HomeMy WebLinkAboutCORRESPONDENCE - RFP - P1097 HEALTH RISK ASSESSMENT LIFESTYLE MANAGEMENT (12)To participate in the RFP process vendors need to sign and return this
Business Associate Agreement
Our organization has received the invitation to respond to the City of Fort Collins
Request for Proposal for Health Risk Assessment and Lifestyle Risk Reduction
services and has the following intentions
❑ We decline to bid at this time
® We intend to bid We agree to keep all client information confidential
and will only use the confidential information to create the requested
business proposal for the City of Fort Collins
BUSINESS ASSOCIATE AGREEMENT — SECURITY STANDARDS
This agreement is entered into between Elite Wellness USA (Business
Associate) and the City of Fort Collins
Business Associate agrees that it will implement policies and procedures to ensure that
its creation receipt maintenance or transmission of electronic protected health
information ( ePHI ) on behalf of the City of Fort Collins complies with the applicable
administrative physical and technical safeguards required to protect the confidentiality
and integrity of ePHI under the Security Standards 45 CFR Part 164
Business Associate agrees that it will ensure that agents or subcontractors agree to
implement the applicable administrative physical and technical safeguards required to
protect the confidentiality and integrity of ePHI under the Security Standards 45 CFR
Part 164
Business Associate agrees that it will report security violations to the City of Fort Collins
Security Manager
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PRINT NAME
TITLE7 I T—
Please return to
City of Fort Collins
Attn Purchasing
PO Box 580
Ft Collins CO 80522