Loading...
HomeMy WebLinkAbout2025-731-E-Health Dept-Piedmont Health Services-Reimbursement for WIC Hemoglobin Testing and use of facilitiesPHS/OCHD Memo of Agreement Revised 11/2025 Memorandum of Agreement Between Piedmont Health Services, Inc. WIC Program and Orange County Health Department For WIC Program Services This Memorandum of Agreement made and entered into the 1st day of July 2025 by and between the Orange County Health Department (“OCHD”) and Piedmont Health Services WIC Program (“PHS”). WITNESSETH: WHEREAS, both PHS and OCHD deem it to be of mutual interest to their patients/clients and their respective organizations to enter into this agreement for certification of WIC clients at OCHD; and WHEREAS, both parties desire to reduce the terms of this agreement to writing; NOW THEREFORE, and in consideration of the mutual promises to the other as hereinafter set forth, the parties hereby mutually agree as follows: A. PHS agrees to perform in a manner satisfactory to OCHD the following responsibilities: 1. Provide WIC services to Maternal and Child Health clinic clients at OCHD in Hillsborough following the policies, procedures and flow of patients as established by OCHD. Services will include height and weight assessment, nutrition assessment and education, WIC certification, food vouchers issuance, child immunization assessment, and appropriate patient referrals in accordance with state WIC policies. 2. Provide the necessary supervision, training and policy guidance to carry out the tasks identified above in consultation with the designated OCHD liaison. 3. Provide personnel for coverage during vacations and other approved leave except PHS scheduled holidays and unavoidable emergencies. Inform the OCHD liaison when WIC staff will be absent so that OCHD clinic staff can be notified. 4. Schedule meetings as needed with the OCHD liaison and WIC Director to discuss problems, procedures, changes in policy and to establish and review objectives. 5. Reimburse OCHD, on a quarterly basis, eleven dollars ($11) per client for each client that is not an OCHD patient, for testing of hemoglobin on WIC clients. This fee is the fee charged to non-insured patients according to OCHD’s fee schedule. 6. Piedmont Health Services will provide their own interpreter services for clients receiving WIC services, including laboratory services at the OCHD location in accordance with Title VI and Title II requirements. Docusign Envelope ID: 1EF8AF85-BDAA-4C06-85CF-46E260B29929 PHS/OCHD Memo of Agreement Revised 11/2025 B. OCHD agrees to perform in a manner satisfactory to PHS the following responsibilities: 1. Provide reasonable working space and equipment necessary for carrying out WIC responsibilities in the Hillsborough office. 2. Provide reasonable working space in the Chapel Hill office for WIC staff to meet with clients referred by Orange County Health Department. 3. Assist WIC employees with gaining read -only access to OCHD patient medical records through current University of North Carolina read-only platform. The parties agree to comply with the Business Associate Agreement attached hereto as Exhibit 1. 4. Through its liaison, OCHD shall be responsible for the following: a. Meet, as needed, with the PHS WIC Director to discuss problems, procedures, changes in policy and to establish and review objectives. b. Inform WIC staff of OCHD holidays, closings, clinic changes, and staff absences, which may affect the delivery of WIC services. 5. Perform hemoglobin testing for all WIC clients served at the Hillsborough OCHD site and submit invoices on a quarterly basis to Piedmont Health Services, Inc. for non-OCHD clients. 6. OCHD will send patient referrals to WIC utilizing The NC Department of Health and Human Services link https://www.ncdhhs.gov/ncwicreferral. C. Term. This agreement is for the performance of services rendered during the period beginning July 1, 2025 and ending June 30, 2026. D. Termination. Either party may terminate this agreement by giving 90 days written notice to the other party. E. Non-Appropriation. It is understood and agreed between PHS and OCHD that continuation or any renewal or extension thereof, is dependent upon and subject to the allocation or appropriation of funds to PHS and/or to OCHD for the purposes set forth in this agreement. It is also understood and agreed that either party shall involve the other in significant scheduling or program changes, which may affect services. F. Access to Records. OCHD agrees that the State of North Carolina, United States Department of Agriculture, the Controller General of the United States, or any of their duly authorized representatives, shall have access to any books, documents, papers and records of OCHD which are directly pertinent to this specific agreement, for the purposes of audit, making excerpts and transcriptions. G. Governing Law and Priority. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of Docusign Envelope ID: 1EF8AF85-BDAA-4C06-85CF-46E260B29929 PHS/OCHD Memo of Agreement Revised 11/2025 North Carolina. Provider shall at all times remain in compliance with all applicable local, state, and federal laws, rules, and regulations and the Orange County Non-Discrimination Policy and Orange County Living Wage Policy (each policy is incorporated herein by reference and may be viewed at, http://www.orangecountync.gov/departments/purchasing_division/contracts.php). Any violation of this requirement is a breach of this Agreement and County may immediately terminate this Agreement without further obligation on the part of the County. This paragraph is not intended to limit and does not limit the definition of breach to discrimination. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147-86.58. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor identified, on the list created by the State Treasurer pursuant to G.S. 147-86.81. In determining the basic services to be provided, should any documents be referenced in or attached to this Agreement, the terms herein shall have priority in any conflict between the terms of referenced documents and the terms of this Agreement. H. Confidentiality of Patient Records. All parties agree to abide by all laws and regulations governing the confidentiality of patient information, including HIPAA privacy rules and further agree to vigorously safeguard privileged information, in accordance with the terms and conditions of the BAA attached hereto. I. Non-discrimination. All activities under this contract will be conducted in accordance with Title VI of the Civil Rights Act of 1964 (42 U.S.C.2000d et seq.), Title IX of the Education Amendments of 1972 (20 U.S.C. 1681 et seq.), Section 504 of the Rehabilitation Act of 1973 (29 U.S.C.794), Age Discrimination Act of 1975 (42 U.S.C. 6101 et seq.); Title II and Title III of the Americans with Disabilities Act (ADA) of 1990 as amended by the ADA Amendment Act of 2008 (42 U.S.C. 12131-12189) as implemented by Department of Justice regulations at (28 CFR Parts 35 and 36); Executive Order 13166, "Improving Access to Services for Persons with Limited English Proficiency." (August 11, 2000), all provisions required by the implementing regulations of the U.S. Department of Agriculture (7 CFR Part 15 et seq); and FNS directives and guidelines to the effect that no person shall, on the ground of race, color, national origin, age, sex (including gender identity and sexual orientation), or disability, be excluded from participation in, be denied the benefits of, or otherwise be subjected to discrimination under any program or activity for which Federal financial assistance is received for the administration of the WIC Program; and hereby gives assurances that it will immediately take measures necessary to effectuate this agreement. By providing this assurance, the contractor agrees to compile data, maintain records and submit records and reports as requested by the Community Nutrition Services Section to permit effective enforcement of the nondiscrimination laws, and to permit the Community Nutrition Services Section personnel during normal working hours to review and copy such records, books and accounts, access such facilities, and interview such personnel as needed to ascertain compliance with the non-discrimination laws. If there are any violations of this assurance, the Community Nutrition Services Section shall have the right to seek judicial enforcement of this assurance. This assurance is given in consideration of and for the purpose of obtaining any and all Federal financial assistance, Docusign Envelope ID: 1EF8AF85-BDAA-4C06-85CF-46E260B29929 PHS/OCHD Memo of Agreement Revised 11/2025 grants, and loans of Federal funds, reimbursable expenditures, grant, or donation of Federal property and interest in property, the detail of Federal personnel, the sale and lease of, and the permission to use Federal property or interest in such property or the furnishing of services without consideration, or at a consideration that is reduced for the purpose of assisting the recipient, or any improvements made with Federal financial assistance extended to the Program applicant by USDA. This includes any Federal agreement, arrangement, or other contract that has as one of its purposes the provision of cash assistance for the purchase of food, and cash assistance for the purchase or rental of food service equipment or any other financial assistance extended in reliance on the representations and agreement made in this assurance. J. Renewal of Agreement. This agreement may be renewed upon the mutual agreement of both parties. Any renewal shall be negotiated 30 days prior to the beginning date of the new contract period. K. Amendment. This agreement may be amended upon the mutual agreement of the parties. All amendments shall be in writing and signed by both parties to the agreement. k. Notices. Any notice required by this Agreement shall be in writing and delivered by certified or registered mail, return receipt requested to the following: Orange County Health Department Piedmont Health Services, Inc. Attention: Kimberlee Quatrone Attention: Daniella Jaimes-Colina, PhD 300 West Tryon Street 88 Vilcom Cntr. Dr., Ste. 110 Hillsborough, NC 27278 Chapel Hill, NC 27514 l. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. IN WITNESS WHEREOF, the Parties, by and through their authorized agents, have hereunder set their hands and seal, all as of the day and year first above written. _______________________________________ ____________ Daniella Jaimes-Colina, PhD, Chief Executive Director Date Piedmont Health Services, Inc. ______________________________________ ____________ Travis Myren, County Manager Date Orange County Docusign Envelope ID: 1EF8AF85-BDAA-4C06-85CF-46E260B29929 12/4/2025 12/8/2025 Revised 01/24 1 ORANGE COUNTY—INTERNAL USE ONLY ______________________________________________________________________________ Finance Information Vendor Name: Piedmont Health Services Vendor Contact Person: Ashley Brewer Phone: 336-382-0242 Address: 88 Vilcom Center Drive City Chapel Hill State: NC Zip: 27514 Department: Health Amount: $3,000 Purpose: Reimbursement for WIC Hemoglobin Testing and use of facilities Budget Code(s): 10414001-476020-71403 – This is a contract for Piedmont to pay us. Vendor # 27898 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 7-1-25 End Date 60-30-26 Notice Date (Notice Purpose ) Award Approved by Board (Agenda Date: 6-17-25); 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 already 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: 1EF8AF85-BDAA-4C06-85CF-46E260B29929 12/5/2025 12/8/2025 12/8/2025 12/8/2025 Exhibit 1 THIS BUSINESS ASSOCIATE AGREEMENT (this “Agreement”) is made as of the 1st day of July, 2025 (the “Effective Date”), by and between Orange County Health Department (“Covered Entity”) and Piedmont Health Services, Inc (“Business Associate”), each individually a “Party” and together the “Parties.” BACKGROUND STATEMENTS A. Purpose. The purpose of this Agreement is to comply with the requirements of the Health Insurance Portability and Accountability Act of 1996 and the associated regulations (45 C.F.R. parts 160-164, as may be amended, including the “Privacy Rule” and the “Security Rule”) (“HIPAA”) and the Health Information Technology for Economic and Clinical Health Act and the associated regulations, as may be amended (“HITECH”). “HIPAA” and “HITECH” are collectively referred to in this Agreement as “HIPAA.” Unless otherwise defined in this Agreement, capitalized terms have the meanings given in HIPAA, as applicable. HIPAA requires Business Associate to provide reasonable assurances to Covered Entity that the Business Associate will appropriately safeguard Protected Health Information (“PHI”). B. Relationship. Covered Entity and Business Associate have entered into an agreement (the “Services Agreement”) pursuant to which Business Associate may receive, use, obtain, access, maintain, transmit, and/or create PHI from or on behal f of Covered Entity in the course of providing certain services (the “Services”) for Covered Entity. AGREEMENT The Parties hereby agree as follows: Section 1. Permitted Uses and Disclosures. Business Associate may use and/or disclose PHI only as permitted or required by this Agreement or as otherwise required by Law. Business Associate may disclose PHI to, and permit the use of PHI by, its employees, contractors, agents, or other representati ves only to the extent directly related to and necessary for the performance of the Services. Business Associate will request from Covered Entity no more than the minimum PHI necessary to perform the Services. Business Associate will request, use and disclose only PHI that constitutes a Limited Data Set, if practicable, and will otherwise limit any request, use or disclosure of PHI to the minimum necessary for the intended purpose of the request, use or disclosure. Business Associate will not use or disclose PHI in a manner (i) inconsistent with Covered Entity’s obligations under HIPAA, or (ii) that would violate HIPAA if disclosed or used in such a manner by Covered Entity. Business Associate will comply with the Privacy Rule requirements applicable to Covered Entity if and to the extent Business Associate’s performance of the Services involves Docusign Envelope ID: 1EF8AF85-BDAA-4C06-85CF-46E260B29929 2 carrying out Covered Entity’s Privacy Rule obligations. Business Associate will also comply with its own direct obligations under HIPAA. Business Associate will not engage in marketing or fundraising that involves the use or disclosure of PHI and will not otherwise receive direct or indirect remuneration for PHI, except as expressly permitted in writing by Covered Entity in connection with the provision of the Services. Section 2. Safeguards for the Protection of PHI. Business Associate will implement and maintain commercially appropriate administrative, physical, and technical security safeguards to ensure that PHI obtained by or on behalf of Covered Entity is not used or disclosed by Business Associate in violation of this Agreement. Such safeguards will be designed to protect the confidentiality and integrity of such PHI obtained, accessed, created, maintained, or transmitted from or on behalf of Covered Entity. Business Associate will comply with the applicable requirements of the Security Rule. Upon request by Covered Entity, Business Associate will provide a written description of such safeguards. Section 3. Reporting and Mitigating the Effect of Unauthorized Uses and Disclosures. Business Associate will report without unreasonable delay and in no case later than sixty (60) calendar days , upon discovery, in writing and in accordance with Section 10.6, any Security Incident or Breach (as defined below) by it or any of its employees, directors, officers, agents, subcontractors or representatives concerning the use or disclosure of PHI. For purposes of this Agreement, “Breach” means any acquisition, access, use or disclosure of PHI under this Agreement that is (a) in violation of HIPAA or (b) not permitted under this Agreement. Business Associate will be deemed to have discovered a Breach as of the first day on which the Breach is, or should reasonably have been, known to (a) Business Associate or (b) any employee, officer, or other agent of Business Associate other than the individual committing the Breach. Business Associate further will investigate the Breach and provide to Covered Entity, as soon as possible all information Covered Entity may require to make notifications of the Breach to Individuals and/or other persons or entities (“Notifications”). Business Associate will cooperate with Covered Entity in addressing the Breach. Business Associate will not notify Individuals or other persons or entities of the Breach without the express written consent of Covered Entity, unless required by applicable law. Covered Entity may direct Business Associate to make the Notifications and implement other mitigation steps, in a reasonable form and manner, and within reasonable timeframes directed by Covered Entity, consistent with Covered Entity’s legal obligations. Business Associate will be responsible for the reasonable costs of required notifications and mitigation directly resulting from such Breach to the extent the Breach is determined to have resulted from the negligence, wrongful acts, or omissions of Business Associate or its employees or agents. Nothing in this Agreement shall be construed to waive Business Associate’s governmental immunities or defenses under North Carolina law Docusign Envelope ID: 1EF8AF85-BDAA-4C06-85CF-46E260B29929 3 Business Associate will establish and implement procedures and other reasonable efforts for mitigating, to the greatest extent possible, any harmful effe cts arising from any improper use and/or disclosure of PHI. Section 4. Use and Disclosure of PHI by Subcontractors, Agents, and Representatives. Business Associate will require any subcontractor, agent, or other representative that is authorized to receive, use, maintain, transmit, or have access to PHI obtained or created under the Agreement, to agree, in writing, to (1) adhere to the same restrictions, conditions and requirements regarding the use and/or disclosure of PHI and safeguarding of PHI that apply to Business Associate under this Agreement; and (2) comply with the applicable requirements of the Security Rule. Section 5. Individual Rights. Business Associate will comply with the following Individual rights requirements as applicable to PHI used or maintained by Business Associate: 5.1 Right of Access. Business Associate agrees to provide access to PHI, at the request of Covered Entity, as necessary to satisfy Covered Entity’s obligations with regard to the individual access requirements under the Privacy Rule. Business Associate will otherwise comply with its obligations regarding an Individual’s right of access to PHI under HIPAA. 5.2 Right of Amendment. Business Associate agrees to make any amendment(s) to PHI as necessary to meet the amendment requirements under HIPAA. 5.3 Right to Accounting of Disclosures. Business Associate agrees to document such disclosures of PHI as would be required for Covered Entity to respond to a request by an Individual for an accounting of disclosures of PHI in accordance with HIPAA, and to provide all such documentation to Covered Entity or, to an Individual, as necessary to satisfy Covered Entity’s obligations with regard to an Individual’s right to an accounting of disclosures. Business Associate will otherwise comply with its obligations regarding an Individual’s right to an accounting of disclosures under HIPAA. Section 6. Use and Disclosure for Business Associate’s Purposes. 6.1 Use. Except as otherwise limited in this Agreement, Business Associate may use PHI for the proper management and administration of Business Associate or to carry out the legal responsibilities of Business Associate. 6.2 Disclosure. Except as otherwise limited in this Agreement, Business Associate may disclose PHI for the proper management and administration of Business Associate, provided the disclosures are Required by Law, or Business Associate obtains reasonable assurances from the person to whom the PHI is disclosed that the PHI will remain confidential and be used or further disclosed only as Required by Law or for the purpose for Docusign Envelope ID: 1EF8AF85-BDAA-4C06-85CF-46E260B29929 4 which it was disclosed to the person, and the person notifies Business Associate immediately upon discovery of any instances in which the confidentiality of the PHI has been Breached, as defined and described in Section 3 of this Agreement. Section 7. Audit and Inspection. With reasonable notice, Covered Entity may audit Business Associate to monitor compliance with this Agreement. Business Associate will promptly correct any violation of this Agreement found by Covered Entity and will certify in writing that the correction has been made. Covered Entity’s failure to conduct an audit or, if an audit is conducted, to detect any unsatisfactory practice, does not constitute acceptance of the practice or a waiver of Covered Entity’s rights under this Agreement. Business Associate will make its internal practices, books, records, and policies and procedures relating to the use and disclosure of PHI received from, or created or received by Business Associate on behalf of Covered Entity, available to the federal Department of Health and Human Services (“HHS”), the Office for Civil Rights (“OCR”), or their agents and to Covered Entity for purposes of monitoring compliance with HIPAA. Section 8. Term and Termination 8.1 Term. This Agreement will become effective on the Effective Date. Unless terminated sooner pursuant to Section 8.2, this Agreement will remain in effect for the duration of all Services provided by Business Associate and for so long as Business Associate will remain in possession of any PHI received from, or created or received by Business Associate on behalf of Covered Entity. 8.2 Termination. In the event of a material breach of this Agreement, the non-breaching Party may immediately terminate the Services Agreement and this Agreement. Alternatively, in the non-breaching Party’s sole discretion, the non-breaching Party may provide the breaching Party with written notice of the existence of the material breach and afford the breaching Party thirty (30) days to cure the material breach. In the event the breaching Party fails to cure the material breach within such time period, the non- breaching Party may immediately terminate the Services Agreement and this Agreement. 8.3 Effect of Termination. Upon termination of the Services Agreement and this Agreement, Business Associate will recover any PHI relating to this Agreement in the possession of its subcontractors, agents or representatives. Business Associate will return to Covered Entity or destroy all such PHI plus all other PHI relating to this Agreement in its possession, and will retain no copies. If Business Associate cannot feasibly return or destroy the PHI, Business Associate will ensure that any and all protections, requirements and restrictions contained in this Agreement will be extended to any PHI retained after the termination of this Agreement, and that any further uses and/or disclosures will be limited to the purposes that make the return or destruction of the PHI infeasible. Docusign Envelope ID: 1EF8AF85-BDAA-4C06-85CF-46E260B29929 5 Section 9. Responsibility for Compliance. Each party shall be responsible for its own acts and omissions and for compliance with its respective obligations under this Agreement and applicable law. Nothing in this Agreement shall be construed to require either party to indemnify the other or to waive any governmental immunities or defenses available under North Carolina law. Section 10. Miscellaneous. 10.1 Survival. The respective rights and obligations of the Parties under Sections 7 (Audit and Inspection), 8.3 (Effect of Termination), 9 (Indemnification) and 10 (Miscellaneous) will survive termination of this Agreement indefinitely. 10.2 Amendments. This Agreement constitutes the entire agreement between the Parties with respect to its subject matter. It may not be modified, nor will any provision be waived or amended, except in a writing duly signed by authorized representatives of the Parties. Notwithstanding the foregoing, Covered Entity may amend this Agreement upon written notice to Business Associate if the amendment is necessary to comply with a statutory or regulatory requirement. 10.3 Waiver. A waiver with respect to one event will not be construed as continuing, or as a bar to or waiver of any right or remedy as to subsequent events. 10.4 Compliance with HIPAA. Any ambiguity in this Agreement will be resolved in favor of a meaning that permits the Parties to comply with HIPAA. The Parties agree to amend this Agreement from time to time as necessary for the Parties to comply with the requirements of HIPAA. 10.5 No Third Party Beneficiaries. Nothing express or implied in this Agreement is intended to confer, nor will anything herein confer, upon any person other than the Parties and their respective successors and permitted assigns, any rights, remedies, obligations or liabilities whatsoever. 10.6 Notices. Any notice to be given under this Agreement to a Party will be made via U.S. Mail, commercial courier or hand delivery to such Party at its address given below, and/or via facsimile to the facsimile telephone number listed below, or to such other address or facsimile number as will hereafter be specified by notice from the Party. Any such notice will be deemed given when so delivered to or received at the proper address. If to Business Associate, to: If to Covered Entity to: Piedmont Health Services, Corporate Office Orange County Health Dept. 88 Vilcom Center Dr., Ste 110 PO Box 8181, 300 W. Tryon St. Chapel Hill, NC 27514 Hillsborough, NC 27278 Attention: Daniella Jaimes-Colina, PhD Attention: Ashley Rawlinson Docusign Envelope ID: 1EF8AF85-BDAA-4C06-85CF-46E260B29929 6 10.7 Relationship between Parties: The relationship of the Parties is that of independent contractors, and nothing in this Agreement will be construed to render either Party a partner, employee or agent of the other, nor will either Party have authority to bind the other in any respect, it being intended that each Party will remain solely responsible for its own actions. No employee or agent of one Party to this Agreement will be considered an employee or agent of the other Party. IN WITNESS WHEREOF, each of the Parties has caused this Agreement to be executed in its name and on its behalf as of the Effective Date. COVERED ENTITY BUSINESS ASSOCIATE Sign: ______________________________ Sign: _____________________________ Orange County Health Department Piedmont Health Services, Inc. Print Name: __Quintana Stewart Print Name: Daniella Jaimes-Colina, PhD__ Title: _Health Director__________ Title: Chief Executive Director_____________ Date: ______________________________ Date: ____________________________ 30063\1\4834-3843-4014.v1 Docusign Envelope ID: 1EF8AF85-BDAA-4C06-85CF-46E260B29929 12/4/202512/5/2025 Docusign Envelope ID: 1EF8AF85-BDAA-4C06-85CF-46E260B29929 Docusign Envelope ID: 1EF8AF85-BDAA-4C06-85CF-46E260B29929