COUNTY OF OSCEOLA BOARD OF COMMISSIONERS' COMMITTEE OF THE WHOLE AGENDA Tuesday, October 1, 2019 301 West Upton Ave., Reed City, Michigan 2 Floor, Board of Commissioners' Room, 9:30 a.m.
NOTE: Claims will be available for review from 9:00 - 9:30 a.m.
1. Meeting Called to Order by Chairperson. 2. Additions or Deletions to the Agenda - Approval of the Agenda. 3. Brief Public Comments (Three Minute Limit). 4. Employee/Board Comments. 5. Consider Approval of the Minutes of September 17,2019. 6. Consider Payment of Claims.
7. Consider Other Budget Amendments, Cash Transfers, and Journal Register Report from Treasurer.
8. Old Business - Discuss: a. Health, Safety & Grounds Committee Meeting Update - Mark Gregory. b. Road Commission Meeting Update - James Custer and Tim Michell. c. Various Items - Tracey Cochran: 1. Policies Discussion. 2. MERS Retirement Plan Options. d. Various Items - Susan Vander Pol: 1. Appointment to 91 1 Authority Board. 2. County 2020 Budget: • Consider setting the Public Hearing for October 16 or November 5, 2019.
9. New Business - Discuss: a. MSU Extension Osceola 4-H Update - Jacob Stieg. b. Probate/Family Court Child Care Fund Additional Funding Request - Kaye Frederick. c. Prosecutor Crime Victim Rights Grant Approval - Dani Taylor. d. Sheriff Cell Phone Plans - Ed Williams. e. GELC Letter of Agreement - Jason Owen. f. C.O.A. Items - Justin Halladay: 1. AAAWM Older Americans Act Contract FY2020-2022. 2. Facebook Page. 3. Purchases: Vehicles, Storage Shed, Blood Pressure Cuffs, AEDs, Walk-ln Cooler and Double Oven. g. Various Items - Susan Vander Pol: 1. LCM Surveying & Engineering, Inc. Agreement. 2. State of Ml Wex Fuel Program.
10. Other Business: 11. Employee/Board Comments. 12. Extended Public Comments (Six Minute Limit). 13. Adjournment.
Note: A quorum of the Board of Commissioners may be present at the Committee meetings.
PUBLIC COMMENT: The Committee welcomes public comment. We appreciate your attendance and look forward to hearing any concerns you may have. We request that the following rules of procedure be followed: At the beginning and at the end of each Committee meeting, there is time to receive public comment from the audience. If you wish to address the Committee, we ask that you stand, give your name and present your concern. If you wish to speak while the Committee is addressing a specific issue, you are asked to make arrangements ahead of time with the Committee Chairperson. No comments or questions will be taken at any other time. If you should require special assistance in order to attend the meeting, please notify the County Coordinator at (231) 832-6196, hventy-four (24) hours before the posted meeting time, for arrangements to be made. OSCEOLA COUNTY COMMITTEE OF THE WHOLE MINUTES SEPTEMBER 17,2019
The Committee meeting was called to order at 9:34 a.m. by Chairman Nehmer.
Present: Commissioners Larry Emig, Jill Halladay, Mark Gregory, Tim Michell, James Custer, Roger Elkins and Jack Nehmer.
Also present: David Belden-Drain Commissioner, Rosie McKinstry-Equalization Director, Tracey Cochran- Payroll/HR Specialist, Susan Vander Pol-County Coordinator, Karen Bluhm-County Clerk and members of the public.
Motion by Commissioner Gregory, seconded by Commissioner Custer, to approve the agenda as presented. Motion carried.
Brief Public Comment: Alan Gingrich, Road Commissioner, reported their joint meeting with two Commissioners and Township Officials will be Thursday morning at 10:00 a.m.
Peggy Hoard, IVIiddle Branch Township Clerk, spoke supporting voters electing Road Commissioners rather than County Commissioners appointing them.
Employee/Board Comments: Rosie McKinstry, Equalization Director, spoke regarding the proposed policy changes to the Personal Appearance and Personal Conduct and Code of Ethics policies.
Jamie Eichenberg, Child Support Specialist, spoke regarding the proposed policy changes to the Personal Appearance and Personal Conduct and Code of Ethics policies.
Tracey Cochran, Payroll & HR Specialist, addressed concerns regarding the proposed policy changes to the Personal Appearance and Personal Conduct and Code of Ethics policies.
Chairman Nehmer noted the employee comments and said he believes the proposed policies can be condensed and that it is being worked on.
Moved by Commissioner Gregory, seconded by Commissioner Custer, to approve the minutes of September 4,2019 as presented. MEotion carried with unanimous voice vote.
Recommended by Commissioner Halladay, seconded by Commissioner Custer, to approve the claims of the County in the amount of $71608.41. Recommendation was unanimously supported.
Budget Amendments, Cash Transfer & Journal Register Report Commissioner Halladay reviewed the budget amendments, cash transfer and journal register report presented for approval.
Recommended by Commissioner Halladay, seconded by Commissioner Michell, to approve the budget amendments, cash transfers and journal register report as presented. Recommendation was unanimously supported.
County 2020 Budget Update Susan Vander Pol, County Coordinator, advised Board members they are continuing to work on putting the budget together and it should be available by the Board's next meeting date. Page 2 Committee Minutes September 17,2019
Orient-Fork Drain Assessment David Belden, Drain Commissioner, summarized the Orient-Fork drain final maintenance on the project. He asked the invoice from Mecosta County be paid. The total invoice will be divided into three portions being split between Orient Township, Osceola County and the Special Assessment District. A brief discussion was held.
Recommended by Commissioner Gregory, seconded by Commissioner Custer, to approve payment of $2,083.67 to IVIecosta County for work on the Orient-Fork Drain as submitted with partial reimbursement from Orient Township and the Special Assessment District. Recommendation was unanimously supported.
Appointment to Board of Canvassers Karen Bluhm, County Clerk, advised Board members that 2 people need to be appointed to the Board of Canvassers once again for a 4-year term. The respective political party chairs are required to submit the names of those they wish appointed. The Republican Party Chair has submitted the name ofPam Prichard. Karen has had no correspondence from the Democratic Party Chair, so the previously appointed Democrat was believed to want to be re-appointed, but has now changed their mind. She asked the Board to appoint the Republican nominee and she will continue to search for a Democrat to fill the other vacancy. A brief discussion was held.
Recommended by Commissioner Emig, seconded by Commissioner Gregory, to approve the appointment to the Board ofCanvassers ofPam Prichard (Republican). Recommendation was unanimously supported.
Building Department-Mobile Home, Foundations and Policies Tony Gagliardo, Building Official, recommended the Board consider an amendment to the requirements for mobile and modular homes foundations if no manufacturer specifications are available. He explained why he was making the recommendation. Discussion was held.
Recommended by Commissioner Mitchell, seconded by Commissioner Custer, to approve the amendment to the Building Department foundation requirements for mobile and modular homes that a full reinforced concrete or fiber mesh 6" slab going to 8" outsides be poured if no special instructions, manufacturer specifications or a structural engineered drawing are included with the home effective October 1, 2019. Recommendation was unanimously supported.
Building Department-Fees for Handicapped Ramps/Accesses Tony Gagliardo, Building Official, suggested a lower fee for handicapped ramps/accesses and explained his recommendation. Discussion was held.
Recommended by Commissioner Gregory, seconded by Commissioner Custer, to set the fee at $50 for a stand-alone ramp with 100 square feet or less landing. Recommendation was unanimously supported.
Building Department-Clerical Position Tony Gagliardo, Building Official, asked that the contracted person who fills in when the full-time clerical is absent be changed to an irregular part-time employee and explained his request. Discussion was held.
Recommended by Commissioner Gregory, seconded by Commissioner Emig, to create an irregular part- time clerical Office Manager position in the Building Department. Recommendation was unanimously supported. Page 3 Committee Minutes September 17,2019
Buildine Department-DS&A Software Online Permit Fees forApplications Tony Gagliardo, Building Official, and Susan Vander Pol, County Coordinator, asked the Board to pass on the cost to customers the BS&A fee for applying on-line for permits. Discussion was held.
Recommended by Commissioner Michell, seconded by Commissioner Gregory, to approve the on-line fee of $2.00 to be added to the Application Fee for building trade permits. Recommendation was unanimously supported.
Appointment to 911 Authority Board Susan Vander Pol, County Coordinator, shared the information from retiring Reed City Police Chief Chuck Davis resigning from his position on the 911 Authority Board. Discussion was held as the history behind the appointment to that position. No appointment to replacement him was made at this time, to give Board members time to consider an interested party.
C.O.A. Reliance CCP Purchase of Service & Business Assoc. Agreements Susan Vander Pol, County Coordinator, explained the Reliance Purchase of Service Agreements advising this contract has been in place for some time.
Recommended by Commissioner Emig, seconded by Commissioner Michell, to approve the agreement for the Reliance CCP Purchase of Service and Business Association Agreement and the Commission on Aging as submitted and authorize the Chairman to sign. Recommendation was unanimously supported.
Contract for Audit Services Susan Vander Pol, County Coordinator, asked the Board for direction on the next years' audit services. She noted our past auditor, Anderson, Tackman, is willing to extend our contract with them for the next two-years and maintain the cost at our current rate. She asked their thoughts on doing this, or would they like to do an RFP for the audit services. Discussion was held.
Recommended by Commissioner Gregory, seconded by commissioner Custer, to extend the audit services agreement with Anderson, Tackman and Company, PLC for the 2019 and 2020 fiscal years for $27,500 each year as presented. Recommendation carried with Commissioner Michell voting no.
Contract for Janitorial Services Susan Vander Pol, County Coordinator, asked for the Board's direction on doing an RFP or renewing our contract with Big Rapids Professional Office Cleaning for 2020. Discussion was held.
Recommended by Commissioner Halladay, seconded by commissioner Michell, to approve a one-year extension with Big Rapids Professional Office Cleaning in the amount of $39,936.00 for 2020. Recommendation was unanimously supported.
Indigent Defense Agreement Amendment FY2019 Susan Vander Pol, County Coordinator, explained the possible need of an extension to the Indigent Defense Agreement for 2019 and with the end of the State's fiscal year quickly approaching we need to be prepared for the extension before the next Board meeting.
Recommended by Commissioner Custer, seconded by Commissioner Michell, to approve the amendment to allow for expenditure of fiscal year 2019 unexpended funds to continue funding for the Indigent Defense programs and authorize the Chairman to sign, if needed to be filed with the State to continue funding. Recommendation was unanimously supported. Page 4 Committee Minutes September 17,2019
Extended Public Comment: Alan Gingrich, Road Commissioner, spoke about representation from the Road Commission regarding the meeting Commissioner Custer mentioned earlier in the meeting today. He also commented on the policy changes and the Board's responsibilities overall.
Moved by Commissioner Emig, seconded by Commissioner Gregory, to adjourn at 10:59 a.m. Motion carried unanimously.
Karen J. Bluhm, County Clerk Jack Nehmer, Chairman Sep, 18, 2019 9;02AM. lo, 0872 ;P, 2
County of Osceola
BUDGET AMEWMENT , '• ,.
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Policy Number: 1024 Policy Titled Personal Appearance Policy: This is a general dress code for all County employees interacting with the public in an office environment, Departments with employees who perform physical labor or who work outside may have standards that better suit the work environment for their employees, As a County employee the expectation for your work area and conduct is to present to the public and co-workers a clean, professional and f'espectful image and attitude. All county employees are representatives of county government as a whole and should, at all times, present a positive image, General Dress Code: 1, Business casual 2, Suits, sports coat or blazer when appropriate 3. Dress shirts and pants, Docker style pants 4. Dresses and skirts 5. Caprisorskorts 6. Sleeveless tops which are not revealing (women only) 7. Leggings and tights are permitted only when a covering top, skirt or dress falls to mid-thigh 8. Appropriate footwear 9. All clothing must be free from holes, tears or stains Prohibited Attire: 1. Jeans (must be clean and free of rips, tears and fraying 2. T-shirts with logos such asgraphictees (unless County related) 3. Clothing with logos that may be considered offensive or objectionable 4. Sweatshirts or exercise wear 5. Shorts, mini-skirts, low cut tops, halter top, crop tops or any attire, top or bottom, that is overly revealing 6. Slippers, flip-flops or similar footwear Department heads may institute a casual attire day, such as casual Friday, and permit employees to wear blue jeans, sweatshirts and similar attire. Even though casual, an employee's attire should be clean, tasteful and not create a distraction for either customers or co-workers. Department heads will address instances where an employee's attire, workspace or appearance does not conform to the guidelines in this section. Employees may be sent home, without pay, to correct their attire or appearance. Repeated violations may subject the employee to disciplinary action. Osceola County Personnel Policy Amended September 17, 2019 Page # Policy Number: 1025 Policy Titled Personal Conduct & Code of Ethics Policy Policy: Adherence to these ethical standards is to ensure each official and employee has a clear understanding of his/her conduct and how essential it is to maintain his/her public responsibilities to the citizens of Osceola County as a standard by which they may be assured that these responsibilities are being faithfully performed. I. Personal Conduct. a. All personnel shall always conduct themselves professionally, with respect for fellow personnel and the public. Employees are expected to be courteous and polite to each other and to those with whom they deal with. Employees shall, refrain from conduct of any kind that is of an offensive nature that will adversely reflect upon their reputations and /or the reputation of Osceola County. b. All policies that relate to the personnel conduct shall be followed, including standards contained within this policy. The following unprofessional conduct shall not be tolerated. This list is not all inclusive and simply provides examples of prohibited conduct, each of which may be grounds for discipline: 1. Calling someone a derogatory name. 2. Use of profanity. 3. Sending sexually explicit or offensive e mail messages, notes or letters. Sexual Harassment Policy, , • 4. Telling Jokes or stories that are based on race, color, national origin, ancestry, religion, sex, age, disability, political belier, military service, or any other protected class. 5. Tamperingwith another person's time record, work papers, or personal belongings and/or in any way falsifying personnel records (including timecards, job application or other work records). 6. Falsifying official records. 7. Removing or discarding records, material, or other property for the premises without permission. Osceola County Personnel Policy Amended September 17, 2019 Page # 8. Theft of private or County property, including property of the public or employees or inappropriate, removal or possession of property. 9. Having intimate personal relation with other employee, members, volunteers or any outside person while on Osceola County premises, in its vehicles, or while engage in its activities. Sexual Harassment Policy 10, Fighting with or threatening others. 11. Defacing another person's personal affects. 12. Gambling on Osceola County property, in its vehicles or at its functions. 13. Possession of weapons on Osceola County property or in its vehicles unless outlined in Osceola County policies. 14. Abuse, unprofessional behavior, insubordination, or disrespect to clients, family member, or other employees, supervisors, officer, volunteers, or members. 15. Accepting tips or gratuities (gifts or money) outside the scope of adopted Osceola County policies. 16. Solicitation or distribution in violation of the Signage in County Buildings Policy 17. Unauthorized or careless use or malicious destruction or damage of property, tools or vehicles. 18. Unlawful or unauthorized release of confidential or proprietary information. 19. Poor or unsatisfactory work performance or conduct. 20. Disorderly conduct or boisterous or disruptive activity such as but not limited to horseplay in workplace. 21. Violation of established sgfety rules (including smoking & tobacco use rules). 22. Unreported or excessive absenteeism ortardiness. 23. Gossip about fellow employees or management. 24. Failure to report a workplace accident or damage to Osceola County property. 25. Refusal to accept a job assignment or reasonable work order, insubordinate conduct and behavior. 26. Creating unsafe or unsanitary conditions, 27, Any other unauthorized use of telephone, faxes, computers, mail system, electronic mail, or other Osceola County owned equipment. 28. Failure to maintain a current and valid driver's license (if required) 29. Failure to maintain a current and professional license (if required) 30. Failure to maintain current and valid required professional certifications (if required) 31. Felony Conviction 32. Misdemeanor Conviction (disclosed or undisclosed) including but not limited to; violent or assaultive offense, driving offense, controlled substance conviction. 33. Assisting or advising another employee in the violation of any provision of policy or procedure. Osceola County Personnel Policy Amended September 17, 2019 Page ft 34. Failure to immediately make written notification to management when you have knowledge that you are under investigation by any law enforcement agency, 35, Failure to report promptly any anticipated absence from work. Being absent from work without proper authorization. 36, Leaving work assignment without being properly relieved or without proper authorization. 37. Conducting private personal business to the extent that it interferes with the performance of official duties, 38, Gambling during work hours. 39. Falsification of or supplying false information in records or reports, including employment applications, absence and sickness records. 40. Deliberate destruction of abuse of employee, public, or County owned property. 41. Unauthorized use of County facilities or operation of County equipment. 42. Violation of any safety rule of practice or conduct which tends to create a safety hazard, including failure to use or wear required safety equipment. 43. Failure to report injuries, accidents, or abuse of safety equipment, 44. Recommending any agency, vendor, or service for profit or gain. General Standards of Care a. Conduct that is dangerous to other, dishonest, immoral, illegal or abusive will not be tolerated. Violation of these standards of conduct will be grounds for disciplinary action, up to and including termination. b, Notwithstanding any "Progressive Discipline" Policy, Osceola County reserves the right to dismiss any nonunion employee without warning, progressive discipline, or notice if we determine that continued employment is not in the best interests of Osceola County, other employee, or the people we serve. In other words, employment is "at will". c, Osceola County reserves the right to suspend a nonunion employee (with or without pay) as it deems appropriate, as part of its investigation of a staff member's conduct, d. Osceola County reserves the right to take any action, which differs from the progressive disciplinary steps, including suspension and termination from employment as a first step. Osceola County Personnel Policy Amended September 17, 2019 Page # Policy Number: 1026 Policy Title: Social Media Policy PoUcv Statement: Osceola County recognizes that social media is a way for employees to share their life and opinions with family, friends and co-workers. However, the use of social media also presents certain risks and carries with it certain responsibilities. To assist you in making responsible decisions about your use of social media, we have established these guidelines for appropriate use of social media. Guidelines^ In the rapidly expanding world of electronic communication, social media can mean many things. Social media includes all means of communicating or posting information or content of any sort on the Internet, including to your own or someone else's blog, journal or diary, personal web site, social networking or affinity web site, web bulletin board or a chat room, whether or not associated or affiliated with Osceola County. The same principles and guidelines found in Osceola County policies apply to your activities online. Ultimately, you are solely responsible for what you post online. Before creating online content, consider some of the risks and rewards that are involved. Keep in mind that any of your conduct that adversely affects your job performance, adversely affects employees or member of the community, may result in disciplinary action up to and including termination. Carefully read these guidelines, the Osceola County Social Media Policy, the Osceola County Personal Conduct & Code of Ethics Policy, the Osceola County Equal Employment Opportunity and the Osceola County Sexual Harassment Policy and Procedures Policy to ensure your postings are consistent with these policies. Inappropriate postings that may include discriminatory remarks, harassment, and threats of violence or similar inappropriate or unlawful conduct will not be tolerated and may subject you to disciplinary action up to and including termination. Be Honest and Accurate^ Employees should make sure posts and information shared are always honest and accurate. Mistakes should be corrected quickly and the employee should be very open and honest about prior posts that have been altered. Remember that the internet archives almost everything; therefore, even deleted positings can be searched. Employees should never post any information or rumors that you know to be false about the County, co-workers, customers, suppliers, or people working on behalf of the County. Osceola County Personnel Policy Amended September 2019 Page # Post Only ApDropriate and Respectful Contend • Employees must maintain the confidentiality of private or confidential information. As such, internal reports, records, files, policies, procedures, communications, or any other business-related matter of a confidential nature may not be posted or shared. • Employees may not create links from their blog, website or other social networking site to the County website, without identifying themselves as a County employee. • Employees should never represent themselves as a spokesperson for the County and should express only their own personal opinions. If the County is subject of the content being created, then the employee needs to be clear and open about the fact that they are an employee and that their views do not represent those of the County, co-workers, customers, suppliers or people working on behalf of the County. If an employee does publish a blog or post online related to their work or about subjects associate with the County, then it must be made clear that is it not on behalf of the County. It is best to include a disclaimer such as "The postings on this site are my own and do not necessarily reflect the view of Osceola County. Using Social Media at Work^ Employees shall refrain from using social media while on work time or on equipment provided, unless it is work-related as authorized by their supervisor or consistent with other policies. Employee may not use County email addresses to register on social networks, blogs or other online tools utilized for personal use. Retaliation is prohibited^ Osceola County prohibits taking negative action against any associate for reporting a possible deviation from this policy or for cooperating in an investigation. Any associate who retaliates against another associate for reporting a possible deviation from his policy or for cooperating in an investigation will be subject to disciplinary action, up to and including termination. Media Contacts^ Employees should not speak to the media on Osceola County's behalf without contacting the County Coordinator. This provision of the policy does not apply to Elected Official and/or their designee who may serve as the official spokesperson for their respective offices. Other: This Policy can be amended or terminated at any time by the Board of Commissioners. Osceola County Personnel Policy Amended September 2019 Page # r--"\ r,^ /^\ n-3 r n. F f^3 ^' "s. , ,;—,> V^ ^ |i=. I. V 1;=. ;p>.\| 3215 EAGLECREST DR. NE Hr"w "'•"'";![ & A,J ^ il ^1 I AREA GRAND RAPIDS, MI AGENCY l! il; . „ lil 49525-7005 SEP 2 3 2019 ^NAGING Ph: 616.456.5664 Fx: 616.456.5692 OF WESTERN 1.888.456.5664 MICHIGAN C3CEOLAy ^ ^ t—r\\ \ /~\/"-», CC'.",H3SiON j<« i j -^ '^ i /'-. n O''-< „-',*' AQ!h * r^ www, aaawm. o rg The Source for Seniors Memorandum To: Justin Halladay, Director Osceola County Commission on Aging From: Barbara Nelson Jandernoa.l Healthy Aging Contract Administrator Staci Gerken, Nutrition Contract Administer ^b Area Agency on Aging of Western Michigan Date: September 16, 2019 Re: FY2020 - 2022 Older Americans Act Contract Enclosed please find two copies of each of your FY2020 - 2022 OAA Contract and our HIPAA Business Associate Agreement. All copies must be signed and dated by the chairperson of your policy board or a duly authorized person. If the chairperson is unable to sign the contract, attach a Policy Board Resolution or a copy of your organizational by-laws, which authorizes elected officers to sign or countersign official documents. Please return one signed, original contract, as well as one signed, original HIPAA agreement, to Staci's attention and retain the other copies for your file. Services are to begin October 1, 2019, but payment for services will not be released until the signed contract is received in our office. If you have any questions, please do not hesitate to contact Barb at (616) 222-701 1 and [email protected] or Staci at (616) 222-7007 and [email protected]. Thank you. Enclosures Contract No. 61.82-FY2020 FY 2020 - 2022 CONTRACT FOR SERVICES TO OLDER ADULTS UNDER TITLE III OF THE OLDER AMERICANS ACT AND/OR OLDER MICHIGANIANS ACT This Contract is between the Area Agency on Aging of Western Michigan, Inc. (AAAWM), a Michigan non- profit corporation, whose address is 3215 Eaglecrest Drive NE, Grand Rapids, Michigan 49525, and Osceola County Board of Commissioners (Service Partner), a public agency, whose address is 301 W. Upton Avenue, Reed City, MI 49677. AAAWM has entered into a contract with the Michigan Aging & Adult Services Agency ("AASA") for a grant under the Older Americans Act of 1965 as amended (the "Act"). AAAWM now desires to engage Service Partner to render certain service(s), in connection with the AASA contract, which are listed on Attachment II. These services will assist AAAWM's accomplishment of activities set forth in its approved Area Plan. AAAWM and Service Partner mutually agree as follows: 1. Authority to Enter Contract Service Partner assures AAAWM that it possesses legal authority to enter into this Contract; that a resolution, motion, or similar action has been duly adopted or passed as an official act of Service Partner's governing body authorizing an official representative to execute this Contract. Service Partner agrees to provide AAAWM with evidence it possesses legal authority upon request. Service Partner certifies that it has not been suspended, excluded or debarred by the U.S. government or the Department of Health and Human Services (DHHS) from receiving federal dollars. 2. Performance and Scope of Services AAAWM shall administer, and Service Partner shall perform, the services listed on Attachment II, which are incorporated into and made a part of this Contract. Service Partner agrees to be bound by all of the policies, procedures, responsibilities, guidelines, terms, and conditions stated in the Policies and Procedures Manual (the "Manual"). Parts of the Manual are restated in this Contract for emphasis. However, the complete Manual, as updated, is incorporated into and made a part of this Contract. Service Partner acknowledges receiving a copy of the Manual. Where the terms of the Manual and Contract conflict, the terms of this Contract control. Service Partner will establish linkages with other area service providers, including volunteer organizations, for continuity of services especially to address the comprehensive range of needs any service recipient may present. 3. Client Elieibility All persons who meet the criteria included in the Manual shall be eligible for services under this Contract. Preference will be given to providing services to older individuals with the greatest economic or social needs, with particular attention to low-income minority individuals. A means test shall not be used to determine eligibility for, denial of, or limitation of services to an older person unless specifically required by state or federal law. Cost sharing by service recipients may be required for services as stated in the Manual. 4. Term This Contract is for a period beginning on October 1, 2019 and ending on September 30,2022. 5. Contract Modification Any modification of this Contract or additional obligation assumed by either party in connection with this Contract shall be binding only if done in writing with the document signed by an authorized person on behalf ofAAAWM and Service Partner. 6. Payment For providing services under this Contract, Service Partner shall receive up to $322,915.00 (Three hundred twenty-two thousand nine hundred fifteen and 00/100 dollars). Reimbursement will be only for actual, reasonable and allowable costs under the terms of this Contract. Sendce Partner shall expend any and all payments solely for the purpose(s) specified in this Contract. That the amount ofNSIP funds AAAWM agrees to pay, for the budget October 1, 2019 through September 30, 2020, shall not exceed $25,004.00 (Twenty-five thousand four and 00/100 dollars). NSIP funds shall only be used for raw food expenditures. AAAWM may set-off against any amounts due under this Contract any amounts which are determined by AAAWM to have been disallowed costs or un-obligated funds under contracts between AAAWM and Service Partner. The Budgets, stated on Attachments I-A, I-B, I-C, I-D, I-E and I-F, are incorporated into and made part of this Contract. 7. Local Match Service Partner agrees to provide Local Match in the amount of $35,879.00 (Thirty-five thousand eight hundred seventy-nine and 00/100 dollars), as shown in the Budgets, Attachments I-A, I-B, I-C, I-D, I-E and I-F, dated August 16, 2019. 8. Audits Service Partner, when receiving more than $300,000 total federal funding (as a legal entity), shall have an annual financial examination (i.e., audit, review, or agreed upon procedures) performed on Contract operations. Service Partner receiving up to $300,000 total federal funding shall have a financial examination performed at least every two (2) years on Contract operations. The purpose of the financial examination shall be to determine the effectiveness of the financial management systems and internal procedures established by the Service Partner to meet the terms of this Contract. Financial examination findings and conclusions will be provided to AAAWM upon request. Nothing in this section is intended to limit the right ofAAAWM, AASA, the federal government, or any of their authorized representatives to conduct financial examination of Service Partner's operations at any time and for any reason or for no reason at all. 9. Services Publicized Services must be publicized to the population Service Partner plans to reach by using means most effective in reaching the target population. Upon request. Service Partner will provide AAAWM with copies of publication and promotional materials including, but not limited to, films, slides, books, reports, including reports, pamphlets, papers and articles. Any promotional materials, including social media, films, slides, books, reports, pamphlets, papers, or articles based on activities receiving support under the Contract shall contain acknowledgement ofAAAWM, AASA, and funding through State appropriations or the Older Americans Act, and a statement of compliance with Title VI of the Civil Rights Act. Where activities under this Contract result in a book or other copyrighted material, the author is free to obtain a copyright, but AAAWM and AASA reserve a royalty-free, non-exclusive and irrevocable license to reproduce, publish, or otherwise use, and to authorize others to use, all such material. 10. Property Service Partner understands and agrees that title to all equipment and supplies acquired with grant support under this Contract shall remain vested in AAAWM and will never pass or vest in Service Partner. Service Partner agrees to secure prior written permission from AAAWM before any disposition of such equipment or supplies. 11. Recordkeeping Service Partner agrees to record and maintain data and information about service recipients which are required by AAAWM. At a minimum, data about service recipients shall include the name, age, sex, race, estimated income, limitations of daily living activities, types of services received, and number of units of service received (by service category). Service Partner agrees to collect statistical fiscal data on a regular basis and to provide fiscal statistical reports at times prescribed by, and in a format acceptable to AAAWM. 12. Access to Records AAAWM, AASA, Department of Community Health, Administration for Community Living (ACL), Controller General of the United States, or any of their authorized representatives shall have the right of access to any books, documents, papers, or other records of Service Partner, in order to make audits, examinations, excerpts, and transcripts, so long as such conforms to the Privacy Act of 1974, as amended. The rights of access in this section shall last as long as the records are retained. 13. Confidentiality Service Partner shall report service recipient information to AAAWM and AAAWM shall have access to the files, as necessary, to administer programs, so long as access conforms to the Privacy Act of 1974, as amended. Information about older persons collected in the conduct of Service Partner's responsibilities shall not be disclosed without the informed written consent of the service recipient or his/her legal representative, unless that disclosure is required by a court order or for program monitoring by authorized agencies. Such agencies are, in him, bound to protect the confidentiality of service recipient information, and such access shall be in conformity with the Privacy Act of 1974, as amended. Referrals to other agencies providing services must also have the service recipient's informed written consent. 14. Conflict of Interest No officer, employee, or agent of Service Partner who acts in connection with carrying out services under this Contract shall participate in any decision, relating to this Contract, which would affect his/her personal interest or the interest of any corporation/partnership/association in which he/she is directly or indirectly interested, or has any personal or pecuniary interest, direct or indirect, in the Contract or its proceeds. 15. Disclosyr^o^^ Service Partner shall submit to AAAWM all information requested by AAAWM including the names of persons with an ownership interest or a controlling interest in Service Partner and certain other disclosing entities. Service Partner shall also submit to AAAWM all information requested by AAAWM relating to Service Partner's past business transactions. AAAWK4 may, at its option, immediately terminate this Contract if Service Partner does not comply with this requirement. 16. General Compliance Service Partner agrees to observe and comply with all applicable federal, state, county, and local laws, mles, regulations and licensing standards, all applicable accrediting standards, and any other criteria established by AAAWM, AASA, Department of Community Health, ACL, and Controller General of the United States to assure quality of services. 17. Compliance with Civil Rights Laws Service Partner shall not discriminate against any employee or applicant for employment because of race, color, religion, national origin, age, sex, sexual orientation, height, weight, or marital status. Breach of this provision of the Contract by Service Partner shall constitute a material breach of this Contract, and AAAWM shall be entitled to immediately terminate the Contract. Service Partner shall observe and comply with all applicable federal, state and local laws, ordinances, mles and regulations, which shall be deemed to include, but not be limited to, the Elliott-Larson Civil Rights Act and any amendments thereto, as they may apply to the performance of the Contract. 18. Safety Service Partner shall at all times observe and comply with all federal, state and local laws, ordinances rules and regulations which may in any manner affect the safety of equipment or material used in accordance with this Contract, those employed to carry out the work, and the conduct of the work. Service Partner shall indemnify and hold AAAWM harmless against any claim or liability arising from the violation of these provisions. 19. Hold Harmless/Notification of Litigation Service Partner agrees to indemnify and hold harmless AAAWM and its directors, officers, and employees from all claims, lawsuits, settlements, judgments, costs, penalties and expenses, including reasonable attorney fees, resulting from, or arising out of, or in connection with this Contract. The provisions of this paragraph shall not apply to claims, lawsuits, settlements, judgments, costs, penalties and expenses caused by or resulting from the willful or negligent act or omissions ofAAAWM, AASA, or any of their directors, officers or employees. If Service Partner becomes involved with or is threatened with litigation, Service Partner shall immediately notify AAAWM in writing of the same. 20. Reduction or Termination of Contract At its election, AAAWM shall have the right to immediately terminate this Contract or reduce the amount paid to Service Partner if: (a) there is any alteration or change in the rules, regulations, laws, or policies that AAAWM and/or AASA are subject to; or (b) there is any termination or reduction in the allocation or allotment of funds provided to AAAWM for the purposes of this Contract. The right to terminate this Contract or reduce the amount paid to Service Partner shall exist regardless of the cause for the same. The termination of the Contract or reduction in the amount paid to Service Partner shall take effect immediately upon receipt of written notice sent by AAAWM to Service Partner, unless a different effective date is specified in the notice. AAAWM shall have the right to terminate this Contract upon written notice, in whole or in part, if Service Partner fails to fulfill its obligations under this Contract or if Service Partner violates any of the covenants, agreements, or stipulations of this Contract. Service Partner will have thirty (30) days to cure any such failure or violation. If Service Partner fails to cure within the thirty (30) day period, the Contract will immediately terminate. Service Partner, for adequate cause, may terminate this Contract at any time by giving written notice to AAAWM at least thirty (30), preferably ninety (90), calendar days before the effective date of such termination and specifying the effective date. 21. Closeout When the Contract is concluded or terminated. Service Partner shall provide AAAWM, within sixty (60) days (unless otherwise notified) after conclusion or termination, with all financial performance and other reports required as a condition of the Contract. AAAWM will make payments to Service Partner for allowable reimbursable costs, as determined by AAAWM, not covered by previous payments. 22. Disputes Service Partner shall notify AAAWM, in writing, of its intent to pursue any claim against AAAWM for breach of Contract. No suit may be commenced by Service Partner for breach of Contract prior to the expiration of sixty (60) calendar days from the date of such notification. Within this sixty (60) calendar day period. Service Partner, at the request ofAAAWM, must meet with the Director ofAAAWM for the purpose of attempting resolution of the dispute. 23. Independent Contractor It is agreed that Service Partner is, for all purposes arising out of this Contract, an Independent Contractor, and shall not be deemed an agent or employee ofAAAWM or AASA. 24. Assignment or Subcontract Service Partner shall not assign this Contract or enter into Subcontracts with additional parties without obtaining prior written approval from AAAWM. 25. Indemnity Service Partner agrees to maintain and provide proof of such insurance as will fully protect Service Partner and AAAWM from any and all claims under The Workmen's Compensation Act or employer's liability laws and from any and all other claims, for damage to property or for personal injury, including death, which may arise from operations carried on under this Contract, either by Service Partner, any Subcontractor, or by anyone directly or indirectly engaged or employed by either of them. Service Partner shall exonerate, indemnify, and hold AAAWM harmless, from and against, and shall assume full responsibility for payment of all federal, state, and local taxes or contributions imposed or required under unemployment insurance, Social Security, and income tax laws, with respect to Service Partner and its employees. AAAWM shall not be held liable for any liabilities, penalties, forfeitures, or for any damage to the goods, property or effects of the Service Partner, or for any other persons, not for personal injury to or death of them, caused by or resulting from any negligent act or omission of the Service Partner. Service Partner further agrees to indemnify and hold harmless AAAWM and its agents and employees against and from any and all of the foregoing liabilities, and any and all costs or expense including attorney's fees, incurred by AAAWM on account of any claim therefore. Service Partner agrees to assume the foregoing obligations and liabilities, by which it is intended by both parties that Service Partner shall indemnify and hold AAAWM harmless from all claims arising by reason of the work done or by reason of any act or omission of Service Partner. Service Partner shall, throughout the period of this Contract, provide public liability and property damage insurance covering all operations of Service Partner, its agents and employees, including, but not limited to, premises and automobiles. Said policies shall provide for a thirty (30), preferably ninety (90), calendar day written notice to AAAWM of any cancellation or material changes. If Service Partner is not a unit of government, it must carry adequate Fidelity Bond coverage for activities under this Contract. Upon request, Service Partner agrees to provide AAAWM with proof of insurance coverage required under this Section. 26. Continuing Right of Enforcement The failure of either of the parties to this Contract to insist on the performance of any of the terms and conditions of the Contract, or the waiver of any breach of any of the terms and conditions of the Contract, shall not be construed as waiving any such terms and conditions. The terms and conditions shall continue and remain in full force and effect as if no such forbearance or waiver had occurred. The failure ofAAAWM to enforce any of the provisions of this Contract, or to require performance by Service Partner of any of the provisions, shall in no way be constmed a waiver of such provisions, nor in any way affect the validity of this Contract, or the right ofAAAWM to enforce each and eveiy provision. 27. Liability for Damages and Disallowed Costs Notwithstanding any term or condition of this Contract to the contrary, Service Partner shall not be relieved of liability to AAAWM for damages sustained by AAAWM by virtue of any breach of the Contract by Service Partner, or by any disallowed cost. AAAWM shall have the right to demand of Service Partner the return of any Contract funds used for such disallowed costs and Service Partner agrees to comply with such demand. 28. Notice and Entire Agreement All notices under any provision of this Contract shall be deemed to be properly served if delivered in writing personally, or sent by first class or certified mail. Any mailed notice shall be deemed effective upon mailing. Notices to AAAWM and Service Partner shall be addressed to: AAAWM: Area Agency on Aging of Western Michigan, Inc. 3215EaglecrestDr.NE Grand Rapids, Michigan, 49525 Attention: Jackie O'Connor, Executive Director SERVICE PARTNER: Osceola County Board of Commissioners (Osceola County Commission on Aging) 301 W. Upton Avenue Reed City, MI 49677 Attention: Justin Halladay, Director 29. Governing Law This Contract shall be governed by Michigan law without regard to principles of conflict of law. Any litigation between the parties relating to the Contract shall be brought m the federal or state courts in or covering Kent County, Michigan. This Contract, together with the following attachments, constitutes the entire agreement between the parties. Any prior understanding, representation or negotiation of any kind proceeding the date of this Contract shall not be binding upon either party except to the extent incorporated in this Contract. Attachment I - Budget(s) Attachment II - Service Funding Distribution Chart Attachment III - Reprogramming and Redistribution Policy Attachment IV - Assurance of Compliance with Applicable Laws Attachment V - Authorization of Signature Form Area Agency on Aging of Western Michigan, Inc. By: l2^j^>. k^x-:^^ _ Date: 9 /^ Bill Routley, Chairperson ^ Service Partner: Osceola County Board of Commissioners la - /-/<9 By: (Qw^i -^U^ev^ _ Date: <7-2S Zo^ Authorized Signature Name: S^sfiv fJAi.t^A^f- JA^C l\f&.^\ Title: Diafcrof-L. _C^uri^^u^ Approved as to Administrative Form By: ^ \OJ^>O>A- ^-) LXSN^(^T\ _ Date: ^. V^» • \^ Jackie\0'Connor, Executive Director Area Agency on Aging of Western Michigan, Inc. Contract No. 61.82-FY2020 UNIT RATE BUDGET FORM Older Americans Act FY2020 OAA61.82-FY20.1 Attachment 1-A Service Partner: Osceola County Board of Commissioners (Osceola County CoA) Service: Congregate Meals Date: 08/16/2019 Prepared by: Jackie Campbell Unit Rate Budget I. Funding Summary: Federal Funds $55,298 One-time Federal Funds State Funds $0 One-time State Funds TOTAL AAAWM FUNDS AWARDED $55,298 Total Number of Units to be Provided 9,125 Estimated Number of Clients Who Will Receive Service 290 II. Total Per Unit Cost: Please explain program costs, lines 1-4, in the narrative below. 1 Administration & Fundraising Expenses $1.66 2 Delivery & Direct Service Cost $5.00 3 Raw Food $3.08 4 Other (Occupancy, Communication, etc.) $0.40 5 Total Cost BEFORE: $10.14 6 Less Program Income $2.83 7 Less NSIP $0.58 8 Less 10% Un it Match $0.67 9 Unit Rate to be Paid by AAAWM to Service Partner: $6.06 YES. Continue to Other Does line 9 equal line 10? Resources. 10 Contracted Unit Rate: 1 $6.06 III. Other Resources: 11 Projected Program Income $13,000 12 Other Resources $15,000 13 NSIP $5,885 IV. Match Required: $6,144 Source of Cash Match: Amount Source of In-Kind Match: Amount ~w Building/Kitchen space in Tustin, $0| Marion and Evart provided b^_ $0| Osceola County $6,144 Total Local Cash Match: $0| Total Local In-Kind Match: $6,144 Total Match: $6,144 YES. Continue to Is Total Match equal to or greater than Match Required listed above? Cost Narrative. UNIT RATE BUDGET FORM Older Americans Act FY2020 V. Program Cost Narrative Complete the following budget narrative describing the basis for expenditures in each category. 1. Administration & Fundraising: Wages and fringes for administrative hours; coordination of service, posting and reporting of service, advocating and fundraising 2. Delivery & Direct Service Cost: Wages and fringes for cooks, drivers and mealsite managers, travel, van and van maintenance 3. Raw Food: Grocery, frozen, meat, poultry, dairy and produce ordered to prepare meals 4. Other: Building and kitchen space, maintenance and utilities, internet/telephone service, paper products and office/kitchen supplies UNIT RATE BUDGET FORM Older Americans Act FY2020 OAA61.82-FY20.1 Attachment 1-B Service Partner: Osceola County Board of Commissioners (Osceola County CoA) Service: Home Delivered Meals Date: 08/16/2019 Prepared by: Jackie Campbell Unit Rate Budget I. Funding Summary: Federal Funds $65,410 One-time Federal Funds State Funds $60,000 One-time State Funds TOTAL AAAWM FUNDS AWARDED $125,410 Total Number of Units to be Provided 22,927 Estimated Number of Clients Who Will Receive Service I 174 II. Total Per Unit Cost: Please explain program costs, lines 1-4, in the narrative below. 1 Administration & Fundraising Expenses $1.66 2 Delivery & Direct Service Cost $4.60 3 Raw Food $3.35 4 Other (Occupancy, Communication, etc.) $0.40 5 Total Cost BEFORE: $10.01 6 Less Program Income $3.35 7 Less NSIP $0.58 8 Less 10% Unit Match -$06T 9 Unit Rate to be Paid by AAAWM to Service Partner: $5.47 YES. Continue to Other Does line 9 equal line 10? Resources. 10 Contracted Unit Rate: I $5.47 III. Other Resources: 11 Projected Program Income $14,000 12 Other Resources I $63,990 13 NSIP $19,119 IV. Match Required: $13,934 Source of Cash Match: Amount Source of In-Kind Match: Amount $0 Building/Kitchen space provided $0 $0 by Osceola County $13,934 $0 $0 Total Local Cash Match: $0 [Total Local In-Kind Match: $13,934 Total Match: $13,934 Is Total Match equal to or greater than Match Required listed above? ' "„" ~T'.""""~ Cost Narrative. UNIT RATE BUDGET FORM Older Americans Act FY2020 V. Program Cost Narrative Complete the following budget narrative describing the basis for expenditures in each category. 1. Administration & Fundraising: Wages and fringes for administrative hours, coordination of service, posting and reporting of service, payroll, ordering supplies and fundraising 2. Delivery & Direct Service Cost: Wages and fringes for cooks and drivers; paper products for delivery of food, travel and mileage reimbursement for drivers, van and van maintenance 3. Raw Food: Grocery, frozen, meat, poultry, dairy and produce to prepare meals 4. Other: Building and kitchen space, maintenance and utilities, internet/telephone service, office and kitchen supplies UNIT RATE BUDGET FORM Older Americans Act FY2020 OAA61.82-FY20.1 Attachment 1-C Service Partner: Osceola County Board of Commissioners (Osceola County CoA) Service: Disease Prevention / Health Promotion Date: 08/16/2019 Prepared by: Jackie Campbell Unit Rate Budget I. Funding Summary: Federal Funds $2,250 One-time Federal Funds State Funds $0 One-time State Funds I TOTAL AAAWM FUNDS AWARDED $2,250 Estimated Number of Clients Who Will Receive Service I 30 II. Other Resources: Projected Program Income $0 Projected Cost Share $0 III. Match Required: $250 Source of Cash Match: Amount Source of In-Kind Match: Amount $0| 136 sq ft office space provided $0 $0| by Osceola County @ $7.00 per $0 $0| square foot $250 Total Local Cash Match: $or Total Local In-Kind Match: $250 Total Match: $250 YES,. Continue to Is Total Match equal to or greater than Match Required listed above? Section IVa. For IVa. through IVc., please explain program costs, lines 1-4, in the narrative below. IVa. Total Per Unit Cost for DP/HP A Matter of Balance 1 Administration & Fundraising Expenses $160.00 2 Direct Service Cost $475.00 3 Equipment & Supplies $164.40 4 Other (Occupancy, Communication, etc.) $33.93 5 Total Cost BEFORE Match: $833.33 6 Less 10% Unit Match $83.33 7 Unit Rate to be Paid by AAAWM to Service Partner: $750.00 Does line 7 equal line 8? YES. Continue to Section IVb. 8 Contracted Unit Rate: $750.00 9 Minimum Number of Units to be Provided 1 UNIT RATE BUDGET FORM Older Americans Act FY2020 Attachment 1-C IVb. Total Per Unit Cost for DP/HP Diabetes PATH 1 Administration & Fundraising Expenses $0.00 2 Direct Service Cost $0.00 3 Equipment & Supplies $0.00 4 Other (Occupancy, Communication, etc.) $0.00 5 Total Cost BEFORE Match: $0.00 6 Less 10% Unit Match -$0:00 7 Unit Rate to be Paid by AAAWM to Service Partner: $0.00 Does line 7 equal line 8? NO. Please adjust. 8 Contracted Unit Rate: I $750.00 9 Minimum Number of Units to be Provided 0 IVc. Total Per Unit Cost for DP/HP Tai Chi 1 Administration & Fundraising Expenses $8.97 2 Direct Service Cost $26.60 3 Equipment & Supplies $9.20 4 Other (Occupancy, Communication, etc.) $1.90 5 Total Cost BEFORE Match: $46.67 6 Less 10% Unit Match $4.67 7 Unit Rate to be Paid by AAAWM to Service Partner: $42.00 YES. Continue to Cost Does line 7 equal line 8? ---- " ~ ^.^^^ Narrative. 8 Contracted Unit Rate: $42.00 9 Minimum Number of Units to be Provided 36 V. Program Cost Narrative Complete the following budget narrative describing the basis for expenditures in each category. 1. Administration & Fundraising: Wages and fringes for all administrative, fundraising, outreach and advocating hours; coordination of classes, registering individuals, posting and reporting of service 2. Direct Service Cost: Wages, fringes and travel costs for three trained class instructors UNIT RATE BUDGET FORM Older Americans Act FY2020 Attachment 1-C 3. Equipment & Supplies: Office supplies, computer/office machines, phone system 4. Other: Building space; Evart, Tustin and Marion, maintenance and utilities, interneVtelephone service UNIT RATE BUDGET FORM Older Americans Act FY2020 OAA61.82-FY20.1 Attachment 1-D Service Partner: psceola County Board of Commissioners (Osceola County CoA) Service: Homemaker Date: 08/16/2019 Prepared by: Jackie Campbell Unit Rate Budget I. Funding Summary: Federal Funds $8,060 One-time Federal Funds State Funds $32,950 One-time State Funds TOTAL AAAWM FUNDS AWARDED $40,950 Minimum Number of Units to be Provided 2,605 Estimated Number of Clients Who Will Receive Service 180 II. Total Per Unit Cost: Please explain program costs, lines 1-4, in the narrative below. 1 Administration & Fundraising Expenses $0.89 2 Direct Service Cost $16.17 3 Equipment & Supplies $0.15 4 Other (Occupancy, Communication, etc.) $0.26 5 Total Cost BEFORE Match: $17.47 6 Less 10% Un it Match $1.75 7 Unit Rate to be Paid by AAAWM to Service Partner: $15.72 YES. Continue to Other Does line 7 equal line 8? Resources. 8 Contracted Unit Rate: $15.72 III. Other Resources: 9 Projected Program Income I $1,900 10 Projected Cost Share $0 IV. Match Required: $4,550 Source of Cash Match: Amount Source of In-Kind Match: Amount $0 650 sq ft office space provided $0 by Osceola County @ $7.00 per $0 square foot $4,550 Total Local Cash Match: $0 Total Local In-Kind Match: $4,550 Total Match: $4,550 Is Total Match equal to or greater than Match Required listed above? " ~_" ~.~.'.'""~~. Cost Narrative. UNIT RATE BUDGET FORM Older Americans Act FY2020 V. Program Cost Narrative Complete the following budget narrative describing the basis for expenditures in each category. 1. Administration & Fundraising: Wages and fringes for administrative hours; coordination of service, posting and reporting of service, payroll, outreach, advocating and fundraising 2. Direct Service Cost: Wages, fringes, travel and mileage reimbursement for services provided by the case managers and homemakers 3. Equipment & Supplies: Office supplies, computer/office machines, phone system, medical supplies for homemakers such as medical gloves, masks 4. Other: Building space, maintenance and utilities, internet/telephone service UNIT RATE BUDGET FORM Older Americans Act FY2020 OAA61.82-FY20.1 Attachment 1-E Service Partner: Osceola County Board of Commissioners (Osceola County CoA) Service: Respite (includes homemaker respite and personal care respite) Date: 08/16/2019 Prepared by: Jackie Campbell Unit Rate Budflet I. Funding Summary: Federal Funds $5,000 One-time Federal Funds State Funds $54,549 One-time State Funds TOTAL AAAWM FUNDS AWARDED $59,549 Minimum Number of Units to be Provided 3,4741 Estimated Number of Clients Who Will Receive Service I 00, II. Total Per Unit Cost: Please explain program costs, lines 1-4, in the narrative below. 1 Administration & Fundraising Expenses $1.25 2 Direct Service Cost $17.05 3 Equipment & Supplies I $0.35 4 Other (Occupancy, Communication, etc.) $0.40 5 Total Cost BEFORE Match: $19.05 6 Less 10% Unit Match $1.91 7 Unit Rate to be Paid by AAAWM to Service Partner: $17.14 YES. Continue to Other Does line 7 equal line 8? Resources. 8 Contracted Unit Rate: $17.14 III. Other Resources: 9 Projected Program Income $500 10 Projected Cost Share I $3,500 IV. Match Required: $6,617 Source of Cash Match: Amount Source of In-Kind Match: Amount $01 1946 sq ft office space provided $0| by Osceola County @ $7.00 per $0[ square foot $6,622 Total Local Cash Match: $0| Local In-Kind Match: $6,622 Total Match: $6,622 YES. Continue to Is Total Match equal to or greater than Match Required listed above? ' ~^' ^7.""""," Cost Narrative. UNIT RATE BUDGET FORM Older Americans Act FY2020 V. Program Cost Narrative Complete the following budget narrative describing the basis for expenditures in each category. 1. Administration & Fundraising: Wages and fringes for administrative hours; coordination of service, posting and reporting of service, payroll, outreach, advocating and fundraising 2. Direct Service Cost: Wages, fringes, travel and mileage reimbursement for services provided by the nurse, case managers, homemakers and home health aides. 3. Equipment & Supplies: Office supplies, computer/office machines, phone system, medical supplies for homemakers and personal care providers such as medical gloves, masks, blood pressure cuffs, gait belts 4. Other: Building space, maintenance and utilities, internet/telephone service UNIT RATE BUDGET FORM Older Americans Act FY2020 OAA61.82-FY20.1 Attachment 1-F Service Partner: QsceglaCpynty Board of Comm (Osceola County CoA) Service: Transportation -Assisted Date: 08/16/2019 Prepared by: Jackie Campbell Unit Rate Budget I. Funding Summary: Federal Funds $39,458 One-time Federal Funds State Funds $0 One-time State Funds TOTAL AAAWM FUNDS AWARDED $39,458 Minimum Number of Units to be Provided 2,134 Estimated Number of Clients Who Will Receive Service ^40 II. Total Per Unit Cost: Please explain program costs, lines 1-4, in the narrative below. 1 Administration & Fundraising Expenses I $1.92 2 Direct Service Cost I $17.94 3 Equipment & Supplies $0.20 4 Other (Occupancy, Communication, etc.) I $0.48 5 Total Cost BEFORE Match: $20.54 6 Less 10% Un it Match $2.05 7 Unit Rate to be Paid by AAAWM to Service Partner: $18.49 YES. Continue to Other Does line 7 equal line 8? Resources. 8 Contracted Unit Rate: $18.49 III. Other Resources: 9 Projected Program Income $3,000 10 Projected Cost Share $0 IV. Match Required: $4,384 Source of Cash Match: Amount Source of In-Kind Match: Amount $0 627 sq ft office space provided $0 by Osceola County @ $7.00 per $0 sqyarefeet $4,389 Total Local Cash Match: $0 Total Local In-Kind Match: $4,389 Total Match: $4,389 YES. Continue to Is Total Match equal to or greater than Match Required listed above? ' ~n"_\17,""-"'J. Cost Narrative. UNIT RATE BUDGET FORM Older Americans Act FY2020 V. Program Cost Narrative Complete the following budget narrative describing the basis for expenditures in each category. 1. Administration & Fundraising: Wages and fringes for administrative hours; coordination of service, posting and reporting of service, payroll, advocating for volunteers used to provide this service, outreach and fundraising 2. Direct Service Cost: 3. Equipment & Supplies: Office supplies, computer/office machines, phone system 4. Other: Building space, maintenance and utilities, internet/telephone services Attachment II Contract No. 61.82 - FY20.1 Area Agency on Aging of Western Michigan Older Americans Act Funding Distribution October 1, 2019 - September 30, 2020 Funding as of: July 22, 2019 Osceola County Board of Commissioners (Osceola County Commission on Aging) Service Source CFDA Award Disease Prevention/Health Promotion HID 93.043 $2,250 Homemaker IIIB 93.044 $8,000 SAG $10,950 SIH $22,000 Respite IIIE 93.052 $5,000 SIH $41,549 Tobacco $13,000 Transportation - Assisted IIIB 93.044 $39,458 Congregate Meals IIIC-1 93.045 $55,298 NSIP** 93.053 $5,885 Home Delivered Meals IIIC-2 93.045 $65,410 SHDM $60,000 NSIP** 93.053 $19,119 Total Funding $347,919 **The NSIP amount is only an approximation. We do not expect NSIP funding to be finalized by the state until September of 2020. Attachment III AREA AGENCY ON AGING OF WESTERN MICHIGAN. INC. REPROGRAMMING & REDISTRIBUTION POLICY Definitions "Reprogramming" means the process of a Service Partner making a change in a service budget or transferring money between service categories as a result of under spending or under serving. Reprogramming refers to the method by which a Service Partner that is under spending or under serving is able to develop a plan to expend the unspent amount(s) as a one-time expense related to the service in question or a different service. "Capture" means the process ofAAAWM reducing a Service Partner's allocation if the Service Partner is unable to develop a reasonable and sound Reprogramming plan. "Redistribution" means the process ofAAAWM reallocating Captured funds to another Service Partner. REPROGRAMMING & REDISTRIBUTION A Service Partner shall be considered for Reprogramming, when that Service Partner's spending is ten percent (10%) below the funding level or (10%) ten percent underserved at midyear of the contract. If at the end of the first six (6) months of a budget year, a Service Partner is found to be under serving or under spent by ten percent (10%) or more, the Service Partner may be required to provide an explanation and a Reprogramming plan to catch up. If the Service Partner is unable to develop a reasonable and sound Reprogramming plan for spending the under spent funds, these funds can be Captured by AAAWM for Redistribution to another Service Partner. If at the end of the first nine (9) months of a budget year, a Service Partner is found to be under serving or under spent by ten percent (10%) or more, the Service Partner shall be required to provide an explanation and a Reprogramming plan to catch up. If the Service Partner is unable to develop a reasonable and sound Reprogramming plan for spending the under spent funds, these funds will be Captured by AAAWM for Redistribution to another Service Partner. When funds have been determined eligible for Reprogramming or Redistribution, AAAWM staff shall attempt to verify the rate of under spending/under serving. After verifying the rate of under spending/under serving, AAAWM may determine that funds should be Captured; however, final decision rests with the AAAWM Board of Directors. If funds are to be Captured, the following procedure will be followed: 1. The Service Partner must be notified in writing at least ten (10) calendar days prior to the Board of Directors meeting, at which time the Capture issue will be considered. 2. If the Service Partner disagrees with the need for Capture, written explanation of that disagreement must be received by AAAWM at least two (2) working days prior to the Board of Directors meeting. 3. Reasons for and against Capture in each case will then be presented to the Board of Directors concurrently. Decisions of the Board of Directors relative to Capture are final and binding upon the Service Partner. 4. Funds which are not spent as a result of contract termination will automatically be Captured. Procedures for Redistribution of Captured Funds Requirements for Service Partners wishing to be considered for Captured funds are delineated below in accordance with the nature of the applicant. Application Type Application Requirements 1. Current Service Partners desire additional a. Narrative explaining why added funds are funds for currently funded services. needed and how added funds will be used. b. A budget for the additional funds. c. Confirmation of added Local Match. 2. Current Service Partners desire funds for a Submission of an abbreviated application new service. provided by AAAWM. 3. New Service Partners Submission of a complete proposal. It should be noted that all requests for additional funds will be considered carefully in view of their implications for total service capacity in future years. That is, AAAWM shall not begin or expand services beyond the level which can be realistically maintained for the following year. Bearing this in mind, applicants should plan to utilize additional funds for one time or temporary costs whenever possible (i.e., purchase of equipment, temporary labor, or one-time publicity printing). The decision to grant or deny an application for Captured funds is at the sole discretion ofAAWM. Finally, ongoing communication between AAAWM and the Service Partner is crucial to effectively implement the Reprogramming and Redistribution Policy. AAAWM staff will contact Service Partners if there are inconsistencies in the monthly/quarteriy reports or if over or under spending/serving is apparent. Service Partners shall promptly alert AAAWM staff under the following circumstances: 1. If problems are experienced in the management of funds, including bookkeeping and reporting. 2. If under spending/under serving is occurring and the Service Partner wishes to spend the money in another manner for the same service. 3. If the Service Partner requires more funds for a service and wishes to be considered a candidate for the Redistributed funds acquired by AAAWM through the Capture process. Priority, when possible, will be placed on keeping funds in the same service for the same Service Partner for which those funds were originally contracted. Attachment IV ASSURANCE OF COMPLIANCE WITH APPLICABLE LAWS Partners shall comply with all federal, state and local laws, regulations, executive orders and ordinances applicable to the Contract with the Area Agency on Aging of Western Michigan, Inc. ("AAAWM.") so far as they applicable to the services provided. Without limiting the generality of the foregoing, Partners expressly agree to comply with the following standards, laws, regulations and executive orders, as they may be amended from time to time during the term of the Contract, to the extent they are applicable to the Contract and to the Partner. Service Program Standards The Department of Community Health has issued standards for the MI Choice Waiver program. These standards identify the responsibilities and requirements associated with being a waiver agent or contracted service partner. The standards are broken down into three categories: (1) General operating standards for waiver agents and their contracted service partners, (2) General operating standards for MI Choice waiver service partners, and (3) Specific operating standards for MI Choice Waiver service partners. Assurance of Compliance with Section 504 of the Rehabilitation Act of 1973, as Amended The undersigned HEREBY AGREES THAT it will comply with section 504 of the Rehabilitation Act of 1973, as amended (29.U.S.C. 794), all requirements imposed by the applicable HHS regulations (45.C.F.R. Part 84) and all guidelines and interpretations issued pursuant thereto. Pursuant to 84.5(a) of the regulation (45.C.F.R. 84(a)) the partner gives this assurance in consideration of and for the pmpose of obtaining any and all grants, loans, contracts (except procurement contracts of insurance or guaranty), property, discounts, or other financial assistance made after such date on applications for financial assistance that were approved before such date. The partner recognizes and agrees that such financial assistance will be extended in reliance on the representations and agreements made in this assurance and that the Michigan Aging and Adult Services Agency (AASA) will have the right to enforce this assurance through lawful means and that failure to comply with section 504 of the Rehabilitation Act of 1973 may result in termination or Capture and Redistribution. This assurance is binding on the partner, its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign this assurance on behalf of the recipient. This assurance obligates the partner for the period during which Federal financial assistance is extended to it by the Michigan Office of Services to the Aging or, where the assistance is in the form of real or personal property for the period provided for in 84.5(b) or the regulation (45.C.F.R. 84.5(b)). Assurance of Compliance with the Equal Opportunity Executive Orders, Department of Health, Education & Welfare Regulation Under Title VI of the Civil Rights Act of 1964, Michigan Handicappers Civil Rights act of 1976, EIliott-Larsen Civil Rights Act of 1976. The undersigned HEREBY AGREES THAT it will comply with the Equal Opportunity requirements of Executive Order 1979-4 issued by the Governor September 7, 1979; Executive Order 1983-4 issued by the Governor March 3, 1983; the Michigan Civil Rights Act, P.A. 453 of 1976, as amended; the Michigan Handicappers' Civil Rights Act, P.A. 220 of 1976, as amended; and the Americans with Disabilities Act, P.L. 101-336, 1990; Title VI of the Civil Rights Act of 1964 (P.L. 88-52), the Michigan Handicapper's Civil Rights Act of 1975 (P.S. 220), and the Elliott-Larsen civil Rights Act of 1975 (P.A. 453, Section 209) and will comply with requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45.C.F.R. Part 80) issued pursuant to that title to the end that, in accordance with Title VI of that Act and the Regulation, no person in the United States shall, on the grounds of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the undersigned receives Federal or state financial assistance from AAAWM, and HEREBY GIVES ASSURANCE THAT it will immediately take any measures necessary to effectuate this agreement. If any real property or structure thereon is provided or improved with the aid of Federal or state financial assistance extended to the undersigned, this Assurance shall obligate the undersigned, or in the case of any transfer of such property, any transferee, for the period during which said real property or structure is used for a purpose for which Federal or state financial assistance is extended or for another purpose involving the provision of similar services or benefits. This Assurance further certifies that the undersigned has no commitments or obligations which are inconsistent with compliance with these and any other pertinent Federal or state regulations and policies, and that any other agency, organization or party which participates in this project shall have no such commitments or obligations, and all activities shall not run counter to the purpose and intent of this agreement. THIS ASSURANCE is given in consideration of and for the purpose of obtaining any and all Federal or state grants, loans, contracts, property, discounts, or other Federal or state grants, loans, contracts, property, discounts or other Federal or state financial assistance extended after the date hereof to the undersigned by AAAWJVt including installment payments after such date on account of applications for Federal financial assistance which were received before such date. The undersigned recognizes and agrees that such Federal financial assistance will be extended in reliance on the representations and agreements made in this Assurance, and that AAAWM or the United States or both shall have the right to seek judicial enforcement of this Assurance or termination or Capture and Redistribution. This Assurance is binding on the undersigned, its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign this Assurance on behalf of the undersigned. -> Ch 3^ck. A/eIn/i^T -3'^fl^S UAWWtvf Full Name (Type or Pririt)sfe Attachment V EFFECTIVE DATE:_ AUTHORIZATION OF SIGNATURE FOR SERVICE AND FINANCIAL REPORTS FOR AAAWM FUNDED PROGRAMS 1. Name and Address of Service Partner: toc^Lx CQLLH^ flomft/\is Signatures of individuals authorized to sign service reports and financial reports 2. Signature/Typed Name and Title: al ^D^s^r^U^^^ b) A/f^ (L^/)6 ^ / Name '3Uyi'll n ^fr^d a•^ Name J^UL^Ie. C^mObte^V Title T)lf(?G-h3r Title V\^C.O\ tA^n^^r O^L d)_ Name ^\QJ-^[C^ Name Title ^cWm. ft-^-sL Title el_ j0_ Name Name Title Title 3. I certify that the signature (s) above is (are) of the individual (s) authorized to sign service reports and financial reports. 10 -(-^ -^^^^d^U^r- _ —^^-^n- Sign^ure of Service Partner C^rperson Date .J^<^<-. A/e^m-i^r C[^t^iri^a~-^\ Name —^"t^q^—^Ufc^^W- _ Title J)(Rcao^. Note: The submitted form is valid until AAAWM is notified of any changes regarding persons authorized to sign service and financial reports. It is the Service Partner's responsibility to notify AAAWM of any changes. AREA AGENCY ON AGING OF WESTERN MICHIGAN BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement ("Agreement") is being entered into between the Area Agency on Aging of Western Michigan, Inc. (AAAWM) ("Covered Entity"), located at 3215 Eaglecrest Dr NE, Grand Rapids, MI 49525, and Osceola County Board of Commissioners ("Business Associate"), located at 301 W. Upton Avenue, Reed City, MI 49677, to facilitate compliance with the Privacy and Security Rules. It is also being entered into between the parties to facilitate compliance with the HITECH Amendment to HIPAA. In consideration for the compensation paid to Business Associate to provide services relating to and on behalf of Covered Entity, the parties agree to the terms set forth in this Agreement. Article 1 Definitions The following terms have the meanings described in this Article for pmposes of the Agreement unless the context clearly indicates another meaning. Terms used, but not otherwise defined, in this Agreement have the same meaning as those terms in the Privacy Rule. 1.1 Business Associate "Business Associate" means the person or entity described in the first paragraph of this Agreement. 1.2 CFR "CFR" means the Code of Federal Regulations. 1.3 Covered Entity "Covered Entity" means the Area Agency on Aging of Western Michigan, Inc. (AAAWM), a Michigan nonprofit corporation. 1.4 Designated Record Set "Designated Record Set" has the same meaning as the term "Designated Record Set" in 45 CFR 164.501. 1.5 Electronic Health Record "Electronic Health Record" (EHR) means an electronic record of health-related information on an individual that is created, gathered, managed, and consulted by authorized health care clinicians and staff. 1.6 HIPAA "HIPAA" means the Health Insurance Portability and Accountability Act of 1996. 1.7 HITECHAmendment "HITECH Amendment" means the changes to HIPAA made by the Health Information Technology for Economic and Clinical Health Act. FY2020 1.7.1 OMNIBUS Final Rule "Omnibus Final Rule" means the changes to HIPAA made by the Department of Health and Human Services (DHHS) 45 CFR parts 160 and 164. 1.8 Individual "Individual" has the same meaning as the term "individual" in 45 CFR 160.103 and includes a person who qualifies as a personal representative in accordance with 45 CFR 164.502(g). 1.9 Privacy Rule "Privacy Rule" means the privacy rule of HIPAA as set forth in the Standards for Privacy of Individually Identifiable Health Information at 45 CFR part 160 and part 164, subparts A and E. 1.10 Protected Health Information "Protected Health Information" or "PHI" has the same meaning as the term "protected health information" in 45 CFR 160.103, limited to the information created, received, maintained or transmitted by Business Associate from or on behalf of Covered Entity. 1.11 Required By Law "Required By Law" has the same meaning as the term "required by law" in 45 CFR 164.103. 1.12 Secretary "Secretary" means the Secretary of the Department of Health and Human Services or his/her designee. 1.13 Security Incident "Security Incident" has the same meaning as the term "Security Incident" in 45 CFR 164.304. 1.14 Security Rule "Security Rule" shall mean the security standards and implementation specifications at 45 CFR Part 160 and Part 164, subpart C. Article 2 Obligations and Activities of Business Associate Business Associate agrees to perform the obligations and activities described in this Article. 2.1 Business Associate understands that pursuant to the HITECH Amendment and Omnibus Final Rule, it is subject to the HIPAA Privacy and Security Rules in a similar manner as the rules apply to Covered Entity. As a result, Business Associate agrees to take all actions necessary to comply with the HIPAA Privacy and Security Rules for business associates as revised by the HITECH Amendment and Omnibus Final Rule, including, but not limited to, the following: Business Associate shall appoint a HIPAA privacy officer and a HIPAA security officer. Business Associate shall establish policies and procedures to ensure compliance with the Privacy and Security Rules, Business Associates shall train its workforce regarding the Privacy and Security Rules, Business Associate shall enter into a privacy/security agreement with Covered Entity, Business Associate shall enter into privacy/security agreements with its subcontractors that perform functions relating to Covered Entity involving PHI, and Business Associate shall conduct a security risk analysis. FY2020 2.2 Business Associate agrees to not use or disclose Protected Health Information other than as permitted or required by the Agreement or as Required By Law. 2.3 Business Associate agrees to use appropriate safeguards, and comply with Subpart C of 45 CFR Part 164 with respect to electronic PHI, to prevent use or disclosure of the Protected Health Information other than as provided for by this Agreement. Business Associate shall implement administrative, physical and technical safeguards (including written policies and procedures) that reasonably and appropriately protect the confidentiality, integrity and availability of electronic PHI that it creates, receives, maintains or transmits on behalf of Covered Entity as required by the Security Rule. 2.4 Business Associate agrees to mitigate, to the extent practicable, any harmful effect that is known to Business Associate of a use or disclosure of Protected Health Information by Business Associate in violation of the requirements of this Agreement. 2.5 Business Associate agrees to report to Covered Entity any use or disclosure of the Protected Health Information not provided for by this Agreement of which it becomes aware and/or any Security Incident of which it becomes aware. In addition. Business Associate agrees to the following in connection with the breach notification requirements of the HITECH Amendment and Omnibus Final Rule: (a) If Business Associate discovers a breach ofunsecured PHI, as those terms are defined by 45 CFR 164.402, Business Associate shall notify Covered Entity without unreasonable delay and within 10 calendar days after discovery. For this purpose, discovery means the first day on which the breach is known to Business Associate or by exercising reasonable diligence would have been known to Business Associate. Business Associate shall be deemed to have knowledge of a breach if the breach is known or by exercising reasonable diligence would have been known to any person, other than the person committing the breach, who is an employee, officer, subcontractor or other agent of Business Associate. The notification must include identification of each individual whose unsecured PHI has been or it has reasonably believed to have been breached and any other available information in Business Associate's possession which the Plan is required to include in the individual notice contemplated by 45 CFR 164.404. (b) Notwithstanding the immediately preceding paragraph. Business Associate shall assume the individual notice obligation specified in 45 CFR 164.404 on behalf of Covered Entity where a breach of unsecured PHI was committed by Business Associate or its employee, officer, subcontractor or other agent of Business Associate or is within the unique knowledge of Business Associate as opposed to Covered Entity. In such case. Business Associate will prepare the notice and shall provide it to Covered Entity for review and approval at least five calendar days before it is required to be sent to the affected individual(s). Covered Entity shall promptly review the notice and shall not unreasonably withhold its approval. (c) Further, where a breach involves more than 500 individuals and was committed by the Business Associate or its employee, officer, subcontractor or other agent or is within the unique knowledge of Business Associate as opposed to Covered Entity. Business Associate shall provide notice to the media pursuant to 45 CFR 164.406. Again, Business Associate FY2020 will prepare the notice and shall provide it to Covered Entity for review and approval at least five calendar days before it is required to be sent to the media. Covered Entity shall promptly review the notice and shall not unreasonably withhold its approval. (d) Business Associate shall maintain a log of breaches of unsecured PHI with respect to Covered Entity and shall submit the log to Covered Entity within 30 calendar days following the end of each calendar year so that the Plan may report breaches to the Secretary in accordance with 45 CFR 164.408. 2.6 Business Associate agrees to ensure that any agent, including a subcontractor, to whom it provides Protected Health Information received from, created, maintained, transmitted or received by Business Associate on behalf of Covered Entity, agrees in writing to the same restrictions and conditions that apply through this Agreement to Business Associate with respect to such information. Moreover, Business Associate shall ensure that any such agent or subcontractor agrees to implement reasonable and appropriate safeguards to protect Covered Entity's electronic PHI. 2.7 Business Associate agrees to provide reasonable access, at the written request of Covered Entity, to Protected Health Information in a Designated Record Set, to Covered Entity or, as directed in writing by Covered Entity, to an Individual in order to meet the requirements under 45 CFR 164.524. If Business Associate receives a request directly from an Individual or the Individual's designee, Business Associate shall notify Covered Entity as soon as administratively feasible in order for the parties to coordinate a response. 2.8 Business Associate agrees to make any amendment(s) to Protected Health information in a Designated Record Set that the Covered Entity directs in writing or agrees to pursuant to 45 CFR 164.526 at the written request of Covered Entity or an Individual. If Business Associate receives a request directly from an Individual or the Individual's designee, Business Associate shall notify Covered Entity as soon as administratively feasible in order for the parties to coordinate a response. 2.9 Following receipt of a written request by Covered Entity, Business Associate agrees to make internal practices, books, and records including policies and procedures and Protected Health Information relating to the use and disclosure of Protected Health Information received from, created, maintained or received by Business Associate on behalf of, Covered Entity reasonably available to the Secretary for purposes of the Secretary determining Covered Entity's compliance with the Privacy Rule. 2.10 Business Associate agrees to document such disclosures of Protected Health Information and information related to such disclosures as would be required for Covered Entity to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528, or effective as of such later effective date prescribed by regulations issued by the U.S. Department of Health and Human Services, an accounting of disclosures of Protected Health Information from an Electronic Health Record in accordance with the HITECH Amendment. 2.11 Following receipt of a written request by Covered Entity, Business Associate agrees to provide to Covered Entity or an Individual, information collected in accordance with Section 2.10 of this Agreement, to permit Covered Entity to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528, or effective as of such later effective date prescribed by regulations issued by the U.S. Department of Health and Human Services, an accounting of disclosures of Protected Health Information from an Electronic Health FY2020 Record in accordance with the HITECH Amendment. If Business Associate receives a request directly from an Individual or the Individual's designee, Business Associate shall notify Covered Entity as soon as administratively feasible in order for the parties to coordinate a response. Article 3 Permitted Uses and Disclosures by Business Associate 3.1 Except as otherwise limited in this Agreement, Business Associate may use or disclose Protected Health Information to perform functions, activities or services for, or on behalf of. Covered Entity as specified in the underlying service agreement between Covered Entity and Business Associate, provided that such use or disclosure would not violate the Privacy Rule if done by Covered Entity or the minimum necessary policies and procedures of the Covered Entity. If there is no underlying service agreement between Covered Entity and Business Associate, Business Associate may use or disclose Protected Health Information to perform functions, activities or services for, or on behalf of. Covered Entity for the purposes of payment, treatment or health care operations as those terms are defined in the Privacy Rule, provided that such use or disclosure would not violate the Privacy Rule if done by Covered Entity or the minimum necessary policies and procedures of the Covered Entity. 3.2 Except as otherwise limited in this Agreement, Business Associate may use Protected Health Information for the proper management and administration of the Business Associate or to carry out the legal responsibilities of the Business Associate. 3.3 Except as otherwise limited in this Agreement, Business Associate may disclose Protected Health Information for the proper management and administration of the Business Associate or to carry out the legal responsibilities of the Business Associate, provided that disclosures are Required by Law, or Business Associate obtains reasonable assurances in writing from the person to whom the information is disclosed that it will remain confidential and used or further disclosed only as Required by Law or for the purpose for which it was disclosed to the person, and the person notifies the Business Associate of any instances of which it is aware in which the confidentiality of the information has been breached. 3.4 Except as otherwise limited in this Agreement, Business Associate may use Protected Health Information to provide Data Aggregation services to Covered Entity as permitted by 45 CFR 164.504(e)(2)(i)(B). 3.5 Business Associate may use Protected Health Information to report violations of law to appropriate Federal and State Authorities, consistent with 45 CFR 164.502(j)(l). Article 4 Obligations of Covered Entity 4.1 Covered Entity shall notify Business Associate of any limitation(s) in its notice of privacy practices of Covered Entity in accordance with 45 CFR 164.520, to the extent that such limitation may affect Business Associate's use or disclosure of Protected Health Information. FY2020 4.2 Covered Entity shall notify Business Associate of any changes in, or revocation of, permission by an Individual to use or disclose Protected Health Information, to the extent that such changes may affect Business Associate's use or disclosure of Protected Health Information. 4.3 Covered Entity shall notify Business Associate of any restriction to the use or disclosure of Protected Health Information that Covered Entity has agreed to in accordance with 45 CFR 164.522, to the extent that such restriction may affect Business Associate's use or disclosure of Protected Health Information. Article 5 Term and Termination 5.1 Term This Agreement shall terminate on the date the Agreement is terminated for cause pursuant to Section 5.2, when the underlying service agreement between the parties terminates, or as of such other date as agreed to by the parties in writing. However, the protections in Section 5.3 shall survive termination of the Agreement and continue as specified in Section 5.3. 5.2 Termination for Cause Upon either party's knowledge of a material breach of this Agreement by the other party (the "breaching party"), the first party shall either: Provide an opportunity for the breaching party to cure the breach or end the violation and terminate this Agreement if the breaching party does not cure the breach or end the violation within a reasonable time, as specified by the first party; Immediately terminate this Agreement if the breaching party has breached a material term of this Agreement and cure is not possible; or If neither termination nor cure are feasible, the first party shall report the violation to the Secretary. 5.3 Effect of Termination Upon termination of this Agreement for any reason. Business Associate shall return or destroy all Protected Health Information received from Covered Entity, or created or received by Business Associate on behalf of Covered Entity. This provision shall apply to Protected Health Information that is in the possession of subcontractors or agents of Business Associate. Business Associate shall retain no copies of the Protected Health Information. In the event that Business Associate determines that returning or destroying the Protected Health Information is infeasible, Business Associate shall provide to Covered Entity written notification of the conditions that make return or destruction infeasible. Upon receipt of written notification that return or destruction of Protected Health Information is infeasible, Business Associate shall extend the protections of this Agreement to such Protected Health Information and limit further uses and disclosures of such Protected Health Information to those purposes that make the return or destruction infeasible, for so long as Business Associate maintains such Protected Health Information, which shall be for a period of at least six years. FY2020 Article 6 Miscellaneous 6.1 Notice Any notice or other written communication required or permitted to be given to the other party under this Agreement must be addressed to the attention of the other party in care of the contact person identified below. Written notice may be delivered by certified mail or overnight mail. Covered Entity: Area Agency on Aging of Western Michigan, Inc. Contact Person: HIPAA Privacy Officer - Suzanne Filby-Clark 3215EaglecrestDrNE Grand Rapids, MI 49525 Business Associate: Osceola County Board of Commissioners Contact Person: 301 W. Upton Avenue Reed City, MI 49677 6.2 Regulatory References A reference in this Agreement to a section in the Privacy Rule or Security Rule means the section as in effect or as amended. 6.3 Amendment This Agreement may only be amended in a written document signed by an authorized representative of each party. The parties agree to take such action as is necessary to amend this Agreement from time to time as is necessary for Covered Entity to comply with the privacy and security requirements of HIPAA. If the Business Associate refuses to sign such an amendment, this Agreement shall automatically terminate. 6.4 Survival The respective rights and obligations of Business Associate under Section 5.3 of this Agreement shall survive the termination of this Agreement. 6.5 Interpretation Any ambiguity in this Agreement shall be resolved to permit Covered Entity to comply with the Privacy Rule and the Security Rule. 6.6 Successors This Agreement is binding on each party's legal successors. 6.7 Indemnification Business Associate agrees to indemnify and hold harmless Covered Entity and its directors, officers and employees against any and all claims, lawsuits, settlements, judgments, costs, penalties and expenses including attorney's fees resulting from or arising out of or in connection with a use or FY2020 disclosure of Protected Health Information by Business Associate or its subcontractors or agents in violation of this Agreement. Covered Entity agrees to indemnify and hold harmless Business Associate and its directors, officers and employees against any and all claims, lawsuits, settlements, judgments, costs, penalties and expenses including attorney's fees resulting from or arising out of or in connection with a use or disclosure of Protected Health Information by Covered Entity, or agents of Covered Entity, in violation of this Agreement. 6.8 No Beneficiaries Nothing expressed or implied in this Agreement is intended to confer, nor shall anything confer, upon any person other than the Covered Entity and Business Associate, and their respective successors or assigns, any rights, remedies, obligations or liabilities. Area Agency on Aging of Western Michigan, Inc. (Covered Entity) By Dated: ^- \^L-\C( Jackiep'Connor, Executive Director And Osceola County Board of Commissioners (Business Associate) lp-(-(£j By_ ^"1 ^^9\M^^VC^ Dated: e\ 2'&-("| ~y~ O^k^ i\/^m^-[^ Name: ^G-7 C-l^^Llrm^u^ Title: OiftecTo^ FY2020 Osceola Commission on Aging Date: 9/23/2019 To: Susan Vander Pol, County Coordinator From: Justin Halladay, COA Director Subject: Purchase Requests for Board Meeting During my first two weeks as Director of Osceola County Commission on Aging I have found some areas that need to be addressed regarding needed equipment. I also have a request to create a COA Facebook page. I have compiled those needs with both an explanation and a plan to replace. Vehicles: The COA operates with five service vehicles. All may have the responsibly of transporting seniors/delivering meals or used as employee transportation to trainings or meetings. At time there are not enough vehicles to provide to our needs requiring employees to drive there personal vehicles during work hours on COA business. Units 1-3 are in proper working order and don't need replacement. Unit 1 2014 Dodge Caravan (7 pass) 60,000 miles Unit 2 2014 Dodge Caravan (7 pass) 50,000 miles Unit 3 2018 Dodge Caravan (lift) 15,000 miles The two remaining units though I have found do have mechanical issues that would be too costly to repair based upon the age and miles of the vehicle. Unit 4 2005 Ford Expedition (maint) 147,000 miles Needs panel/radiator support and AC repaired; approx. cost $3000 Unit 5 2006 Ford Freestar (6 pass) 106/000 miles Needs engine overhaul, no compression on 2 cyl; approx. cost $3500 For these reasons I am requesting to purchase three vehicles. Two to replace the older units and the third to fill the gap of when a unit is unavailable. We would sell both older ones. These units would be used as stated above. 2019/20 Dodge Caravan (7 pass) $21,097 (mideal state bid) 2019/20 Chevrolet Express (12 pass) $23,656 (mideal state bid) Total $44,753 For the third vehicle I have listed some options for purchase. Used: I checked Autotrader and found a 2011 Ford Fusion with 58,000 miles for $10,000 at Betten Baker in Cadillac. Further search expanding the area found others of similar options. New: I checked mideal for mid size sedans and have included that information. I also checked for small SUV AWD types that would provide extra security in inclement weather and provide seating for clients. The final option would be to purchase an additional Dodge Caravan (7 pass) as listed above. Sedan 2019 Ford Fusion S $16,285 $61,038 2019 Chevrolet MALIBU $17,390 suv 2019 Ford Escape SE 4x4 $20,530 $65,283* 2019 Jeep COMPASS SPORT 4x4 $20,881 Mini-Van 2019/20 Dodge Caravan $21,097 $65,850 Funding for the purchases can come from unused COA director wages. 280.120.702.001 (2/3 of $63,056) $42,000 (approx. unused funds) The remaining amount could come from the 280 line which encompasses the benefits for the COA Director which also has 1/3 used this year. The remaining could come from the general fund balance in 280. Storage Building: The current storage building behind COA is very small (5x7) and does not provide enough space for maintenance. A building (12x16) would accommodate the needs for storage. Mid Michigan Barns 12x16 pre built delivered/set up $3,768.50 Store More Mini Barns 12x16 pre built delivered/set up $4,443.52 Home Depot 12x16 pre built delivered/set up $4,489.00 Funding for the building purchase could come out of the 280 line as stated above or the COA general fund. Blood Pressure Cuffs: The home health aids need blood pressure cuffs. The type used last for about a year and many are starting to fail. Purchasing ten of these will restock and replace those units. ADW Diabetes: Omron Wrist BP monitor 58.90 each $589.00 Target: Omron Wrist BP monitor 58.99 each $589.90 Walmart: Omron Wrist BP monitor 66.31 each $663.10 Funding for the BP monitors could come out of the 280 line as stated above or the COA general fund. The following purchase requests should come from the 282.120.989.000 Capital Outlay $64,800 was budgeted for 2019 to put a ramp at the side door of the Tustin meal site. After inspecting the location and meeting with COA staff, it was determined that the ramp was not a priority at this time. The funds would be used for purchases that are of a higher need within the meal sites. AEDs: There are currently no operable AEDs in any COA facility. With the population that we serve this is not acceptable and needs to be addressed. I have contacted two sources for AEDs to costs. My suggestion would be to purchase four AED's and trade in an inoperable unit. BioMedical Solutions LifePak CR plus with wall mounts $795 for AED. $140 for wall mount (4) $3,740 Stryker Medical Lifepak CR2 with wall mounts $1,988 for AED and wall mount (4) $7,954 I would suggest after my research into each model and our need to purchase the AEDs from BioMedical Solutions for $3,740. I plan to apply for a grant to assist with the purchase but with the need being a priority I request to move forward with the purchase now. Walk in Cooler: The top three walk-in cooler quotes from Robin & Brad for the Cargill grant request. They prefer the one from Central HVAC Supply as it's a local vendor in Big Rapids and it would be easier to obtain repair parts in the future. If you deduct shipping costs, it falls within the 5% local vendor allowance. Central HVAC Supply (includes $200 shipping estimate) #C068FL.PA95 Cooler Box w/ Equipment $8,630.50 Webstaurant Store (ships free) Nor-Lake KODB68-C Kold Locker 6'x8'x6/7" Outdoor Walk-ln Cooler $8,139.50 Serv-U (shipping ? ) ft760610-X PHXZ0150BT SKW #MASW-4002 Outdoor Walk-ln Freezer 5'10"x9/8" PRS-2 Series $9,149.00 Double Oven: Our current double oven at the Tustin meal site was donated as used equipment approximately 10 years ago and is starting to fail. A new oven is needed. Webstaurant: Vulcan VC44GD 100,000 BTU $7,770 Big Tray: Vulcan VC44GD 100,000 BTU $7/770 Serv-U: Vulcan VC44GD 100,000 BTU $8,613 Travel Expense Line Item: A budget amendment was done totaling $12,000 from this fund to 282.125.860.000 Generator: The Tustin meal site needs an emergency generator installed, due to the location being the primary meal site preparation area and also an emergency shelter. I request to move forward with the purchase process by completing a request for bid (RFB) on a generator. The estimated cost for the generator at this time should be between 10 and 15 thousand. FundinR/Cost Breakdown: line item Start $64,800 Budget/Amendment - 12,000 AEDs - 3,740 Generator -15,000 (approx) Cooler - 8,630 Marion sign - 1,232 Oven - 7,770 $16,428 remaining P.O.Box594 Evart, Michigan 49631 231-734-5559 Fax 231-734-6009 AGREEMENT THIS AGREEMENT, made and entered into this _day of_,20_, by and between the Osceola County Board of Commissioners (hereafter referred to as the "Board"), acting on behalf of the County ofOsceola, a municipal corporation and political subdivision of the State of Michigan (hereinafter referred to as the "County") and LCM SURVEYING & ENGINEERING, INC, whose address is 225 East Main St, P.O. Box 408, Marion, Michigan 49665 (hereinafter referred to as the "Consultant"). WITNESSETH WHEREAS, The county has entered into a Grant Agreement with the Michigan Department of Consumer and Industry Services, Property Development Division, Survey and Remonumentation Section for the conduction of surveying, monumentation and remonumentation of property controlling corners in Osceola County during the 2019 calendar year; and WHEREAS, the Consultant, is licensed as a surveyor in the State of Michigan, has submitted a proposal to the County to perform the surveying, monumentation and remonumentation service required by the County on an independent consultant basis; and WHEREAS, the County accepts the Consultant's proposal subject to the terms and conditions of this Agreement. NOW THEREFORE, for and in consideration of the mutual covenants hereinafter contained. IT IS HEREBY AGREED as follows: I. SCOPE OF SERVICES. The Consultant shall perform the following services in areas of Osceola County designated in the attached Exhibit A: A. Research of public and private records for information regarding public land survey corners. B. Field work including, but not limited to: 1. Field traversing for determining mathematical relationships. 2. Excavation for physical evidence of monumentation of government corners. 3. Setting restoring and perpetuating physical monumentation for government comers under the requirements of P.A. 74 of 1970. 4. Establishment of accessories for all monumented Section comers. C. Preparation of Comer Recordatioa Certificates under the guideline of P.A. 74 of 1970 and presentation of data to peer review committee for review and approval. D. Compiled data of field activities and comer research will be main- tained and filed at the county, according to current written County Standards. E. Record keeping of all time and materials expended to accomplish the above listed tasks for a period of 7 years. II. SERVICES NOT EXCLUSIVE TO CONSULTANT. It is expressly understood and agreed by the Consultant that the performance of the services required in Section I are not exclusive to the Consultant. The board shall at all times be free to contract on behalf of the County with other surveyors licensed in the State of Michigan to perform the services described in Section I. Ill COMPENSATION. The Consultant shall be compensated for the services performed under this agreement at the rate of $1330 per corner for the 34 comers to be monumented as designated in exhibit A, which the Consultant performs the services required in Section I. It is expressly understood and agreed that the total compensation, which the Consultant shall receive under this agreement, shall not exceed the sum of: $45220. The Consultant shall submit bills to the Grant Administrator for services completed on the comers designated in Exhibit A after data regarding the comers to be billed has been presented to the Peer Review Committee for review and has received the Committee's approval. All bills properly submitted shall he paid within thirty (30) days of submission in accordance with the County's procedure for payment of Accounts Payable. IV. HOURS OF WORK. The Consultant shall have control over determining the days and hours in which he performs work under this Agreement. V. CONSULTANT'S OFFICE. TOOLS AND EQUIPMENT. The Consultant shall maintain and utilize his own office while performing services required by this Agreement. The Consultant shall also at his own expense, supply all tools, equipment, and vehicles he needs to perform the services required by this Agreement. The County shall be responsible to provide the monuments and monument boxes as required to perform the services under this agreement. VI. LICENSING. Throughout the term of this Agreement, the Consultant must maintain a license as a Professional Land Surveyor in the State of Michigan. If, for any reason, the Consultant's license is revoked, suspended, or otherwise not in effect, such shall be deemed terminated on the date that the Consultant is no longer licensed as a surveyor in the State of Michigan. VII. APPLICABLE LAW AND VENUE. This Agreement shall be construed according to the laws of the State of Michigan. It is expressly understood and agreed that in the event any actions in law or in equity arising under this Agreement are brought by either party against the other party, the venue for such actions shall be Osceola County, Michigan. VIII. COMPLIANCE WITH THE LAW. The Consultant shall render the services required by this Agreement in complete compliance with all applicable Federal, State and local laws, ordinances, rules and regulations. The Consultant shall also adhere, at his own expense, to any rules, regulations, policies or guidelines of the Osceola County Road Commission when doing any work on an Osceola County road. Failure to comply with the provisions of this section shall be regarded as a material breach of this Agreement, and grounds for its immediate termination by the County. IX. PROTECTION OF PERSONS AND PROPERTY. The Consultant shall ensure that precautions are exercised for the protection of persons and property. The safety provisions of all applicable laws and codes shall be observed. The Consultant shall comply with all Federal and State laws and municipal ordinances and regulations in any manner affecting the work or performance of this Agreement and shall at all times carefully observe and comply with all rules, ordinances, and regulations. The Consultant shall secure all necessary certificates and Permits for municipal or other public authorities as may be required in connection with the performance of service covered by this Agreement. X. NON DISCRIMINATION. The Consultant shall adhere to all applicable Federal, State and local laws, ordinances, rules and regulations prohibiting discrimination. The Consultant, as required by law, shall not discriminate against an employee or applicant for employment with respect to hire, tenure, terms, conditions or privileges of employment, or a matter directly or indirectly related to employment because of race, color, religion, national origin, age, sex, height, weight, marital status, political affiliation, or beliefs or handicap which is unrelated to the individual's ability to perform the duties of a particular job or position. Breach of this section shall be regarded as a material breach or this Agreement. In the event the Consultant is found not to be in compliance with this section, the County may terminate this Agreement effective as of the date of delivery of written notification to the Consultant. XI. INDEPENDENT CONSULTANT. It is expressly understood and agreed that the Consultant is an independent consultant. The Consultant and any persons employed by him shall in no way be deemed to be and shall not hold themselves out as employees, servants or agents of the County or the State of Michigan and shall not be entitled to any fringe benefits of the County or the State of Michigan, such as, but not limited to, health and accident insurance, life insurance, longevity, paid sick or vacation leave. The Consultant shall be responsible for paying salaries, wages and any other compensation due his personnel for services performed under this Agreement and for the withholding and payment of all income and social security taxes to the proper Federal, State and local governments. The Consultant shall also be responsible for providing his personnel with workers' compensation and unemployment compensation coverage, as required by law. XII. INDEMNIFICATION AND HOLD HARMLESS. The Consultant shall, at his own expense, protect, indemnify and hold harmless the County, the County Grant Administrator, the State of Michigan and their elected and appointed officers, employees and agents from all claims, damages, costs, law suits and expenses, including but not limited to, all costs from administrative proceedings, court costs and attorney fees that they may incur as a result of any acts, omissions of negligence of the Consultant or any of his officers, employees or agents which may arise out of the Agreement. The Consultant's indemnification responsibilities under this section shall include the sum of damages, costs and expenses which are in excess of the sum paid out on behalf of or reimbursed to the County, the County Grant Administrator, the State of Michigan, their officers, employees and agents by the insurance coverage obtained and/or maintained by the Consultant pursuant to the requirements of the Agreement. XIII. LIABILITY INSURANCE. A. The Consultant shall procure, pay the premium on, keep and maintain during the term of this Agreement as long as insurance is available, liability insurance coverage with limits of not less than the following: 1. Workers' Compensation: When and as required by law. 2. Employers' Liability: When and as required by law. 3. General Liability (occurrence basis only) with the following coverage Inclusions: a. Broad Form General Liability Endorsement or equivalent, if not in policy proper. b. Independent Consultant Coverage. c. Contractual Liability. 4. Vehicle Liability Coverage, and Michigan No-Fault Coverage's including all owned, non-owned, and hired vehicles. 5. The Consultant may maintain such other insurances as he deems appropriate for his own protection. B. In the event that that the Consultant's insurance coverage is at any time reduced of terminated during the duration of the Agreement, the County may terminate this Agreement effective immediately upon delivery of notice of termination to the Consultant. XIV. MODIFICATION OF AGREEMENT. Modifications, amendments or waivers of any provisions of this Agreement may be made only by the written mutual consent of the parties hereto. XV, ASSIGNMENT OR SUBCONTRACTING. The Consultant may not assign, subcontract of otherwise transfer his duties and/or obligations under this Agreement. XVI. DISREGARDING TITLES. The titles of the sections set forth in this Agreement are inserted for the convenience of reference only and shall be disregarded when construing of interpreting any of the provisions of this Agreement. XVII. COMPLETENESS OF THE AGREEMENT. This Agreement contains all the terms and conditions agreed upon by the parties hereto, and no other agreements, oral of otherwise, regarding the subject matter of this Agreement or any part thereof shall have any validity or bind any of the parties hereto. XVIII. AGREEMENT PERIOD. The Consultant shall commence performance of the services and obligations required of the Consultant hereunder after this Agreement has been fully designed by the authorized representatives of both parties to this Agreement. The Consultant shall complete all services required by this Agreement by no later than the 31st day of December, 2018. This Agreement shall terminate on the 31st day of December, 2018 of whenever all funding is exhausted, whichever occurs first. Notwithstanding any other provision in this Agreement to the contrary, this Agreement my be terminated by the County upon thirty (30) days written notice to the Consultant, in the sole discretion of the County. In the event of early termination of this Agreement, the County shall reimburse the Consultant for the services rendered by the Consultant up to the effective date of termination. XIX. SEVERABILITY OF INVALID PROVISIONS. If any part of this Agreement is declared by any Court having jurisdiction to be invalid, unconstitutional, or beyond the authority of either party to enter into or carry out, such part shall be deemed deleted and shall not affect the validity of the remainder of this Agreement, which shall continue in full force and effect. If the removal of such provision would result in the illegality and/or unenforceability of this Agreement, this Agreement shall terminate as of the date in which the provision was found invalid, unconstitutional or beyond the authority of the parties and the Consultant shall be reimbursed for all services which it has provided under this Agreement up to the date of termination. XX. CERTIFICATION OF AUTHORITY TO SIGN AGREEMENT. The persons signing this Agreement on behalf of the parties hereto certify by their signatures that they are fully authorized to sign this Agreement on behalf of said parties and that this Agreement has been authorized by said parties. IN WITNESS WHEREOF, The authorized representatives of the parties hereto have fully executed this Agreement on the day and year first above written. Witnessed by: OSCEOLA COUNTY Karen J. Bluhm Date Chairperson Date County Clerk County Board of Commissioners CONSULTANT Susan VanderPol Date Grant Administrator William E. Sikkema, Secretary Date LCM SURVEYING & ENGINEERING INC STATE OF MICHIGAN FLEET CARD PROGRAM BETTER BETTER BETTER SAVINGS SECURITY ACCOUNTING Save up to 15%* of your Manage spending Track spending online overall fueling costs with purchase limits and see fuel grade, cost you control per gallon, and sales tax Get monthly rebates and for every purchase discounts based on gallons Use Driver IDs at the purchased pump to help prevent Download monthly reports fraud and misuse including exception reporting Use electronic billing to reduce administrative costs Tax exemption and reporting available for qualified fleets Participation is FREE — no enrollment, setup, or card fees A BETTER EXPERIENCE APPLY TODAY State of Michigan Fleet Card Contract No. 071B7700171 FAX the enclosed addendum to 1-866-527-8873 "Actual savings may vary. V.'EXG;0)7t!323 FOR MORE INFORMATION CALL 1-866-527-8870 | VISIT wexinc.com/Michigan FUEL ANYWHERE. SAVE EVERY DAY. Accepted at over 90% of fuel stations nationwide. ACCEPTING FUEL SITES AC&T Halley's Quality Oil ACCEPTEOINCANADAat } .bp «< .^9 Aloha Hand/Andy's QuikMart Rssdl <|^> ^^ (ALOI} AMPRIDE ARCOO ^^^ Aviation Huck's Read Rangu BdlGas ICO Robinson Oil Big font Ideal Rotten Robbie Capital City Inter City Royal Faims Carausel Johnson & Dixon Rutteis CITGO Certified fenyon Rymes24 City Garage King Son pers SC Fuels Cconoco^ (CROWN) g ^ l^^l] E^on (^ijSiARr Cogos Koch SmokBS Express ^—^^ _.ffl^/nwrf Crystal Flash KM me [ Sprint Cumbeilind Films Kiauie Stewaits Shops D&DOil Kum&do TaylorFoods IGOGAS gomart Dairy Mart Kv/ik Pantiy TCI GATC Depot Lil Champ Thumtons Drivers Trawl ei TOTAL Lucky Stop IRVING 111^013; Dynamic Mart M&II Town&Country R£U APPLE Economy MacsStoiei Trade f.l^ft EddinsV/ilcher McClureOil Trade Oil \/(WM Enrraik MfAOil TripirOil Tw/> HiLUKOIL w^ ES51 luumoir Express Stop Mf. Cut Rate US Oil Family Express MultiServ usco A^uffflwy^ \-i. Farstad IIAPA Valle/Dairy MURPHY meljer mm^ Mobil EXPRESS "UM^" M/UIUTU21L FiStTuck Ha'/us V/cigel Stoie Faum Oil HU-V/ay Weico [•'] FFP Oasis Williams Tiarel e Fliih Foods O'Connor Xtia Fuefs OATr^)' Food Chief OK Petroleum Zip Mail FueiMart Paniry Gai America Petro King CaidicctpunKi" Giiflt Peiro Stop iut);irttoindtptr Oivricr/Ojitnlor Git-n-dn PRIDE pirtiopitionand !iiper. staMart -E^."'h Global Pure iubjccttochidit SPUR SUrt S H,i EK~A, vi'i th out not ire. TESOROo Grow M Bit TURKEYHJLL •^•ssafSEgo^ VALERO Wawa €^ ACCEPTING SERVICE SITES American LubeFast Dodge Bus in eisl ink"' Netcost Auto Class BigOTiics (MecL..> lireCentefslfii ^ ^^ ^^ - i^^ jiffyiube- participitiufi) Daimlef/CFirysler ,.,,^.'.j....._i. Wash Depot G'.ldoodwrench Sswssss K-titeif ^) ^^^ STS SafelHe, SOSFS ft^ff^ Q ^miUHf Diamcnd/Triumph [limited ..M^wfn^m} A^ FOR MORE INFORMATION, visit our website at wexinc.com/Michigan ADDENDUM TO THE FUEL CARD SERVICES AGREEMENT BETWEEN WEX BANK AND THE STATE OF MICHIGAN (the "State") CREDIT INFORMATION Participating Entity agrees that in the event the account is not paid as agreed, WEX Bank may report the undersigned's jiability for. and the status of, the account to crediF bureaus and others who may lawfully receive such information. Participating Entity Phone # Faxff Headquarters Name and Physical Address (Do not include PO Box) Applicant's Taxpayer ID # (TIN. FEtN or SSN)- in Business Since (yyyy) Yearof Incorporation (yyyy) Nufnber of Vehicles j Avg Monthly Fuel Expenditures ( Avg Monthly Service Expenditures ACCOUNT SETUP INFORMATION Write Partta'pating Entity name as you wish it to appear on cards. Limit of 20 characters & spaces. Unless specified, no company name will appear on cards. DDDDDDDDDDDDDDDDDDDD Billing Contact Billing Address City State Zip+4 Designate ihe Fleet Contact authorized to receive ail charge cards, reports, and other such information we provide from time to time and to tate actions with respect to vour account and account access. This is also the person designated by your company to provide all fieet vehicles, driver and other information we may request. Authorized Fleet Contact Name Title Phone # Fax # Mailing Address (if different from billing address) City State | 2ip+4 Email address (required to take advantage of product type card controls) Card Controls: To help us estimate your needs, indicate the types of cards you D All Products D Fuel & Service D Mix of card types anticipate using. )f you provide a valid emaii address above, you can select from these D Fuel & Fluids w/ Roadside Assistance Q Fuel w/ Roadside Assistance product type options: D Check here if Authorized User is exempt from motor fuels tax "DEFlRmONS: "Agreement" means: Contract No. 071 B7700171 effective August 1, 2017 for Fuel Cards (the "Agreement") between the State and WEX BANK. "Participating Entity" shall mean the Participating Entity as defined in the Agreement permitted to purchase services under the Agreement, as specified in the Credit Information above. All other capitalized terms used in this Addendum without definition have the meanings set forth in the Agreement. AGREEMENTS OFWEX BANK AND PARTICIPATING ENTIP/: 1. This Addendum is to allow the Partidpating Entity to participate under the Agreement behveen WEX Bank and the State. It does not modify, amend or change the Agreement in any way. 2. Participating Entity represents that it is authorized or allowed by the laws of its home stale to enter into this Addendum and to participate under the Agreement. 3. Participating Entity hereby requests the services of WEX Bank described in the Agreement and agrees to perform all duties of a Participating Entity under the Agreement, including without limitation, payment of alf charges on its accounts) within^ the time periods provided under the Agreement, payment of any fees provided in the Agreement, and cooperation with respect to providing all necessary information for the administration of the Agreement.' Participating Entity agrees to be bound by the terms and conditions of the Agreement, including, without limitation, mfes for authorized and unaulhorized use of cards. disputes of charges, reporting lost and stolen cards, and ail other rules and provisions relating to use of Participating Entity's account. 4. Participating Entity acknowledges that its failure to make timely payment in accordance with the terms of the Agreement and/or the Addendum may result in suspension or cancellation of the account(s). The undersigned represents and warrants ihat he/she is duly authorized to execute this Addendum on behalf of the Participating Entity and this Addendumis the valid and binding obligation of the Participating Entity. enforceable in accoidance with its terms. REBATE: You may be offered discounts and/or rebates by participating under this Agreement from time to time. Such discounts and/or rebates may be suspended, modified, or discontinued at any time without prior notice and may not be applicable to ail fuel types. In addition, certain conditions in order to earn or receive the rebate or discount such as, but not limited to, maintaining your account in good standing will apply and be provided to you when such offers are made. INFORMATIONSHARtNGJ31SCLOSURE: tnformation regarding your transactions may be provided to accepting merchants or their service providers to facilitate discounts or other promotionai campaigns of interest to you. COMPLIANCE WITH FEDERAL LAW: WEX Bank complies with federal law which requires al) financial institutions to obtain, verify, and record information that identifies each company or person who opens an account. Issuer may as>< for name, address, date of birth, and other applicable information to identify the Company and/or Account Users. DISCLAIMER: THIS IS AN APPLICATION FOR SERVICES AND SUBJECT TO APPLICABLE LIMITATIONS SHALL NOT BE BINDING UPON WEX BANK UNTIL FINAL CREDIT APPROVAL HAS BEEN GRANTED BYWEX BANK. CONTRACTING AGENCY AUTHORIZED SIGNATURE REQUIRED Any person signing on behalf of the Authorized User has been duly authorized by al! necessary action of their governing body. and that the undersigned is authorized to make this application on behalf of the Authorized User. Signature: Printed Name; Titie: Date: Complete and sign addendum. Fax to1 -866-527-8873. FOR OFFICE Oppty Number Sales Code Plastic Type Coupon Code Account Number USE ONLY QMR 04 Promotional Code: QMR-39455930