board of commissioners of the county of ......swearing in of commissioner nelson peters by judge...

BOARD OF COMMISSIONERS OF THE COUNTY OF ALLENCouncil Chambers Courtroom - Citizens Square

200 East Berry Street, Room 035Fort Wayne IN 46802

AGENDA

Commissioners' Legislative Session10:00 AM Friday, January 8, 2021

Call to Order Pledge of Allegiance and Moment of Silence Swearing In of Commissioner Nelson Peters by Judge Craig J. Bobay, Judge, Allen SuperiorCourt

OATH OF OFFICE

I, F. Nelson Peters, do solemnly swear that I will support the Constitution of the United States andthe Constitution of the State of Indiana, and that I will faithfully and impartially perform my dutiesas Commissioner of Allen County, Indiana, according to the best of my skill and ability, so help meGod. Reorganization of Board of Commissioners, Election of Officers 1. Items for Consideration: 1.a Consideration of approval of the minutes of the legislative session from December 11, 2020. 12-11-20 Minutes.docx 1.b Consideration of 2021-2023 Excess Workers Compensation Policy with USI. 21-23 XS WC USI Proposal for 12-7-2020 Meeting.pdf 1.c Consideration of agreement between the Board of Commissioners and Indiana Family &

Social Services for medical care for incarcerated offenders. AllenCounty-2021.pdf 1.d Consideration of Interlocal Cooperation Agreement for use of Sheriff's Regional Training

Facility between the City of Fort Wayne, Sheriff of Allen County and the Commissioners ofAllen County.

Shooting Range.docx 1.e Consideration of prior approval of 2020 Northeast Indiana Innovation Center funding. DOC121620-12162020115623.pdf

https://legistarweb-production.s3.amazonaws.com/uploads/attachment/pdf/779327/12-11-20_Minutes.pdfhttps://legistarweb-production.s3.amazonaws.com/uploads/attachment/pdf/789301/21-23_XS_WC_USI_Proposal_for_12-7-2020_Meeting.pdfhttps://legistarweb-production.s3.amazonaws.com/uploads/attachment/pdf/781916/AllenCounty-2021.pdfhttps://legistarweb-production.s3.amazonaws.com/uploads/attachment/pdf/782672/Shooting_Range.pdfhttps://legistarweb-production.s3.amazonaws.com/uploads/attachment/pdf/777740/DOC121620-12162020115623.pdf

1.f Consideration of prior approval of COVID-19 Foundation Donation Fund. Title 12 - Article 241 (COVID Donation Fund).doc 1.g Consideration of Settlement between Garry Wetherill V. Allen County Sheriff. WETHERILL SETTLEMENT.pdf 1.h Consideration of Plats for Approval:

1. Buckner's Crossing, Section V 2. Palmira Lakes Villas, Section II

1.i Consideration of citizen appointments to various boards and commissions. 2021 board appointments - citizens.doc 1.j Consideration of citizen appointments to various boards and commissions. 2021 board appointments - commissioners.doc 2. Consideration of Claims Submitted for Payment 2.a Consideration of claims submitted for the period of December 8, 2020 and January 6, 2021 in

the amount of $ 12082020-01062021.xlsx 3. Other Business: 4. Approval to waive the 2nd Reading on any matter approved today and for which it may be

deemed necessary for today's Legislative Session. 5. Motion to Adjourn

Allen County does not discriminate because of disability in the admission to, or treatment or employment in, its programs or activities. TheHuman Resources Director has been designated to coordinate compliance with nondiscrimination requirements contained in Section35.107 of the Department of Justice regulations. Information concerning the provisions of the Americans with Disabilities Act, and therights provided therein, and Allen County's ADA policy is available from the ADA Coordinator. Suggestions on how the County can bettermeet the needs of persons with disabilities may be submitted to the ADA coordinator at: Human Resources Department, 200 East BerryStreet, Suite 380, Fort Wayne, IN 46802, or by phone at (260) 449-7217.

https://legistarweb-production.s3.amazonaws.com/uploads/attachment/pdf/776611/Title_12_-_Article_241__COVID_Donation_Fund_.pdfhttps://legistarweb-production.s3.amazonaws.com/uploads/attachment/pdf/788952/WETHERILL_SETTLEMENT.pdfhttps://legistarweb-production.s3.amazonaws.com/uploads/attachment/pdf/790464/2021_board_appointments_-_citizens.pdfhttps://legistarweb-production.s3.amazonaws.com/uploads/attachment/pdf/790427/2021_board_appointments_-_commissioners.pdfhttps://legistarweb-production.s3.amazonaws.com/uploads/attachment/pdf/790352/12082020-01062021.pdf

BOARD OF COMMISSIONERS OF THE COUNTY OF ALLEN

Council Chambers Courtroom - Citizens Square200 E Berry St., Ft Wayne IN 46802

**Due to the building closure, the meeting is viewableLIVE at Facebook.com/AllenCounty

MINUTES

Commissioners' Legislative Session10:00 AM Friday, December 11, 2020

Commissioners Present: F. Nelson Peters, Richard E BeckCommissioners Absent: Therese Brown

Others Present: Chris Cloud, Chief of StaffBill Fishering, County AttorneyZack Sand, Government LiaisonEric Johnson and Pat Frazier, Veterans National Memorial Shrine and MuseumTom Fox, ACDEMChristopher Dunn, Youth Services CenterBernie Beier, Department of Homeland SecurityVance Hernandez, Maintenance DirectorMichelle Wood, DPS Senior PlanningBill Hartman, Highway DirectorDeb Hudson, HR Benefits ManagerEric Sand, Design Collaborative

Call to Order The legislative session was called to order by Commissioner Richard Beck at 10:10 AM.

Pledge of Allegiance and Moment of Silence

Presentation from Veterans National Memorial Shrine and Museum: Pat Frazier and Eric Johnson gave a PowerPoint on the Vietnam Wall replica, a Healing Wall, identical to the original in Washington DC., just slightly smaller. Groundbreaking for the 360-foot anodized aluminum structure was started Nov. 11 and is expected to bring many visitors and tourism dollars from surrounding states to the area.

Presentation of the 2020 Allen County Department of Environmental Management Sustainability Award WinnersJodi Leamon, the sustainability coordinator at ACDEM, presented the Sustainability Superheroes for 2020. Honorees included: Connolly’s Do It Best for lightbulb and battery recycling; Megan Masterson and Ground Down for composting and food waste reduction; Hop River Brewing Company owners Ben Jackson and Paris McFarthing for commitment to disposable plastic reduction; Adrianna Farris &

ECOFest FW for planning and implementation of an environmentally focused festival; Cyndi Adamson for volunteering to Food Rescue US; and several volunteers for volunteering at Food Rescue US and Food Box.The food presentation can be found on our Facebook page at https://www.facebook.com/AllenCounty/videos/385798545971189The presentation begins at 33:23 into the video.

1. Items for Consideration:

1.a Approval of the minutes of November 13, 2020 legislative session.F. Nelson Peters made a motion to Approve. Richard E Beck seconded the motion. Motion Passed: 2 - 0

1.b Consideration of extension to contract for mercury disposal with Veolia on behalf of the Allen County Department of Environmental Management.ACDEM Director Tom Fox presented a contract extension with Veola for mercury and household hazardous waste disposal. The previous agreement expired December 31, 2020 and the extension will be until February 28, 2021, allowing a RFP to be issued and a new contract to be negotiated.F. Nelson Peters made a motion to Approve. Richard E Beck seconded the motion. Motion Passed: 2 - 0

1.c Consideration of Residential Treatment Services Contract with Indiana Department of Child Services on behalf of the Youth Services CenterYSC Director Christopher Dunn presented the standard contract with Indiana Department of Child Services for 2021 that provides reimbursement from the State for children housed in the emergency shelter.F. Nelson Peters made a motion to Approve. Richard E Beck seconded the motion. Motion Passed: 2 - 0

1.d Consideration of Provider Agreement with Choices Inc. on behalf of Youth Services Center.Choices is an agency that does case management. DCS places children in their care for case management that need a lot of services and pays a flat set rate. Choices gets the child a lot of services up front and then step them down to less services as quickly as possible. Basic foster care or returning to bio family is always the goal.The kids stay here as long as they need too, often longer than others because of their behavior and the fact that they are more challenging.F. Nelson Peters made a motion to Approve. Richard E Beck seconded the motion. Motion Passed: 2 - 0

1.e Consideration of Memorandum of Understanding on Co-Location of City of Fort Wayne Utility Equipment on Tornado Warning Siren Poles.

Bernie Beier, director of the Allen County Department of Homeland Security, presented an

agreement with the City of Fort Wayne for water meter reading equipment to be placed on

tornado warning siren poles. He noted that testing had been completed and there was no

interference in radio signals of the two systems.

F. Nelson Peters made a motion to Approve. Richard E Beck seconded the motion. Motion Passed: 2 - 0

1.f Consideration of Performance Grant Agreement with the Indiana Department of Homeland Security for the reimbursement of payroll and fringe benefits of the Allen County Office of Homeland Security.DHS Director Bernie Beier presented the annual federal grant which is used for payroll reimbursements for staff personnel.F. Nelson Peters made a motion to Approve. Richard E Beck seconded the motion. Motion Passed: 2 - 0

1.g Consideration of bid award for Allen County Jail Camera Replacement/Upgrade project to Security Automation Systems.Maintenance Director Vance Hernandez presented a bid from Security Automation Systems of Indianapolis for the installation of a camera replacement and upgrade at the Jail. The total cost for the project is $1,275,890.F. Nelson Peters made a motion to Approve. Richard E Beck seconded the motion. Motion Passed: 2 – 0

Rejection of Elevator BidMaintenance Director Vance Hernandez also recommended the rejection of two bids that had been submitted for the elevator replacement project at the Rousseau Building. He explained that Schindler failed to submit a surety bond with its bid documents and American Elevator submitted quotes for equipment that was not on the approved list. He noted that the project would be rebid in 2021.F. Nelson Peters made a motion to Approve. Richard E Beck seconded the motion. Motion Passed: 2 - 0

1.h Consideration of Rezoning Petition REZ- 2020-0042 to rezone 47.4 acres on the South side of the 4000 to 4300 blocks of Union Chapel Road and the east side of the 12000 to 12600 blocks of Diebold Road from A1/Agricultural to NC/Neighborhood Center for commercial development including an event center.DPS Senior Planner Michelle Wood explained that the rezoning petition came with a DO-PASS recommendation from the Zoning Commission and had received minor objections from area residentsF. Nelson Peters made a motion to Approve. Richard E Beck seconded the motion. Motion Passed: 2 - 0

1.i Consideration of Bid Award for Bid Ref #35-2020 for Ternet Road Bridge #298 over Ellison Ditch, Project #0100316; to the lowest bidder Primco, Inc. in the amount of $777,144.85.Allen County Highway Director Bill Hartman noted that the bid from Primco Inc., the lowestof five received, was ten percent under the engineering estimate for the project.F. Nelson Peters made a motion to Approve. Richard E Beck seconded the motion. Motion Passed: 2 - 0

1.j Approval of Bid Award for Foote Rd Small Structure #116006 over Hamm Interceptor, Project #1500419; to the lowest bidder R.G. Zachrich Construction, LLC in the amount of $721,207.50.

Allen County Highway Director Bill Hartman noted that there were five bidders on this project with RG Zachrich Construction LLC being the lowest bidder. The bid was seven percent above the engineer estimate for the project, however.F. Nelson Peters made a motion to Approve. Richard E Beck seconded the motion. Motion Passed: 2 - 0

1.k Consideration of Agreement with Engineering Resources, Inc. for Preliminary Engineering Services and Construction Inspection Services for Lower Huntington Rd and Homestead Rd Improvements, Project #2100120, in the amount of $146,180.00.Bill Hartman, Allen County Highway Director, presented a bid from Engineering Resources Inc. for the Lower Huntington and Homestead Road intersection, noting that the project included right of way work for eight parcels.F. Nelson Peters made a motion to Approve. Richard E Beck seconded the motion. Motion Passed: 2 - 0

1.l Consideration of Agreement with Engineering Resources, Inc. for Preliminary Engineering Services for Covington Rd and West Hamilton Rd Traffic Signalization, Project #2100220, in the amount of $37,930.00.Allen County Highway Department Director Bill Hartman presented an agreement with Engineering Resources Inc. for services for Covington and West Hamilton Roads traffic signals project.F. Nelson Peters made a motion to Approve. Richard E Beck seconded the motion. Motion Passed: 2 - 0

1.m Consideration of Agreement with DLZ Indiana, LLC for Preliminary Engineering Services for Main Street Bridge #601 over Trier Ditch in New Haven, Project #N00-016; in the amount of $56,800.00.An agreement with DLZ Indiana for the Main St. over Trier Ditch Bridge was approved following a presentation by Allen County Highway Director Bill Hartman.F. Nelson Peters made a motion to Approve. Richard E Beck seconded the motion. Motion Passed: 2 - 0

1.n Consideration of Supplemental Agreement #1 with DLZ Indiana LLC for additional preliminary services required for the Cedar Creek Trail, Project #2900218, in the amount of $53,500.00.

Allen County Highway Director Bill Hartman presented a supplemental agreement with DLZ Indiana for the Cedar Creek Trail. Due to the project being situated on a wetlands, additional geotechnical services are required.F. Nelson Peters made a motion to Approve. Richard E Beck seconded the motion. Motion Passed: 2 - 0

1.o Consideration of Agreement with GME Testing for sub -surface investigation for Prine Rd Small Structure #107012 over Jacob-Johnson Ditch, Project #1500120, in the amount of $7,961.00.Allen County Highway Director Bill Hartman presented an agreement with GME Testingfor the geotechnical work on the box structure at Prine Road over the Jacob-Johnson Ditch.F. Nelson Peters made a motion to Approve. Richard E Beck seconded the motion. Motion Passed: 2 - 0

1.p Consideration of Allen County Highway Department Street Acceptance and Mileage Certification for 2020.Allen County Highway Director Bill Hartman noted that 3.638 miles have been added to the department's responsibilities, with 10.431 miles taken away due to annexation, total mileage covered will be 1,318.7 miles.F. Nelson Peters made a motion to Approve. Richard E Beck seconded the motion. Motion Passed: 2 - 0

1.q Consideration of Interlocal Agreements with the Towns of Grabill, Monroeville, and Zanesville for miscellaneous services, consultation services, and materials on behalf of the Allen County Highway Department.Two year interlocal agreements were presented by Allen County Highway Director Bill Hartman which included the standard 30 percent markup in labor, equipment and materials.F. Nelson Peters made a motion to Approve. Richard E Beck seconded the motion. Motion Passed: 2 - 0

1.r Consideration of Warranty Deeds for Union Chapel Rd - East of Tonkel Rd, Project #1800718.

a. Parcel 13 - Ramsey, D.b. Parcel 16 - Sitcler

No action was taken after County Attorney Fishering advised they were not ready for approval.

1.s Consideration of Boarder Bridge Agreement with Van Wert County, Ohio for splitting costs 50/50 for significant repairs and replacement of Allen County Bridge #609/Van Wert County Bridge #8135004.F. Nelson Peters made a motion to Approve. Richard E Beck seconded the motion. Motion Passed: 2 - 0

1.t Consideration of agreement with City of New Haven for additional reimbursement for the Ryan Road Water Tower and Ryan/Bruick Road Project from the CASAD East and Bandelier Economic Development Areas.

County Attorney Bill Fishering noted that, at the request of New Haven, the contribution by Allen County toward the water tower and road project was being increased from $650,000 to $840,000.F. Nelson Peters made a motion to Approve. Richard E Beck seconded the motion. Motion Passed: 2 - 0

1.u Consideration of Amendment #1 to Economic Development Services Agreement with Greater Fort Wayne Inc. to operate the PPE reimbursement program.Chief of Staff Chris Cloud explained that GFW assisted the PPE program by administering the grant and the agreement was being amended to compensate GFW for seven percent of awarded grants for staff time for that project.F. Nelson Peters made a motion to Approve. Richard E Beck seconded the motion. Motion Passed: 2 – 0

1.v Consideration of annual maintenance agreement with MicroVote for firmware, software, and technical support of voting machines on behalf of the Allen County Election Board.Chief of Staff Chris Cloud noted the annual software maintenance agreement for the voting machines was at a cost of $12,000.F. Nelson Peters made a motion to Approve. Richard E Beck seconded the motion. Motion Passed: 2 - 0

1.w Consideration of Technical Assistance Agreement for website analysis with Purdue University Fort Wayne.Chief of Staff Chris Cloud introduced a technical assistance agreement with Purdue Fort Wayne to perform a user experience and ADA accessibility evaluation of a portion of the AllenCounty.us website, a project which was a part of the county's strategic plan. The agreement will be charged at an hourly rate, not to exceed $2,971.F. Nelson Peters made a motion to Approve. Richard E Beck seconded the motion. Motion Passed: 2 - 0

1.x Presentation of plats for approval as follows:a. Secondary Plat, Magnolia Meadows, Section V b. Secondary Plat, Morgan Creek, Section VIII c. Verona Lakes, Section I d. Balmoral, Section Ie. Balmoral, Section IIf. Sage Pointe, Section II


1.y Consideration of memorandum of contribution between the Board of Commissioners and Allen County Regional Water and Sewer District for contribution toward Indiana Finance Authority State Revolving Fund debt.


2. Consideration of Claims Submitted for Payment

2.a Claims submitted for the period of November 4 to December 7, 2020 in the amount of $8,618,900.65F. Nelson Peters made a motion to Approve. Richard E Beck seconded the motion. Motion Passed: 2 - 0

3. Other Business:

3.a Consideration of the following agreements pending final legal review:

a) Symetra, new carrier for life and LTD coverageb) First Responders, a special counseling service for first respondersc) Clinix, a new Case Management party to replace our former oned) Reliastar Life, new Stop Loss carrier for 2021 excess health plan claims

Human Resources Benefits Manager Deb Hudson presented agreements with a new long-term and life insurance carrier, to insure that coverage could begin immediately following the first of the year, and following final legal review.F. Nelson Peters made a motion to Approve. Richard E Beck seconded the motion. Motion Passed: 2 - 0

3.b Consideration of Amendment Number 1 to Active and Retiree Employee Benefit Plan Summary Plan DescriptionsHuman Resources Benefits Manager Deb Hudson presented plan description updates to the summary. F. Nelson Peters made a motion to Approve. Richard E Beck seconded the motion.Motion Passed: 2 - 0

4. Approval to waive the 2nd Reading on any matter approved today and for which it may be deemed necessary for today's Legislative Session.F. Nelson Peters made a motion to Approve. Richard E Beck seconded the motion. Motion Passed: 2 - 0

5. Motion to Adjourn: The session was adjourned by Commissioner Beck at 11:27 AM.

The Minutes of this legislative session were approved at the Board of Commissioners meeting on

_________________________ .

_______________________________________Therese Brown, President

_______________________________________Richard E. Beck, Vice-President

_______________________________________F. Nelson Peters, Secretary

Allen County does not discriminate because of disability in the admission to, or treatment or employment in, its programs or activities. The Human Resources Director has been designated to coordinate compliance with nondiscrimination requirements contained in Section 35.107 of the Department of Justice regulations. Information concerning the provisions of the Americans with Disabilities Act, and the rights provided therein, and Allen County's ADA policy is available from the ADA Coordinator. Suggestions on how the County can better meet the needs of persons with disabilities may be submitted to the

ADA coordinator at: Human Resources Department, 200 East Berry Street, Suite 380, Fort Wayne, IN 46802, or by phone at (260) 449-7217.

© 2018 USI Insurance Services. All rights reserved. This is a coverage summary, not a legal contract. This summary is provided to assist in your understanding of your insurance program. Please refer to the actual policies for specific terms, conditions, limitations and exclusions that will govern in the event of a loss. Specimen copies of all policies are available for review prior to the binding of coverage. Higher limits and additional coverage may be available. Please contact us if you are interested in additional quotes.

Property & Casualty Insurance Proposal

Board of Commissioners of the County of Allen

CJ Mills, CSRM, cyRM, AAI, AIS, Advisor

Margo L Kyser, CIC, CISR, AIS, CPIW, Account Manager

Date Presented: December 07, 2020

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Table of Contents About USI Insurance Services ...................................................................................................................... 3

The USI ONE Advantage ........................................................................................................................... 3 Service Team ................................................................................................................................................ 4 Schedule of Named Insureds ....................................................................................................................... 5 Schedule of Locations ................................................................................................................................... 6 Excess and Aggregate Workers’ Compensation/Employers Liability ......................................................... 7 Premium Summary ....................................................................................................................................... 9 Quote Options ............................................................................................................................................ 10 Marketing Summary ................................................................................................................................... 11 Agency Bill Payment Options ..................................................................................................................... 12 USI Disclosures ........................................................................................................................................... 13 USI Privacy Notice ...................................................................................................................................... 14 Insurance Carrier Ratings ........................................................................................................................... 15 Client Authorization to Bind ...................................................................................................................... 16

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About USI Insurance Services USI is one of the largest brokerage and consulting firms in the world, delivering property and casualty, employee benefits, personal risk, program and retirement solutions to large risk management clients, middle market companies, smaller firms and individuals. Headquartered in Valhalla, New York, USI connects together over 6,000 industry leading professionals across more than 150 offices to serve clients’ local, national and international needs. USI has become a premier insurance brokerage and consulting firm by leveraging the USI ONE Advantage®, an interactive platform that integrates proprietary and innovative client solutions, networked local resources and expertise, and enterprise-wide collaboration to deliver customized results with positive, bottom line impact. USI attracts best-in-class industry talent with a long history of deep and continuing investment in our local communities. For more information, visit usi.com. The USI ONE Advantage What truly distinguishes USI as a leading middle market insurance brokerage and consulting firm is the USI One Advantage, a game-changing value proposition that delivers clients a robust set of risk management and benefit solutions and exclusive resources with financial impact. USI ONE™ represents Omni, Network, Enterprise—the three key elements that create the USI ONE Advantage and set us apart from the competition. Omni – USI’s Proprietary Analytics Omni, which means “all,” is USI’s one-of-a-kind solutions platform—real time, interactive, dynamic and evolving, and customized for each client. Built in-house by USI subject matter experts, Omni captures the experience of more than 100,000 clients, thousands of professionals and over 100 years of business activity through our acquired agencies into targeted, actionable solutions. Network – USI’s Local and National Resources USI has made a very large investment in local resources and technical expertise, with more than 6,000 professionals networked nationally to build strong vertical capabilities and integrated account teams. Our local and regional experts ensure account team availability, hands-on service, and ongoing diligent follow-through so we can deliver on the solutions we customize for our clients. Enterprise – USI’s Team Based Strategic Planning USI’s enterprise planning is a disciplined, focused, analysis centered on our client’s issues and challenges. Highly consultative meetings integrate USI’s Omni analytics with our broad resource network to build a risk management strategy aligned with client business needs. Our enterprise process is a proven method for identifying, quantifying and minimizing client risk exposures. The USI ONE Advantage—our Omni knowledge engine, with our Network of local and national resources, delivered to our clients through our Enterprise planning process gives USI fundamentally different solutions, the resources to deliver, and a process to bring superior results to our clients.

USI ONE

Advantage®

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Service Team

USI Insurance Services LLC

9910 Dupont Circle Dr. E, Suite 120, Fort Wayne, IN 46825

(260) 432-3400 www.usi.com

Lead Advisor

Your Advisor is CJ Mills

Direct Number: 260-435-4134

E-Mail: [email protected]

Account Manager

Your Account Manager is Margo L Kyser

Direct Number: 260-435-4238

Fax Number: 866-702-7119


Claims Department

Your Claims Specialist is Kelly Trosper at USI Insurance

USI Phone Number: 574-266-3569


Loss Control Department

Your Loss Control Specialist is Scott Knoll at USI Insurance

USI Phone Number: 317-766-9573


mailto:[email protected]:[email protected]:[email protected]:[email protected]

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Schedule of Named Insureds Insurance Company: Midwest Employers Casualty Company

Policy Term: 01/01/2021 to 01/01/2023

Named Insureds

Board of Commissioners of the County of Allen

Only the Named Insureds shown above are included in this proposal. If any Named Insureds are not shown above and should be included for coverage, please notify us immediately.

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Schedule of Locations Insurance Company: Midwest Employers Casualty Company

Policy Term: 01/01/2021 to 01/01/2023

Location Number

Address City State ZIP Code

1 200 East Berry Street Fort Wayne IN 46802

Only the locations shown above are included in this proposal. If any locations are not shown above and should be included for coverage, please notify us immediately.

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Excess and Aggregate Workers’ Compensation/Employers Liability Insurance Company: Midwest Employers Casualty Company

Policy Term: 01/01/2021 to 01/01/2023

Coverage: Part One – Workers’ Compensation agrees to pay the benefits required under the applicable State’s Workers’ Compensation Law. Part Two – Employers Liability for work-related injuries or disease other than that which is imposed by a state Workers’ Compensation Law. Part Three – Other States. States in which you have no exposure on the policy inception date, but in which you may have a temporary or future worksite or exposure in during the policy term. If listed, statutory benefits will apply as if the state were listed in Part One.

Coverage Description Limit

Employers Liability - Each Accident $1,000,000

Employers Liability - Disease (Each Employee) $1,000,000

Experience Mod 1.00

Statutory Limits Apply Y

Unites States Longshore and Harbor (USL&H) N/A

Voluntary Compensation N/A

Other States N/A

Coverage is not automatic in all states. Please notify us immediately if you begin operations in another state.

Workers’ Compensation Schedule of Exposures

State: IN

Class Code

Classification Description Expiring

Estimated Annual Payroll


9410 Municipal, Township, County Or State Employee NOC

$5,907,554 $4,322,663

9102 Park - All Employees & Drivers $457,588 $251,710

9016 Amusement Park Or Exhibition Operation & Drivers

$2,691,001 $1,641,433

9015 Buildings $1,922,678 $1,784,349

8842 Group Homes-All Employees $1,186,616 $1,330,362

8832 Physician & Clerical $3,010,164 $1,990,227

8820 Attorney--all Employees & Clerical, Messengers, Drivers

$14,002,909 $14,276,733

8810 Clerical Office Employees NOC $9,586,355 $18,118,753

8601 Engineer/Architect Consulting $834,883 $1,791,228

8380 Auto Service or Repair Center $199,228 $897,324

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Class Code

Classification Description Expiring



7720 Police Officers & Drivers $29,835,578 $30,341,895

5506 Street or Road Construction $3,446,573 $2,571,565

7705 Ambulance Service and EMS (Emergency Medical Service) Providers and Drivers

If Any $10,485

7710 Firefighters & Drivers If Any $10,587

8864 Social Services Organization - All Employees & Salespersons, Drivers

If Any $371,735

8868 School: Professional Employees & Clerical If Any $167,640

Total Estimated Annual Payrolls $73,081,127 $79,878,689

Audit Provisions

Description Minimum Premium

Audit based on Payroll $128,925

Premiums are calculated based on the insurance company's rules and rates. Premiums shown as advance or deposit premiums are subject to audit and adjustment at the close of each audit period. If the advance premium is less than the earned premium as determined by the audit, the insured pays the difference. If the advance premium is more than the earned premium as determined by the audit, the insurance company returns the difference to the insured. The insured must keep records of the information needed for the audit and the premium calculations and send copies to the insurance company when it requests them.

Key Endorsements, Limitations, Warranties and Exclusions include, but are not limited to, the following:

Coverage Description Limit Retention

Specific Retention 800,000 $800,000

Aggregate Limit/Retention $2,000,000 $500,000

Waiver of Subrogation: CSX Transportation, Inc.

Excluded coverage or other coverages sought may be available: please discuss with USI Other exclusions and policy limitations may apply. Please refer to the actual policies for specific terms, conditions, limitations, exclusions and sublimits that will govern in the event of a loss.

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Premium Summary

Coverage Carrier AM Best

Rating

Admitted or Non Admitted

Expiring Annual

Premium

Proposed Annual - One

Year Term Premium

Proposed Annual Two Year Term Premium

Excess Workers Compensation

Midwest Employers Casualty Company

A+ Admitted $42,331 $63,122 $71,625 / year

Renewal Quotes are now net of commission. $5K added to July Fee Agreement. This saves the county $8500 annually.

Terrorism Option: Due to the Terrorism Risk Insurance Act of 2002, you now have the right to purchase coverage for losses arising out of the Acts of Terrorism, as defined in Section 102 (1) of the act. Under Federal Law you may purchase this terrorism coverage for an additional premium as follows. Please note the additional premium is not included in the above quote. We will require written confirmation at the time of binding if you elect or reject this coverage.

Coverage Additional Premium

Workers Compensation Included in Premium Above

Binding Requirements: ▪ “Client Authorization To Bind” signed by the insured Payment Terms: ▪ 2 Annual Installments – Agency Billed - if Two Year Term Selected ▪ 1 Annual Installment – Agency Billed – if One Year Term Note - In evaluating your exposure to loss, we have been dependent upon information provided by you. If there are other areas that need to be evaluated prior to binding of coverage, please bring these areas to our attention. Should any of your exposures change after coverage is bound, such as your beginning new operations, hiring employees in new states, buying additional property, etc., please let us know so proper coverage(s) can be discussed. Higher limits may be available. Please contact us if you would like a quote for higher limits.

Loss Trend Summary:

Year

Total # of

Claims

Total

Incurred

Average

Incurred

2020 64 $807,425.97 $12,616.03

2019 90 $1,429,797.78 $15,886.64

2018 115 $1,373,440.01 $11,942.96

2017 146 $847,532.22 $5,805.02

2016 99 $665,750.38 $6,724.75

2015 90 $452,282.93 $5,025.37

2014 182 $396,305.77 $2,177.50

2013 193 $633,567.78 $3,282.73

2021 178 $479,043.82 $2,691.26

2011 173 $575,507.82 $3,326.63

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Quote Options

Line Of Business Carrier Quote Description


Midwest Employers Casualty Company (Admitted)

MEC $800K SIR with Aggr. - 1 year policy

Policy Premium:

Premium $63,122.00

TRIA Included in Premium Above

Total for the above quote $63,122.00

Minimum Earned Premium: $56,810.00



The Gray Insurance Company (Admitted)

Gray Buffer $200K Excess $600K

Policy Premium:

Premium $20,800.00






The Gray Insurance Company (Admitted)

Gray Buffer $100K Excess $700K

Policy Premium:

Premium $12,500.00




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Marketing Summary

This list represents the carriers that were approached to provide a competitive insurance program for your business.

Coverage Carrier Result

Excess Workers Compensation ARCH Insurance Group Account below Arch’s Minimum

premium of $100,000

Excess Workers Compensation Bridge Excess Solutions LLC

Public entities are a prohibited class of business

Excess Workers Compensation Chubb Account is below Chubb’s minimum

premium of $300,000

Excess Workers Compensation Midlands Management Corporation

Effective 1/1/2021 Midland will have a minimum premium of $150,000 on municipal accounts


Safety National Casualty Corporation

Safety has a higher minimum premium than their subsidiary Midlands Management. Can only submit to one of the two

Excess Workers Compensation US Specialty Underwriters, Inc.

Public entities are a prohibited class of business

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Agency Bill Payment Options

We sincerely appreciate the opportunity to service your insurance needs. We believe good credit

relationships are established by making our clients aware in advance of the terms of our payment

procedures.

OUR BASIC PAYMENT PLAN IS THAT ALL PAYMENTS ARE DUE ON OR BEFORE THE EFFECTIVE DATE OF

COVERAGE. THERE ARE THREE METHODS OF PAYMENT AVAILABLE:

....CASH ON EFFECTIVE DATE

....PREMIUM FINANCING BY A PREMIUM FINANCE COMPANY

....INSURANCE COMPANY PAYMENT PLAN, IF AVAILABLE

Please note that USI Insurance Services LLC and its subsidiaries and affiliates do not provide customer financing.

In some instances, you will receive invoices covering additions or changes to your coverage, endorsements. These invoices are payable upon receipt. You will receive a monthly statement of your account as a reminder as we realize that it is occasionally possible to miss a payment through oversight. Accounts with payments past due are subject to cancellation for non-payment. This is a serious situation as your insurer may refuse to reinstate coverage even if payment is made later. Accounts are subject, but not limited to, reasonable attorney fees, interest, collection fees and/or court costs incurred in connection with collection of past due balances.

PAYMENTS: Please remember to return the remittance copy of the invoice with your payment in the provided envelope. Otherwise, all payments will be applied to your oldest balance or left as unapplied if we cannot identify the applicable invoice being paid.

CREDITS: Credit invoices may be applied against other invoices due us. Please indicate in your remittance or contact us as to where to apply credit invoices on your account.

These payment procedures will apply for any and all policy renewals or future business written.

If you have any questions concerning our payment procedures or any other matters pertaining to account payments, please contact your insurance representative.

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USI Disclosures Information Concerning Our Fees: As a licensed insurance producer, USI is authorized to confer with or advise our clients and prospective clients concerning substantive benefits, terms or conditions of insurance contracts, to sell insurance and to obtain insurance coverages for our clients. You have agreed to pay compensation to USI, for the placement of insurance, pursuant to a written agreement. We may also receive from insurers and insurance intermediaries (which may include USI affiliated companies) additional compensation (monetary and non-monetary) based in whole or in part on the insurance contract we sell, which is contingent on volume of business and/or profitability of insurance contracts we supply to them and/or other factors pursuant to agreements we may have with them relating to all or part of the business we place with those insurers or through those intermediaries. Some of these agreements with insurers and/or intermediaries include financial incentives for USI to grow its business or otherwise strengthen the distribution relationship with the insurer or intermediary. Such agreements may be in effect with one or more of the insurers with whom your insurance is placed, or with the insurance intermediary we use to place your insurance. You may obtain information about the nature and source of such compensation expected to be received by us, and, if applicable, compensation expected to be received on any alternative quotes pertinent to your placement upon your request. Reviewing Client Contracts DISCLOSURE: As a service to our clients, upon their request, USI will review those portions of your contract regarding the insurance and indemnity requirements as they relate to your insurance program and provide comments and/or recommendations based upon such review. This service should not be taken as legal advice and it does not replace the need for review by the insured’s own legal counsel.

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USI Privacy Notice Our Privacy Promise to You

USI provides this notice to you, our customer, so that you will know what we will do with the personal information, personal financial and health information (collectively referred to as the “protected information”) that we may receive from you directly or receive from your health care provider or receive from another source that you have authorized to send us your protected information. We at USI are concerned about your privacy and assure you that we will do what is required of us to safeguard your protected information.

What types of information will we be collecting?

USI collects information from you required both for our business and pursuant to regulatory requirements. Without it, we cannot provide our products and services for you. We will be collected protected information about you from:

• Applications or other forms, such as name, address, Social Security number, assets and income, employment status and dependent information;

• Your transactions with us or your transactions with others, such as account activity, payment history, and products and services purchased;

• Consumer reporting agencies, such as credit relationships and credit history. These agencies may retain their reports and share them with others who use their services;

• Other individuals, businesses and agencies, such as medical and demographic information; and

• Visitors to our websites, such as information from on-line forms, site visitorship data and on-line information collection devices, commonly called “cookies.”

What will we do with your protected information?

The information USI gathers is shared within our company to help us maximize the services we can provide to our customers. We will only disclose your protected information as is necessary for us to provide the insurance products and services you expect from us. USI does not sell your protected information to third parties, nor does it sell or share customer lists. We may also disclose all of the information described above to third parties with which we contract for services. In addition, we may disclose your protected information to medical care institutions or medical professionals, insurance regulatory authorities, law enforcement or other government authorities, or to affiliated or nonaffiliated third parties as is reasonably necessary to conduct our business or as otherwise permitted by law.

Our Security Procedures

At USI, we have put in place the highest measures to ensure the security and confidentiality of customer information. We will handle the protected information we receive by restricting access to the protected information about you to those employees and agents of ours who need to know that information to provide you with our products or services or to otherwise conduct our business, including actuarial or research studies. Our computer database has multiple levels of security to protect against threats or hazards to the integrity of customer records, and to protect against unauthorized access to records that may harm or inconvenience our customers. We maintain physical, electronic, and procedural safeguards that comply with federal and state regulations to safeguard all of your protected information.

Our Legal Use of Information

We retain the right to use ideas, concepts, know-how, or techniques contained in any nonpublic personal information you provide to us for our own purposes, including developing and marketing products and services.

Your Right to Review Your Records

You have the right to review the protected information about you relating to any insurance or annuity product issued by us that we could reasonably locate and retrieve. You may also request that we correct, amend or delete any inaccurate information by writing to us at the above address.

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Insurance Carrier Ratings As a service to our clients, USI is furnishing an assessment by a financial rating service of the insurance companies included in our proposal. We are including the legends used by this service.

All ratings are subject to periodic review, therefore, it is important to obtain updated ratings from each service. Should you desire further information concerning the financial statements of any of the insurance companies being proposed, so that you can make your own assessment of the financial strength of the companies being offered, it is available from USI at your request.

USI has made no attempt to determine independently the financial capacity of the insurance companies that we are including in our proposal as we believe the nationally recognized services are better equipped to comment.

A. M. BEST RATINGS

A++ & A+ Superior D Poor A & A- Excellent E Under Regulatory Supervision B++ & B+ Good F In Liquidation B & B- Fair S Rating Suspended C++ & C+ Marginal NR Not Rated

FINANCIAL SIZE CATEGORY

(In $ Thousands)

Class I Less than 1,000 Class II 1,000 to 2,000 Class III 2,000 to 5,000 Class IV 5,000 to 10,000 Class V 10,000 to 25,000 Class VI 25,000 to 50,000 Class VII 50,000 to 100,000 Class VIII 100,000 to 250,000 Class IX 250,000 to 500,000 Class X 500,000 to 750,000 Class XI 750,000 to 1,000,000 Class XII 1,000,000 to 1,250,000 Class XIII 1,250,000 to 1,500,000 Class XIV 1,500,000 to 2,000,000 Class XV 2,000,000 to or greater

RATING "NOT ASSIGNED" CLASSIFICATIONS

NR-1 Insufficient Data NR-2 Insufficient Size and/or Operating Experience NR-3 Rating Procedure Inapplicable NR-4 Company Request NR-5 Not Formally Followed

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Client Authorization to Bind

Important Information - Coverage cannot be bound when severe weather is threatening regardless of the expiration date.

After careful consideration of your proposal dated December 7, 2020, we accept your insurance program as presented with the following exceptions, changes, and/or recommendations:

Client Signature Date Signed ALLENCOU2-Excess WC

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INCARCERATED OFFENDERS PROVIDER AGREEMENT ALLEN COUNTY 2021 503Allen21CountyMed

This Agreement (this “Agreement” or “Contract”) entered into by and between the Indiana Family and Social Services Administration (“FSSA”) or (“State”) and Allen County (the “County”), is executed pursuant to the terms and conditions set forth herein. In consideration of those mutual undertakings and covenants, the parties agree as follows.

Adult and juvenile offenders (“offenders”) may be eligible for Medicaid coverage as offered through the FSSA’s programs while receiving inpatient services delivered at a Medicaid approved facility during incarceration, and upon release or discharge. The intent of the parties is to make applicable health coverage available to offenders eligible to receive such coverage for inpatient services during the period of the offenders’ incarceration and upon the offenders’ release and to outline the County’s responsibilities for reimbursing FSSA the state share of Medicaid costs incurred under this Agreement.

I. PURPOSE IC 36-2-13-19(c) authorizes FSSA and an interested county to enter into an agreement for purposes of making Medicaid available to cover eligible offenders who are incarcerated and to help coordinate benefits coverage for offenders transitioning to civilian life. However, such agreement must take the form of a contract. The purpose of this Agreement is to implement those requirements and outline the division of responsibilities between FSSA and County to carry out the terms therein. This Agreement covers two scenarios: 1) FSSA makes coverage available to eligible offenders for inpatient services and the county reimburses FSSA in the amount of the State share; and 2) the County assists offenders whose period of incarceration is ending to apply for Medicaid, including HIP 2.0. The terms and conditions addressed in this Agreement are meant to be uniform and consistent among all counties that choose to participate in the health coverage opportunities afforded by this Agreement. County understands that it would be administratively cumbersome for FSSA to negotiate a different contract with each of the State’s counties. As a result, County understands that this Agreement is a standard document that will not be negotiated or modified. Counties choosing to receive additional health coverage opportunities outlined in this Agreement must agree to the terms as they are set forth herein.

II. AUTHORITIES AND DEFINITIONS

The following authorities and definitions are hereby incorporated into this Agreement.

A. 42 U.S.C. § 1396d(a)(29)(A) prohibits Medicaid payments for services provided to an inmate in a public institution. However, Medicaid funding is available for medical services provided by an enrolled Medicaid provider to an eligible inmate not in a prison setting who becomes an inpatient in a medical setting. See also 42 C.F.R. § 435.1009(a)(1).

B. 42 C.F.R. § 435.1010 defines a “Public Institution” as “an institution that is the responsibility of a governmental unit or over which a governmental unit exercises administrative control.”

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C. 42 C.F.R 435.1009 provides that a public institution does not include the following: medical institution, intermediate care facility, a publicly operated community residence serving no more than 16 residents, or a child care institution.

D. 42 C.F.R. 435.1010 defines “Medical Institution” as an institution that meets all of the following:

is organized to provide medical care, including nursing and convalescent care; has the necessary professional personnel equipment, and facilities to manage the medical,

nursing, and other health needs of patients on a continuing basis in accordance with accepted standards;

is authorized under State law to provide medical care; and is staffed by professional personnel who are responsible to the institution for professional

medical and nursing services. The services must include adequate and continual medical care and supervision by a physician; registered nurse or licensed practical nurse supervision and services and nurses’ aid services, sufficient to meet the nursing care needs; and a physician’s guidance on the professional aspects of operating the institution.

E. IC 12-15-44.2 and IC 12-15-44.5 expanded Medicaid coverage to certain adult populations whose income is at or below 138% of the federal poverty level (“HIP 2.0”). See also 405 IAC 10. Such individuals, once determined eligible, cannot receive retroactive coverage. However, such individuals, if determined presumptively eligible, may receive immediate coverage for a specified period of time at a Medical Institution that is also qualified to provide such designations. See 405 IAC 10-4-11. Such individuals must subsequently submit an application in order to be enrolled in Medicaid, including HIP 2.0.

F. IC 12-15-2-20 provides that an individual convicted of fraud under IC 35-43-5 or legend drug deception under IC 35-43-10 related to the application of or receipt of Medicaid is ineligible to receive Medicaid assistance for various periods of time depending on the number of repeat offenses. Medicaid coverage for such individuals is subject to the eligibility rules and restrictions as set forth in 42 CFR § 435 et seq., IC 12-15-2, and IC 35-43-10.

G. House Enrolled Act 1269 - 2015 amended various provisions of the Indiana Code as follows:

IC 36-2-13-19(a)(1) defines an inmate as an individual “subject to lawful detention” by the County. The term “offender” as used in this Agreement shall refer to such individuals.

IC 36-2-13-19(a) specifies the County shall submit a Medicaid application on behalf of an offender whenever the offender incurs non-reimbursable medical expenses during an inpatient hospital visit, is unwilling to pay for the inmate’s healthcare services, and is potentially eligible for Medicaid.

IC 11-12-5-9(c) and (d) indicates for offenders incarcerated for thirty (30) days or longer, the County shall assist the offender in applying for Medicaid or other benefits on the healthcare exchange within a sufficient amount of time before the offender is released from the County jail. The County shall act as the offender’s Authorized Representative (“A/R”) or health navigator for purposes of this section.

IC 11-12-5-9(b) details offenders incarcerated for less than thirty (30) days, the County may assist the offender in applying for Medicaid and act as the offender’s A/R so that the offender may be reviewed for eligibility for coverage on or before the offender’s release.

IC 11-12-5-9(e) recognizes an entity contracted by the County to perform the Medicaid application function on behalf of the offender as the offender’s A/R where applicable.

IC 11-12-5-9(e) states that once FSSA determines an offender to be eligible for public assistance, the agency shall immediately suspend the person’s Medicaid status until such time as the offender is released.

IC 36-2-13-19(c) and (e) outlines that the County shall reimburse FSSA any administrative costs including the state share of costs incurred on behalf of the offender.

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H. 7 C.F.R 273.1(b)(7) outlines the individuals ineligible for Supplemental Nutrition Assistance Program (“SNAP”) benefits. Federal law prohibits SNAP benefits to anyone with a felony conviction.

III. CONSIDERATION

The consideration for this Agreement is the mutual assurances and covenants set forth herein. However, both FSSA and County will incur costs in order to implement the terms of this Agreement.

IV. COSTS

The Parties understand that for eligible offenders, FSSA will pay the cost of the covered Medicaid inpatient services and shall seek reimbursement from the County in the amount of the State share as provided under this Agreement. FSSA shall not be responsible for covering Medicaid inpatient services provided to ineligible offenders or for those whose presumptive eligibility application and determination are not properly completed.

A. State share of Medicaid payments provided on behalf of offenders eligible for Medicaid

1. The cost of the Medicaid inpatient services provided to eligible offenders will be covered with Federal funding based on the Federal Medical Assistance Percentages (“FMAP”) rate effective during the period in which the service is delivered and State funding, which is also referred to as the State match or SMAP.

2. FSSA agrees to provide the State match using funds from its appropriation for inpatient services provided to eligible offenders under this section. County agrees to reimburse FSSA in the amount of the State match.

3. The FSSA will provide County with expenditure reports, along with SMAP estimate, of the amount the County will reimburse FSSA, on or near the quarter end dates of the applicable year as follows during the term of this Agreement:

January 15 April 15 July 15 October 15

4. These reports will cover all expenditures FSSA incurred on behalf of the County for services rendered during the period of this Agreement.

5. On a quarterly basis, and within 15 days of the receipt of the expenditure report and invoice from the FSSA Office of Medicaid Policy and Planning, (“OMPP”) the County shall submit payment to FSSA for the State match owed for services provided to the County on behalf of Medicaid recipients. The payment should be made payable to the State of Indiana and sent to the below address along with a copy of the invoice previously provided to the County.

FSSA Claim Repayment P.O. Box 621007 Indianapolis, IN 46262-1007

Any payment received beyond the date specified in this section shall be subject to interest in accordance with IC 5-17-5.

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6. FSSA will not contribute any funds to cover the SMAP amount if the County determines that the funding needed to provide the SMAP amount is unavailable. Should an evaluation of financial strength indicate an ongoing concern, designated liaisons should proactively work together for resolution. If a resolution cannot be reached in accordance with section VII prior to the depletion of the County funding, FSSA may take necessary steps to recoup funds owed and consider terminating this Agreement.

7. FSSA will identify any changes in the applicable federal medical assistance percentage (FMAP) in the state share estimate it provides to County under section IV.B.3.

8. FSSA will make eligibility determinations for the offenders based on the information submitted by the offender or the offender’s A/R. As such, FSSA shall be primarily responsible for addressing overpayment determinations by the Federal government. County agrees to cooperate with FSSA in providing documentation to address an overpayment determination upon FSSA’s request. Determination for financial liability will be made between parties as disallowances occur and payment made as necessary.

9. County will be responsible for any costs associated with any safety training required for FSSA staff who may visit a County facility to assist an offender as outlined in this Agreement.

10. County will be responsible for reimbursing FSSA for any costs associated with claims paid by FSSA for health care services subsequently deemed not covered by Medicaid.

B. Financial records and inspections

1. Both parties agree to maintain a proper accounting of expenditures under this Agreement including in their respective books, records, or documents.

2. Either party agrees to provide all audits, monitoring reports, documentation, and records related to the administration of funds under this Agreement upon request of the other.

3. County agrees to cooperate and provide all requested support to the OMPP in all audits conducted by an authorized state or federal entity, including but not limited to the Indiana State Board of Accounts and Health and Human Services Office of the Inspector General.

V. DUTIES OF THE PARTIES

The parties agree to the following responsibilities: A. Duties regarding incarcerated offenders

1. County agrees to:

i. Identify offenders potentially eligible for Indiana Health Coverage Programs such as Medicaid and HIP 2.0 and assist such individuals and inpatient facilities as applicable with completing the necessary applications for those benefits and for presumptive eligibility upon inpatient admission of an offender if needed. Pursuant to IC 36-2-13-19(, the County shall be the offender’s A/R. County shall permit an offender to revoke this designation of authority. A party revoking an A/R must submit a written statement to DFR.

ii. Submit an application for health coverage within sixty (60) days of an application for presumptive eligibility for any offender receiving presumptive eligibility health coverage.

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iii. Include all necessary/requested verifications and medical records required to establish eligibility for the assistance. FSSA will contact the A/R or the offender if additional documentation is required.

iv. Transfer funds on a quarterly basis to FSSA to cover the Medicaid State match on all Medicaid expenditures paid for services provided to offenders.

v. Provide program information on a quarterly basis to FSSA regarding the number of offenders having inpatient stays and other data upon request so that FSSA can monitor and evaluate this program.

vi. Submit monthly reports to FSSA providing a list of all currently incarcerated offenders who are enrolled in the Medicaid program.

vii. Notify DFR of the incarceration of any offender who is a Medicaid recipient, if known.

viii. Notify DFR of the hospitalization of any offender who is enrolled in the Medicaid program. Such notice may be satisfied when completing the Presumptive Eligibility process.

ix. Provide the required information on each inmate requiring hospitalization to complete the Presumptive Eligibility process upon admission to a medical institution.

2. FSSA agrees to:

i. Provide all necessary assistance to County staff to convey information needed to carry out its responsibilities under this Agreement including training on how to complete all necessary forms for public assistance.

ii. Process the offender’s submitted application and all requested documentation. FSSA will mail the appropriate correspondence (i.e. Medicaid card, approval letter, request for additional information, or denial letter) to the appropriate addresses as provided on the application and to the appropriate A/R.

iii. Provide quarterly reports to County including total Medicaid expenditures paid for offenders during the specific quarter and the State match owed on those expenditures based on the current FMAP percentage.

iv. FSSA cannot make SNAP or TANF benefits available to offenders. As such, FSSA shall not process a SNAP or TANF application unless the individual is eligible for such benefits under State or Federal law.

B. Duties regarding offenders whose incarceration is ending

1. County agrees to:

i. Within 45 days prior to an offender’s release, discharge, or transfer from a Public Institution, County shall:

a. Submit an application for health coverage for any offenders considered by County to be potentially eligible for Medicaid or for HIP 2.0 coverage.

b. For offenders who are Aged or Disabled, screen for other forms of public assistance and submit applications, including initiating an application to the Social Security Administration for offenders who are eligible to receive coverage as Aged or Disabled.

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c. Notify FSSA of the offender’s impending release date. d. Notify FSSA of the date of revocation of County’s A/R status for the offender.

ii. In some circumstances, the offender may need to obtain Medicaid coverage via presumptive eligibility upon release or discharge. In such situations, an entity qualified to make such determinations may need information in the possession of County. When appropriate, County will provide the information necessary for the entity to make the presumptive eligibility determination on behalf of a released offender.

iii. Maintain the original application documentation in the offender’s release portfolio and provide this information to the offender upon release. Instruct the offender to take this paperwork to the local DFR office at the time of the offender’s scheduled appointment, if necessary. County will notify FSSA of any change in the offender’s release date.

iv. If it becomes necessary for FSSA staff to travel to the County facility, provide appropriate safety and security training to FSSA staff who would need to be on-site assisting offenders with completing the application documentation.

v. Not to interfere with an offender applicant’s right to file an appeal of an FSSA determination under this section. County may assist with any offender appeal to the extent legally required, or may file an appeal on behalf of the offender as an A/R.

2. FSSA agrees to:

i. Where necessary, schedule a phone interview with the offender and/or A/R to receive information necessary to begin processing the offender’s application for Medicaid benefits (for the aged and disabled categories) upon receipt of the notice under section V.B.1.i.of this Agreement. This phone interview may include both the potentially eligible offender and the appropriate County staff where authorized to participate.

ii. Process applications within the federally required timeframes, provide notices to the applicant or the A/R, and provide “pending verification checklists” requesting missing information from the applicant or the A/R, as applicable, in a timely manner.

iii. FSSA shall cease routine correspondence with County as the A/R after the date that County or the Offender revokes the A/R status by notifying DFR in accordance with the notice provided under V.B.1.i.c. of this Agreement.

VI. TERM AND TERMINATION

This Agreement shall become effective on March 11, 2021 and terminate on February 28, 2024, unless earlier terminated pursuant to this section. Parties may renew this Agreement under the same terms and conditions, for an additional two years. The term of this Agreement may not be longer than 6 years. Any renewal of this Agreement shall be made in writing.

When the Director of the State Budget Agency makes a written determination that funds are not appropriated or otherwise available to support the continuation of performance of this Agreement, the Agreement shall be canceled. A determination by the Director of the State Budget Agency that funds are not available to support continuation of performance shall be final and conclusive.

Either party may terminate this Agreement as follows:

A. The parties fail to resolve a dispute following the dispute resolution procedures in Section VII of this Agreement. This Agreement may be terminated in whole or in part under this subdivision immediately upon the service of written notice to the other party.

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B. Either party decides that termination is in the best interest of the terminating agency. A party terminating this Agreement under this subdivision must provide written notice to the other party 30 days in advance of terminating the Agreement.

C. All written notices required under this section shall state the reasons for termination.

VII. DISPUTE RESOLUTION

To ensure that problems and issues arising under this Agreement are resolved expeditiously, the County and FSSA Controllers are hereby designated as the primary liaison from each agency. If disputes cannot be resolved between the parties’ liaisons, the dispute shall be referred to the Secretary of the FSSA and the County Commissioners. The decision reached by the Secretary and the County Commissioners shall be final. All parties agree to seek the most rapid resolution of all disputes.

VIII. MODIFICATION/AMENDMENTS

This Agreement may be modified or amended upon the initiative of any party. Such modifications must be made in writing and must be agreed to and be signed by authorized representatives of the agencies that are parties to this Agreement. No oral understanding or agreement not incorporated herein shall be binding on any of the parties hereto.

To the extent that any change in law conflicts with this Agreement, such law nullifies this conflicting provision in this Agreement. However, the remaining provisions of this Agreement remain in full force and effect.

IX. HEALTH INSURANCE PORTABILITY AND ACCOUNTING ACT (HIPAA)

The County agrees to comply with all requirements of the Health Insurance Portability and Accountability Act of 1996, Title II, Administrative Simplification (HIPAA), including amendments signed into law under the American Recovery and Reinvestment Act of 2009 (ARRA), in particular, Title XIII known as the Health Information Technology for Economic and Clinical Health Act (HITECH), Subtitle D, in all activities related to the Agreement, to maintain compliance during the term of the Agreement and after as may be required by federal law, to operate any systems used to fulfill the requirements of this Agreement in full compliance with HIPAA and to take no action which adversely affects the FSSA’s HIPAA compliance.

X. COMPLIANCE WITH LAWS

A. The County shall comply with all applicable federal, state, and local laws, rules, regulations, and ordinances, and all provisions required thereby to be included herein are hereby incorporated by reference. The enactment or modification of any applicable State or federal statute or the promulgation of rules or regulations thereunder after execution of this Agreement shall be reviewed by the State and the County to determine whether the provisions of this Agreement require formal modification.

B. The County, its officials, employees, representatives and agents shall abide by all ethical requirements that apply to persons who have a business relationship with the State as set forth in IC §4-2-6, et seq., IC §4-2-7, et seq. and the regulations Promulgated thereunder. If the County has knowledge, or would have acquired knowledge with reasonable inquiry, that a state officer, employee, or special state appointee, as those terms are defined in IC 4-2-6-1, has a financial interest in the Agreement, the County shall ensure compliance with the disclosure requirements in IC 4-2-6-10.5 prior to the execution of this contract. If the County is not familiar with these ethical requirements, the County should refer any questions to the Indiana State Ethics Commission, or visit the Inspector General’s

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website at http://www.in.gov/ig/. If the County or its officials, employees, representatives or agents violate any applicable ethical standards, the State may, in its sole discretion, terminate this Agreement immediately upon notice to the County. In addition, the County may be subject to penalties under IC §§4-2-6, 4-2-7, 35-44.1-1-4, and under any other applicable laws.

C. The County certifies by entering into this Agreement that neither it nor its principal(s) is presently in arrears in payment of taxes, permit fees or other statutory, regulatory or judicially required payments to the State of Indiana. The County agrees that any payments currently due to the State of Indiana may be withheld from payments due to the County. Additionally, further work or payments may be withheld, delayed, or denied and/or this Agreement suspended until the County is current in its payments and has submitted proof of such payment to the State.

D. The County warrants that it has no current, pending or outstanding criminal, civil, or enforcement actions initiated by the State, and agrees that it will immediately notify the State of any such actions. During the term of such actions, the County agrees that the State may delay, withhold, or deny work under any supplement, amendment, change order or other contractual device issued pursuant to this Agreement.

E. If a valid dispute exists as to the County’s liability or guilt in any action initiated by the State or its agencies, and the State decides to delay, withhold, or deny payment to the County, the County may request that it be allowed to continue, or receive payment, without delay. The County must submit, in writing, a request for review to the Indiana Department of Administration (IDOA) following the procedures for disputes outlined herein. A determination by IDOA shall be binding on the parties. Any payments that the State may delay, withhold, deny, or apply under this section shall not be subject to penalty or interest, except as permitted by IC §5-17-5.

F. The County warrants that the County and its subcontractors, if any, shall obtain and maintain all required permits, licenses, registrations, and approvals, and shall comply with all health, safety, and environmental statutes, rules, or regulations in the performance of work activities for the State. Failure to do so may be deemed a material breach of this Agreement and grounds for immediate termination and denial of further work with the State.

XI. DEFAULT BY STATE

No claim of default by the State may be pursued unless and until the State has failed to make progress toward correction of the issue of default within 60 days after the provision of written notice of default by the County.

XII. DRUG-FREE WORKPLACE CERTIFICATION

As required by Executive Order No. 90-5 dated April 12, 1990, issued by the Governor of Indiana, the County hereby covenants and agrees to make a good faith effort to provide and maintain a drug-free workplace. The County will give written notice to the State within ten (10) days after receiving actual notice that the County, or an employee of the County in the State of Indiana, has been convicted of a criminal drug violation occurring in the workplace. False certification or violation of this certification may result in sanctions including, but not limited to, suspension of contract payments, termination of this Agreement and/or debarment of contracting opportunities with the State for up to three (3) years.

In addition to the provisions of the above paragraph, if the total amount set forth in this Agreement is in excess of $25,000.00, the County certifies and agrees that it will provide a drug-free workplace by:

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A. Publishing and providing to all of its employees a statement notifying them that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the County’s workplace, and specifying the actions that will be taken against employees for violations of such prohibition;

B. Establishing a drug-free awareness program to inform its employees of (1) the dangers of drug abuse in the workplace; (2) the County’s policy of maintaining a drug-free workplace; (3) any available drug counseling, rehabilitation and employee assistance programs; and (4) the penalties that may be imposed upon an employee for drug abuse violations occurring in the workplace;

C. Notifying all employees in the statement required by subparagraph (A) above that as a condition of continued employment, the employee will (1) abide by the terms of the statement; and (2) notify the County of any criminal drug statute conviction for a violation occurring in the workplace no later than five (5) days after such conviction;

D. Notifying the State in writing within ten (10) days after receiving notice from an employee under subdivision (C)(2) above, or otherwise receiving actual notice of such conviction;

E. Within thirty (30) days after receiving notice under subdivision (C)(2) above of a conviction, imposing the following sanctions or remedial measures on any employee who is convicted of drug abuse violations occurring in the workplace: (1) taking appropriate personnel action against the employee, up to and including termination; or (2) requiring such employee to satisfactorily participate in a drug abuse assistance or rehabilitation program approved for such purposes by a federal, state or local health, law enforcement, or other appropriate agency; and

F. Making a good faith effort to maintain a drug-free workplace through the implementation of subparagraphs (A) through (E) above.

XIII. EMPLOYMENT ELIGIBILITY VERIFICATION

As required by IC §22-5-1.7, the County swears or affirms under the penalties of perjury that the County does not knowingly employ an unauthorized alien. The County further agrees that:

A. The County shall enroll in and verify the work eligibility status of all his/her/its newly hired employees through the E-Verify program as defined in IC §22-5-1.7-3. The County is not required to participate should the E-Verify program cease to exist. Additionally, the County is not required to participate if the County is self-employed and does not employ any employees.

B. The County shall not knowingly employ or contract with an unauthorized alien. The County shall not retain an employee or contract with a person that the County subsequently learns is an unauthorized alien.

C. The County shall require his/her/its subcontractors, who perform work under this Agreement, to certify to the County that the subcontractor does not knowingly employ or contract with an unauthorized alien and that the subcontractor has enrolled and is participating in the E-Verify program. The County agrees to maintain this certification throughout the duration of the term of a contract with a subcontractor.

The State may terminate for default if the County fails to cure a breach of this provision no later than thirty (30) days after being notified by the State.

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XIV. NONDISCRIMINATION

Pursuant to the Indiana Civil Rights Law, specifically including IC §22-9-1-10, and in keeping with the purposes of the federal Civil Rights Act of 1964, the Age Discrimination in Employment Act, and the Americans with Disabilities Act, the County covenants that it shall not discriminate against any employee or applicant for employment relating to this Agreement with respect to the hire, tenure, terms, conditions or privileges of employment or any matter directly or indirectly related to employment, because of the employee’s or applicant’s race, color, national origin, religion, sex, age, disability, ancestry, status as a veteran, or any other characteristic protected by federal, state, or local law (“Protected Characteristics”). County certifies compliance with applicable federal laws, regulations, and executive orders prohibiting discrimination based on the Protected Characteristics in the provision of services. Breach of this paragraph may be regarded as a material breach of this Agreement, but nothing in this paragraph shall be construed to imply or establish an employment relationship between the State and any applicant or employee of the County or any subcontractor.

The State is a recipient of federal funds, and therefore, where applicable, County and any subcontractors shall comply with requisite affirmative action requirements, including reporting, pursuant to 41 CFR Chapter 60, as amended, and Section 202 of Executive Order 11246 as amended by Executive Order 13672.

XV. PENALTIES/INTEREST/ATTORNEY’S FEES

The Parties will in good faith perform its required obligations hereunder and does not agree to pay any penalties, liquidated damages, interest or attorney’s fees, except as permitted by Indiana law, in part, IC §5-17-5, IC §34-54-8, IC §34-13-1 and IC § 34-52-2-3.

Notwithstanding the provisions contained in IC §5-17-5, any liability resulting from the State’s failure to make prompt payment shall be based solely on the amount of funding originating from the State and shall not be based on funding from federal or other sources.

XVI. NOTICE TO PARTIES

Both parties agree to designate one liaison for purposes of this Agreement. County may conduct routine correspondence with case workers in the local FSSA/DFR offices. Whenever any notice, statement, or other communication is required under this Agreement, it shall be in writing and shall be sent to the address specified herein or such other address as a party may in the future specify in writing to the others.

ALLEN COUNTY CONTACT: Richard Beck c/o Allen County Clerk’s Office 715 South Calhoun Street Fort Wayne, IN 46802 (260) 449-7555

FSSA CONTACT: Paul Bowling, Chief Financial Officer Family and Social Services Administration 402 W. Washington Street, Room W461 Indianapolis, IN 46204 (317) 233-4451

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NON-COLLUSION AND ACCEPTANCE

The undersigned attests, subject to the penalties for perjury, that the undersigned is the properly authorized representative of the County. Further, to the undersigned’s knowledge, neither the undersigned nor any other member, employee, representative, agent or officer of the County, directly or indirectly, has entered into or been offered any sum of money or other consideration for the execution of this Agreement other than that which appears upon the face hereof. Furthermore, if the undersigned has knowledge that a state officer, employee, or special state appointee, as those terms are defined in IC 4-2-6-1, has a financial interest in the Contract, the County attests to compliance with the disclosure requirements in IC 4-2-6-10.5.

AGREEMENT TO USE ELECTRONIC SIGNATURES

I agree, and it is my intent, to sign this Agreement by electronically submitting this Agreement to the State of Indiana. I understand that my signing and submitting this Agreement in this fashion is the legal equivalent of having placed my handwritten signature on the submitted Agreement and this affirmation. I understand and agree that by electronically signing and submitting this Agreement in this fashion I am affirming to the truth of the information contained therein.

In Witness Whereof, the County and the State have, through their duly authorized representatives, entered into this Agreement. The parties, having read and understood the foregoing terms of this Agreement, do by their respective signatures dated below agree to the terms.

ALLEN COUNTY

By:

Title:

Date:

INDIANA FAMILY AND SOCIAL SERVICES ADMINISTRATION, OFFICE OF MEDICAID POLICY AND PLANNING

By:

Title:

Date:

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INTERLOCAL COOPERATION AGREEMENT FOR THE EXCHANGE OF SERVICES

BETWEEN ALLEN COUNTY, INDIANA ANDTHE CITY OF FORT WAYNE, INDIANA

THIS INTERLOCAL COOPERATION AGREEMENT ("Agreement"), is made and entered into under the authority of Indiana Code 36-1-7 et seq. this 29th day of December 2020, by and between The Board of Commissioners of the County of Allen, Indiana ("Commissioners"), the City of Fort Wayne, Indiana, (the "City"), and the Sheriff of Allen County, Indiana (the "Sheriff'). The Commissioners, the City and the Sheriff are sometimes individually referred to as a "Party" and collectively as the "Parties."

WHEREAS, the Sheriff operates the Allen County Sheriff’s Regional Training Facility, located at 5080 Adams Center Road, Fort Wayne, Indiana 46806 ("Facility"); and

WHEREAS, the Sheriff intends to make improvements to the Facility, which include the following: drainage modifications, installation of a stone drive and separation wall, construction of an additional shooting range areas and on-site structures with completion scheduled for the end of 2021 or early 2022; and

WHEREAS, the City of Fort Wayne Police Department ("FWPD") wishes to use the Facility, including, but not limited to, the rifle shooting range as the FWPD's primary Facility for live fire range practice; and

WHEREAS, the City wishes to assist the Sheriff with a portion of the Facility improvement costs to enable FWPD officers access to rifle and other firearms training facilities; and

NOW, THEREFORE, for and in consideration of the mutual promises, covenants and other undertakings set forth hereinafter, the Parties agree as follows:

Section 1. Term: This Agreement shall begin on December 31, 2020 ("Effective Date") and shall remain in effect for at least fifteen (15) years ("Term"). Thereafter, this Agreement may be renewed by agreement of the Parties for an additional ten (10) years.

Section 2. Payment: On or before March l , 2021, the City shall pay the Commissioners a one-time payment of $ 150,000.00 for the cost of improvements.

Section 3. Termination: Any Party may terminate this Agreement with thirty (30) days written notice to the other Parties for any reason. The terminating Party shall be responsible for reimbursing the City its pro-rata share for the remainder of the Term, which shall be calculated

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pursuant to the following schedule: $833.33 per month times the number of months remaining in the Term. For example, if the Agreement terminates in the 60th month, the Commissioners shall pay the City $99,999.60 [120 months remaining times $833.33/month].

Section 4. Scheduling: The Sheriff shall allow the City to utilize the Facility at mutually agreeable times. FWPD and the Sheriff shall use good faith efforts to resolve scheduling conflicts to accommodate Facility use conflicts. In the event FWPD and the Sheriff are unable to identify mutually agreeable times for FWPD to utilize the Facility, FWPD will notify theCommissioners of such disagreement. Thereafter, the FWPD Chief of Police and Sheriff agree to meet and discuss resolution within thirty (30) days and use good faith efforts to resolve the conflict. If the scheduling conflict is not resolved, the City may terminate this Agreement and receive a pro-rata refund based on the remaining unused months.

Section 5. Rent: The Sheriff shall charge the City rent in the amount of $100 per day, which may include partial day usage, and which shall not increase during the Term of the Agreement.

Section 6. Invoice and Payment. The Sheriff shall invoice the City on a monthly basis for the number of days used per calendar month and the City shall pay amount due within fifteen (15) days of receipt of invoice.

Section 7. Mutual Indemnity: Each Party agrees to indemnify and hold the other Parties and their directors, officers, agents and employees harmless from any and all liability, loss, damage or claims, of any description, which results from the negligence of the offending Party and its employees, officers and/or agents that the Party may suffer arising out of or in connection with this Agreement.

Section 8. Notices: All notices and requests required pursuant to this Agreement shall be deemed sufficiently made if delivered, as follows:

To the County: The Board of Commissioners of theCounty of Allen200 East Berry Street, Suite 410Fort Wayne, Indiana 46802

To the City: Mayor of Fort Wayne200 East Berry Street, Suite 430 Fort Wayne, Indiana 46802

Fort Wayne Police Department1 East Main StreetFort Wayne, Indiana 46802

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To the Sheriff: Allen County Sheriff's Department715 South Calhoun Street, Room 101Fort Wayne, Indiana 46802

by personal delivery, courier, or by registered mail, return receipt requested, with proof of delivery thereof. In the event notice delivered by registered mail is refused or otherwise undeliverable, said notice may be delivered by regular mail. Mailed notices shall be deemed effective on the third day after mailing; all other notices shall be effective when delivered.

Section 9. Assignment. This Agreement shall be binding upon and inure to the benefits of the Parties, their legal representatives, successors and assigns, provided, however, because this Agreement is personal to each of the parties hereto, no party may sell assign, delegate, or transfer this Agreement or any portion thereof, including, without limitation, any rights, title, interests, remedies, powers, and/or duties hereunder without the express written consent of the other party.

CITY OF FORT WAYNE

Thomas C. Henry, Mayor

The Board of

board of commissioners of the county of ......swearing in of commissioner nelson peters by judge...

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