HomeMy WebLinkAboutHALCYON BEHAVIORAL, LLC dba HALCYON BEHAVIORAL ADMINISTRATORSti
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VSURANCE NOT ON FILE N-2021-201
v VORK MAY NOT PROCEED
CLERK OF COUNCIL
DATE;
S p (1 AGREEMENT WITH HALCYON BEHAVIORAL ADMINISTRATORS
t£ P Aola� TO PROVIDE WELLNESS PROGRAM PLUS SERVICES
THIS AGREEMENT is made and entered into on this 9th day of September, 2021 by and between
Halcyon Behavioral, LLC, a California limited liability company doing business as Halcyon
Behavioral Administrators ("Consultant'), and the City of Santa Ana, a charter city and municipal
corporation organized and existing under the Constitution and laws of the State of California
("City"). Consultant and City are also referred to herein as"Parties" or individually as a "Party."
RECITALS
A. The City desires to retain a Consultant having special skill and knowledge in the field of
providing employee wellness program services to the City.
B. Consultant represents that it is able and willing to provide such services to the City.
C. hi undertaking the performance of this Agreement, Consultant represents that it is
knowledgeable in its field and that any services performed by Consultant under this
Agreement will be performed in compliance with such standards as may reasonably be
expected from a professional consulting firm in the field.
NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the
terms and conditions hereinafter set forth, the parties agree as follows:
1. SCOPE OF SERVICES
Consultant shall perform during the term of this Agreement, the tasks and obligations
including all labor, materials, tools, equipment, and incidental customary work required to fully
and adequately complete the services described and set forth in Exhibit A, attached hereto and
incorporated by reference.
2. COMPENSATION
a. City agrees to pay, and Consultant agrees to accept as total payment for its services for
City, the rates and charges identified in Exhibit B. The total amount to be expended
during the term of this Agreement shall not exceed forty-two thousand dollars and zero
cents ($42000.00). If City decides to exercise the optional services and pricing for
Biometric Screening Coordination as set forth in Exhibits A and B, City will amend
this Agreement to add additional compensation to pay for those services.
b. Payment by City shall be made within forty-five (45) days following receipt of proper
invoice evidencing work performed, subject to City accounting procedures. Payment
need not be made for work, which fails to meet the standards of performance set forth
in the Recitals, which may reasonably be expected by City.
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3. TERM
This Agreement shall commence on October 1, 2021, and continue until June 30, 2024,
unless terminated earlier in accordance with Section 15, below.
4. INDEPENDENT CONTRACTOR
Consultant shall, during the entire term of this Agreement, be construed to be an
independent Consultant and not an employee of the City. This Agreement is not intended nor shall
it be construed to create an employer -employee relationship, a joint venture relationship, or to
allow the City to exercise discretion or control over the professional manner in which Consultant
performs the services which are the subject matter of this Agreement; however, the services to be
provided by Consultant shall be provided in a manner consistent with all applicable standards and
regulations governing such services. Consultant shall pay all salaries and wages, employer's social
security taxes, unemployment insurance and similar taxes relating to employees and shall be
responsible for all applicable withholding taxes.
5. OWNERSHIP OF MATERIALS
This Agreement creates a non-exclusive and perpetual license for City to copy, use,
modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property
embodied in plans, specifications, studies, drawings, estimates, and other documents or works of
authorship fixed in any tangible medium of expression, including but not limited to, physical
drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared or
caused to be prepared by Consultant under this Agreement ("Documents & Data"). Consultant
shall require all subcontractors to agree in writing that City is granted a non-exclusive and
perpetual license for any Documents & Data the subcontractor prepares under this Agreement.
Consultant represents and warrants that Consultant has the legal right to license any and all
Documents & Data. Consultant makes no such representation and warranty in regard to
Documents & Data, which were provided, to Consultant by the City. City shall not be limited in
any way in its use of the Documents and Data at any time, provided that any such use not within
the purposes intended by this Agreement shall be at City's sole risk.
6. INSURANCE
A. Prior to undertaking performance of work under this Agreement, Consultant shall
maintain and shall require its subcontractors, if any, to obtain and maintain the
following insurance coverages:
1) Commercial General Liability Insurance (CGL): Insurance Services Office Form
CG 00 01 covering CGL on an "occurrence" basis, including products and
completed operations,property damage, bodily injury and personal & advertising
injury with limits no less than $2,000,000 per occurrence. If a general aggregate
limit applies, either the general aggregate limit shall apply separately to this
project/location (ISO CG 25 03 or 25 04)or the general aggregate limit shall be
twice the required occurrence limit.
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2) Cyber Liability Insurance: with limits not less than $2,000,000 per occurrence or
claim, $2,000,000 aggregate. Coverage shall be sufficiently broad to respond to the
duties and obligations as is undertaken by Consultant in this agreement and shall
include,but not be limited to, claims involving security breach, system failure, data
recovery, business interruption, cyber extortion, social engineering, infringement
of intellectual property, including but not limited to infringement of copyright,
trademark, trade dress,invasion of privacy violations, information theft, damage to
or destruction of electronic information, release of private information, and
alteration of electronic information. The policy shall provide coverage for breach
response costs, regulatory fines and penalties as well as credit monitoring expenses.
3) Automobile_ Liability Insurance: ISO Form Number CA 00 01 covering any auto
(Code I), or if Contractor has no owned autos, hired, (Code 8) and non -owned autos
(Code 9), with limit no less than $1,000,000 per accident for bodily injury and
property damage.
4) Workers' Compensation Insurance: If Consultant has employees, Consultant must
maintain worker's compensation insurance coverage as required by the State of
California, with Statutory Limits, and Employer's Liability Insurance with limit of
no less than $1,000,000 per accident for bodily injury or disease.
5) Professional Liability Insurance (Errors and Omissions): Insurance appropriates to
the Consultant's profession, with limit no less than $2,000,000 per occurrence or
claim, $2,000,000 aggregate.
B. If the Vendor maintains broader coverage and/or higher limits than the minimums
shown above, the Entity requires and shall be entitled to the broader coverage and/or
the higher limitsmaintained by the contractor. Any available insurance proceeds in
excess of the specified minimum limits of insurance and coverage shall be available to
the Entity.
C. Other Insurance Provisions- The insurance policies required herein are to contain, or
be endorsed to contain, the following provisions:
1) Additional Insured Status —the City, its officers, officials, employees, and
volunteers are to be covered as additional insureds on the CGL policy with
respect to liability arising out of work or operations performed by or on behalf
of the Consultant including materials, parts, or equipment furnished in
connection with such work or operations. General liability coverage can be
provided in the form of an endorsement to the Consultant's insurance (at least
as broad as ISO Form CG 2010 1185 or both CG 20 10, CG 20 26, CG 20 33,
or CG 20 38; and CG 20 37 forms if later revisions used).
2) Primary Coverage- For any claims related to this contract, the Consultant's
insurance coverage shall be primary. Coverage for commercial liability shall be
at least as broad as ISO CG 20 01 04 13 as respects the City, its officers,
officials, employees, and volunteers. Any insurance or self-insurance
maintained by the City, its officers, officials, employees, or volunteers shall be
excess of the Consultant's insurance and shall not contribute with it.
3) Notice of Cancellation- Each insurance policy required above shall state that
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coverage shall not be canceled, except with notice to the.City.
4) Waiver of Subrogation- Consultant hereby grants to City a waiver of any right
to subrogation, which any insurer of said Chahtmay acquire against the City by
virtue of the payment of any loss under such insurance. Consultant agrees to
obtain any endorsement that may be necessary to affect this waiver of
subrogation, but this provision applies regardless of whether or not the City has
received a waiver of subrogation endorsement from the insurer.
5) Self -Insured Retentions- Self -insured retentions must be declared to and
approved by the City. The City may require to Consultant to provide proof of
ability to pay losses and related investigations, claim administration, and
defense expenses within the retention. The policy language shall provide,or be
endorsed to provide, that the self -insured retention may be satisfied by either
the namedinsured or City.
6) Acceptability of insurers- Insurance is to be placed with insurers authorized to
conduct business in the state with a current A.M. Best's rating of no less than A-
:VII, unless otherwise acceptable to the City.
7) Claims Made Policies- If any of the required policies provide coverage on a
claims -made basis:
i. The Retroactive Date must be shown and must be before the date of the
contract or thebeginning of contract work.
ii. Insurance must be maintained and evidence of insurance must be
provided for at leastfrve (5) years after completion of the contract of
work.
iii. If coverage is canceled or non -renewed, and not replaced with another
claims -made policy form with a Retroactive Date prior to the contract
effective date, the Consultant must purchase "extended reporting"
coverage for a minimum of five (S) years after completion of contract
work.
8) Verification of Coverage- Consultant shall furnish the City with original
Certificates of Insurance including all required amendatory endorsements (or
copies of the applicable policy language effecting coverage required by this
clause) and acopy of the Declarations and Endorsement Page of the CGL policy
listing all policy endorsements to the City before work begins. However, failure
to obtain the required documents prior to the work beginning shall not waive
the Consultant's obligation to provide them. The City reserves the right to
require complete, certified copiesof all required insurance policies, including
endorsements required by these specifications, at any time.
9) Subcontractors- Consultant shall require and verify that all subcontractors
maintain insurance meeting all the requirements stated herein, and Consultant
shall ensure that City is an additional insured on insurance required from
subcontractors.
10) Special Risks or Circumstances- City reserves the right to modify these
requirements, including limits, based on the nature of the risk, prior experience,
insurer, coverage, or other special circumstances.
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7. INDEMNIFICATION
Consultant agrees to defend, and shall indemnify and hold harmless the City, its officers,
agents, employees, contractors, special counsel, and representatives from liability: (1) for personal
injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for
personal injury, including death, and claims for property damage, which may arise from the
negligent operations of the Contractor, its subcontractors, agents, employees, or other persons
acting on its behalf which relates to the services described in section 1 of this Agreement; and (2)
from any claim that personal injury, damages, just compensation, restitution, judicial or equitable
relief is due by reason of the terms of or effects arising from this Agreement. This indemnity and
hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial
or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in
this Section or by reason of the terms of, or effects, arising from this Agreement. The Consultant
further agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including
fees and costs for special counsel to be selected by the City, regarding any action by a third party
challenging the validity of this Agreement, or asserting that personal injury, damages, just
compensation, restitution, judicial or equitable relief due to personal or property rights arises by
reason of the terms of, or effects arising from this Agreement. City may make all reasonable
decisions with respect to its representation in any legal proceeding. Notwithstanding the foregoing,
to the extent Contractor's services are subject to Civil Code Section 2782.8, the above indemnity
shall be limited, to the extent required by Civil Code Section 2782.8, to claims that arise out of,
pertain to, or relate to the negligence, recklessness, or willful misconduct of the Contractor.
8. INTELLECTUAL PROPERTY INDEMNIFICATION
Consultant shall defend and indemnify the City, its officers, agents, representatives, and
employees against any and all liability, including costs, for infringement of any United States'
letters patent, trademark, or copyright infringement, including costs, contained in the work product
or documents provided by Consultant to the City pursuant to this Agreement.
3�N X411I710
Consultant shall keep records and invoices in connection with the work to be performed
under this Agreement. Consultant shall maintain complete and accurate records with respect to
the costs incurred under this Agreement and any services, expenditures, and disbursements
charged to the City for a minimum period of three (3) years, or for any longer period required by
law, from the date of final payment to Consultant under this Agreement. All such records and
invoices shall be clearly identifiable. Consultant shall allow a representative of the City to
examine, audit, and make transcripts or copies of such records and any other documents created
pursuant to this Agreement during regular business hours. Consultant shall allow inspection of all
work, data, documents, proceedings, and activities related to this Agreement for a period of three
(3) years from the date of final payment to Consultant under this Agreement.
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10. CONFIDENTIALITY
If Consultant receives from the City information which due to the nature of such
information is reasonably understood to be confidential and/or proprietary, Consultant agrees that
it shall not use or disclose such information except in the performance of this Agreement, and
further agrees to exercise the same degree of care it uses to protect its own information of like
importance, but in no event less than reasonable care. "Confidential Information" shall include all
nonpublic information. Confidential information includes not only written information, but also
information transferred orally, visually, electronically, or by other means. Confidential
information disclosed to either party by any subsidiary and/or agent of the other party is covered
by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any
information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the
Consultant disclosed in a publicly available source; (c) is in rightful possession of the Consultant
without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e)
is independently developed by the Consultant without reference to information disclosed by the
City.
11. CONFLICT OF INTEREST CLAUSE
Consultant covenants that it presently has no interests and shall not have interests, direct
or indirect, which would conflict in any manner with performance of services specified under this
Agreement.
12. NON-DISCRIMINATION
Consultant shall not discriminate because of race, color, creed, religion, sex, marital status,
sexual orientation, gender identity, gender expression, gender, medical conditions, genetic
information, or military and veteran status, age, national origin, ancestry, or disability, as defined
and prohibited by applicable law, in the recruitment, selection, teaching, training, utilization,
promotion, termination or other employment related activities or any services provided under this
Agreement. Consultant affirms that it is an equal opportunity employer and shall comply with all
applicable federal, state and local laws and regulations.
13. EXCLUSIVITY AND AMENDMENT
This Agreement represents the complete and exclusive statement between the City and
Contractor, and supersedes any and all other agreements, oral or written, between the parties. In
the event of a conflict between the terms of this Agreement and any attachments hereto, the terms
of this Agreement shall prevail. This Agreement may not be modified except by written instrument
signed by the City and by an authorized representative of Contractor. The parties agree that any
terms or conditions of any purchase order or other instrument that are inconsistent with, or in
addition to, the terms and conditions hereof, shall not bind or obligate Consultant or the City. Each
party to this Agreement acknowledges that no representations, inducements, promises or
agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any
party, which is not embodied herein.
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14. ASSIGNMENT
Inasmuch as this Agreement is intended to secure the specialized services of Contractor,
Consultant may not assign, transfer, delegate, or subcontract any interest herein without the prior
written consent of the City and any such assignment, transfer, delegation or subcontract without
the City's prior written consent shall be considered null and void. Nothing in this Agreement shall
be construed to limit the City's ability to have any of the services which are the subject to this
Agreement performed by City personnel or by other Contractors retained by City.
15. TERMINATION
This Agreement may be terminated by either Party upon ninety (90) days written notice of
termination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant
compensation for all services performed by Consultant prior to receipt of such notice of
termination, subject to the following conditions:
a. As a condition of such payment, the Executive Director of Human Resources may
require Consultant to deliver to the City all work product(s) completed as of such
date, and in such case such work product shall be the property of the City unless
prohibited by law, and Consultant consents to the City's use thereof for such
purposes as the City deems appropriate.
b. Payment need not be made for work, which fails to meet the standard of
performance specified in the Recitals of this Agreement.
16. WAIVER
No waiver of breach, failure of any condition, or any right or remedy contained in or
granted by the provisions of this Agreement shall be effective unless it is in writing and signed by
the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or
remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not
similar, not shall any waiver constitute a continuing waiver unless the writing so specifies.
17. JURISDICTION -VENUE
This Agreement has been executed and delivered in the State of California and the validity,
interpretation, performance, and enforcement of any of the clauses of this Agreement shall be
determined and governed by the laws of the State of California. Both parties further agree that
Orange County, California, shall be the venue for any action or proceeding that may be brought or
arise out of, in connection with or by reason of this Agreement.
18. PROFESSIONAL LICENSES AND COMPLIANCE WITH ALL LAWS
A. Consultant shall, throughout the term of this Agreement, maintain all necessary
licenses, permits, approvals, waivers, and exemptions necessary for the provision
of the services hereunder and required by the laws and regulations of the United
States, the State of California, the City of Santa Ana and all other governmental
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agencies. Consultant shall notify the City immediately and in writing of its inability
to obtain or maintain such permits, licenses, approvals, waivers, and exemptions.
Said inability shall be cause for termination of this Agreement.
B. Consultant shall comply with all applicable federal state, and local laws and
regulations, including but not limited to, the Health Insurance Portability and
Accountability Act and the California Confidentiality of Medical Information Act.
19. NOTICE
Any notice, tender, demand, delivery, or other communication pursuant to this Agreement
shall be in writing and shall be deemed to be properly given if delivered in person or mailed by
first class or certified mail, postage prepaid, or sent by fax or other telegraphic communication in
the manner provided in this Section, to the following persons:
To City:
Clerk .ofthe City Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
Fax: 714- 647-6956
With courtesy copies to:
Executive Director, Human Resources
Department
City of Santa Ana
20 Civic Center Plaza (M-24)
P.O. Box 1988
Santa Ana, California 92702
Fax:714-647-6930
To Contractor:
Halcyon Behavioral, LLC
Attn: Jeremy Oswald, CEO and President
P.O. Box 25159
Fresno, CA 93721-5159
Fax:559-492-2314
A party may change its address by giving notice in writing to the other party. Thereafter,
any communication shall be addressed and transmitted to the new address. If sent by mail,
communication shall be effective or deemed to have been given three (3) days after it has been
deposited in the United States mail, duly registered or certified, with postage prepaid, and
addressed as set forth above. If sent by fax, communication shall be effective or deemed to have
been given twenty-four (24) hours after the time set forth on the transmission report issued by the
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N-2021-201
transmitting facsimile machine, addressed as set forth above. For purposes of calculating these
time frames, weekends, federal, state, County or City holidays shall be excluded.
20. MISCELLANEOUS PROVISIONS
a. Each undersigned represents and warrants that its signature herein below has the
power, authority and right to bind their respective parties to each of the terms of
this Agreement, and shall indemnify City fully, including reasonable costs and
attorney's fees, for any injuries or damages to City in the event that such authority
or power is not, in fact, held by the signatory or is withdrawn.
b. The Agreement is the final and complete agreement and any prior or
contemporaneous agreements for similar services between the parties is superseded
by this Agreement. This shall not apply where the Parties are currently engaged
and Consultant is providing services not contemplated by this Agreement
C. All Exhibits referenced herein and attached hereto shall be incorporated as if fully
set forth in the body of this Agreement.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and
year first above written.
ATTEST:
APPROVED AS TO FORM:
SONIA R. CARVALHO
City Attorney
By:' A . Kel�
Laura A. Rossini
Chief Assistant City Attorney
LJ�rl'MEI
FyR APPROVAL:
lek
N-14-114 Director
Human Resources Department
CITY OF SANTA ANA
Kristine Ridge
City Manager
HALCYON BEHAVIORAL, LLC
"DGt
Jeremy Oswald
CEO and President
Page 9
EXHIBIT A - WELLNESS PROGRAM SERVICES TO BE PROVIDED
Halcyon hereby agrees to perform, arrange for, or assist in the performance of the following Core
Wellness Plus Program services for the City:
1. Core Wellness Plus
a. Health and Wellness Coaching: CIS will have unlimited telephonic and web -based
access to Health Coaches for counseling, education, and referrals for lifestyle
management programs including weight management, nutrition, tobacco cessation,
fitness and exercise, pre- and post -natal care and stress management.
in addition to Health and Wellness Coaching, Halcyon may provide CIS with
information concerning conventional and alternative preventive health and wellness
resource options, as well as selection and evaluation criteria that they should be aware
of with regard to the specific type of wellness approach they are considering.
a. Wellbeing Website: Halcyon will provide CIS with access to a health and wellness
website.
i. Access: CIS can access the website or a customized domain, which will be
hosted by Halcyon.
ii. Content: Halcyon will provide the following resources for City on the
Wellbeing Website:
1. Discounted Gym Memberships: Halcyon, will provide CIS with
discounted gym memberships, through GlobalFit, to over 2,000 gyms
across the country.
2. Orientation Video: Halcyon will provide an orientation video for CIS,
which will be linked to the Wellbeing Website.
3. Online Behavior Modification Programs: Halcyon will provide City
with access to six -to -eight -week web -based modules for tobacco
cessation, weight management, and exercise.
4. eConnect®: Halcyon, through a partnership with CuraLinc Healthcare,
will provide CIS with access to the eConnect® platform. eConnect®
offers scheduled video, telephonic, and web chat health coaching.
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Health Risk Assessment: Halcyon will provide City with a self-service
assessment that is written so that end users may evaluate their risk for
different conditions and learn how to reduce it.
6. My WellBeing Blog: Halcyon will provide CIs with access to a
wellbeing blog consisting of content to improve emotional, physical,
and financial health.
7. My Wellness Videos: Halcyon will provide CIs with access to a video
library consisting of wellbeing videos to improve emotional, physical
and financial health.
8. My Webinars: Halcyon will provide monthly, live 30-minute webinars
for all CIs on various wellbeing topics. Webinars will also be recorded
and available through the Wellbeing Website.
9. Competition Portal: Halcyon will provide City's Clients with a
Competition Portal that will allow them to administer team or
individual health -related challenges.
10. My Rewards — Activity -Based Rewards Program: Halcyon will
provide the City with a points -based, online platform to track and
reward healthy activities and behaviors through the following tracking
and reward fulfillment mechanisms:
• Self -.Reported: Healthy activities that are tracked by the
participant and manually entered within the My Rewards
member portal on the Halcyon web portal (ex: exercising three
times a week; flu shots; local IOk run; community service day).
• Device Verified: Activities tracked electronically by personal
fitness devices and uploaded automatically to the member web
portal (ex: Fitl3it, Fuelband)
• System Verified: Activities that are completed within the portal
and wellness program and then uploaded systematically within
the participant's My Rewards page (ex: an online coaching
program such as UBreathe or UFit; participation in a monthly
webinar; completion of the health risk questionnaire).
• Fulfill the rewards either electronically or via mail.
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iii. Customization: The Wellbeing Website will be tailored to suit City's brand,
including a logo and links to other health care benefits through City.
b. Promotional Materials: Halcyon will provide City with branded electronic promotional
materials to assist in promoting the program to CIs.
i. A wellness program introductory letter will be provided electronically to City.
City is responsible for customizing the letter for City's employees.
ii. Wellness program posters will be sent electronically to City on a semi-annual
basis.
iii. Wellness program monthly promotional campaign flyers will be sent
electronically to City on a monthly basis.
iv. Wellness program newsletters will be sent electronically to City on a quarterly
basis.
c. Utilization Reporting: Halcyon will provide utilization and program activity reports so
that City can track the utilization and performance of the Program. This reporting will
be provided on a monthly basis. Halcyon will also provide a member -level data report
containing participation, health risk, biometric screening, and other program data at
the end of each program year to Keenan, its benefits broker, for the purpose of
conducting program evaluation.
2. Biometric Screening Coordination (Optional)
a. If the City selects biometric screening as an optional service to be provided through
Halcyon, Halcyon will coordinate biometric screening collection utilizing onsite
services, lab option, and/or physician verification
b. Services will include:
i. Online scheduler with consent forms and confirmation -page
ii. Intake of biometrics / blood data either via physician verification form
iii. Individual My Health Profile report delivered electronically to each
participant
iv. Corporate report (dashboard and end of project report)
v. Data export in standard format to City, if needed
vi. Intake of an eligibility file in standard format, if applicable
vii. Assigned Project Manager to build out each event in system and provide
technical support to client
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EXHIBIT B — COST S/RATES
Core Wellness Plus Proms:
The cost of the Core Wellness Plus Program to the City for all CIS will be $ $1.05 PEPM (per
employee per month). This PLPM pricing for the Core Wellness Plus Program will be effective
for the duration of the agreement (October 1, 2021 through June 30, 2024), and will only increase
if the City requests additional services.
Billing for the service will occur the first week of the month after the delivery of services during
the previous month, based upon the number of CIS identified by the City multiplied by the PEPM.
Biometric Screening (Ootional):
The cost of optional Biometric Screening services, if selected by the City, will be as follows:
Fingerstick Standard Panel*
$58.00 per participant
Total Cholesterol, HDL, and Glucose, with Blood Pressure, Height, Weight, and Body Mass
Index (BMI); or substitute Waist Circumference or Waist/Hip Ratio.
Fingerstick Premium Panel*
$59.00 per participant
Full Lipid Panel (Total Cholesterol, HDL, LDL, Triglycerides), and Glucose, with Blood
Pressure, Height, Weight, and Body Mass Index (BMI) - or substitute Waist Circumference or
Waist/Hip Ratio.
Venipuncture Premium Panel* $59.00 per participant**
Full Lipid Panel (Total Cholesterol, HDL, LDL, LDL/HDL ratio, VLDL, Triglycerides),
Glucose, with Blood Pressure, Height, Weight, and Body Mass Index (BMI); or substitute Waist
Circumference or Waist/Hip Ratio.
Venipuncture Comprehensive Panel* $110.00 per participant**
Full Chemistry 30 Panel, with Blood Pressure, Height, Weight, and Body Mass Index (BMI); or
substitute Waist Circumference or Waist/Hip Ratio, plus PSA (men over 40), TSH (women over
50) & Ale (diabetics).
Physician Submission Screening*** $15.00 per participant
Used as an exception, in this option, participants will download a form via our web portal to take
on their next physician visit. Results are sent back to Halcyon Health & Wellness and manually
uploaded. Each participant receives an online report and the employer receives an aggregate
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results report to assist with planning. The results can also be uploaded to receive credit within
the My Rewards program.
*Biometric screenings require a minimum of 25 screenings per site per event. In the event, a
screening date falls short of the 25 minimum, the client will be billed for 25 participants.
**For Offshe Screenings at a lab, please add $10 to the fee if Blood Pressure, Height and Weight
are added.
** *Members may be subject to any applicable co -payments or patient responsibility associated
with the physician visit medical claim.
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NOTICE OF COMPLIANCE
CITY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL
Contractor
Halcyon Behavioral LLC
Name:
Project
N-2021-201-01
Number:
Project
First Amendment To Agreement With Halcyon Behavioral, LLC
Name:
The Certificate of Insurance (COI) submitted indicates that the coverages are in
compliance with the insurance requirements. No further action is required at this time.
The compliant coverage(s) are:
POLICY EXPIRATION
TYPE OF INSURANCE COI DATE FILE NAME
NUMBER DATE
2022 CERT City
AUTOMOBILE LIABILITY 57SBABN5132 01/01/2023 09/27/2022 of Santa Ana
09272022.pdf
09282022 CERT
CYBER LIABILITY AX01055004 07/01/2023 09/28/2022 City of Santa
Ana.pdf
2022 CERT City
GENERAL LIABILITY 57SBABN5132 01/01/2023 09/27/2022 of Santa Ana
09272022.pdf
PROFESSIONAL LIABILITY HC7CAB4HM9002 10/29/2022 09/20/2022
2022 CERT City
WORKERS COMPENSATION AND
57WECAF7PA9 01/01/2023 09/27/2022 of Santa Ana
EMPLOYERS' LIABILITY
09272022.pdf
Thank you,
City of Santa Ana
Risk Management Division
in partnership with
CTrax Plus Services Team
9/28/2022 6:37 PM
NOTICE OF COMPLIANCE
CITY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL
Contractor
Halcyon Behavioral LLC
Name:
Project
N-2021-201-01
Number:
Project
First Amendment To Agreement With Halcyon Behavioral, LLC
Name:
The Certificate of Insurance (COI) submitted indicates that the coverages are in
compliance with the insurance requirements. No further action is required at this time.
The compliant coverage(s) are:
POLICY EXPIRATION
TYPE OF INSURANCE COI DATE FILE NAME
NUMBER DATE
2022 CERT City of
AUTOMOBILE LIABILITY 57SBABN5132 01/01/2023 09/27/2022 Santa Ana
09272022.pdf
09282022 CERT City
CYBER LIABILITY AX01055004 07/01/2023 09/28/2022
of Santa Ana.pdf
1665748585.0524035-
ACORD 0025 2016-
CYBER LIABILITY AX01055004 07/01/2023 10/14/2022
03 Acroform-
locked.pdf
1665748585.0524035-
ACORD 0025 2016-
EXCESS TECH E&O / CYBER EKS3445640 07/01/2023 10/14/2022
03 Acroform-
locked.pdf
2022 CERT City of
GENERAL LIABILITY 57SBABN5132 01/01/2023 09/27/2022 Santa Ana
09272022.pdf
2022 CERT City of
WORKERS COMPENSATION AND
57WECAF7PA9 01/01/2023 09/27/2022 Santa Ana
EMPLOYERS' LIABILITY
09272022.pdf
Thank you,
City of Santa Ana
Risk Management Division
in partnership with
CTrax Plus Services Team
10/25/2022 11:58 AM
NOTICE OF COMPLIANCE
CITY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL
Contractor
Halcyon Behavioral LLC
Name:
Project
N-2021-201
Number:
Project Agreement With Halcyon Behavioral Administrators To
Name: Provide Wellness Program Plus Services
The Certificate of Insurance (COI) submitted indicates that the coverages are in
compliance with the insurance requirements. No further action is required at this time.
The compliant coverage(s) are:
POLICY EXPIRATION COI
TYPE OF INSURANCE FILE NAME
NUMBER DATE DATE
12192022 CERT City
of Santa Ana
AUTOMOBILE LIABILITY 57SBABN5132 01/01/2024 12/19/2022
Compliance (CSA -
R1351).pdf
09282022 CERT City
CYBER LIABILITY AX01055004 07/01/2023 09/28/2022
of Santa Ana.pdf
09282022 CERT City
CYBER LIABILITY AX01055004 07/01/2023 09/28/2022
of Santa Ana.pdf
1665748585.0524035-
ACORD 0025 2016-
EXCESS TECH E&O / CYBER EKS3445640 07/01/2023 10/14/2022
03 Acroform-
locked.pdf
12192022 CERT City
of Santa Ana
GENERAL LIABILITY 57SBABN5132 01/01/2024 12/19/2022
Compliance (CSA -
R1351).pdf
1665748585.0524035-
ACORD 0025 2016-
UMBRELLA LIABILITY 57SBABN5132 01/01/2023 10/14/2022
03 Acroform-
locked.pdf
POLICY EXPIRATION COI
TYPE OF INSURANCE FILE NAME
NUMBER DATE DATE
12192022 CERT City
of Santa Ana
UMBRELLA LIABILITY 57SBABN5132 01/01/2024 12/19/2022
Compliance (CSA -
R1351).pdf
12192022 CERT City
WORKERS COMPENSATION of Santa Ana
57WECAF7PA9 01/01/2024 12/19/2022
AND EMPLOYERS' LIABILITY Compliance (CSA -
R1351).pdf
Thank you,
City of Santa Ana
Risk Management Division
in partnership with
CTrax Plus Services Team
12/20/2022 11:41 AM
NOTICE OF COMPLIANCE
CITY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL
Contractor
Halcyon Behavioral LLC
Name:
Project
N-2021-201
Number:
Project Agreement With Halcyon Behavioral Administrators To
Name: Provide Wellness Program Plus Services
The Certificate of Insurance (COI) submitted indicates that the coverages are in
compliance with the insurance requirements. No further action is required at this time.
The compliant coverage(s) are:
POLICY EXPIRATION
TYPE OF INSURANCE COI DATE FILE NAME
NUMBER DATE
12192022 CERT City of Santa Ana
AUTOMOBILE LIABILITY 57SBABN5132 01/01/2024 12/19/2022
Compliance (CSA - R1351).pdf
SIMTH01-City of Santa Ana-
EXCESS TECH E&O/CYBER E5K3485033 07/01/2024 07/07/2023
19715405(R).pdf
2022 CERT City of Santa Ana
GENERAL LIABILITY 57SBABN5132 01/01/2024 12/26/2022 Compliance (CSA - R1351)
12262022.pdf
SIMTH01-City of Santa Ana-
TECH E&O/CYBER H23TG3367600 07/01/2024 07/07/2023
19715405(R).pdf
2022 CERT City of Santa Ana
UMBRELLA LIABILITY 57SBABN5132 01/01/2024 12/26/2022 Compliance (CSA - R1351)
12262022.pdf
WORKERS COMPENSATION AND 12192022 CERT City of Santa Ana
57WECAF7PA9 01/01/2024 12/19/2022
EMPLOYERS' LIABILITY Compliance (CSA - R1351).pdf
Thank you,
City of Santa Ana
Risk Management Division
NOTICE OF COMPLIANCE
CITY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL
Contractor
Halcyon Behavioral LLC
Name:
Project
N-2021-201-01
Number:
Project
First Amendment To Agreement With Halcyon Behavioral, LLC
Name:
The Certificate of Insurance (COI) submitted indicates that the coverages comply with the
insurance requirements.
The compliant coverage(s) are:
POLICY EXPIRATION
TYPE OF INSURANCE COI DATE FILE NAME
NUMBER DATE
City of Santa Ana
AUTOMOBILE LIABILITY 57SBAAY4GNC 01/01/2025 12/19/2023 Insurance COI
12.19.2023.pdf
City of Santa Ana
GENERAL LIABILITY 57SBAAY4GNC 01/01/2025 01/11/2024 COI 01112024
CORRECTED.pdf
SIMTH01-City of
TECH E&O/CYBER H23TG3367600 07/01/2024 07/07/2023 Santa Ana-
19715405(R).pdf
SIMTH01-City of
TECH E&O/CYBER H23TG3367600 07/01/2024 07/07/2023 Santa Ana-
19715405(R).pdf
City of Santa Ana
UMBRELLA LIABILITY 57SBAAY4GNC 01/01/2025 01/11/2024 COI 01112024
CORRECTED.pdf
City of Santa Ana
WORKERS COMPENSATION AND
37WECAF7PA9 01/01/2025 12/19/2023 Insurance COI
EMPLOYERS' LIABILITY
12.19.2023.pdf
No further action is required at this time.
Thank you,
City of Santa Ana
Risk Management Division
in partnership with
CTrax Plus Services Team
1/17/2024 12:11 PM