HomeMy WebLinkAboutCAG2019-010 - Amendment - #3 - Unify HR - ACA compliance tracking software and IRS reporting - 10/1/2024 Agreement Routing Form
• For Approvals,Signatures and Records Management
KENT This form combines&replaces the Request for Mayor's Signature and Contract Cover Sheet forms.
WASHINGTON (Print on pink or cherry colored paper)
Originator: Department:
Laura Horea HR
Date Sent: Date Required:
> 10/08/24 10/10/24
0
Authorized to Sign: Date of Council Approval:
Q
❑ Director or Designee 0 Mayor N/A
Budget Account Number: Grant? ❑Yes 0 No
Budget? 0 Yes ❑ No Type:
Vendor Name: Category:
Unify HR Contract
Vendor Number: Sub-Category:
Amendment
0
Project Name:
E
i
= Project Details:Amendment to existing UnifyHR contract for ACA compliance tracking
}, software and IRS reporting.
c
a
E Agreement Amount: $28,000 Basis for Selection of Contractor:
W
Istart Date: 10/01/2024 Termination Date: 9/30/2026
Q
Local Business? ❑Yes 0 No*
*If meets requirements per KCC 3.70.700,please complete"Vendor Purchase-Local Exceptions"form on Cityspace.
Notice required prior to disclosure? Contract Number:
❑Yes El No CAG2019-010
Date Received by City Attorney: Comments:
c Amendment#3
30
1A
40
� 3
� 40
f0
C
p� Date Routed to the Mayor's Office: 10/9/24
V1
Date Routed to the City Clerk's Office: 10/17/24
adccW22313_1_20 Visit Documents.KentWA.gov to obtain copies of all agreements
AGREEMENT TO RENEW AND AMEND
("Renewal Agreement")
Whereas,the Parties to the Statement of Work("Agreement")by and between City of Kent "Client"and
WEX Health, Inc. as successor in interest to Unify HR, LLC("WEX")dated October 1, 2018 desire to
renew the Agreement pursuant to Section 13.1 and supersede and replace the Fee Exhibit with the attached
RENEWAL FEE EXHIBIT, to take effect October 1, 2024, and remain effective through
September 30, 2026.
This Renewal Agreement supersedes any previous Renewal Agreements currently in place.
This Renewal Agreement may be executed in two(2)or more counterparts, each of which shall be deemed
an original and all of which,together, shall constitute one and the same instrument. Facsimile execution
and delivery of the Amendment is legal, valid, and binding for all purposes.
Executed this October 1, 2024, by their respective duly authorized representatives:
City of Kent WEX Health,Inc.
By: � — By:
Name: Dana Ralph Name: Andy Doeden
Title: Mayor Title: Senior VP,National Sales
Date: 10/16/2024 Date: 9/9/2024
UHR Renewal Amendment 0.0
RENEWAL FEE EXHIBIT
City of Kent
This schedule of fees for services enumerated below is subject in all respects to the Statement of Work
between Client and WEX ("Agreement"). In the event of a conflict between the Service Description and
the Agreement,the Agreement shall prevail.
Service Fee Description
General Implementation Fee N/A
Offer of Coverage and/or Affordability Tracking Setup N/A
6055 and 6056 Setup Fee N/A
Offer of Coverage and/or Affordability Tracking PEPM $0.77
6055 and 6056 Fulfillment and Distribution $3.40 Per Notice
Mid-Year New Acquisition Setup fee Included
Mid-Year New FEIN Setup Fee Included
Annual Plan Maintenance Fee
Per each 5 FEINs $1,000
Per each 5 Health Plans $1,000
Manual Data Entry Fee $50 Per Hour
Annual Minimum Service Fee Total $5,000
Fees will be invoiced pursuant to section 4 of the Agreement.
UHR Renewal Amendment 0.0