The URL can be used to link to this page

Home My WebLink About2024-369-E-IT Dept-Patagonia Health-Yearly Patagonia licenses for pharmacy apDocuSign Envelope ID: DA2EF093-C4D3-45EE-8D0D-4482321D9D24 A PatagoniaHealth http://www.patagoniahealth.com 4.lnsuranceOrange County will be listed on the Patagonia Health Certificate of Insurance as an additional insured for General Liability, Auto, Umbrella Coverage. This will be noted on the COi by an "X" marked in the Additional Insured Box or noting it in the Comment section. The Certificate of Insurance will be furnished after the execution of this Agreement. Orange County Health Department - NC Signature: ___________ _ Date: Name: Bonnie Hammersley Title: County Manager Phone:919-245-2306 Email: bhammersley@orangecountync.gov Please send invoices to: Name: Sally Kadle and Kimberlee Quatrone Email: skadle@orangecountync.gov kquatrone@orangecountync.gov Patagonia Health, Inc. Signature: ___________ _ Date: ____________ _ Name: Amos Slaymaker Title: Director of Sales & Marketing Phone:919-439-0964 Email: amos@patagoniahealth.com We appreciate your partnership and look forward to supporting you! Page 2 of 2 Confidential. Copyright© 2024 Patagonia Health, Inc. 15100 Weston Parkway, Suite 204, Cary, NC 27513 I 919.238.4780 I Email: info@patagoniahealth.com DocuSign Envelope ID: DA2EF093-C4D3-45EE-8D0D-4482321D9D24 6/21/20247/2/2024 Revised 01/24 1 ORANGE COUNTY—INTERNAL USE ONLY ______________________________________________________________________________ Finance Information Vendor Name: Patagonia Health Vendor Contact Person: Karen Khoury Phone: 919-200-6011 Address: 15100 Weston Parkway #204 City Cary State: NC Zip: 27513 Department: IT Amount: $16,571.76 Purpose: Yearly Patagonia licenses for pharmacy ap Budget Code(s): 10315020-625010 Vendor # 61583 Vendor Status with NCSOS: Current/Active Vendor is a BOCC consultant: Yes No Contract Details Contract Type: New Amendment (Original Contract: ) (Most Recent Amendment ) Effective Date 6/29/24 End Date 6/28/25 Notice Date (Notice Purpose ) Award Approved by Board (Agenda Date: ); Made or Administered by Signature Authority - BOCC Express Delegation (Agenda Date: ) - Policy 9.4: Under $5,000; Service Under $90,000; Construction Under $250,000 - Budget Policy Section XV (Capital Improvement Project: ) Bidding Informal Bidding ($30k-$90k); Formal RFP ($90k+); Other (<$30k); Exception(# ) Department Affirmation This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project has not been initiated prior to execution of the agreement. This agreement is approved as to technical form and content. Services related to this agreement have alread y begun or been completed. Description of the nature of the emergency condition that was addressed: Department Director’s Signature ________________________________________ Date: ________ Information Technologies This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer___________________________________ Date: ________ Inapplicable because no hardware/software purchases or related services Risk Management This agreement is approved for sufficiency of insurance standards, specifications, and requirements: Office of the Risk Management Officer___________________________________ Date: _________ Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: Office of the Chief Financial Officer ____________________________________ Date: _________ Legal Services This agreement is approved as to legal form and sufficiency: Office of the County Attorney __________________________________________Date: ________ Clerk to the Board All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync.gov The following signature block is for hard copies only and is not required for Docusign contracts: Received for record retention: Office of the Clerk to the Board __________________________________________Date:_________ DocuSign Envelope ID: DA2EF093-C4D3-45EE-8D0D-4482321D9D24 6/25/2024 6/28/2024 7/1/2024 7/2/2024 7/2/2024 05/13/2024 Tompkins Insurance Agencies, Inc 1240 Broadcasting Road P.O. Box 6707 Wyomissing PA 19610 Melissa Streeter (888) 601-2611 (888) 339-8337 mstreeter@tompkinsfinancial.com Patagonia Health Inc 15100 Weston Pkwy Ste 204 Suite 204 Cary NC 27513 Sentinel Ins Co, LTD 11000 Travelers Property Casualty Company of America 25674 CL2413105764 A Y 39SBMAE5408 02/13/2024 02/13/2025 1,000,000 1,000,000 10,000 1,000,000 2,000,000 2,000,000 A Y 39SBMAE5408 02/13/2024 02/13/2025 1,000,000 A Y 39SBMAE5408 02/13/2024 02/13/2025 10,000,000 10,000,000 B 39WECAX2PTR 05/01/2024 10/27/2024 500,000 500,000 500,000 C EXCESS LIABILITY EX-2X014546-23-NF 10/27/2023 10/27/2024 EACH OCCURRENCE $10,000,000 AGGREGATE $10,000,000 Orange County Health Department 300 West Tryon Street P.O.Box 8181 Hillsborough NC 27278 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY DocuSign Envelope ID: DA2EF093-C4D3-45EE-8D0D-4482321D9D24 Patagonia Health Inc 00120135 Tompkins Insurance Agencies, Inc 25 Certificate of Liability Insurance: Notes Technology E&O/Cyber Liability Coverage: Carrier: Coalition Insurance #C4LRN111050 10/27/2023 - 10/27/2024 Limit $5,000,000 Carrier: Continental Casualty Company #768747364 10/27/2023 - 10/27/2024 Limit $5,000,000 Carrier: Great American Fidelity Ins Co #CYXF11996400 10/27/2023 - 10/27/2024 Limit $5,000,000 Carrier: Princeton E & S Lines Ins Co #5DA3FF000034900 10/27/2023 - 10/27/2024 Limit $5,000,000 ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: DocuSign Envelope ID: DA2EF093-C4D3-45EE-8D0D-4482321D9D24 DocuSign Envelope ID: DA2EF093-C4D3-45EE-8D0D-4482321D9D24 DocuSign Envelope ID: DA2EF093-C4D3-45EE-8D0D-4482321D9D24 DocuSign Envelope ID: DA2EF093-C4D3-45EE-8D0D-4482321D9D24 DocuSign Envelope ID: DA2EF093-C4D3-45EE-8D0D-4482321D9D24 DocuSign Envelope ID: DA2EF093-C4D3-45EE-8D0D-4482321D9D24 DocuSign Envelope ID: DA2EF093-C4D3-45EE-8D0D-4482321D9D24 DocuSign Envelope ID: DA2EF093-C4D3-45EE-8D0D-4482321D9D24 DocuSign Envelope ID: DA2EF093-C4D3-45EE-8D0D-4482321D9D24 DocuSign Envelope ID: DA2EF093-C4D3-45EE-8D0D-4482321D9D24 DocuSign Envelope ID: DA2EF093-C4D3-45EE-8D0D-4482321D9D24 DocuSign Envelope ID: DA2EF093-C4D3-45EE-8D0D-4482321D9D24 http://www.patagoniahealth.com Page 1 of 2 Confidential. Copyright© 2017 Patagonia Health, Inc. 15100 Weston Parkway, Suite 204, Cary, NC 27513 | 919.238.4780 | Email: info@patagoniahealth.com Sales Agreement Addendum Addendum: This is an add-on addendum to the Sales Agreement dated October 24, 2012 and holds all of the same terms and conditions therein. Customer: Orange County Health Department Date: August 7th, 2019. Addendum Effective Date: October 1st, 2019. (OCHD has access to complete end to end EHR, as previously agreed, till 30th Sep 2019. Thus, this addendum effective date is after 30th Sep 2019.) Functionality Description: Orange County Health Department OCHD has been using Patagonia Health EHR software solution since 2012. OCHD has elected to switch to UNC affiliated EPIC EHR. However, OCHD wishes to continue to use Patagonia Health Pharmacy App only. This addendum and price only includes Pharmacy App and associated functionality which is only a subset of complete end to end EHR which OCHD has had access since 2012. This excludes the use of any billing or electronic prescription functionality. Term: This Agreement will run for an initial term of three months from the Service Effective Date. OCHD has a choice to use and pay for system on a month to month basis. Payment for first three months paid in advance. All fees including monthly subscription fees and training will increase by 4% at the beginning of each annual anniversary date. All payments made are non-refundable. Cancellation: OCHD may cancel the agreement at anytime with a three month written notice for October through December 2019 and with a 30 day written notice after that period. Reactivation post cancellation will incur an initiation fee. Functionality and Costs: Description One Time: Upfront Costs Ongoing: Monthly Costs Initial to Accept or mark “X’ to Decline Functionality: Pharmacy App for the health department. Includes Surescript certified electronic prescription solution and support for up to fifteen (15) users. Additional users can be added at an additional cost of $30/month/user. Minimum cost is $795/month $795.00 Initial to Accept or mark X to Decline DocuSign Envelope ID: 881484B7-44A8-4DD9-9947-6209CB23CD79DocuSign Envelope ID: DA2EF093-C4D3-45EE-8D0D-4482321D9D24 http://www.patagoniahealth.com Page 2 of 2 Confidential. Copyright© 2017 Patagonia Health, Inc. 15100 Weston Parkway, Suite 204, Cary, NC 27513 | 919.238.4780 | Email: info@patagoniahealth.com Implementation $0 Initial to Accept or mark X to Decline Data Extraction $15,000 Initial to Accept or mark X to Decline Remote Training: $100/hr. Minimum 2 hours to be purchased. Initial to Accept or mark X to Decline If applicable # of hours: Training: On site, in person, Training: $1500/day. Initial to Accept or mark X to Decline If applicable # of days: Costs: ● Initial payment (3 months at $795/month): $2,385. ● On -going Monthly Payment: $795/month ● Additional Cost for training, if selected will be added to Initial payment. Payment Terms: 1. Payment Plan: All costs paid in advance. Initial payment billed upon execution of this Addendum Agreement. All payments due within 30 days of invoicing. CUSTOMER Patagonia Health, Inc. Signature: Signature: Name: Bonnie Hammersley Name: Amos Slaymaker Title: County Manger Title: Vice President, Sales & Marketing x x DocuSign Envelope ID: 881484B7-44A8-4DD9-9947-6209CB23CD79DocuSign Envelope ID: DA2EF093-C4D3-45EE-8D0D-4482321D9D24