Bose McKinney & Evans/HR Appropriation No. 1201,400 C"` E/4`-7-44 )IDaoa a�
P. 0. No. •11659
Contract Not To Exceed $950.00
BOSE
MclaNNEY W. James Hamilton
4JN Li
E LLP Downtown Office
& `/1�1. A\J Direct Dial(317)684-5419
Direct Fax(317)223-0419
ATTORNEYS AT LAW E-Mail:)Hamilton@boselaw.com
APPAONED AS TO PORM EN ,
September 11, 2003 V
Douglas C. Haney
City Attorney
City of Carmel
One Civic Square, Second Floor
Carmel, IN 46032
Re: HIPAA Privacy Compliance Package
Dear Doug:
Thank you for your interest in the Bose McKinney & Evans HIPAA Privacy Compliance
Package (the "HIPAA Package"). The HIPAA Package includes template documents and
training designed to assist your entity to bring its group health plans into compliance with the
Privacy Rule set forth in the Health Insurance Portability and Accountability Act of 1996
("HIPAA"). This letter sets forth a description of the documents and services that we will
provide in connection with the HIPAA Package, as well as a discussion of your obligations.
The HIPAA Package includes the following template documents: HIPAA policies and
procedures, business associate addendum, notice of privacy practices, amendment to plan
document, certification by plan sponsor, authorization for release of information, documentation
of affiliated covered entity and form letters to participants. These documents do not constitute
specific legal advice and may not address all developments relevant to your particular situation.
These template documents are samples only and should not be used "as is" for any purpose.
Rather, using these documents as a starting point, you should work with an attorney experienced
in HIPAA Privacy issues as necessary to develop individually tailored documents for your
specific situation.
The HIPAA Package documents were developed by Bose McKinney & Evans and are
protected by copyright. By signing this letter, you are accepting a perpetual nonexclusive limited
license to use and reproduce the documents and to prepare, use and reproduce revisions (subject
to the disclaimer in the preceding paragraph) only in connection with your own group health
plan(s). Without our express written consent and except as required by applicable law or
court order, you are not permitted to display, reproduce, transfer or otherwise distribute
these documents, or any revisions of these documents, by any means to any third party, nor
may you authorize any third party to display, use, reproduce, revise or distribute any of
Downtown • 2700 First Indiana Plaza • 135 North Pennsylvania Street • Indianapolis,Indiana 46204 • (317)684-5000 • Fax(317)684-5173
North Office • 600 East 96th Street • Suite 500 • Indianapolis,Indiana 46240 • (317)684-5300 • Fax(317)684-5316
www.boselaw.com
BOSE
McKINNEY
&EVANS a
ATTORNEYS AT LAW
City of Carmel
September 11, 2003
Page Two
these documents or any revisions. We reserve all rights, title and interests not specifically
transferred by this license and we reserve the right to enforce our copyright in the event of
unauthorized reproduction, distribution or use. Notwithstanding the foregoing, this limited
license permits you to use, reproduce and distribute copies of the Business Associate Addendum,
and any revisions, to your staff, City officers and officials and business associates and to use,
reproduce and distribute copies of the authorization, notice or privacy practices and sample
letters, and any revisions, to your group health plan participants.
The HIPAA Package also includes two hours of on-site HIPAA Privacy training by a
Bose McKinney & Evans attorney experienced in HIPAA Privacy issues for employers located
within 50 miles of downtown Indianapolis, Indiana.
The purchase price of the HIPAA Package is $950.00. Please make your check or money
order payable to Bose McKinney & Evans LLP. Please note that the HIPAA Package is
designed for your group health plans only; if your municipality maintains an ambulance service
or has any other HIPAA provider issues, these issues will need to be addressed separately.
In the event that you request or require additional assistance beyond what is specifically
provided by the HIPAA Package as set forth above, our services will be billed at hourly rates for
the legal personnel performing the services. My current rate for this matter is $195.00 per hour;
however, I would anticipate using the assistance of other attorneys within my office and their
hourly rates may be more or less than my own. However, the City will be charged only for the
higher, hourly rated attorney involved in intra-office conferences or conversations regarding City
issues. In addition to hourly fees, you will be responsible for disbursements, expenses, costs and
charges incurred on your behalf and with your consent, including but not limited to, long
distance telephone expense, outgoing long distance facsimile charges (currently $1.00 per page),
travel (mileage at $0.36 per mile), photocopying ($0.10 per page), and computerized research.
Our general practice will be to send you each month an itemized statement of services
rendered and disbursements made during the preceding month to keep you posted on what
expenses have occurred. These statements are generally payable within 30 days after invoice
receipt date and prompt payment within this time period is a condition of our continued
representation.
You have the right to terminate our assistance at any time. We may also terminate for
any reason consistent with the Rules of Professional Conduct.
BOSE
MCKINNEY
&EVANS LIT
ATTORNEYS AT LAW
City of Carmel
September 11, 2003
Page Three
If you have any questions or concerns about this letter or about our services, fees or
statements rendered hereafter, please contact me. If you would like to purchase our HIPAA
Package, please sign the enclosed copy of this letter to confirm your agreement to these terms.
Again, thank you for allowing Bose McKinney & Evans and me to submit a proposal to
provide HIPAA Privacy services.
Sincerely,
W. J es Hamilton
ACCEPTED AND AGREED TO THIS DAY OF , 2003.
CITY OF CARMEL
By: Douglas C. Haney
484955v2
f
}in
Approved and adopted this \-' day of ' 4?itibe( , 2003.
l
CARMEL BOARD OF PUBLIC WORKS AND SAFETY
By: l
J Brainard, esid' g Officer
Date: ,Cl%�O �p_
Mary ur,Ice, Member
Date: /1 — D.3
�--
Lori S(Watson tuber
Date: Y"/e5ye-,
ATTEST: ycSX7
/44
ana L. Crdray, IAMC, Clerk-Treasurer
Date: II ,.. �) i