No. 010-1990 or any County officer or employee in violation of Section 3 of Ordinance No. 010-1990. For breach or violation of this provision the County may, in its discretion, terminate this Agreement without liability and may also, in its discretion, deduct from the Agreement or purchase price, or otherwise recover, the full amount of any fee, commission, percentage, gift, or consideration paid to the former county officer or employee." tnure) Date: 02/24/2014 (W STATE OFC1 COUNTY OF: 2Qi"A" Subscribed and sworn to (or affirmed) before me on (date) by 4 [ L (name of affiant). He/She is Nft�- U ) ersonally known to me or has produced (type of identification) as identification. ?o� �,� DENEAH D.BLEDSOE _ Notary Public-state of Florida � or My Comm.Expires Dec 18,2014 NOTARY PUBLIC -•;fig�► •' Commission#EE 38456 M Commission Expires: 12 1 L# Y p 32 NON-COLLUSION AFFIDAVIT 1, Anthony Riccio of the cityof Palm Coast according law g to a on my oath, and under penalty of perjury, depose and say that 1. 1 am Anthony Riccio of the firm of Quantum Health Solutions of Florida Inc. the bidder making the Proposal for the project described in the Request for Proposals for Monroe County, Florida and that I executed the said proposal with full authority to do so; 2. The prices in this bid have been arrived at independently without collusion, consultation, communication or agreement for the purpose of restricting competition, as to any matter relating to such prices with any other bidder or with any competitor; 3. Unless otherwise required by law, the prices which have been quoted in this bid have not been knowingly disclosed by the bidder and will not knowingly be disclosed by the bidder prior to bid opening, directly or indirectly, to any other bidder or to any competitor; and 4. No attempt has been made or will be made by the bidder to induce any other person, partnership or corporation to submit, or not to submit, a bid for the purpose of restricting competition; 5. The statements contained in this affidavit are true and correct, and made with full knowledge that Monroe County relies upon the truth of the statements contained in this affidavit in awarding contracts for said pr ect. (SXnature)* Date: 02/24/2014 STATE 0 COUNTY OF: Subscribed and sworn to (or affirmed) before me on (date) by (name of affiant). He/She is Dersonallv known Wme or has produced (type of identification) as identification. NOTARY PUBLIC +•APR'PU9��i, DENEAH D.BLEDSOE Notary Public-State of Florida 14 My Comm.Expires Dec 18,2014 My Commission Expires: %W ��14± Commission#EE 38456 33 DRUG-FREE WORKPLACE FORM The undersigned vendor in accordance with Section 287.087 Florida Statutes hereby certifies that: Quantum Health Solutions of Florida, Inc. (Name of Business) 1. Publishes a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Informs employees about the dangers of drug abuse in the workplace, the business' policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Gives each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in subsection (1). 4. In the statement specified in subsection (1), notifies the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 803 (Florida Statutes) or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction. 5. Imposes a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community , or any employee who is so convicted. :t C. Makes a good faith effort to continue to maintain a drug-free workplace through implementation of this section. As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements. (sXatbre) Date: 02/24/2014 w STATE : COUNTY OF: r �r Su ri bed and swo r r affirmed) a i med} before me on (date) by4 inhh)l b (name of affiant). He/She is ersonall own U ) %_ to mg or has produced (type entificatio as identification. NOTARY PUBLIC 4,,0 �J,,� DENEAH D.BLEDSOE My Commission Expires: Notary Public-state of Florida R My Comm.Expires aec 18,2014 r(W dot'OF F, Commission#EE 38456 34 PUBLIC ENTITY CRIME STATEMENT %W1 "A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or CONTRACTOR under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017 Florida Statutes, for CATEGORY TWO for a period of 36 months fro the date of being placed on the convicted vendor list." I have read the above and state that neither nffian LA 1<=X-1j (Proposer's name) nor any Affiliate has been placed on the convicted vendor vendor-4dt within the last 36 months. (Si at re) Date: 02/24/2014 STATE O : COUNTY OF: Al A IA02 Subscribe nd sworn to med before me on (date) by (name of affiant). He/She is oersonally known to me or has produced (type of identification) as identification. NOTARY PUBLIC -•''wY c:'' H D.BLEDSOE My Commission Expires: ti•,s � DENEA Notary Public-State of Florida R My Comm.Expires Dec 18,281 '•;fE ,p,; Commission #EE 38456 35 MONROE COUNTY, FLORIDA RISK MANAGEMENT POLICY AND PROCEDURES CONTRACT ADMINISTRATION MANUAL Indemnification and Hold Harmless For Other Contractors and Subcontractors The Contractor covenants and agrees to indemnify and hold harmless Monroe County Board of County Commissioners from any and all claims for bodily injury (including death), personal injury, and property damage (including property owned by Monroe County) and any other losses, damages, and expenses (including attorneys fees) which arise out of, in connection with, or by reason of services provided by the Contractor or any of its Subcontractor(s) in any tier, occasioned by negligence or intentional acts, errors, or other wrongful act of omission of the Contractor or its Subcontractors in any tier, their employees, or agents. In the event the completion of the project (to include the work of others) is delayed or suspended as a result of the Contractor's failure to purchase or maintain the required insurance, the Contractor shall indemnify the County from any and all increased expenses resulting from such delay. The first ten dollars ($10.00) of remuneration paid to the Contractor is for the indemnification provided for above. The extent of liability is in noway limited to, reduced, or lessened by the insurance requirements contained elsewhere within this agreement. 36 WORKERS' COMPENSATION INSURANCE REQUIREMENTS IL FOR EMPLOYEE ASSISTANCE PROGRAM BETWEEN MONROE COUNTY, FLORIDA AND Quantum Health Solutions of Florida, Inc. Prior to the commencement of work governed by this contract, the Contractor shall obtain Workers' Compensation Insurance with limits sufficient to respond to the applicable state statues. In addition, the Contractor shall obtain Employers' Liability Insurance with limits of not less than: $500,000 Bodily Injury by Accident $500,000 Bodily Injury by Disease, policy limits $500,000 Bodily Injury by Disease, each employee Coverage shall be maintained throughout the entire term of the contract. Coverage shall be provided by a company or companies authorized to transact business in the state of Florida. %W- If the Contractor has been approved by the Florida's Department of Labor, as an authorized self-insurer, the County shall recognize and honor the Contractor's status. The Contractor may be required to submit a Letter of Authorization issued by the Department of Labor and a Certificate of Insurance, providing details on the Contractor's Excess Insurance Program. If the Contractor participates in a self-insurance fund, a Certificate of Insurance will be required. In addition, the Contractor may be required to submit updated financial statements from the fund upon request from the County. 37 VEHICLE LIABILITY INSURANCE REQUIREMENTS 4W FOR CONTRACT BETWEEN MONROE COUNTY, FLORIDA AND Quantum Health Solutions of Florida, Inc. Recognizing that the work governed by this contract requires the use of vehicles, the Contractor, prior to the commencement of work, shall obtain Vehicle Liability Insurance. Coverage shall be maintained throughout the life of the contract and include, as a minimum, liability coverage for: • owned, Non-owned, and Hired Vehicles The minimum limits acceptable shall be: $300,000 combined Single Limit (CSL) If split limits are provided, the minimum limits acceptable shall be: $100,000 per Person %W $300,000 per Occurrence $50,000 Property Damage The Monroe county Board of county commissioners shall be named as Additional Insured on all policies issued to satisfy the above requirements. 38 GENERAL LIABILITY INSURANCE REQUIREMENTS FOR EMPLOYEE ASSISTANCE PROGRAM BETWEEN MONROE COUNTY, FLORIDA AND Quantum Health Solutions of Florida. Inc. Prior to the commencement of work governed by this contract, the Contractor shall obtain General Liability Insurance. Coverage shall be maintained throughout the life of the contract and include, as a minimum: • Premises Operations • Products and Completed Operations • Blanket Contractual Liability • Personal Injury Liability • Professional Liability • Expanded Definition of Property Damage The minimum limits acceptable shall be: $1,000,000 Combined Single Limit (CSL) If split limits are provided, the minimum limits acceptable shall be: $ 500.000 per Person $ 1,000.000 per Occurrence $ 100,000 Property Damage An Occurrence Form policy is preferred. If coverage is provided on a Claims Made policy, its provisions should include coverage for claims filed on or after the effective date of this contract. In addition, the period for which claims may be reported should extend for a minimum of twelve (12) months following the acceptance of work by the County. The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies issued to satisfy the above requirements. 39 PROFESSIONAL MEDICAL LIABILITY INSURANCE REQUIREMENTS FOR EMPLOYEE ASSISTANCE PROGRAM BETWEEN MONROE COUNTY, FLORIDA AND Quantum Health Solutions of Florida, Inc. Recognizing that the work governed by this contract involves the furnishing of advice or services of a professional nature, the Contractor shall purchase and maintain, throughout the life of the contract, Professional Medical Liability Insurance which will respond to damages resulting from any claim arising out of the performance of professional services or any error or omission of the Contractor arising out of work governed by this contract. The minimum limits of liability shall be: $500,000 per Occurrence $1,ggg,000 Aggregate 40 r t *-, .. . t.x,. r'/ d... .7: 7» pp •+a• -r ti r ...r '% %•Ki. -.�`• ram: _+. s`t•:::rY,� r I: '+c •r' r r --.1'• 'er.. 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Thus Tax Recent i�NOT T 3 1 3 9 I I I I I I I 5 S11 5 HEALTHCARE PROVIDERS SERVICE Print Date: 6125l2413 ORGANIZATION PURCHASING GROUP 4rNA NHP80 Certificate of Insairance OCCURENCE POLICY FORM Producer Branch Prefix Policy Number Policy Period 018098 970 HPG 0270500214 from 08/08113 to 08/08/14 at 12:01 AM St ndard Time Named Insured and Address: Program Administered by: Quantum Health Solutions, Inc. Healthcare Providers Service Organization 14 Park Lake Rd Ste 2 159 E.County Line Road Sparta, NJ 07871-3241 Hatboro, PA 19040-1218 1-888-288-3534 www.hpso.com Medical Specialty: Code: Insurance is provided by: Counselor Educator Firm 80723 American Casualty Company of Reading,Pennsylvania 333 S. Wabash Avenue, Chicago, IL 60004 Excludes Cosmetic Procedures Professional Liability $1,000,000 each claim $3,000,000 aggregate Your professional liability limits shown above include the following: • Good Samaritan Liability Malplacement Liability '" Personal Injury Liability " Sexual Misconduct Included in the PL limit shown above subject to$25,000 aggregate sublimit Coverage Extensions License Protection S 25,000 per proceeding $25,000 aggregate Defendant Expense Benefit $ 1,000 per day limit $25,000 aggregate Deposition Representation $10,000 per deposition $10,000 aggregate Assault $25,000 per incident $25,000 aggregate Includes Workplace Violence Counseling I Medical Payments $25,000 per person $1001000 aggregate First Aid $108000 per incident $10,000 aggregate Damage to Property of Others $ 10*000 per incident $10,000 aggregate Information Pnvacy(HIPAA)Fines and Penalties $25,000 per incident $25,000 aggregate Workplace Liability Workplace Liability Included in Professional Liability Limit shown above Fire&Water Legal Liability Included in the PL limit shown above subject to $150,000 aggregate sublimit Total:$ 700.25 f Base Premium $ 094.00 Surcharge $ 6.25 Local Tax $0.00 ' } t Policy Forms&Endo rsements(Please see attached list for a general description of many common policy'forms and endorsements.) t G-121500-D G-121503-C G-121501-C G-145184-A G-147292-A GSL15563 GSL15564 GSL15565 GSL17101 GSL13424NJ GSL13425 G-123846-C29 GSL3886 GSL3908 GSL19904 GSL-5587 I Medical Speciality is amended to include Consulting Services(GSL-5587) Keep this document in a safe place.n and proof of payment ar your proof of coverage. There is no c verage in force unless the premium is paid in full In order Chairman of the Board Secretary to activate your coverage,please remit premium in fug by the effective date of Ws Certificate of Insurance. Master Policy#188711433 G-141241-13(0312010) Coverage Change Date: Endorsement Change date: POLICY FORMS&ENDORSEMENTS The list below contains general descriptions of the policy forms and endorsements that may or may not apply to your professional liability insurance policy. Please refer to your Certificate of Insurance for the policy forms& endorsements specific to your state and your policy period.Coverages, rates and limits may differ or may not be available in all states.All products and services are subject to change without notice. Think Green-expanded definitions and copies of these policy forms and endorsements are available online at www.hpso.com/policyforms COMMON POLICY FORMS& ENDORSEMENTS a FORM# DESCRIPTION G-121500-D Common Policy Conditions G-121503-C Workplace Liability Form G-121501-C Occurrence Policy Form G-145184-A Policyholder Notice-OFAC Compliance Notice G-147292-A Policyholder Notice-Silica, Mold&Asbestos Disclosure GSL15563 Information Privacy Coverage Endorsement HIPAA Fines, Penalties&Notification Costs GSL15564 Sexual Misconduct Sublimits of Liability Professional Liability&Sexual Misconduct Exclusion GSL15565 Healthcare Providers Professional Liability Assault Coverage GSL17101 Exclusion of Specified Activities Reuse of Parenteral Devices and Supplies GSLI 3424NJ Services to Animals-New Jersey GSL13425 Business Owner Coverage Extension Endorsement G-123848-C29 New Jersey Cancellation and Non-Renewal GSL3886 Coverage&Cap on Losses from Certified Acts Terrorism GSL3908 Notice-Offer of Terrorism Coverage&Disclosure of Premium GSL19904 Exclusion of Cosmetic Procedures OPTIONAL ENDORSEMENTS ' E FORM# DESCRIPTION GSL-5587 Consulting Services Liability Endorsement PLEASE REFER TO YOUR CERTIFICATE OF INSURANCE FOR THE POLICY FORMS& ENDORSEMENTS SPECIFIC TO YOUR STATE AND YOUR POLICY PERIOD. For NJ residents: The PLIGA surcharge shown on the Certificate of Insurance is the NJ Property&Liability Insurance Guaranty Association. For KY residents: The Surcharge shown on the Certificate of Insurance is the KY Firefighters and Law Enforcement Foundation Program Fund and the KY LGPT is the KY Local Government Premium Tax which includes charges at a municipality and/or county level. For WV residents: The surcharge shown on the Certificate of Insurance is the WV Premium Surcharge. For FL residents: The FIGA Assessment shown on the Certificate of Insurance is the FL Insurance Guaranty Association -2012 Regular Assessment. Form#:G-141241-B(0312010) Named Insured:Quantum Health Solution: Master Policy#:188711433 Policy#:0270500214 HEALTHCARE PROVIDER DATE DUE PROFESSIONAL LIABILITY INSURANCE 0WOW13 Poll #: 0270500214 Name:Quantum Health Solution GY s, Inc. El Yes, please renew my firm s protection ol$1,000,000 per occurrence AMOUNT DUE $3,000,00o annuai aggregate. $710.25 Amount due includes a$10.0 HPSO Membership Fee. check either. ❑ I'VE ENCLOSED THE AMOUNT DUE(make check payable to HPSO-) $710.25 Mai!to:HPSO, 159 East County Line Road,Hatboro,PA t 9040-1 2 18 or BILL MY CREDIT CARD, IiVE COMPLETED AND SIGNED THE CREDIT CARD AUTHORISATION BEL OW 452229 591 Use this form to charge Professional Liability payment. Simply fill out this form and enclose It with your premium notice in the envelope provided. ❑ VISA DMasterCard 4 Name Quantum Health Solutions, Inc. ❑ DISCOVER❑ American Express Address 14 Park Lake Rd Ste 2 city Sparta Expiration date ❑ Authorization For Payment Through VISA,Nlastercarc or State/Zip NJ 07871 Discover Card: I hereby authorize HPSO to charge as a purchase my insurance premium to my VISA/MasterCard/Discover Card account Amount Due a710.25 number as shown Above. I understand and agree that � premiums wail not be paid through my VISA/Master Card(; Policy Number 0270500214 Discover Card account if I am in default under the terms of my account or if my account has been cancelled. Telephone Number 462229 591 Insured's Signature Date HEALTHCARE PROVIDER PROFESSIONAL LIABILITY INSURANCE . Make sure you enclose this completed form with your payment. . Return this completed form and your payment in the postage paid envelope enclosed. . If you have any questions, call HPSO toll-free at 1-888-288-3534. • Thank you for choosing HSPO for your professional liability insurance needs. f i H5 DATE(MM/DD/YYYY) �-�- CERTIFICATE OF LIABILITY INSURANCE R054 4/16/2014 THIS CERTIFICATEIS ISSUED AS A MATTER OF 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 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATIONIS 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 CONTACT NAME: USAA INSURANCE AGENCY INC/PHS (A/C,NPH°"Eo,ExR): (888) 242-1430 {A/C,No): (888) 443-6112 812846 P: (888) 242-1430 F: (888) 443-6112 ADDRESS: PO BOX 33015 INSURER(S)AFFORDING COVERAGE NAIC# SAN ANTONIO TX 78265 INSURERA: Hartford Casualty Ins Co 29424 INSURM INSURERB: Hartford Underwriters Ins. Co. 30104 INSURER C: QUANTUM HEALTH SOLUTIONS INC INSURER D: 4873 PALM COAST PKWY NW UNIT 3 INSURERE: PALM COAST FL 32137 INSURER F: COVERAGES CERTIFICATE NUMBER: 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. 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. INSR TYPE OF INSURANCE ADDL.SUBR POLICY NUMBER FOLIC EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s2, 000, 000 CLAIMS-MADE Fx OCCUR DAMAGE TO RENTED $1 0 0 0 0 0 PREMISES(Ea occurrence) ► ► A X General Liab X 65 SBA PS3897 02/17/2014 02/17/2015 MED EXP(Any one person) $10, 000 PERSONAL&ADV INJURY s2, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s4, 000, 000 POLICY PRO LOC PRODUCTS-COMP/OP AGG s4, 000, 000 JECTFx1 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s2, 000, 000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED x 65 SBA PS 3 8 9 7 0 2/17/2 014 0 2/17/2 015 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ Ol=O RETENTION$ $ WORKERS COMPENSA TION X I PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT $1► 0 0 0, 0 0 0 OFFICER/MEMBER EXCLUDED? B [Mandatory in NH) ❑ N�a 65 WEC GD 3 8 21 0 2/11/2 014 0 2/11/2 015 E.L.DISEASE-EA EMPLOYEE $1► 0 0 0, 0 0 0 If yes,describe under E.L.DISEASE-POLICY LIMIT 110001, 000 DESCRIPTION OF OPERATIONS below ► F_ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Those usual to the Insuredrs operations. Monroe County BOCC i ad itional insured per the business liability Coverage form ss0008. ' ap EMENT DA .. • WAIVER N A E CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. MONRO E COUNTY BO C C AUTHORIZED REPRESENTATIVE Y' 1100 SIMONTON ST KEY WEST, FL 33040 1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ACCPREP CERTIFICATE OF LIABILITY09/18/13THIS CERTIFICATE IS ISSUED AS A 1�IIATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES CERTIFICATE DOES NOT AF NSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERJS}, AUTHORIZED : S ELOW. THIS CERTIFICATE OF I ' REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. subject tc • �eltificate o s an O?ML INSURED, Ilcy�ies�must ert arse , SU BROGATI WANW, j —IMPORTANT: the of the vlic ,cert�n alicles may require an endorsement. A statement on this Cer�l�i��does not C017fe1'rights t4 � the terms and conditionsP Y P GertfIcate holder in lieu of such endomeinent(s). CONTAIA PRODUCER NAME; Affinity Insurance Services Inc fH°NE =AJCNo ): Healthcare Provider Service Organization A 159 East County Line Road INSURER(S)AFFORDING COVERAGI NAICa Hatboro,PA l 904-0 12 i S INSURER A: American Casual[ Company of Readin PA 8�g4 INSUREv INSURER B Quantum Health Solutions Inc.. iNSURE 14 Park Lake Road, Suite 2 INSURER a: Sparta, NJ 07871 3241 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER. THIS IS To CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR WITH EHT PO VCY P TINS INDICATED. NorNITHSTANDING ANY REQUIREMENT, IOD TERM UI CONDITION OF ANY CONTRACT OR OTHER DOCUMENT O HEREIN TS SLISJECT To ALL THE TERNS, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED $Y THE POLICIES DESCR EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_LIMITS SHOWN MAY HAVE BEEN REDUC��Ex� LlNI�ITS D BY PAID CLAIMS. I '[YPE OF INSi�R.AI�CE POLIO NUMBER �Z�lY I�I�vDa �HERAI"Leas ILiTY E____J4GH OCCURRENCE s E� � � E TO RENTEO COMMERCIAL GENERAL LNABtLtTY PREMISES C1.AIMS•61ADE 0 OCCUR MSD EXP(Any one person) s PERSONAL&ADV 114JURY � GENERAL AGGREGATE S PRODUCTS•COMPIOP AGO 5 GF-ITL AGO RELATE L%&T APPLIES PER: 5 PCUGY Za LGC Mh46 i LN4ST AUTOMOBILE LIABILITY JEa acei0no A AIS E BODILY INMRY(Per Person) S ANY AUTO BODILY INJURY(Per accident) S TO 1+iEN3u� 5uLED BY Iya+-011�1ED ZsRGPER DAMA g _ Per wiftafl HIRED AUTOS AUTOS DATE J UMBRELLA uAe p�uR WAIVER NI Y S, EACH aCCtf!#�EhICE S AGGREGATE EXCESS LIAR CLAIMS-MADE S S QED FtETENTIaN S ❑TH- WORKEI3 COMPENSATION LM LIMFTS AND EMPLOYERS'LIABR.ITY YIN E.L.EACH ACCIDENT I+1Y S A PROPRIETOR,IPARTNERIEXECUTIVE N!A OFFICERNEMBER EXCLUDED? � E.L DISEASE-EA EMPLOYE S (Mandatory in NHS mmmmmpwwawww� U sr�e�uil7e underE.L.,DISEASE•FOUCY LIMIT S SCRIFTION OF QPERATIO�V b 1o►� nil Liability 270500214 08l0$ 3 0$148f 1 — 4 A Pra essI 11000,000 Each Occurrence o ty $3,000,000 Aggregate DESCRIPT101 OF OPERATIONS r LOCATIONS r VEHICLES (Attach ACORD J01,AddMonsl Remarks SdmdulL.,it mom Space is required) CERTIFICATE HOLDER CANCELLATION �� SHOULD ANY of THE ABOVE DESCRIBED POLICIES BE CANCELLM BEFORE;. FIB304a- rd 1'lroe ]I THE ExpIRArI4l DATE TI=RREOF, NOTICEwILL BE DELRED IN '€County commissionersACCORDANCE WITH THE POLICY PROVISIONS. 11 o o S I m o nton Street AUTHORIZED REPRESENTATIVE Key west, F L 33040 r. 0 1988 2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD i CNAi "DBA" OR SPECIFIED LOCATION ENDORSEMENT In consideration of the Premium paid, it is agreed that: { I. The PROFESSIONAL LIABILITY COVERAGE PART, Section IV. Additional Definitions, is amended as � follows: The defined term "You"or`Your" also means the named insured doing business as "DIBIA" the entity as set f forth in the Schedule below. E s i Named Insured Doing Business As (DJBIA): { E i I I i i i 11, The Certificate of Insurance is amended to identify the named insured's additional practice location(s) when set forth below. Specified Location Address 4873 Palm Coast Parkway, NW, Unit 3; Palm Coast, FL 32137 All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy and expires concurrently with said Policy unless another effective date is shown below. I I BY Authorized Representative (No signature is required if issued with the policy or if It is effective on the Policy Effective Date) GSL13428XX(5-00) Policy No: 270500214 Page 1 Endorsement No: I Effective Date: 04125/14 Insured Name: Quantum Health Solutions, Inc, 0 CNA All Rjghis Reserved. ILKEVIN XIADO& CPA MONROE COUNTY CLERK OF THE CIRCUIT COURT&COMPIROLLER DATE: January 31, 2017 TO: Maria Fernandez-Gonzalez Sr. Benefits Administrator FROM: Pamela G. Hanco k, .C. SUBJECT: January 18di BOCC Meeting Attached is a duplicate original of Item C9 First Amendment wide Quantum Health Solutions for a three year renewal at a cost of$74,000.00. Should you have any questions, please feel free to contact me at ext. 3130. Thank you. cc: County Attorney Finance Fild 5 FIRST AMENDMENT TO MONROE COUNTY CONTRACT FOR PROFESSIONAL SERVICES FOR EMPLOYEE ASSISTANCE PROGRAM THIS AMENDMENT, entered into on , 201 ("Effective Date") is by and between Monroe County (hereinafter caQ the "county") and Quantum Health Solutions (hereinafter called the "Contractor") (collectively, the "Parties"). WHEREAS, on April 25, 2015, the Parties entered into an agreement for the provision of professional services for employee assistance ("Agreement"); and Y WHEREAS, the County would like to extend the agreement beyond its current expiration date of June 1, 2017; and WHEREAS, the Contractor has provided new rates for the renewal as defined within the Agreement and Exhibit A, Scope of Services, and has offered to have the rates remain constant for three (3) years; and WHEREAS, the Parties desire to amend the Agreement to reflect the terms and conditions desired by the Parties, including updated public records language required by Section 119.0701, Fla. Stat. NOW THEREFORE, in consideration of the mutual covenants and provisions contained herein, the Parties amend the Agreement as follows: 1. In Exhibit A to the Agreement ("Scope of Services"), the cost per employee for services defined in Scope of Work C ("Additional Services") is increased from $0.25 to $0.50 per employee per month. 2. In Exhibit A to the Agreement ("Scope of Services"), Scope of Work D ("Other services offered by the hour if specifically requested by the County") is revised to add the following sentence: • Cessation of tobacco products: $125 per hour, with a limit of five 5 sessions per client. 3. Paragraph 3.1 of the Agreement is revised in its entirety to read as follows: The term of this Agreement, as amended, will be for three (3) years beginning on the Effective Date of this Agreement. Monroe County's performance and obligations are contingent upon an annual appropriation by the Monroe County Board of County Commissioners. 4. Section 8, Records, is revised to add the following sentence: IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS, BRIAN BRADLEY, AT (305) 292-3470, bradlev_ brian@rnonroecounly-fl.ciov, c/o Monroe County Attorneys Office, 111112 th St., Suite 408, Key West FL 33040. 5. Except as set forth herein, the Agreement between the parties remains the same. IN WITNESS WHEREOF, this Amendment has been executed by the duly authorized representatives of the parties. QUANTUM HEALTH SOLUTIONS MONROE COU�'i'Y By. By. Tit Z21Ati. Title: Monroe County Mayor CL'q� a G Date: "1 1 � a Madok , Clerk o By. MONROE COUNTY ATTORNEY Deputy Clerk PPROVED AS TO FORM: CHRIS NE M. LIM ERT-BARROWS ASSISTANT COUNTY ATTORNEY Date i ,.. � .. Kevin Mad CPA jp*''•. .•' CircuitCourtComptroller MonroeCounty, Florida DATE: July 1, 2020 TO: Bryan an Cook, Director Employee Services ATTIC: I andie Maddox FROM: Pwiiela CF. H lc , .1"0, . SUBffECT: May 'BOCC Meeting eta litd is an clectr nic copy of the 1()11 ii it-cm f r your hm tin : `4 2nd Atnendment to an A'e in n( ith Quantum Health Solutions to provide Einployee Assistance Pro n Services to all tie lit-c li ible employees ili die BOCC and Cots stit-Lifi ti al 1l ice , extending die urr nt a r'e c Y i n t.by dire c years wifli no change in (.enn s s ngces or cost, Should you limic my questjoii please ['eel frce to contact nee ( -35 5 . CG;1 County Att nisy Finance lnance File KEY WEST MARATHON PLANTATION KEY PK/R OTH BUILDING 500 Whitehead Street 3117 Overseas Highway 88820 Overseas Highway 50 High Point RDad Y West,Florida 33040 Marathon,FioricLa 33050 plantaWn Key,Florida 33070 PI antabon Key,F I d a 33070 - 4-4641 05- 89- 7 305-8 -7145 -85 -7145 SECOND AMENDMENT TO MONROE COUNTY CONTRACT FOR PROFESSIONAL SERVICES FOR EMPLOYEE ASSISTANCE PROGRAM THIS SECOND AMENDMENT ("Second Amendment"), entered into on May , 2020 ("Effective Date"), is by and between Monroe County (hereinafter called the "County") and Quantum Health Solutions of Florida, Inc. (hereinafter the "Contractor") (collectively, the "Parties"). WHEREAS, on June 1, 2014, the Parties entered into an agreement for the provision of professional services for employee assistance ("Agreement"); and WHEREAS, the Agreement was extended on January 18, 2017 by a First Amendment ("First Amendment") to extend the term of the Agreement by three years from the Effective Date of the First Amendment; and WHEREAS, the County would like to renew and extend the Agreement beyond its current term; and WHEREAS, the Contractor has provided rates with no cost increase for the renewal as defined within this Amendment and Exhibit A, Scope of Services, and has offered to have the rates remain constant for an additional three (3) years; and WHEREAS, the Parties now desire to amend the Agreement by three years on the terms and conditions offered by the Contractor. NOW THEREFORE, in consideration of the mutual covenants and provisions contained herein, the Parties amend the Agreement as follows: 1. Paragraph 3.1 of the Agreement, as amended by Paragraph 3 of the First Amendment, is revised to read as follows: The term of this Agreement, as amended, is extended retroactively to January 17, 2020 and renewed for an additional three (3) years, to run through January 17, 2023. Monroe County's performance and obligations under this Second Amendment remain contingent upon annual appropriation by the Monroe County Board of County Commissioners. 2. In all other respects, the terms and conditions of the Agreement between the Parties, as amended by the First Amendment, remain in full force and effect. 1 IN WITNESS E ERE F, this S000nd Amendment has been executed by the d u I authorized representaftm of the Parties, each of whom has full auth c rity to enter into Sewnd Amendment. For the County: M N ROE COUNTY BOARD OF Kevin Madok, Clerk COUNTY COMMIPSIONERS Ir B . � s Deputy Clerk Heaq4r er # Mayor Date: r the Contractor* QUANTUM HEALTH SOLUTIONS OF FLORID& INC. B . i F Anthony Riccio, President Date: May 4, 2020 LL- �• + .Y.F•. Y�r LL' APPROVAL AS TO FORM AND CONTENTS: MONROE COUNTY ATTORNEY'S ATTORNEY' OFFICE Digita Ily sig ned by Cynth is L.Hal I DN.cn=Cynthia L.Foal�o=Mon roe # County Bocc,a u,emai I=ha II- nth la@monroecou r)ty-fl j r C=us Date:2020.0630 14: ;20-04' " 2 __ _ r a ii � .;••�-• .�� s r S§'ri''`+!r r i Neexv�� k'Srrd� r .<ca �v S•e '-�ri r sy� �,:_)_==:=-s:=fir=_______- u-•y-=-•-�s-_=__�=r__=[Sti�hsis,-��.._...�hsFt�=F..zF�...jS�t,3{JjFf(ry.'�iti�.1�S-513'11F}+7.FAtrlfiy�°a��--�S11i=�--ii-"..ZS�Yi-�-+-'+i.yF.,�'.-r�ea'i:�T�11Y�9NANsd�n)11�rEdbSlhv/FsSSSI�x.!F[F�t�l[�IY'F.e<�\\fY<i.V\rSYSA�AeYh:.rSSiL_.���Vi-.�YeL�--�a..1......3.___._FF�-=.._-�sf��.'_�'35�.{+.��sk"`s�Y.._L�v,�_.n�.•n�"fi4sd 4'F��CY.�..r_�.-_iF�6fn �5�f.bPY k�s+,�YnY)h1C'.e�SE�rSV.r'.itET.^fAL1F�L 1.F k^�IIS 5,�15� a1SIFE•?l�i�if'F�7�SfstY�S"ie�11.NflllAlf[F.33._..1ll�S onmxwr" CERTIFICATE OF LIABILITY INSURANCE VAN•��C7� 06111f202O THIS CERTIFICATE IS ISSUED AS A NATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXPEND 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 tertlNcate holder Is an ADDITIONAL INSURED,the poky(les)mist be endorsed.It SUBROGATIONIS WAIVE% subject to the tar*and condhlons of the policy,cataln polldss may Mqulre an endorsement.A- on this certlilc9W does not confer r1gift to the certificate holder In lieu of such lndomenwnt(s� PROVONR USAA INSURANCE AGENCY INC*HS SM12840 PH ME (888)24 -1 FAX Mol.(888)443-8'112 The Haz M Business Senrioe Cenlw 0c,Na 64. VVlsem n ONd EMAIL San Antonia,TX 78251 ►DDRESs INSURER(S)AFFORDIM co�►aRAae RNAICr INSURED DISURIIR A: Hadfix Casusily Insurance Company 20-4 4 QUANTUM HEALTH SOLUTIONS INC VJSURER 8: Ha lnwmn0e Company 30104 4873 PALM COAST PKWY NW UNIT 3 MISURER C: PALM COAST FL 32137-Mg INSURER D INSURERS: INSURER F: COVERAt�Ea CERTIFICATE NUMBER: REVISION -------- -------------------------- ---THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATEMNOTWITHSTANDINQ ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT MATH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED 8Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE M IUSURANCE POLICY RAW R LIMITS - - -- COMYERCIAL GENEIM MKITY EACH=URR0 CE $z=, ---- -- INS•LAADE -- $300,OW -----....................... neral LhOl - 000 �[ tY ABED ExP anep�no� 31�, A x 85 SBA TFOM 12J0512019 1210512020 ;a, , QEN'L AGGREGATE LiIYIiT APPLIES PEFt LiE1+1ERAL AGGRE"TE $4, .= PCLICY[:]R� LAC JECT x PRODUCTS-CQMPFOP AW $4.000.000 OTHER: --------------------- --------------------------------------------------------............... ............... ........... ............... "uTaMOUIUE EI" PROVED RISK NAGEM NT ANYAUTO BODILY INJURY IP�r ALLOWED 9CHEd D 0&12-2020mom AU1011 BODILY II►RJLIRYIPrr kNj RUED NOk4D MGD - AUTOS AUTOS rC --------------------.......-----------------------------.....--------'...-......._........................-.......... ----- UWRELtiA LIIAO ---------- EACH O -- ------------- @]ICES AGGREGATE MADE .................... RETENTION ----------------------- - AND EMPe OYIEW we1UTY x AW YnN EL EACH ACCIDENT $1,000,000 B TORNARTNERM(ECUT E wA 65 WEC GD3821 021111 0?J1112021 OFFICERNEMBER EXCLUDED? EL.DISEASE-EA EJAPLOYEE $1,00010 If I"duo**wmdw E.L.DISEASE-POLICY LUAIT $1,000,0 - ----------- ----------------- ------ ----------Ll ---------------.-----.. .......................... ----- A EMPLOYMENT PRACTICES 65 SBA TFOW 1?�51 % 012020 Each Claim Lund $5.Q00 ------------------LIABiL�TY Aggregate Urnh $5,000 - - ---------------------------------------------------- Of T[0lI18I LOCA1 lIIiSI V WCLO(ACOM 101,AddiSmM Rameft Schakfte may he SNOW If own sp m Is nqulreq Thow usual to the Insuned's OparaliOna.MOMS County SOCC is additional loured per the Business Liabildy Cowage Farm SS0008 aaached to this pow. ATE H LD MONROE COUNTY SOCC SWRILD ANY OF THE ABOV11 DESCRIBED POLICIES BE CANCELLED 1100 SIMONTON ST BEFORE THE EXPIRAT=DATE THEREOF,NOTICE WILL BE 0110ARED KEY WEST FL 33049-3110 IN ACCORDANCE WITH THE POLM PWMKM. AM110FAMR11PRUENTAME �Sf o3� Gov 19684015 ACORD CORPORATION.All rights reserved. ACORD 2$(301W03) The ACORD name and logo are registered marks of ACORD _ _ _ __ _ _ _ __ __ _ ___ :_;__v _ _-__ -:i+:.'�:_} ___ _ _ - _ __. ::::.:<...rr.....b.::::::vy.;:un•c=". .. __:.::.:♦-:ss:v t:+== ._.:.:n :..:.'r.y.::.::.. .:::_::�=: =x=:i===.: _-a x:..515m.:1r::1��s_y]`v:_:� :=. ...r....... ..�3.... ....:. .. .. .... ....a .........................,=s..-::,........ s....... ............a.....<----.._.:...---_'-----• .....,=r......... .....=k...r-.;::b.-,_�-=s=.:L!v.=n..nn:;:::-r:::::::::..-. ..is. x -- - ....%ice'•=:�.-::ee.�-.-:.r.: ; - - - - _- ... ..... >;..1.... s.......... ......f.. .... � 4 F..1......... .S:..i f.,r. ... F7 Y......ti 1................. ....._.._..._,....... 'Y ...--.... .1 i.F > r x]-lf Yf......_-n-....... ......-'ai._�'-Y[:::�r;;.::.-__,.;�q�,a;lfF:s=i;p--;k.':;;,:K,;..:= =Dt8�dan MONROE CDTl1 fflp FLORMA REQULST FOR WAIM OF WSURANCE REQUMBUMM It is raquestod that t1 ass spec Sad is tho CDUWB oP �e w�dved or mad�d on the ti�Uowi�g eoat�t. Ag III A A.,, k.P, /jo A 1A-EAA If LSO=-fl I f M aedort ors F/,Pl s is 4AP Pro C4 rar", oador 912 1/ -)Ads a� �: f �/ s oto 8�1 e0ol o o ofwo& n-oo/imu. 14-jt4s,�O,Abo - A, da g�2 tw 1 Ram for Waiver a Ara !� e_vi4L momeagm poRdes Waiver or Modificafm mill apply ts: ■1 a 'twAIM w S*at=of Coutraat dVewor exi 7k c�ra--- Dat*: 5-1 3-2020 Appmvod Not Approved Risk Maaegeateat 9igpature Dater County Adotlal*o rapped: Approvcd: Not Approved: Date: W■ w BOW of Comay Commisaionom appeal: Approvo k Not Approved: Maotiag Down AdWwgmtive lmuuwm 7Soo,7 104 r k' t4N- ,ss r 1 i 0,,L -T-U-,M. March 13, 2020 Ms. Natalie Maddox Employee Benefits Administrator Monroe County BOCC 1100 Simonton Street Key West, FL 33040 RE: Quantum Health Solutions Employee Assistance Program Renewal Rates Agreement Dear Ms. Natalie: Thank you for your consideration and continue trust in Quantum to assist Monroe County. In reference to the above Agreement. The following rates are provided for the renewal as defined within the Agreement and Exhibit A, Scope of Services: $1.25 per employee per month for the services described in Scope of Work A & B. $.50 per employee per month described in Scope of Work C. Additional Critical Incident Program Services: $150 per hour. • Conflict Resolution Services at $15 o per hour. • Cessation of tobacco products at $125 per hour, With a limit of five sessions per client. Fees quoted are in effect for a three year period. Please contact me to discuss any questions and coordination for renewal planning as appropriate. Thanks again for your trust in the Quantum team! Warm regards, Anthony Riccio, MA, LEAP, CRRA, CAP, SAP �G3 o couRr� Kevin Madok, CPA Lij �o ......... f� Clerk of the Circuit Court& Comptroller Monroe County, Florida ti40Z coo N-1 DATE: December 13, 2022 TO: Bryan Cook, Director Employee Services ATTN: Natalie Maddox, Administrator Employee Benefits FROM: Liz Yongue, Deputy Clerk SUBJECT: November 15th BOCC Meeting Attached is a copy of the following item for your handling: F 19 3rd Amendment to the Agreement with Quantum Health Solutions to provide Employee Assistance Program services to all benefit-eligible employees in the BOCC and Constitutional Offices, extending the current agreement by three (3)years with no change in terms, services, or cost. Should you have any questions please feel free to contact me at(305) 292-3550. c c: County Attorney Finance File KEY WEST MARATHON PLANTATION KEY 500 Whitehead Street 3117 Overseas Highway 88770 Overseas Highway Key West, Florida 33040 Marathon, Florida 33050 Plantation Key, Florida 33070 THIRD AMENDMENT TO MONROE COUNTY CONTRACT FOR PROFESSIONAL SERVICES FOR EMPLOYEE ASSISTANCE PROGRAM 1 5th THIS THIRD AMENDMENT ("Third Amendment"), entered into on November 4-6 2022, is by and between Monroe County (hereinafter called the "County") and Quantum Health Solutions of Florida, Inc. (hereinafter the "Contractor") (collectively, the "Parties"). WHEREAS, on June 1, 2014, the Parties entered into an agreement for the provision of professional services for employee assistance ("Agreement"); and WHEREAS, the Agreement was extended on January 18, 2017 by a First Amendment ("First Amendment") to extend the term of the Agreement by three years from the Effective Date of the First Amendment; and WHEREAS, the Agreement was extended on January 1 7,2020 by a Second Amendment ("Second Amendment") to extend the term of the Agreement by three years from the Effective Date of the First Amendment; and WHEREAS, the County would like to renew and extend the Agreement beyond its current term; a n d WHEREAS, the Contractor has provided rates with no cost increase for the renewal as defined within this Amendment and Exhibit A, Scope of Services, and has offered to have the rates remain constant for an additional three (3) years; and WHEREAS, the Parties now desire to amend the Agreement by three years on the terms and conditions offered by the Contractor. 1. Paragraph 3.1 of the Agreement, as amended by Paragraph 3 of the Second Amendment, is revised to read as follows: The term of this Agreement, as amended, is extended from January 17, 2023 and renewed for an additional three (3) years, to run through January 17, 2026. Monroe County's performance and obligations under this Third Amendment remain contingent upon annual appropriation by the Monroe County Board of County Commissioners. 2. In all other respects, the terms and conditions of the Agreement between the Parties, as amended by the Second Amendment, remain in full force and effect. 1 IN WITNESS HEREOF, this Third Amendment has been executed by the duly authorized representatives of the Parties, each of whom has full authority to enter ' OPis,:Third Amendment. .- r E j4' For the County: = � MONROE COU TY BOARD OF t in Madok, Clerk COUNTY C ISSION S By: AmAzo-- s Dep ty CI rk Mayor Date: 1 For the contractor: QUANTUM HEALTH SOLUTIONS OF 6 � FLORIDA, INC. •''ilk ME- aye � ' �w.... y` -F� Anthonyiccio President �- y , Date 10-26-2022 Digltally signed by Cynthia L.Hall DH:cn=Cynthia L.Hal1,o=Monroe • Ccunty'Z ou,emall=hail- cynthiaomonroecounty-il.gov,C=US ate:2022.11.1515-14S1-D5'W Approved for form and legal sufficiency Cynthia Hall, Sr. Assistant County Attorney 1((� THE HARTFORD BUSINESS SERVICE CENTER THE 10, 3600WISEMAN BLVD HARTFORD SAN ANTON lO TX 78251 December 13, 2022 Monroe County BOCC 1100 SIMONTON ST KEY WEST FL 33040 Account Information: El Contact Us PolicyHolder Details : QUANTUM HEALTH SOLUTIONS INC Need Help? Chat online or call us at (866)467-8730. We're here Monday- Friday. Enclosed please find a Certificate Of Insurance for the above referenced Policyholder. Please contact us if you have any questions or concerns. Sincerely, Your Hartford Service Team WLTRO05 DATE(M M1D DIYYYY) CERTIFICATE OF LIABILITY INSURANCE 12/13/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF 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 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS 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 CONTACT USAA INSURANCE AGENCY INCIPHS NAME: PHONE (888)242-1430 FAX 65$12$46 (A/C,No,Ext): (A/C,No): The Hartford Business Service Center 3600 Wiseman Blvd E-MAIL San Antonio,TX 78251 ADDRESS: INSURERS)AFFORDING COVERAGE NAIC# INSURED INSURER A: Hartford Casualty Insurance Company 29424 QUANTUM HEALTH SOLUTIONS INC INSURER B: Hartford Underwriters Insurance Company 30104 4873 PALM COAST PKWY NW UNIT 3 INSURER C: PALM COAST FL 32137-3669 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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.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. INS TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MMIDD/YYYY MM/DD/Y YY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED $300,000 PREMISES Ea occurrence X General Liability MED EXP(Any one person) $10,000 A X 65 SBA TF9660 12/05/2022 12/05/2023 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 JECT POLICY 1:1 PRO- -]Fx LOC PRODUCTS-COMP/OP AGG $4,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO APPROVED BY RISK MANAGEMENT BODILY INJURY(Per person) ALL OWNED SCHEDULED �_ �' AUTOS AUTOS DATE 11 f 1 J� 02 BODILY INJURY Per accident) HIRED NON-OWNED WAIVER NIA—YES_ PROPERTY DAMAGE AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- MADE AGGREGATE DED RETENTION$> WORKERS COMPENSATION X I PER I JOTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY Y1NE E.L.EACH ACCIDENT $1,000,000 B PROPRIETOR/PARTNER/EXECUTIVE Nl A 65 WEC GD3821 02/11/2022 02/11/2023 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below A EMPLOYMENT PRACTICES 65 SBA TF9660 12/05/2022 12/05/2023 Each Claim Limit $5,000 LIABILITY Aggregate Limit $5,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured's Operations.Certificate holder is an additional insured per the Business Liability Coverage Form SS0008 attached to this policy. CERTIFICATE HOLDER CANCELLATION Monroe County BOCC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1100 SIMONTON ST BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED KEY WEST FL 33040 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988-2015 ACORD CORPORATION.All rights reserved. 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