Agreements - Business Associate and Confidentiality for HIPAA Compliance and Confidential Data Transfer, Maintenance & Disclosure for SBFD - enFocus

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BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date 12/3/19 Name Todd Skwarcan Department Fire BPW Date 12/10/19 Phone Extension 9255 �;_ �_ le'�z�retl Prior to Submittal to Board _ BPW Attorney Attorney Name Clara McDaniels Dept. Attorney Attorney Name Elliot Anderson _ ........— Purchasing �necx the r item,,! elf �i��c��l , All Submissions _uu _ ....... Professional Services Agreement Z Contract [:1 Proposal El Open Market Contract ❑ Amendment/Addendum ❑ Special Purchase, QPA ❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Quote Opening [❑ Proposal Opening Chg. Order, No. _ F-1 Other: ] Quote Award ❑ Reject Bids/Quotes R C/O & PCA No. ❑ PCA E] Traffic Control ❑ Resolution F Ease./Encroach ❑ Title Sheet Company or Vendor Name enFocus New Vendor Yes[] If Yes, Approved by Purchasing ® No MBE/WBE Contractor ❑ MBE Completed E-Verify Form Attached ❑ Yes ❑ WBE ❑ No Project Name Business Associate Agreement for NIOSH Grant Project _. ...... ............... . Terms of Contract Final date of PHI return/destruction Purpose/Description Further to the underlying Consulting Agreement between the City and enFoous dated December 20, 2018, the South Bend Fire Department is requesting that the BPW approve a Business Associate Agreement between the City and enFocus to ensure the parties' HIPAA compliance and govern the parties' confidential data transfer, maintenance, and disclosure responsibilities in furtherance of enFocus' support on and project management of the SBFD's NIOSH Grant application. For Cln ° Orders Only Amount of ❑ Increase Decrease �$ ) Previous Amount $ ..... _....._..�....._...... .._... . Increase % Current Percent of Change: Decrease New Amount $ Increase % Total Percent of Change: .............. Decrease % Time Extension Amount: .............._. _..� New Completion Date: