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Home My WebLink About20243361.tiffRESOLUTION RE: APPROVE SERVICES AGREEMENT FOR VARIOUS EMPLOYEE BENEFIT PLANS, AND BUSINESS ASSOCIATE AGREEMENT, AND AUTHORIZE CHAIR TO SIGN - ROCKY MOUNTAIN RESERVE, LLC WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with a Services Agreement for Various Employee Benefit Plans (Health Flexible Spending Account (FSA), Dependent Care Assistance Flexible Spending Account (DCA), Health Savings Account (HSA), and COBRA Administration), and a Business Associate Agreement between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Resources, and Rocky Mountain Reserve, LLC, commencing January 1, 2025, with further terms and conditions being as stated in said agreements, and WHEREAS, after review, the Board deems it advisable to approve said agreements, copies of which are attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the Services Agreement for Various Employee Benefit Plans (Health Flexible Spending Account (FSA), Dependent Care Assistance Flexible Spending Account (DCA), Health Savings Account (HSA), and COBRA Administration), and a Business Associate Agreement between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Resources, and Rocky Mountain Reserve, LLC, be, and hereby are, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said agreements. cc pE(ss/av/Fkr/sP) of/2.V25 2024-3361 PE0036 SERVICES AGREEMENT FOR VARIOUS EMPLOYEE BENEFIT PLANS, AND BUSINESS ASSOCIATE AGREEMENT - ROCKY MOUNTAIN RESERVE, LLC PAGE 2 The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 23rd day of December, AD., 2024. ATTEST: ^J w „i/.:4 Weld County Clerk to the Board BY: ni•W0141k).k Deputy Clerk to the Board County Attorney I Date of signature: BOARD OF COUNTY COMMISSIONERS WELD COUN , COLORA n Kevin D. Ross, Chair EXCUSED Perry L. Buck, Pro-Tem Mike Freeman 2024-3361 PE0036 ontvacl�S90q BOARD OF COUNTY COMMISSIONERS PASS -AROUND REVIEW PASS -AROUND TITLE: Rocky Mountain Reserve Services Agreement DEPARTMENT: Human Resources DATE: 10/22/2024 PERSON REQUESTING: Allison Palmer, Jill Scott, Amy Dyer Brief description of the problem/issue: With the introduction of the new High Deductible Health Plan (HDHP) in 2025, we need to have an Health Savings Account (HAS) administrator in place. Currently, we use Rocky Mountain Reserve (RMR) for FSA and DCA services, and we would like to extend this partnership by having RMR also handle our COBRA administration and HSA. Consolidating all services with a single provider offers both cost savings and streamlined administration on the benefits side for employee and employer. What options exist for the Board? Approve Agreement. Do not approve agreement. Consequences: Delay in Health Saving Accounts and COBRA administration. Employee benefit services were changes previously discussed on 9/4/2024 at a BOCC works session. Impacts: Failing to sign this agreement will significantly affect employees' benefits for 2025. Specifically, it will impact the $1,000 upfront contribution to the HSA that was promised during open enrollment. Additionally, we will need a COBRA administrator to remain compliant in 2025. Costs (Current Fiscal Year / Ongoing or Subsequent Fiscal Years): The monthly fees charged for each benefit enrolled employee as of the first day of each month for the term of the Agreement shall be $0.48 per benefit enrolled employee per month. Rocky Mountain Reserve will retain the 2% COBRA Administration fee paid by the Qualified Beneficiary. Recommendation: HR recommends approving Rocky Mountain Reserve agreement for employee Cobra and HSA. Perry L. Buck, Pro-Tem Mike Freeman Scott K. James Kevin D. Ross , Chair Lori Saine Suaoort Recommendation Schedule Place on BOCC Agenda Work Session Other/Comments: 2024-3361 11123 Pe Oa3co ROCKY MOUNTAIN ROCKY MOUNTAIN RESERVE (RMR) SERVICES AGREEMENT FOR Cafeteria Plan Health Flexible Spending Account (FSA) Dependent Care Account Flexible Spending Account (DCA) Health Savings Account (HSA) COBRA Administration Recitals Weld County Government has established a program to make certain benefits available to its employees. The program includes: • Tax -favored arrangements such as pre-tax payment of the employee share of the cost for certain benefits including: o Health Flexible Spending Account (FSA) o Dependent Care Assistance Program (Dependent Care FSA) o Health Savings Account (HSA) • Continuation of coverage services including: o COBRA The components of the program are subject to various legal requirements under ERISA, COBRA, HIPAA, the Code, and other laws. Employer has adopted and sponsors the Weld County Government Health Plan (Plan), which is a group health plan within the meaning of the Employee Retirement Income Security Act of 1974, as amended (ERISA), and the Internal Revenue Code of 1986, as amended (the Code), for eligible employees of the Employer and their dependents. The Plan is required to offer continuation of coverage to certain individuals pursuant to the provisions of §4980B of the Code and Part 6, Subtitle B, Title I of ERISA (collectively referred to herein as "COBRA"). Employer is the Plan's Plan Administrator within the meaning of ERISA and the Code, and under COBRA, the Plan's Plan Administrator has the responsibility for the administration of COBRA as it applies to the Plan. Rocky Mountain Reserve is in the business of assisting with the performance of various services related to employee benefit programs. Weld County Government has requested that Rocky Mountain Reserve assist it, and act on its behalf, with respect to a variety of services as described in this Agreement. Rocky Mountain Reserve is not providing tax or legal advice, and Weld County Government shall be solely responsible for determining the legal and tax status of the program. To the extent Rocky Mountain Reserve is considered a business associate under HIPAA with regard to one or more elements of the program, the necessary parties have entered into a separate business associate agreement (or agreements) to document compliance with HIPAA's privacy, security, breach notification, and electronic data interchange (EDI) requirements. In consideration of the mutual promises contained in this Agreement, Weld County Government and Rocky Mountain Reserve agree as follows. Article I: Introduction 1.1 Effective Date and Term The effective date of this Agreement is January 1, 2025 ("Effective Date"). This agreement shall remain in effect until the Agreement is terminated in accordance with section "Termination of Agreement" herein. 1.2 Scope of Undertaking Employer has sole and final authority to establish, maintain, control, and manage the operation of the Program. Rocky Mountain Reserve is and shall remain an unrelated contractor with respect to the services being performed hereunder, and no representative of Rocky Mountain Reserve shall for any purpose be deemed an employee of Employer. Nor shall Rocky Mountain Reserve and Employer be deemed partners, engaged in a joint venture, or governed by any legal relationship other than that of unrelated contracting parties. Rocky Mountain Reserve expressly does not assume any responsibility for the general design of the Program, the adequacy of its funding, or any act or omission or breach of duty by Employer. Nor is Rocky Mountain Reserve in any way to be deemed an insurer, Rocky Mountain Reserve, or guarantor with respect to any benefits payable under the Program. Rocky Mountain Reserve merely facilitates payments of insurance premiums to the applicable insurer or reimbursements to participants and does not assume any financial risk or obligation with respect to premium payments or claims for benefits payable by Employer under the Program. To the fullest extent permitted under applicable law, Rocky Mountain Reserve does not intend to be the "named fiduciary," "plan sponsor," or "plan administrator" (as such terms are described in ERISA, other applicable law, or the Program documentation) or assume any of the obligations or responsibilities corresponding to those designations. Unless required by applicable law, nothing in this Agreement shall be deemed to (a) render the Rocky Mountain Reserve a party to the Program; (b) confer upon Rocky Mountain Reserve any authority or control respecting management of the Program, authority or responsibility in connection with administration of the Program, or responsibility for the terms or validity of the Program; or (c) impose upon Rocky Mountain Reserve any obligation to any employee of Employer, any Participant, or any person otherwise entitled to benefits through the Program. 1.3 Definitions "Agreement" means this Rocky Mountain Reserve Services Agreement, including all Appendices hereto. "Appendix" or "Appendices" means one or more appendices to this Agreement, which are incorporated by reference into and form part of this Agreement. "Business Associate Contract" means any separate agreement entered into between one or more employee benefit plans or arrangements (as covered entities, or by Employer on their behalf) under the Program and the Rocky Mountain Reserve (as business associate) to document compliance with HIPAA's privacy, security, breach notification, and electronic data interchange (EDI) requirements. "2% COBRA Administration Fee" and "50% COBRA Administration Fee" mean the difference between the "applicable premium" within the meaning of COBRA and the premium amount the Plan may charge for Continuation Coverage (102% of the applicable premium or 150% of the applicable premium in the case of an extension based on the disability of a Qualified Beneficiary). "COBRA" means the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended, including regulations thereunder. "Code" means the Internal Revenue Code of 1986, as amended, including regulations thereunder. "Continuation Coverage" means the continued coverages under the Plan following a Qualifying Event provided to a Qualified Beneficiary as required by COBRA. "Dependent Care FSA" means a dependent care assistance program (Dependent Care FSA) under Code §129 offered under the Employer's Code §125 cafeteria plan. "Employer" means Weld County Government, and refers to the Employer in its various roles, including (as applicable) Named Fiduciary, Plan Administrator, and Plan Sponsor. "ERISA" means the Employee Retirement Income Security Act of 1974, as amended, including regulations thereunder. "Effective Date" has the meaning given in Section 1.1. "Electronic PHI" is a type of PHI and has the meaning assigned to such term under HIPAA. "Health FSA" means a health flexible spending arrangement (Health FSA) under Code §105 offered under the Employer's Code §125 cafeteria plan. "HIPAA" means the Health Insurance Portability and Accountability Act of 1996, as amended, including regulations thereunder. "HSA" means Health Savings Account "Litigation" means any litigation or other proceeding, including but not limited to any judicial or administrative proceeding, involving a dispute arising under COBRA or this Agreement, or an audit, investigation, or proceeding by the Internal Revenue Service or the United States Department of Labor involving directly or indirectly the duties or responsibilities of the Employer, the Plan Administrator, or Rocky Mountain Reserve. "Named Fiduciary" means, with respect to any Plan subject to ERISA, the named fiduciary as defined in ERISA §402(a)(1). The Employer is the Named Fiduciary for any Plan subject to ERISA unless another party is identified as the Named Fiduciary in applicable Plan documentation. "Participant" means any individual participating in the Program. "Plan" means each portion of the Program through which benefits are provided. "Plan Administrator" means, with respect to any Plan subject to ERISA, the administrator as defined in ERISA §3(16)(A). The Employer is the Plan Administrator for any Plan subject to ERISA unless another party is identified as the Plan Administrator in applicable Plan documentation. "Plan Sponsor" means the Employer. "Program" means the program established by the Employer to make certain benefits available to its employees (as described in the Recitals) and refers to the Plans collectively. "Protected Health Information" or "PHI" has the meaning assigned to such term under HIPAA. "Qualified Beneficiary" means any individual specified in COBRA who is eligible to elect Continuation Coverage. In addition, solely to the extent the Employer elects on Exhibit B, "Qualified Beneficiary" also includes dependents of an employee whom the Employer treats as a "spouse" under the Plan (for example, domestic partners). "Qualifying Event" means a qualifying event within the meaning of COBRA (generally, an event upon which a Qualified Beneficiary must be given the opportunity to elect Continuation Coverage as specified in COBRA). "Rocky Mountain Reserve" or "RMR" means Rocky Mountain Reserve, LLC Article II: Employer Responsibilities 2.1 Sole Responsibilities (a) General. Employer has the sole authority and responsibility for the Program and its operation, including the authority and responsibility for establishing, administering, construing, and interpreting the provisions of the Program and making all determinations thereunder. Employer gives Rocky Mountain Reserve the authority to act on behalf of Employer in connection with the Program, but only as expressly stated in this Agreement or as mutually agreed in writing by Employer and Rocky Mountain Reserve. All final determinations as to a Participant's entitlement to Program benefits are to be made by Employer, including any determination upon appeal of a denied claim for Program benefits. (b) Responsibilities. Without limiting Employer's responsibilities with respect to any Plan, it shall be Employer's sole responsibility and duty to ensure compliance with COBRA; perform required nondiscrimination testing; amend the Plans as necessary to ensure ongoing compliance with applicable law; file any required tax or governmental returns relating to the Plans; collect and forward any fees related to the Plans; determine if and when a valid election change has occurred; handle Participant claim appeals; execute and retain required Plan and claims documentation; and take all other steps necessary to maintain and operate the Plans in compliance with applicable provisions of the Plans, ERISA, the Code, and other applicable federal and state laws. Employer's engagement of Rocky Mountain Reserve to assist it in meeting any such obligation does not relieve Employer of responsibility for the obligation. 2.2 Service Charges; Fees and Expenses Employer shall pay Rocky Mountain Reserve the service charges set forth in the Appendices hereto, as described in Article V. All service charges and fees shall be guaranteed to the Employer for a period of three (3) years from the effective date of this agreement. After this time period, Rocky Mountain Reserve reserves to right adjust service charges and fees given that Rocky Mountain Reserve provides the employer with a minimum 30 day notice. 2.3 Benefit Funding Employer shall promptly make funds available for the payment of Program benefits as described in Article IV. These funds shall be clearly separate from any funds otherwise made available for other purposes (e.g., service charges, fees and expenses). It is the Employer's intent that the Program be operated to fall within an exception or nonenforcement policy with respect to ERISA's trust requirement for plan assets. 2.4 Information to Rocky Mountain Reserve Employer shall furnish the information requested by Rocky Mountain Reserve as determined necessary to perform Rocky Mountain Reserve's functions hereunder, including information concerning the Program and the eligibility of individuals to participate in and receive Program benefits. Such information shall be provided to Rocky Mountain Reserve in the time and in the manner agreed to by Employer and Rocky Mountain Reserve. Rocky Mountain Reserve shall have no responsibility with regard to benefits paid (or not paid) in error, or with regard to failure to timely provide required notices or other communications, due to Employer's failure to timely update or ensure the accuracy of such information. Employer shall be responsible for ensuring the accuracy of all information provided, and bears the burden of proof in any dispute with Rocky Mountain Reserve relating to the accuracy of any information provided to Rocky Mountain Reserve. Rocky Mountain Reserve shall have no liability to Employer or any Participant as a consequence of an inaccurate information provided, and Rocky Mountain Reserve shall not have any obligation to credit Employer for any claims expenses or administrative fees incurred or paid to Rocky Mountain Reserve as a consequence of Employer failing to review information for accuracy. Rocky Mountain Reserve shall assume that all such information that appears at least facially reasonable is complete and accurate, and is under no duty to question the completeness or accuracy of such information. With respect to any Plan subject to the HIPAA privacy rule, such information (once in the possession of Rocky Mountain Reserve) shall be considered PHI, and when transmitted by or maintained in electronic media thereafter shall be considered ePHI, subject to the privacy, breach notification, and security rules under HIPAA and the applicable separate Business Associate Contract. Employer will provide Rocky Mountain Reserve with the names of individuals authorized to act for the Employer in connection with this Agreement. Information to be furnished to Rocky Mountain Reserve necessary to provide COBRA administration services, including, but not limited to: (a). The names of all Qualified Beneficiaries eligible to elect Continuation Coverage, as well as the COBRA Qualifying Event date and the type of event (i.e., termination of employment), employee census information (including the coverage that the employee had at the time of the Qualifying Event), and dependent information for all dependents covered under the employee's Plan at the time of the Qualifying Event. (b). Employer will determine the cost to the Plan for Continuation Coverage and establish the premium to be charged to Qualified Beneficiaries. Employer will also establish the length of the grace period within which a Qualified Beneficiary may pay premiums for Continuation Coverage without the loss of such coverage. Employer will communicate both the cost to the Plan for Continuation Coverage and the premium to be charged to Qualified Beneficiaries to Rocky Mountain Reserve. (c). Mailing addresses and any other information necessary to enable Rocky Mountain Reserve to perform the administrative services under this Agreement; (d). Information concerning any violations of COBRA known to Employer immediately upon acquiring such information. (e). PHI will be subject to the privacy and security rules under HIPAA and the separate Business Associate Contract. 2.5 Compliance Employer is responsible for the Program's compliance with all applicable federal and state laws and regulations. Employer acknowledges that Rocky Mountain Reserve is not providing tax or legal advice and that Employer shall be solely responsible for determining the legal and tax status of the Program. Rocky Mountain Reserve will provide information requested by the Employer in the assistance of the Employers sole obligation to complete and file any forms or documents for legal purposes. 2.6 Financial Responsibility for Claims Employer is responsible for payment of claims made pursuant to, and the benefits to be provided by, the Program. Rocky Mountain Reserve does not insure or underwrite the liability of Employer under the Program. Except for (a) expenses required for Rocky Mountain Reserve to be in the business of providing services under this Agreement; and (b) expenses specifically assumed by Rocky Mountain Reserve in this Agreement, Employer is responsible for all expenses incident to the Program. 2.7 Medical Records Employer shall, if required by law or regulation, (a) notify each Participant and provide each Participant with an opportunity to opt out (if required); or (b) obtain from each Participant such written authorization for release of any personal financial records and medical records in accordance with applicable state and federal law (including without limitation HIPAA and the Gramm -Leach -Bliley Act) to permit Employer and Rocky Mountain Reserve to perform their respective obligations under this Agreement. 2.8 HIPAA Privacy and Security With respect to any Plan or arrangement under the Program that is subject to the HIPAA privacy rule, Employer shall provide Rocky Mountain Reserve with certification that the applicable Plan document has been amended as required by the privacy rule to permit disclosures of PHI to Employer for plan administration purposes and that Employer agrees to the conditions set forth in applicable Plan documentation. Upon request, Employer will provide a copy of any applicable Plan amendments to Rocky Mountain Reserve. Other aspects of the HIPAA privacy, breach notification, and security rules are reflected in the separate applicable Business Associate Contract. In the event of a conflict between this Agreement and the Business Associate Contract regarding HIPAA compliance obligations, the terms of the Business Associate Contract will control. 2.9 Collection of Due and Unpaid Premiums As part of normal administration RMR will send required notices and collect COBRA applicable premiums on behalf of Qualified Beneficiaries and remit such premiums back to Employer for payment to carriers. RMR will each month also make available a remittance report detailing all COBRA activity and payment information. It is Employer's responsibility to reconcile carrier invoices. At the client's request and for an agreed upon fee, RMR can provide carrier billing reconciliation services. Article III: Rocky Mountain Reserve Responsibilities 3.1 Limited Responsibilities Rocky Mountain Reserve's sole responsibilities shall be as described in this Agreement, including the obligations listed in any Appendix to this Agreement. Rocky Mountain Reserve generally provides certain reimbursement, recordkeeping, and other administrative services, as described further below. The Rocky Mountain Reserve and any subcontractors (as described below) will carry out these duties in accordance with the Plan documents and applicable law. 3.2 Customer Service Rocky Mountain Reserve shall provide customer service personnel during normal business hours as determined by Rocky Mountain Reserve. Subject to the terms of any Business Associate Contract, Rocky Mountain Reserve shall not be deemed in default of this Agreement as a result of, nor held responsible for, any cessation, interruption, or delay in the performance of its obligations hereunder due to causes beyond its reasonable control, including, but not limited to, natural disaster, act of God, labor controversy, civil disturbance, disruption of the public markets, war or armed conflict, or the inability to obtain sufficient materials or services required in the conduct of its business, including Internet access, or any change in or the adoption of any law, judgment, or decree. 3.3 Benefit Processing and Payment Rocky Mountain Reserve shall, on behalf of Employer, operate under the express terms of this Agreement and the Program. Rocky Mountain Reserve shall accept and process claims of Participants received by Rocky Mountain Reserve for benefits under the Program in accordance with the terms and conditions, including timeframes, of the applicable Plan (as set forth in the Plan document) and applicable law. Rocky Mountain Reserve shall adjudicate and pay Program benefits to Participants, as set forth in this Article III and Article IV, in accordance with Plan terms and in its usual and customary manner. Where a claim is not paid in full, Rocky Mountain Reserve shall provide written denial notices in accordance with the terms and conditions, including timeframes, of the applicable Plan (as set forth in the Plan document) and applicable law. Rocky Mountain Reserve shall have no duty or obligation with respect to claims incurred prior to the Effective Date ("Prior Reimbursement Requests"), if any, or Program administration (or other) services arising prior to the Effective Date ("Prior Administration"), if any, regardless of whether such services were/are to be performed prior to or after the Effective Date. Employer agrees that (a) Rocky Mountain Reserve has no responsibility, liability, or obligation with respect to Prior Reimbursement Requests or Prior Administration; and (b) Employer will be responsible for processing Prior Reimbursement Requests (including any run -out claims submitted after the Effective Date) and maintaining legally required records of all Prior Reimbursement Requests and Prior Administration sufficient to comply with applicable legal (e.g., IRS substantiation) requirements. In consideration for the services provided by RMR in accordance with this Agreement, Employer agrees to pay RMR the applicable Service Charges in accordance with this Agreement. Notwithstanding any provision herein to the contrary, Employer and RMR intend and agree that any funds submitted by Employer to RMR: (i) are and shall remain the general assets of Employer; (ii) are not "plan assets" within the meaning of ERISA (without regard to whether ERISA applies); (iii) were never held in an account, fund, or trust bearing the name of a Benefit Plan or any participants or beneficiaries thereof. 3.4 Forwarding Premium Payments Rocky Mountain Reserve shall, on behalf of Employer, operate under the express terms of this Agreement and the Program. At the direction of Employer, Rocky Mountain Reserve shall transmit to the applicable insurance carrier (or carriers), from Employer funds, the amount of premiums due and owing by the payment date specified in the insurance contract. Rocky Mountain Reserve is entitled to rely upon records provided by Employer in determining the amount needed to be paid to the insurance carrier (or carriers). 3.5 Bonding and Insurance Coverage Rocky Mountain Reserve has, and will maintain, a fidelity bond for all persons involved in collecting money or making claim payments, and all officers of Rocky Mountain Reserve. This bond covers the handling of Employer's aid Participants' money and must protect such money from losses by dishonesty, theft, forgery or alteration, and unexplained disappearance. Such bond shall be in an amount sufficient to at least satisfy the fidelity bonding requirement under ERISA §412 and any other applicable bonding requirement(s). Rocky Mountain Reserve shall also maintain business liability coverage in the amount of at least $1 million. Rocky Mountain Reserve shall provide proof of such bonding and business liability coverage upon Employer's request. 3.6 Reporting As permitted under, and in accordance with, a Business Associate Contract (if applicable), Rocky Mountain Reserve shall make available to Employer at least monthly via electronic medium (unless otherwise agreed by the parties) reports summarizing the reimbursement account activities. Rocky Mountain Reserve shall also make available to Participants at least monthly via electronic medium a report showing individualized payment history, status of claims, and the amounts and transactions of the individual accounts during the preceding month. All disclosures under this section shall be made in accordance with HIPAA, including the minimum necessary standard. The employer is responsible for reviewing the reports made available via electronic medium (unless otherwise agreed by the parties) and notifying Rocky Mountain Reserve of any errors of which it is aware within a reasonable period of time after reviewing them. 3.7 Claims Appeals Rocky Mountain Reserve shall refer to Employer or its designee, for final determination, any claim for benefits or coverage that is appealed after initial denial by Rocky Mountain Reserve, or any class of claims that Employer may specify, including (a) any question of eligibility or entitlement of the claimant for coverage under the Program; (b) any question with respect to the amount due; or (c) any other appeal. 3.8 Additional Documents If Employer requests, and Employer and Rocky Mountain Reserve mutually agree upon payment of applicable fees, then Rocky Mountain Reserve shall furnish Employer (a) sample documents, to be reviewed by Employer with its legal counsel, for creation of customized documentation for the Program to be approved and executed by Employer, including board resolutions, summary plan descriptions (SPDs), plan documents, and plan amendments (if any); and (b) sample administrative forms needed for Rocky Mountain Reserve to perform its duties under this Agreement. Employer acknowledges that Employer is solely responsible for determining the legal and tax status of the Program and the legal sufficiency of all governing documents. 3.9 Recordkeeping Rocky Mountain Reserve shall maintain, for the duration of this Agreement, the usual and customary books, records, and documents, including electronic records, that relate to the Program and its Participants that Rocky Mountain Reserve has prepared or that have otherwise come within its possession. These books, records, and documents, including electronic records, are the property of Employer, and Employer has the right of continuing access to them during normal business hours at Rocky Mountain Reserve's offices with reasonable prior notice. No documentation shall be destroyed by Rocky Mountain Reserve. If this Agreement terminates Rocky Mountain Reserve will make available for retrieval, all such books, records, and documents to Employer, subject to Rocky Mountain Reserve's right to retain copies of any records it deems appropriate. Employer shall be required to pay Rocky Mountain Reserve reasonable charges for transportation of such records. To the extent that any records are provided in an electronic format, the format must be readily accessible and usable by Employer. Notwithstanding the foregoing, upon termination of this Agreement, Rocky Mountain Reserve must comply with the terms of any applicable separate Business Associate Contract with respect to the destruction or return of all PHI, including PHI that is in the possession of subcontractors or agents of Rocky Mountain Reserve. 3.10 Standard of Care; Erroneous Payments Rocky Mountain Reserve shall use reasonable care and due diligence in the exercise of its powers and the performance of its duties under this Agreement, provided that a higher standard of care will be exercised where required by applicable law. If Rocky Mountain Reserve makes any payment under this Agreement to an ineligible person, or if more than the correct amount is paid, Rocky Mountain Reserve shall promptly notify Employer and make diligent efforts to recover any payment made to or on behalf of an ineligible person or any overpayment. To the extent electronic payment cards are used, Rocky Mountain Reserve shall follow the Plan language and applicable legal requirements regarding the efforts to be made. Rocky Mountain Reserve will not be financially responsible for such erroneous payment, unless Rocky Mountain Reserve would otherwise be financially responsible under another provision of this Agreement. 3.11 Notices to Employer Rocky Mountain Reserve shall provide to Employer all notices (including any required opt - out notice) reflecting its privacy policies and practices, including any notices required by state or federal law (including, but not limited to, HIPAA and the Gramm -Leach -Bliley Act) or the Business Associate Contract. 3.12 Nondiscretionary Duties; Additional Duties Rocky Mountain Reserve and Employer agree that, to the fullest extent permitted by applicable law, the duties to be performed under this Agreement by Rocky Mountain Reserve are nondiscretionary duties. Rocky Mountain Reserve and Employer may agree to additional duties in writing as may be specified in an amendment to this Agreement, including amendment to any of the Appendices from time to time. With respect to any such additional duties, Rocky Mountain Reserve and Employer agree that, to the fullest extent permitted by applicable law, any such additional duties shall be nondiscretionary duties. 3.13 Subcontractors Rocky Mountain Reserve may engage subcontractors to assist Rocky Mountain Reserve in the performance of its obligations under this Agreement. Subcontractors may include, among others, electronic, cloud, or other data storage providers, and vendors of debit card services. The Employer must be promptly notified of the initial engagement of a subcontractor and any subsequent material modifications to the subcontractor relationship, including changing subcontractors, discontinuing use of a subcontractor, and change in scope of subcontractor responsibilities. Rocky Mountain Reserve guarantees the subcontractor's performance to the same degree as if the Rocky Mountain Reserve provided the services directly. Rocky Mountain Reserve will ensure that, if necessary, a Business Associate Contract is in place with respect to applicable services provided by a subcontractor. 3.14 COBRA Services (a). Determine whether a Qualifying Event has occurred. (b). Determine when required COBRA notices must be furnished and provide all required COBRA notices to employees, spouses, dependents, and Qualified Beneficiaries. (c). Receive all required COBRA notices from employees, spouses, dependents, and Qualified Beneficiaries. (d). Determine the date by when COBRA elections must be made and provide all necessary election forms. (e). Receive and process duly executed COBRA election forms received from Qualified Beneficiaries. (f). Determine whether a COBRA Continuation Coverage election is valid. (g). Determine the duration of Continuation Coverage and whether an event has occurred terminating coverage. (h). Design, print, and send statements and payment coupons to Qualified Beneficiaries who have elected Continuation Coverage stating the amount of the monthly premium for Continuation Coverage. (i). Receive, process, and forward to the Employer amounts received as premiums from Qualified Beneficiaries for Continuation Coverage. (j). Notify the carriers when qualified beneficiaries enroll or cease to be eligible for COBRA. 3.15 Deposit of COBRA Premium Payment Upon receipt of premium payments from Qualified Beneficiaries for Continuation Coverage, RMR will deposit such amounts in an account established by the RMR, until such amounts are required to be remitted back to the Employer for payment to the applicable carrier. RMR will maintain and render accounting of the premiums received from Qualified Beneficiaries for Continuation Coverage, and remit the amounts collected to Employer at such times and in such manner as may be agreed upon by RMR and Employer, but not more frequently than monthly. Article IV: Benefit Program Payment; Employer's Funding Responsibility 4.1 Funding of Benefits Funding for any benefit payment to (or on behalf of) the Participants under the Program, including but not limited to, all benefits to Participants in accordance with the Program, is the sole responsibility of Employer. Employer agrees to accept liability for, and provide sufficient funds to satisfy, all payments to Participants under the Program, including claims for reimbursement for covered expenses as described in the applicable Plan documents, if such expenses are incurred and the claim is presented for payment during the term of this Agreement or any subsequent run -out period as may be specified in the applicable Plan documents. Employer agrees to provide funds to Rocky Mountain Reserve in the form of an initial up -front payment prior to Rocky Mountain Reserve making any payments to the Participants under the Program.s Article V: Rocky Mountain Reserve Compensation 5.1 Service Charges The monthly service charges of Rocky Mountain Reserve are described in the Appendices. Rocky Mountain Reserve may change the amount of such charges during the term of this Agreement only upon mutual agreement and with at least thirty (30) days' advance written or electronic notice to Employer. The parties may agree that a change in service charges will take effect sooner in certain circumstances, such as in the event of a material Program change. 5.2 Billing of Charges All service charges of Rocky Mountain Reserve shall be billed separately from statements for payment of premiums and claims so that proper accounting can be made by Employer of the respective amounts paid for claims and for administrative expenses. 5.3 Payment of Charges All charges under this Article V shall be determined by Rocky Mountain Reserve and billed to Employer monthly. Employer shall make payment to Rocky Mountain Reserve within twenty (20) business days of receipt of notice of the amount due. 5.4 Compensation Disclosures Rocky Mountain Reserve shall disclose direct and indirect sources of compensation received by Rocky Mountain Reserve, other than the items discussed above, attributable to this Agreement. Total compensation received by Rocky Mountain Reserve for the performance of services under this Agreement, including direct and indirect sources of compensation, may not exceed what is considered "reasonable" for purpose of ERISA's prohibited transaction exemption with respect to services provided to any plan subject to ERISA. 5.5 Third -party Compensation As set forth herein the Employer understands and agrees that Rocky Mountain Reserve receives compensation from third parties related to certain services that it may provide hereunder. Such compensation may include interchange revenue related to the use of electronic payment cards for related transactions, interest on Employer funds held to pay Plan benefits, interest on funds established in any Rocky Mountain Reserve account. Although these amounts are not paid by Employer, this compensation is in addition to other payments Employer makes to Rocky Mountain Reserve for the administrative and other services described herein. Article VI: Indemnification and Hold Harmless 6.1 Indemnification by Employer Employer shall indemnify Rocky Mountain Reserve and hold it harmless from and against all loss, liability, damage, expense, attorney's fees, or other obligations resulting from, or arising out of, any act or omission of Employer in connection with the Program, or claim, demand, or lawsuit by Program Participants and beneficiaries against Rocky Mountain Reserve in connection with benefit payments or services performed (or not performed) by Employer hereunder. In addition, Employer shall indemnify Rocky Mountain Reserve and hold it harmless from and against any liability, expense, demand, or other obligation resulting from or arising out of any applicable premium charge, tax, or similar assessment (federal or state), for which the Program or Employer is solely liable to the extent permitted under Colorado law. 6.2 Indemnification by Rocky Mountain Reserve Rocky Mountain Reserve shall indemnify Employer and hold it harmless from and against all loss, liability, damage, expense, attorney's fees, or other obligations resulting from, or arising out of, any act or omission of Rocky Mountain Reserve in connection with the Program, or claim, demand, or lawsuit by Program Participants and beneficiaries against Employer in connection with benefit payments or services performed (or not performed) by Rocky Mountain Reserve hereunder. In addition, Rocky Mountain Reserve shall indemnify Employer and hold it harmless from and against any liability, expense, demand, or other obligation resulting from or arising out of any premium charge, tax, or similar assessment (federal or state), for which Rocky Mountain Reserve is liable. Article VII: General Provisions 7.1 Severability; Headings If any term of this Agreement is declared invalid by a court, such invalidation will not affect the validity of any other provision, provided that the basic purposes of this Agreement are achieved through the remaining valid provisions. The headings of Articles and sections contained in this Agreement are for reference purposes only and shall not affect in any way the meaning or interpretation of this Agreement. 7.2 Compliance; Non -Waiver Failure by Employer or Rocky Mountain Reserve to insist upon strict performance of any provision of this Agreement will not modify such provision, render it unenforceable, or waive any subsequent breach. No waiver or modification of any of the terms or provisions of this Agreement shall be valid unless in each instance the waiver or modification is accomplished pursuant to the amendment provisions of Section 7.3. 7.3 Assignment Rocky Mountain Reserve may assign or transfer this Agreement and attachments or amendments issued hereunder in connection with the sale of its assets, stock, or securities, or in connection with any change in control. This Agreement may be amended only by written agreement of duly authorized officers of Employer and Rocky Mountain Reserve. 7.4 Nondisclosure of Proprietary Information (a). General. Employer and Rocky Mountain Reserve each acknowledge that in contemplation of entering into this Agreement (and as a result of the contractual relationship created hereby), each party has revealed and disclosed, and shall continue to reveal and disclose to the other, information which is proprietary or confidential information of such party. Employer and Rocky Mountain Reserve agree that each party shall (1) keep such proprietary or confidential information of the other party in strict confidence; (2) not disclose confidential information of the other party to any third parties or to any of its employees not having a legitimate need to know such information; (3) not use confidential information of the other party for any purpose not directly relaters to and necessary for the performance of its obligations under this Agreement (unless required to do so by a court of competent jurisdiction or a regulatory body having authority to require such disclosure); and (4) comply with the terms of use and disclosure of PHI in any Business Associate Contract. (b). Confidential Information Defined. Information revealed or disclosed by a party for any purpose not directly related to and necessary for the performance of such party's obligations under this Agreement shall not be considered confidential information for purposes hereof (1) if, when, and to the extent such information is or becomes generally available to the public without the fault or negligence of the party receiving or disclosing the information; (2) if the unrestricted use of such information by the party receiving or disclosing the information has been expressly authorized in writing and in advance by an authorized representative of the other party; or (3) if required by applicable law. For purposes of this section, confidential information is any information in written, human -readable, machine-readable, or electronically recorded form (and legended as confidential or proprietary, or words of similar import) and information disclosed orally in connection with this Agreement and identified as confidential or proprietary (or words of similar import); and programs, policies, practices, procedures, files, records, and correspondence concerning the parties' respective businesses or finances. The terms and conditions of this this section "Nondisclosure of proprietary information" shall survive the termination of this Agreement. 7.5 Arbitration Any controversy or claim arising out of or relating to this Agreement between Employer and Rocky Mountain Reserve, or the breach thereof, shall be subject to nonbinding arbitration prior to the filing of a complaint in a court of law; provided, however, that such arbitration shall be final and binding and may be enforced in any court with the requisite jurisdiction if the parties agree in advance, in writing, that such arbitration shall have final, binding effect. All arbitration, whether binding or nonbinding, shall be conducted in accordance with the Commercial Arbitration Rules of the American Arbitration Association. The arbitration shall take place in the State of Colorado. Nothing precludes the parties from waiving, in writing, the requirement to first pursue arbitration. 7.6 Termination of Agreement (a). Either Party may terminate any or all of the Services provided under this Agreement by providing the other Party with: (i) in the case of RMR providing such notice, no less than sixty (60) days prior written notice, and (ii) in the case of Employer providing such notice, no less than sixty (60) days prior written notice. Such notice to be effective on the date specified in such notice. (b). RMR may terminate any or all Services, in whole or in part, if Employer materially breaches the terms of this Agreement or any Services Appendix and does not cure that material breach within the timeframe specified by RMR in its notice of breach (if any). (c). Employer may terminate a Services Appendix if RMR materially breaches its obligations under that Services Appendix and does not cure that material breach within thirty (30) days after receipt of Employer's notice. (d). Each Party may also terminate a Service as set forth in the Services Appendix applicable to such Service. (e). This Agreement shall terminate automatically with respect to any Benefit Plan Service as of the date the underlying Benefit Plan is terminated. (f). RMR may terminate any or all Services, in whole or in part, for cause as of the date specified in a termination notice if Employer: (i) files for bankruptcy, (ii) becomes or is declared insolvent, (iii) is the subject of any proceedings (not dismissed within 30 days) related to its liquidation, insolvency or the appointment of a receiver or similar officer, (iv) makes an assignment for the benefit of all or substantially all of its creditors, (v) takes any corporate action for its winding -up, dissolution or administration, (vi) enters into an agreement for the extension or readjustment of substantially all of its obligations, or (vii) recklessly or intentionally makes any material misstatement as to its financial condition. (g). Termination of this Agreement (including Appendices) shall not terminate the rights or obligations of either party arising prior to the effective date of such termination. The indemnity, confidentiality and privacy provisions of this Agreement shall survive its termination. (h). Survival of Certain Provisions. Termination of this Agreement shall not terminate (1) the rights or obligations of either party arising out of a period prior to such termination; (2) the indemnity, confidentiality, privacy, and security provisions of this Agreement; or (3) any provision in this Agreement that specifically provides for survival following termination of this Agreement. 7.7 Complete Agreement; Governing Law This Agreement (including the Appendices) is the full Agreement of the parties with respect to the subject matter hereof and supersedes all prior agreements and representations between the parties, other than the separate applicable Business Associate Contract between any Plan subject to the HIPAA privacy rule and Rocky Mountain Reserve. This Agreement shall be construed, enforced, and governed by the laws of the State of Colorado. IN WITNESS WHEREOF, Employer and Rocky Mountain Reserve have caused this Agreement to be executed in their names by their undersigned officers, the same being duly authorized to do so. Rocky Mountain Reserve Tucker Davis Weld County Government Kevin D. Ross Name Name Tuaea.+, PaiAei Signature COO Signature Chair, Board of Weld County Commissioners Title Title 12/24/24 Date Appendix Capitalized terms used in this Appendix and not otherwise defined herein have the meanings given in the Agreement. DEC 232024 Appendix — Overall Fees Document Amendment Fee: $75.00, payable if Plan Documents should be amended after a written request has been made by the Employer. Appendix - Health FSA Guidelines Monthly Service Charges: z oz4 - 33 dot The monthly fees charged for each Participant enrolled in the FSA as of the first day of each month for the term of the Agreement shall be $2.75 per Participant per month. Services Included: Employer is responsible for all legal requirements and administrative obligations with regard to the Health FSA, except for the following administrative duties to be performed by Rocky Mountain Reserve or a subcontractor of Rocky Mountain Reserve engaged in accordance with the Agreement: 1. Rocky Mountain Reserve shall make available (by electronic medium and paper copy) enrollment and reimbursement forms and instructions for filing Participant claims. Upon payment of additional fees, Rocky Mountain Reserve shall make available other Health FSA documents. 2. Make a requested change in a Participant's coverage election as soon as practicable after receiving instructions from Employer. 3. Rocky Mountain Reserve shall prepare the information necessary to enable Employer to satisfy its Form 5500 filing obligation (if any) with regard to the Health FSA. Employer shall be responsible for reviewing the information provided by Rocky Mountain Reserve to ensure its accuracy, and, unless otherwise agreed by the parties in writing, Employer shall prepare and submit any Form 5500. 4. Rocky Mountain Reserve shall assist Employer in performing preliminary, midyear, and final nondiscrimination tests for the Health FSA. Employer shall remain solely liable for the consequences of any action or inaction arising from those tests. 5. RMR shall make initial decisions with regard to Participant claims as specified in the applicable underlying Plan document. Disbursement of benefit payments that it determines to be due shall be made promptly. Unless special circumstances exist, including denial of all or a portion of the claim, payment shall be disbursed within seven (7) business days of the day on which RMR receives the claim. Unless the Plan document provides otherwise, benefit payments shall be made by direct deposit or check payable to the Participant. If the amount of the claim exceeds the amount the Participant has had withheld to -date, RMR will contact Employer to make available such excess amount. 6. RMR shall notify Participants with regard to any claims that are denied due to inadequate substantiation or data submission, and provide an adequate period of time for the Participant to resubmit the claim. RMR shall follow the requirements of ERISA as reflected in the Plan document with regard to denial of claims. Services Not Included: Rocky Mountain Reserve is not responsible for any of the following: 1. Payment of claims from other than an Employer general assets account. 2. Employer's compliance with COBRA or USERRA, if applicable. 3. Employer's compliance with HIPAA privacy, breach notification, and security provisions, if applicable, but Rocky Mountain Reserve will comply with provisions of HIPAA's privacy, breach notification, and security rules applicable to Rocky Mountain Reserve in carrying out its duties. 4. Employer's compliance with qualified medical child support orders (QMCSOs). 5. Determining whether Employer's Health FSA documents are in compliance with the Code or any other applicable state, federal, or local statutes or regulations. 6. Determining if and when an event has occurred under the IRS permitted election change regulations (or other applicable law) such that a change in election is permitted under the Health FSA. Appendix - Dependent Care FSA Guidelines Monthly Service Charges: The monthly fees charged for each Participant enrolled in the FSA as of the first day of each month for the term of the Agreement shall be $2.75 per Participant per month. Fees for FSA services include Health FSA, Dependent Care FSA, and Limited Purpose FSA. For any and all of these services administered, only one base fee and one minimum fee shall apply. A participant participating in one, multiple, or all of these services shall be considered one participant and only one fee will apply. Services Included: Employer is responsible for all legal requirements and administrative obligations with regard to the Dependent Care FSA, except for the following administrative duties, to be performed by Rocky Mountain Reserve or a subcontractor of Rocky Mountain Reserve engaged in accordance with the Agreement: 1. Rocky Mountain Reserve shall make available (by electronic medium and paper copy) enrollment and reimbursement forms and instructions for filing Participant claims. Upon payment of additional fees, Rocky Mountain Reserve shall make available other Dependent Care FSA documents. 2. Upon receiving instructions from Employer with regard to a Participant's change in status or other event that permits an election change under applicable laws, including IRS regulations, Rocky Mountain Reserve shall make the requested change in the Participant's election as soon as practicable. 3. Rocky Mountain Reserve shall assist Employer in performing preliminary, midyear, and final nondiscrimination tests for the Dependent Care FSA. 4. RMR shall make initial decisions with regard to Participant claims as specified in the applicable underlying Plan document. Disbursements of benefit payments that it determines to be due shall be made promptly. Unless special circumstances exist, including denial of all or a portion of the claim, payment shall be disbursed within seven (7) business days of the day on which RMR receives the claim. Unless the Plan document provides otherwise, benefit payments shall be made by direct deposit or check payable to the Participant. If the amount of the claim exceeds the amount the Participant has had withheld to -date, RMR will hold the claim and make reimbursements as monies are withheld from the Participant's pay. 5. Rocky Mountain Reserve shall notify Participants with regard to any claims that are denied due to inadequate substantiation or data submission, and provide a specified period of time for the Participant to perfect and resubmit the claim. The Rocky Mountain Reserve shall follow the terms and conditions specified in the underlying Plan document. Services Not Included: Rocky Mountain Reserve is not responsible for any of the following: 1. Determining whether Employer's Dependent Care FSA documents are in compliance with the Code or any other applicable state, federal, or local statutes or regulations. 2. Determining if and when an event has occurred under the IRS permitted election change regulations (or other applicable law) such that a change in election is permitted under the Dependent Care FSA. 3. Determining the maximum permissible contribution for any particular Participant. Appendix - HSA Monthly Service Charges: The monthly fees charged for each Participant as of the first day of each month for the term of the Agreement shall be $2.25 per Participant per month. Services Included: Employer is responsible for all legal requirements and administrative obligations with regard to the Cafeteria Plan and Health Savings Accounts, except for the following administrative duties to be performed by RMR or a subcontractor of RMR engaged in accordance with the Agreement: 1. RMR shall make available (by electronic medium and paper copy) enrollment and reimbursement forms and instructions for filing Participant claims. 2. Upon receiving instructions from Employer with regard to a Participant's change in status or other event that permits an election change under applicable laws, including IRS regulations, RMR shall make the requested change in the Participant's election as soon as practicable. 3. RMR shall work with the custodial bank to provide the information necessary to prepare the required reporting. 4. RMR will find and engage a debit card vendor to access the HSA account. 5. RMR will provide access to a help center to help answer questions about the participant's HSA account and use of their HSA debit card. 6. RMR will make available a website for participants to access general HSA information and specific account information. 7. RMR shall request from the Employer the information necessary to prepare nondiscrimination tests. RMR will prepare a preliminary and final nondiscrimination tests for the Cafeteria Plan. Services Not Included: RMR is not responsible for any of the following: 1. Payment of claims from other than an Employer general assets account. 2. Employer's compliance with HIPAA portability provisions (including notifications such as certificates of creditable coverage), if applicable, or with HIPAA privacy and security provisions (including notification obligations), if applicable (but RMR will comply with applicable provisions of HIPAA's privacy and security rules in carrying out its duties). 3. Employer's compliance with qualified medical child support orders (QMCSOs). Appendix - COBRA Guidelines Monthly Service Charges: The monthly fees charged for each benefit enrolled employee as of the first day of each month for the term of the Agreement shall be $0.48 per benefit enrolled employee per month. Rocky Mountain Reserve will retain the 2% COBRA Administration fee paid by the Qualified Beneficiary. Open Enrollment Services (Optional) If chosen by the employer, Rocky Mountain Reserve will prepare and send out open enrollment packets for an additional fee of $8.00 per packet. These fees must exceed in total $0.00 or the minimum fee of $0.00 will be charged. If chosen by the employer, Rocky Mountain Reserve will send a General Rights Notice to all employees at takeover for an additional fee of $2.00 per notice. Services Included: Employer is responsible for all legal requirements and administrative obligations with regard to COBRA, except for the following administrative duties, to be performed by Rocky Mountain Reserve or a subcontractor of Rocky Mountain Reserve engaged in accordance with the Agreement: 1. Determine whether a Qualifying Event has occurred. 2. Determine when required COBRA notices must be furnished and provide all required COBRA notices to employees, spouses, dependents, and Qualified Beneficiaries. 3. Receive all required COBRA notices from employees, spouses, dependents, and Qualified Beneficiaries. 4. Determine the date by when COBRA elections must be made and provide all necessary election forms. 5. Receive and process duly executed COBRA election forms received from Qualified Beneficiaries. 6. Determine whether a COBRA Continuation Coverage election is valid. 7. Determine the duration of Continuation Coverage and whether an event has occurred terminating coverage. 8. Design, print, and send statements and payment coupons to Qualified Beneficiaries who have elected Continuation Coverage stating the amount of the monthly premium for Continuation Coverage. 9. Receive, process, and forward to the Employer amounts received as premiums from Qualified Beneficiaries for Continuation Coverage. 10. Notify the carriers when qualified beneficiaries enroll or cease to be eligible for COBRA. 1221 W Mineral Avenue, Suite 202, Littleton, CO 80120 (888) 722-1223 * www.rockymountainreserve.com Business Associate Agreement Weld County Government ("Covered Entity") has asked Rocky Mountain Reserve ("Business Associate") to provide administrative services for certain employee benefit plans maintained by the Covered Entity. As part of that arrangement the Covered Entity and Business Associate enter into this Agreement. L Definitions (a) Breach. "Breach" shall have the same meaning as the term "breach" in 45 CFR §164.402. (b) Breach Notification Rule. "Breach Notification Rule" shall mean the Standards and Implementation Specifications for Notification of Breaches of Unsecured Protected Health Information under 45 CFR Parts 160 and 164, subparts A and D. (c) Business Associate. "Business Associate" shall mean Rocky Mountain Reserve (RMR). (d) Covered Entity. "Covered Entity" shall mean Weld County Government. (e) Electronic Protected Health Information. "Electronic Protected Health Information" shall have the same meaning as the term "electronic protected health information" in CFR §160.103. (f) Electronic Transactions Rule. "Electronic Transactions Rule" shall mean the final regulations issued by HHS concerning standard transactions and code sets under 45 CFR Parts 160 and 162. (g) Enforcement Rule. "Enforcement Rule" shall mean the Enforcement Provisions set forth in 45 CFR Part 160. (h) Genetic Information. "Genetic Information" shall have the same meaning as the term "genetic information" in CFR §160.103. (1) HHS. "HHS" shall mean the Department of Health and Human Services. (j) HIPAA Rules. "HIPAA Rules" shall mean the Privacy Rule, Security Rule, Breach Notification Rule, and Enforcement Rule. (k) Individual. "Individual" shall have the same meaning as the term "individual" in 45 CFR §160.103 and shall include a person who qualifies as a personal representative in accordance with 45 CFR § 164.502(g) . (I) HITECH Act. "HITECH Act" shall mean the Health Information Technology for Economic and Clinical Health Act, enacted as part of the American Recovery and Reinvestment Act of 2009. (m) Privacy Rule. "Privacy Rule" shall mean the Standards for Privacy of Individually Identifiable Health Information at 45 CFR Part 160 and Part 164, subparts A and E. (n) Protected Health Information. "Protected Health Information" shall have the same meaning as the term "protected health information" in 45 CFR § 160.103, limited to the information created or received by Business Associate from or on behalf of Covered Entity. (o) Required By Law. "Required By Law" shall have the same meaning as the term "required by law" in 45 CFR §164.103. (p) Security Incident. "Security Incident" shall have the same meaning as the term "security incident" in 45 CFR §164.304. (q) Security Rule. "Security Rule" shall mean the Security Standards and Implementation Specifications at 45 CFR Part 160 and Part 164, subpart C. (r) Subcontractor. "Subcontractor" shall have the same meaning as the term "subcontractor" in 45 CFR §164.103. (s) Transaction. "Transaction" shall have the meaning given the term "transaction" in 45 CFR §164.103. (t) Unsecured Protected Health Information. "Unsecured Protected Health Information" shall have the meaning given the term "unsecured protected health information" in 45 CFR §164.402. Page 1 of 8 II. Privacy and Security of Protected Health Information (a) Permitted Uses and Disclosures. Business Associate is permitted to use and disclose Protected Health Information only as set forth below: (i) Functions and Activities on Covered Entity's Behalf. To provide the described services in the Service Agreement between Rocky Mountain Reserve and the Covered Entity. (ii) Business Associate's Operations. 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. Business Associate may disclose Protected Health Information for the proper management and administration of the Business Associate or to carry out Business Associate's legal responsibilities, provided that - (A) The disclosure is required by law; or (B) Business Associate obtains reasonable assurance from any person or entity to which Business Associate will disclose Protected Health Information that the person or entity will - (1) Hold the Protected Health Information in confidence and use or further disclose the Protected Health Information only for the purpose for which Business Associate disclosed Protected Health Information to the person or entity or as Required by Law; and (2) Promptly notify Business Associate of any instance of which the person or entity becomes aware in which the confidentiality of Protected Health Information was breached. (iii) Minimum Necessary. Business Associate will, in its performance of the functions, activities, services, and operations specified above, make reasonable efforts to use, to disclose, and to request only the minimum amount of Protected Health Information reasonably necessary to accomplish the intended purpose of the use, disclosure, or request, except that Business Associate will not be obligated to comply with this minimum -necessary limitation if neither Business Associate nor Covered Entity is required to limit its use, disclosure, or request to the minimum necessary under the HIPAA Rules. Business Associate and Covered Entity acknowledge that the phrase "minimum necessary" shall be interpreted in accordance with the HITECH Act and the HIPAA Rules. (b) Prohibition on Unauthorized Use or Disclosure. Business Associate will neither use nor disclose Protected Health Information, except as permitted or required by this Agreement or in writing by Covered Entity or as Required by Law. This Agreement does not authorize Business Associate to use or disclose Covered Entity's Protected Health Information in a manner that would violate the HIPAA Rules if done by Covered Entity, except as permitted for Business Associate's proper management and administration, as described above. (c) Information Safeguards. (i) Privacy of Protected Health Information. Business Associate will develop, implement, maintain, and use appropriate administrative, technical, and physical safeguards to protect the privacy of Protected Health Information. The safeguards must reasonably protect Protected Health Information from any intentional or unintentional use or disclosure in violation of the Page 2 of 8 Privacy Rule and limit incidental uses or disclosures made pursuant to a use or disclosure otherwise permitted by this Agreement. To the extent the parties agree that the Business Associate will carry out directly one or more of Covered Entity's obligations under the Privacy Rule, the Business Associate will comply with the requirements of the Privacy Rule that apply to the Covered Entity in the performance of such obligations. (ii) Security of Covered Entity's Electronic Protected Health Information. Business Associate will comply with the Security Rule and will use appropriate administrative, technical, and physical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of Electronic Protected Health Information that Business Associate creates, receives, maintains, or transmits on Covered Entity's behalf (iii) No Transfer of PHI Outside United States. Business Associate will not transfer Protected Health Information outside the United States without the prior written consent of the Covered Entity. In this context, a "transfer" outside the United States occurs if Business Associate's workforce members, agents, or subcontractors physically located outside the United States are able to access, use, or disclose Protected Health Information. (d) Subcontractors. Business Associate will require each of its Subcontractors to agree, in a written agreement with Business Associate, to comply with the provisions of the Security Rule; to appropriately safeguard Protected Health Information created, received, maintained, or transmitted on behalf of the Business Associate; and to apply the same restrictions and conditions that apply to the Business Associate with respect to such Protected Health Information. (e) Prohibition on Sale of Protected Health Information. Effective September 23, 2013, Business Associate shall not engage in any sale (as defined in the HIPAA rules) of Protected Health Information. (f) Prohibition on Use or Disclosure of Genetic Information. Effective September 23, 2013, Business Associate shall not use or disclose Genetic Information for underwriting purposes in violation of the HIPAA rules. (g) Penalties for Noncompliance. Business Associate acknowledges that it is subject to civil and criminal enforcement for failure to comply with the HIPAA Rules, to the extent provided by the HITECH Act and the HIPAA Rules. (h) Reproductive Health Care. i. Effective beginning December 23, 2024, or such other date required by applicable law, Business Associate shall comply with the requirements of 45 CFR §§ 164.502(a)(5)(iii) and 164.509 with respect to uses and disclosures of Protected Health Information related to Reproductive Health Care, including: a. making the determination required by 45 CFR § 164.502(a)(5)(iii)(B); and b. obtaining and determining the validity of an attestation from the person requesting such use or disclosure in accordance with 45 CFR §164.509. ii. Business Associate shall promptly notify Covered Entity of a. any request it receives from a third party for a purpose described in 45 CFR §164.502(a)(5)(iii); b. any request from a third party for which an attestation would be required under 45 CFR §164.509(a); and c. any instance in which Business Associate discovers information reasonably showing that a representation made in an attestation required under 45 CFR §164.509(a) was Page 3 of 8 materially false. III. Compliance With Electronic Transactions Rule. If Business Associate conducts in whole or part electronic Transactions on behalf of Covered Entity for which HHS has established standards, Business Associate will comply, and will require any Subcontractor it involves with the conduct of such Transactions to comply, with each applicable requirement of the Electronic Transactions Rule and of any operating rules adopted by HHS with respect to Transactions. IV. Individual Rights. (a) Access. Business Associate will, within 30 calendar days following Covered Entity's request, make available to Covered Entity (or, at Covered Entity's written direction, to an individual or the individual's designee) for inspection and copying Protected Health Information about the individual that is in a Designated Record Set in Business Associate's custody or control, so that Covered Entity may meet its access obligations under 45 CFR §164.524. Effective September 23, 2013, if Covered Entity requests an electronic copy of Protected Health Information that is maintained electronically in a Designated Record Set in the Business Associate's custody or control, Business Associate will provide an electronic copy in the form and format specified by the Covered Entity if it is readily producible in such format; if it is not readily producible in such format, Business Associate will work with Covered Entity to determine an alternative form and format that enable Covered Entity to meet its electronic access obligations under 45 CFR §164.524. (b) Amendment. Business Associate will, upon receipt of written notice from Covered Entity, promptly amend or permit Covered Entity access to amend any portion of an individual's Protected Health Information that is in a Designated Record Set in the custody or control of the Business Associate, so that Covered Entity may meet its amendment obligations under 45 CFR §164.526. (c) Disclosure Accounting. To allow Covered Entity to meet its obligations to account for disclosures of Protected Health Information under 45 CFR §164.528: (i) Disclosures Subject to Accounting. Business Associate will record the information specified below ("Disclosure Information") for each disclosure of Protected Health Information, not excepted from disclosure accounting as specified below, that Business Associate makes to Covered Entity or to a third party. (ii) Disclosures Not Subject to Accounting. Business Associate will not be obligated to record Disclosure Information or otherwise account for disclosures of Protected Health Information if Covered Entity need not account for such disclosures under the HIPAA Rules. (iii) Disclosure Information. With respect to any disclosure by Business Associate of Protected Health Information that is not excepted from disclosure accounting under the HIPAA Rules, Business Associate will record the following Disclosure Information as applicable to the type of accountable disclosure made: (A) Disclosure Information Generally. Except for repetitive disclosures of Protected Health Information as specified below, the Disclosure Information that Business Associate must record for each accountable disclosure is (i) the disclosure date, (ii) the name and (if known) address of the entity to which Business Associate made the disclosure, (iii) a brief description of the Protected Health Information disclosed, and (iv) a brief statement of the purpose of the disclosure. (B) Disclosure Information for Repetitive Disclosures. For repetitive disclosures of Page 4 of 8 Protected Health Information that Business Associate makes for a single purpose to the same person or entity (including Covered Entity), the Disclosure Information that Business Associate must record is either the Disclosure Information specified above for each accountable disclosure, or (i) the Disclosure Information specified above for the first of the repetitive accountable disclosures; (ii) the frequency, periodicity, or number of the repetitive accountable disclosures; and (iii) the date of the last of the repetitive accountable disclosures. (iv) Availability of Disclosure Information. Business Associate will maintain the Disclosure Information for at least 6 years following the date of the accountable disclosure to which the Disclosure Information relates. Business Associate will make the Disclosure Information available to Covered Entity within 60 calendar days following Covered Entity's request for such Disclosure Information to comply with an individual's request for disclosure accounting. (d) Restriction Agreements and Confidential Communications. Covered Entity shall notify Business Associate of any limitations in the notice of privacy practices of Covered Entity under 45 CFR §164.520, to the extent that such limitation may affect Business Associate's use or disclosure of Protected Health Information. Business Associate will comply with any notice from Covered Entity to (1) restrict use or disclosure of Protected Health Information pursuant to 45 CFR §164.522(a), or (2) provide for confidential communications of Protected Health Information pursuant to 45 CFR §164.522(b), provided that Covered Entity notifies Business Associate in writing of the restriction or confidential communications obligations that Business Associate must follow. Covered Entity will promptly notify Business Associate in writing of the termination of any such restriction or confidential communications requirement and, with respect to termination of any such restriction, instruct Business Associate whether any of the Protected Health Information will remain subject to the terms of the restriction agreement. V. Breaches and Security Incidents. (a) Reporting. (i) Impermissible Use or Disclosure. Business Associate will report to Covered Entity any use or disclosure of Protected Health Information not permitted by this Agreement not more than 30 calendar days after Business Associate discovers such non -permitted use or disclosure. (ii) Breach of Unsecured Protected Health Information. Business Associate will report to Covered Entity any potential Breach of Unsecured Protected Health Information not more than 30 calendar days after discovery of such potential Breach. Business Associate will treat a potential Breach as being discovered in accordance with 45 CFR §164.410. Business Associate will make the report to Covered Entity's Privacy Officer. If a delay is requested by a law -enforcement official in accordance with 45 CFR §164.412, Business Associate may delay notifying Covered Entity for the applicable time period. Business Associate's report will include at least the following, provided that absence of any information will not be cause for Business Associate to delay the report: (A) Identify the nature of the Breach, which will include a brief description of what happened, including the date of any Breach and the date of the discovery of any Breach; (B) Identify the types of Protected Health Information that were involved in the Breach (such as whether full name, Social Security number, date of birth, home address, account number, diagnosis, or other information were involved) Page 5 of 8 (C) Identify who made the non -permitted use or disclosure and who received the non - permitted disclosure; (D) Identify what corrective or investigational action Business Associate took or will take to prevent further non -permitted uses or disclosures, to mitigate harmful effects, and to protect against any further Breaches; (E) Identify what steps the individuals who were subject to a Breach should take to protect themselves; (F) Provide such other information, including a written report and risk assessment under 45 CFR §164.402, as Covered Entity may reasonably request. (iii) Security Incidents. Business Associate will report to Covered Entity any Security Incident of which Business Associate becomes aware. Business Associate will make this report once per month, except if any such Security Incident resulted in a disclosure not permitted by this Agreement or Breach of Unsecured Protected Health Information, Business Associate will make the report in accordance with the provisions set forth above. (b) Mitigation. Business Associate shall mitigate, to the extent practicable, any harmful effect known to the Business Associate resulting from a use or disclosure in violation of this Agreement. VI. Term and Termination. (a) Term. This Agreement shall be effective as of the effective date of the Service Agreement with Rocky Mountain Reserve and, shall terminate on termination of the Service Agreement with Rocky Mountain Reserve. (b) Right to Terminate for Cause. Covered Entity may terminate this Agreement if it determines, in its sole discretion, that Business Associate has breached any provision of this Agreement, and after written notice to Business Associate of the breach, Business Associate has failed to cure the breach within 30 calendar days after receipt of the notice. Any such termination will be effective immediately or at such other date specified in Covered Entity's notice of termination. (c) Treatment of Protected Health Information on Termination. (i) Return or Destruction of Covered Entity's Protected Health Information If Feasible. Upon termination of this Agreement, Business Associate will, if feasible, return to Covered Entity or destroy all Protected Health Information in whatever form or medium, including all copies thereof and all data, compilations, and other works derived therefrom that allow identification of any individual who is a subject of the Protected Health Information. This provision shall apply to Protected Health Information that is in the possession of any Subcontractors of Business Associate. Further, Business Associate shall require any such Subcontractor to certify to Business Associate that it has returned or destroyed all such information which could be returned or destroyed. Business Associate will complete these obligations as promptly as possible, but not later than 30 calendar days following the effective date of the termination of this Agreement. (ii) Procedure When Return or Destruction Is Not Feasible. Business Associate will identify any Protected Health Information, including any Protected Health Information that Business Page 6 of 8 Associate has disclosed to Subcontractors, that cannot feasibly be returned to Covered Entity or destroyed and explain why return or destruction is infeasible. Business Associate will limit its further use or disclosure of such information to those purposes that make return or destruction of such information infeasible. Business Associate will complete these obligations as promptly as possible, but not later than 30 calendar days following the effective date of the termination or other conclusion of Agreement. (iii) Continuing Privacy and Security Obligation. Business Associate's obligation to protect the privacy and safeguard the security of Protected Health Information as specified in this Agreement will be continuous and survive termination or other conclusion of this Agreement. VII. General Provisions. (a) Definitions. All terms that are used but not otherwise defined in this Agreement shall have the meaning specified under HIPAA, including its statute, regulations, and other official government guidance. (b) Inspection of Internal Practices, Books, and Records. Business Associate will make its internal practices, books, and records relating to its use and disclosure of Protected Health Information available to Covered Entity and to HHS to determine compliance with the HIPAA Rules. (c) Amendment to Agreement. This Agreement may be amended only by a written instrument signed by the parties. Ia case of a change in applicable law, the parties agree to negotiate in good faith to adopt such amendments as are necessary to comply with the change in law. (d) No Third -Party Beneficiaries. Nothing in this Agreement shall be construed as creating any rights or benefits to any third parties. (e) Interpretation. Any ambiguity in the Agreement shall be resolved to permit Covered Entity and Business Associate to comply with the applicable requirements under the HIPAA Rules. (f) Governing Law, Jurisdiction, and Venue. This Agreement shall be governed by the law of Colorado, except to the extent preempted by federal law. (g) Severability. The invalidity or unenforceability of any provisions of this Agreement shall not affect the validity or enforceability of any other provision of this Agreement, which shall remain in full force and effect (h) Construction and Interpretation. The section headings contained in this Agreement are for reference purposes only and shall not in any way affect the meaning or interpretation of this Agreement. This Agreement has been negotiated by the parties at arm's -length and each of them has had an opportunity to modify the language of the Agreement. Accordingly, the Agreement shall be treated as having been drafted equally by the parties, and the language shall be construed as a whole and according to its fair meaning. Any presumption or principle that the language is to be construed against any party shall not apply. This Agreement may be executed in counterparts, each of which shall be deemed to be as original, but all of which, taken together, shall constitute one and the same agreement. (i) Notices. All notices and communications required by this Agreement shall be in writing. Such notices and communications shall be given in one of the following forms: (i) by delivery in person, Page 7 of 8 (i) by a nationally -recognized, next -day courier service, (iii) by first-class, registered or certified mail, postage prepaid; or (iv) by electronic mail to the address that each party specifies in writing. (k) Entire Agreement. This Agreement constitutes the entire agreement between the parties with respect to its subject matter and constitutes and supersedes all prior agreements, representations and understandings of the parties, written or oral, with regard to this same subject matter. VIII. Signatures Rocky Mountain Reserve Tucker Davis Weld County Government Kevin D. Ross Name Name Signature Signature COO Title 12/24/24 Chair, Board of Weld County Commissioners Title CEC 2 3 2024 Date Date ATTEST: C/., 4j lerk to the Board nay Deputy Clerk to the Page 8 of 8 202,4-33tol (cCPA). Details may be read here: hops:/lwww.libertvmutualgroup.com/about-Im/corporate-information/privacy-policy eBonding CoverLetter Liberty Mutual. ERISA BOND SURETY NAMED INSURED: Bond Number Rocky Mountain Reserve 999263901 MAILING ADDRESS: 5240 Apache Creek Ct, Castle Rock, CO 80109 KNOW ALL BY THESE PRESENTS: That in Return for the Payment of the Premium, The Ohio Casualty Insurance Company , organized under the laws of the State of New Hampshire and duly authorized to transact business as Surety ("Surety") in the State of Colorado , agrees to provide you, the Insured ("Insured"), the insurance as stated below subject to all of the teens in this bond. WHEREAS, nothing herein shall bestow any rights of any nature on anyone other than the Insured. Surety agrees to indemnify the Insured against direct pecuniary loss that the Insured incurs when such loss arises from any Fraudulent or Dishonest Act, as hereinafter defined, by a Plan Official, as herein defined, directly or through the collusion with others, and committed during the term of the bond, as hereinafter defined, provided, however, that the aggregate amount of such indemnity shall be limited to $50,000.00 Fifty Thousand Dollars And Zero Cents Dollars (5 ). WHEREAS, the term of this bond begins 15th day July , 2023 and remains in full force and effect until canceled by the Surety as provided for herein. NOW, THEREFORE, THE CONDITIONS AND LIMITATIONS OF THIS OBLIGATION ARE SUCH: 1. Loss is covered under this bond only if arising from Fraudulent or Dishonest Acts (as hereinafter defined) which are both sustained and discovered during the bond term or sustained during the bond term and discovered within one year after the earlier of either (a) the cancellation of this bond or (b) the termination date provided for in any riders altering the term of the bond. 2. A Fraudulent or Dishonest Act shall be determined pursuant to the provisions of Chapter XXV of Title 29 of the Code of Federal Regulations (CFR 2580.412-9) as it now appears or may hereafter be amended. 3. Plan Official means one who is both: (1) an Employee of the Insured and (2) a fiduciary (as defined pursuant to the Employment Retirement Income Security Act of 1974 ("ERISA"), as it now appears or may hereafter be amended, and the regulations adopted consistent thereof with ERISA) of the Plan or a person who handles funds or other property of the Plan and is required to be bonded pursuant to the provisions of ERISA. 4. The word Employee or Employees as used herein shall be deemed to mean, respectively, one or more of the natural persons who is a trustee, an officer, employee, administrator or a manager (except an administrator or a manager who is an independent contractor) of the Plan(s) covered under this bond and a director or trustee while that person is handling Funds or other property of the Plan(s) covered under this bond (CFR2580.412-3 for further definition). 5. Regardless of the number of years this bond shall continue in force and the amount of premium that shall be payable or paid, the liability of the Surety under this bond shall not be cumulative in amounts from year to year or period to period. In no event shall the Surety's aggregate liability to the Plan exceed the amount stated above. 6. In the event that any loss or losses sustained by the Insured and covered under the conditions of this bond are also covered in whole or in part under other bonds or policies issued by the Surety, or other bonds or policies issued to or for the Insured by any other person or entity, the total liability of Surety under this bond or under any other such bond or policy issued by the Surety shall not exceed in the aggregate, the lesser of (a) the amount of this bond available as set forth above, or (b) that portion of the amount of this bond available, as set forth above, computed pro rata with the amount available to the Insured under any bond or policy issued to or for the Insured by any person or entity other than the Surety. Liberty Mutual Surety Claims • P.O. Box 34526, Seattle, WA 98124 • Phone: 206-473-6210 • Fax: 866-548-6837 Lnns-15235e 10/07 uuu. LibertyMutualSuretyClaims.com Email: HOSCL@Iibertymutual.com • 7. This bond shall be deemed canceled as to any future acts of any Plan Official immediately upon discovery by the Insured of any possible Fraudulent or Dishonest Act on the part of any such Plan Official. For purposes of this paragraph, discovery shall include that time at which the Insured, in the exercise of reasonable care, should have discovered such possible Fraudulent or Dishonest Act. 8. The Insured may cancel this bond by mailing or delivering to the Surety advance written notice of cancellation. The Surety may cancel this bond by mailing or delivering to the Insured written notice of cancellation at least 30 days before the effective date of cancellation. If the notice is mailed, proof of mailing will be sufficient proof of notice. In the event of cancellation, the Surety shall have no obligation after the effective date of cancellation except for claims made in accordance with item 10 below. 9. The Insured hereby warrants that no Plan Official has committed any Fraudulent or Dishonest Act in the service of the Insured or otherwise. In the absence of prior written agreement by the Surety, the Surety shall have no liability whatsoever if any Plan Official, prior to the issuance of this bond, committed any Fraudulent or Dishonest Act of which the Insured had, or in the exercise of reasonable care, should have had knowledge. If prior to the issuance of this bond, any bond or insurance issued in favor of the Insured or any predecessor in interest of the Insured covering any Plan Official shall have been canceled as to any Plan Official by reason of: (a) the discovery of any Fraudulent or Dishonest Act on the part of any such Plan Official; or (b) providing written notice of cancellation as to any such Plan Official by any such surety or insurer, whether Surety or not, and if any such Plan Official shall not have been reinstated under the coverage of any such bond or insurance, the Surety shall not be liable under this bond. 10. The Surety shall be given written notice of loss as soon as possible after discovery by the Insured, or within said time period after the Plan should have made discovery in the exercise of a reasonable care, of any possible Fraudulent or Dishonest Act on the part of any such Plan Official. Within four (4) months after such discovery, the Insured shall file with the Surety affirmative proof of loss, itemized and duly sworn to, and shall upon request of the Surety render every assistance, not pecuniary, to facilitate the investigation and adjustment of any loss. No suit to recover on account of loss under this bond shall be brought before the expiration of two (2) months from the filing of proof as aforesaid on account of such loss or after the expiration of twelve (12) months from the discovery as aforesaid of the Fraudulent or Dishonest Act causing such loss. 11. If, at the inception of this bond, the limit of liability for the Plan is equal to or greater than that required under ERISA, the Surety agrees to automatically increase the limit of liability, subject to Item 5 above, to an amount equal to the amount required under ERISA at the time you discover a loss. 12. The Insured must transfer to the Surety all rights of recovery against any person or organization for any loss sustained by the Insured and paid or settled by the Surety. The Insured must do everything necessary to secure those rights and do nothing after loss to impair them. 13. If any limitation in this bond for cancellation, termination, giving notice, filing claim or bringing suit is prohibited or made void by any law or decision controlling the construction of this bond, such limitation shall be deemed to be amended so as to be equal to the minimum limitation permitted by law. Signed and sealed this 15th day of July , 2023 . The Ohio Casualty Insurance Company BY: 7-":k ". Timothy A. Mikolajewski, Assistant Secretary ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/04/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDIT ONAL 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). PRODUCER CONTACT NAME: Kris Brader(072728H) PHONE FAX 115 Wilcox St Ste 220 (A/C, NO, EXT): 720-789-7980 (A/C, NO): 720-789-7982 E-MAIL Castle Rock CO 80104-2049 ADDRESS: kbrader@farmersagent.com INSURER(S) AFFORDING COVERAGE NAIL # INSURED INSURER A: Truck Insurance Exchange 21709 INSURE.: Farmers Insurance Exchange 21652 ROCKY MOUNTAIN RESERVE LLC 5240 APACHE CREEK CT INSURER C: Mid Century Insurance Company 21687 INSURER O: ATTN: BOB DAVIS INSURER E: CASTLE ROCK CO 80109 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH TH S CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDTL INSD SUER WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS B X COMMERCIAL GENERAL LIABILITY �/ CLAIMS -MADE /� OCCUR Y N 605068851 01/13/2024 01/13/2025 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED PREMISES(Ea Occurrence) $ 75,000 MED EXP (Anyone person) $ 5,000 PERSONAL&ADVINJUR,' 0 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ PROJECT ❑ LAC OTHER: GENERALAGGREGATE $ 4,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 B AUTOMOBILE LIABILITY ANY AUTO AUTOS ONLY HIRED AUTOS ONLY SCHEDULED X NON -OWNED AUTOS ONLY N 605068851 01/13!2024 01/13/2025 COMBINEDSINGLE LIMIT (Ea accident) $ 2,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/ Y/ft EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A PER OTHER STATUTE $ E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE II E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Add'tional Remarks Schedule, may be attached if more space is required) Employee Dishonesty $1,000,000 CERTIFICATE HOLDER CANCELLATION Weld County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION PO Box 758 DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1150 O Street AUTHORIZ RERRES TIVE Greeley CO 806322G�Z ACORD 25 (2016/03) 31-1769 11-15 ©1988-2015 ACORD CORPORATION. All Rights Reserved The ACORD name and logo are registered marks of ACORD Contract Form Entity Information Entity Name* ROCKY MOUNTAIN RESERVE LLC Entity ID* @00049318 ❑ New Entity? Contract Name* Contract ID ROCKY MOUNTAIN RESERVE CONSOLIDATION 8909 SERVICES AGREEMENT Contract Status CTB REVIEW Contract Lead * BPETERSON Contract Lead Email bpeterson@weld.gov Parent Contract ID Requires Board Approval YES Department Project # Contract Description* WE CURRENTLY USE ROCKY MOUNTAIN RESERVE FOR FSA AND DCA SERVICES AND WOULD LIKE TO EXTEND THE PARTNERSHIP TO INCLUDE COBRA ADMINISTRATION AND HSA. THIS WOULD STREAMLINE BENEFITS AND REDUCE COSTS FOR BOTH EMPLOYEES AND EMPLOYER. Contract Description 2 Contract Type* Department AGREEMENT HUMAN RESOURCES Amount* $0.00 Renewable" NO Automatic Renewal Grant IGA Department Email CM- HumanResources@weld.g ov Does Contract require Purchasing Dept. to be Department Head Email included? CM-HumanResources- DeptHead@weld.gov Requested BOCC Agenda Due Date Date* 12/12/2024 12/16/2024 Will a work session with BOCC be required?* HAD County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COUNTYATTORNEY@WEL D.GOV If this is a renewal enter previous Contract ID If this is part of a MSA enter MSA Contract ID Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in OnBase Contract Dates Effective Date 01/01/2025 Review Date * 10/01/2026 Termination Notice Period Committed Delivery Date Contact Information Contact Info Renewal Date Expiration Date* 12/31/2026 Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2 Purchasing Purchasing Approver Purchasing Approved Date Approval Process Department Head JILL SCOTT DH Approved Date 12/16/2024 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 12/23/2024 Finance Approver CHERYL PATTELLI Legal Counsel BYRON HOWELL Finance Approved Date Legal Counsel Approved Date 12/17/2024 12/17/2024 Tyler Ref # AG 122324 Originator BPETERSON Hello