CN-680000-FP083-A5.pdf

Docusign Envelope ID: 1A350620-0C46-460F-9BBD-B813569BE881

AHCA CONTRACT NO. FP083

AMENDMENT NO. 5

THIS CONTRACT, entered into between the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the "Agency," and CAREPLUS HEALTH PLANS, INC., hereinafter referred to as the "Vendor" or "Managed Care Plan," is hereby amended as follows:

1. Effective January 1, 2025, Attachment I, Scope of Services, Exhibit C - Effective January 1, 2024, MA D-SNP Capitation Rates, is hereby deleted in its entirety and replaced with Exhibit C - Effective January 1, 2025, D-SNP Capitation Rates, attached hereto and made a part of this Contract. All references in this Contract to Exhibit C - Effective January 1, 2024, shall hereinafter refer to Exhibit C - Effective January 1,

2. Attachment II, Business Associate Agreement, is hereby deleted in its entirety and replaced with Attachment 11-A, Business Associate Agreement. All references to Attachment II, Business Associate Agreement, shall hereinafter refer to Attachment 11- A, Business Associate Agreement.

3. Attachment V., Agency Approved Modifications and Additions to the Agency Standard Contract, is hereby incorporated and made part of this Contract.

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FP083, Amendment No. 5, Page 1 of 2

AMENDMENT NO. 5

All provisions not in conflict with this Amendment are still in effect and are to be performed at the level specified in this Contract.

This Amendment and its attachment are hereby made a part of this Contract.

This Amendment cannot be executed unless all previous Amendments to this Contract have been fully executed.

IN WITNESS WHEREOF, the Parties hereto have caused this thirteen (13) page Amendment to be executed by their officials thereunto duly authorized. This Amendment is not valid unti l signed and dated by both Parties.

CAREPLUS HEAL TH PLANS, INC.

~DocuSigned by:

SIGNBE~ ~~t~~J.iiA, NAME: George Renaudi n

TITLE: President, Medicare and Medicaid

DATE: 6/17/2025

STATE OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION

SIGNED

BY:

NAME:

TITLE:

DATE:

)S\Jo..,.,.., shevaun L. Harris secretary

List of Attachments included as part of this Amendment:

Specify Type Number Description Attachment I Exhibit C - Effective January 1, 2025, D-SNP

Capitation Rates ( 1 Page)

Attachment

Attachment

II-A

V

Business Associate Agreement (5 Pages)

Agency Approved Modifications and Additions to the Agency Standard Contract (2 Pages)

Attachment VI Vendor Certification Form (PUR 7801) (3 Pages)

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FP083, Amendment No. 5, Page 2 of 2

AMENDMENT NO. 5

All provisions not in conflict with this Amendment are still in effect and are to be performed at the level specified in this Contract.

This Amendment and its attachment are hereby made a part of this Contract.

This Amendment cannot be executed unless all previous Amendments to this Contract have been fully executed.

IN WITNESS WHEREOF, the Parties hereto have caused this thirteen (13) page Amendment to be executed by their officials thereunto duly authorized. This Amendment is not valid until signed and dated by both Parties.

CAREPLUS HEAL TH PLANS, INC.

I✓ DocuSigned by:

SIGN:~ L~~tg~)i~

NAME: George Renaudi n

STATE OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION

SIGNED

BY:

NAME: Shevaun L. Harris

TITLE: President, Medicare and Medicaid TITLE:

secretary

DATE: 6/17/2025 DATE:

List of Attachments included as part of this Amendment:

Specify Type Number Description Attachment I Exhibit C - Effective January 1, 2025, D-SNP

Capitation Rates (1 Page)

Attachment

Attachment

Attachment

II-A

V

VI

Business Associate Agreement (5 Pages)

Agency Approved Modifications and Additions to the Agency Standard Contract (2 Pages)

Vendor Certification Form (PUR 7801) (3 Pages)

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FP083, Amendment No. 5, Page 2 of 2

ATTACHMENT I

EXHIBIT C - EFFECTIVE JANUARY 1, 2025

D-SNP CAPITATION RATES

DATE SPAN REGION CATEGORIES OF RATE

MEDICAID ELIGIBILITY

01/01/2025- Region A QMB $36.11 12/31/2025 Region B

Region C Region D Region E Region F

01/01/2025- Region G QMB $26.85 12/31/2025 01/01/2025- Region H QMB $11.41 12/31/2025 01/01/2025- Region I QMB $8.66 12/31/2025 01/01/2025- Region A QMB Plus, SLMB Plus, $72.84 12/31/2025 Region B and FBDE

Region C Region D Region E Region F

01/01/2025- Region G QMB Plus, SLMB Plus, $73.39 12/31/2025 and FBDE 01/01/2025- Region H QMB Plus, SLMB Plus, $49.48 12/31/2025 and FBDE 01/01/2025- Region I QMB Plus, SLMB Plus, $111.36 12/31/2025 and FBDE

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FP083, Attachment I, Exhibit C - Effective 01/01/2025, Page 1 of 1

ATTACHMENT II-A

BUSINESS ASSOCIATE AGREEMENT

The parties to this Attachment agree that the following provisions constitute a business associate agreement for purposes of complying with the requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPM). This Attachment is applicable if the Vendor is a business associate within the meaning of the Privacy and Security Regulations, 45 C.F.R. 160 and 164.

The Vendor certifies and agrees as to abide by the following:

1. Definitions. Unless specifically stated in this Attachment, the definition of the terms contained herein shall have the same meaning and effect as defined in 45 C.F.R. 160 and 164.

a. Protected Health Information. For purposes of this Attachment, protected health information shall have the same meaning and effect as defined in 45 C.F.R. 160 and 164, limited to the information created, received, maintained or transmitted by the Vendor from, or on behalf of, the Agency.

b. Electronic Protected Health Information (e-PHI). For purposes of this Attachment, electronic protected health information shall have the same meaning and effect as defined in 45 C.F.R. 160 and 164 (The Security Rule), limited to the electronic information created, received, maintained or transmitted by the Vendor from, or on behalf of, the Agency.

c. Security Incident. For purposes of this Attachment, security incident means the attempted or successful unauthorized access, use, disclosure, modification, or destruction of information or interference with system operations in an information system and includes any event resulting in computer systems, networks, or data being viewed, manipulated, damaged, destroyed or made inaccessible by an unauthorized activity.

d. Confidentiality. For the purposes of this Attachment, confidentiality refers to when electronic protected health information is not made available or disclosed to unauthorized persons or processes.

e. Integrity. For the purposes of this Attachment, integrity means that electronic protected health information has not been altered or destroyed in an unauthorized manner.

f. Availability. For the purposes of this Attachment, availability refers to electronic health information remaining accessible and usable upon demand by an authorized person.

2. Applicability of HITECH and HIPM Privacy Rule and Security Rule Provisions. As provided by federal law, Title XI 11 of the American Recovery and Reinvestment Act of 2009 (ARRA), also known as the Health Information Technology Economic ad Clinical Health (HITECH) Act, requires a Business Associate (Vendor) that contracts with the Agency, a HIPM covered entity, to comply with the provisions of the HIPM Privacy and Security Rules (45 C.F.R. 160 and 164) and comply with 45 C.F.R. 162 as applicable.

3. Use and Disclosure of Protected Health Information. The Vendor shall comply with the provisions of 45 CFR 164.504(e)(2)(ii). The Vendor shall not use or disclose protected

AHCA Contract No. FP083, Attachment II-A, Page 1 of 5

AHCA Form 2100..0017, Revised (SEP 2024)

BUSINESS ASSOCIATE AGREEMENT

health information other than as permitted by this Contract or by federal and state law. The sale of protected health information or any components thereof is prohibited except as provided in 45 CFR 164.502(a)(5). The Vendor will use appropriate safeguards to prevent the use or disclosure of protected health information for any purpose not in conformity with this Contract and federal and state law. The Vendor will implement administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of electronic protected health information the Vendor creates, receives, maintains, or transmits on behalf of the Agency.

4. Use and Disclosure of Information for Management. Administration, and Legal Responsibilities. The Vendor is permitted to use and disclose protected health information received from the Agency for the proper management and administration of the Vendor or to carry out the legal responsibilities of the Vendor, in accordance with 45 C.F.R.

164.504(e)(4). Such disclosure is only permissible where required by law, or where the Vendor obtains reasonable assurances from the person to whom the protected health information is disclosed that: (1) the protected health information will be held confidentially,

(2) the protected health information will be used or further disclosed only as required by law or for the purposes for which it was disclosed to the person, and (3) the person notifies the Vendor of any instance of which it is aware in which the confidentiality of the protected health information has been breached.

5. Disclosure to Third Parties. The Vendor will not divulge, disclose, or communicate protected health information to any third party for any purpose not in conformity with this Contract without prior written approval from the Agency. The Vendor shall ensure that any agent, including a subcontractor, to whom it provides protected health information received from, or created or received by the Vendor on behalf of the Agency, agrees to the same terms, conditions, and restrictions that apply to the Vendor with respect to protected health information. The Vendor's subcontracts shall fully comply with the requirements of 45 CFR 164.314(a)(2)(iii).

6. Access to Information. The Vendor shall make protected health information available in accordance with federal and state law, including providing a right of access to persons who are the subjects of the protected health information in accordance with 45 C.F.R.164.524.

7. Amendment and Incorporation of Amendments. The Vendor shall make protected health information available for amendment and to incorporate any amendments to the protected health information in accordance with 45 C.F.R. 164.526.

8. Accounting for Disclosures. The Vendor shall make protected health information available as required to provide an accounting of disclosures in accordance with 45 C.F.R. 164.528.

The Vendor shall document all disclosures of protected health information as needed for the Agency to respond to a request for an accounting of disclosures in accordance with 45 C.F.R. 164.528.

9. Privacy Protection. The Vendor shall permit an individual to request a restriction on the use and disclosure of protected health information about the individual to carry out treatment, payment, or health care operations; and disclosures permitted under 164.510(b) in accordance with 45 C.F.R. 164.522. The Vendor shall permit an individual

AHCA Contract No. FP083, Attachment II-A, Page 2 of 5

AHCA Form 2100-0017, Revised (SEP 2024)

BUSINESS ASSOCIATE AGREEMENT

to request to receive communications of protected health information from the Vendor by alternative means or at alternative locations in accordance with 45 C.F.R. 164.522.

10. Access to Books and Records. The Vendor shall make its internal practices, books, and records relating to the use and disclosure of protected health information received from, or created or received by the Vendor on behalf of the Agency, available to the Secretary of the Department of Health and Human Services ("HHS") or the Secretary's designee for purposes of determining compliance with the HHS Privacy Regulations.

11. Reporting. The Vendor shall make a good faith effort to identify any use or disclosure, or loss of confidentiality, integrity, or availability, of protected health information, ore-PHI, not provided for in this Contract.

a. To Agency. The Vendor will report to the Agency in the manner and format obtained from the Contract Manager or Agency contact, within ten (10) business days of discovery, any use or disclosure, or loss of confidentiality, integrity, or availability, of protected health information, ore-PHI, not provided for in this Contract of which the Vendor is aware. The Vendor will report to the Agency in the manner and format obtained from the Contract Manager or Agency contact, within twenty-four (24) hours of discovery, any security incident of which the Vendor is aware. A violation of this paragraph shall be a material violation of this Contract. Such notice shall include the identification of each individual whose unsecured protected health information has been or is reasonably believed by the Vendor to have been, accessed, acquired, used, or disclosed during such breach.

b. To Individuals. In the case of a breach of protected health information discovered by the Vendor, the Vendor shall first notify the Agency of the pertinent details of the breach and upon prior review by the Agency shall notify each individual whose unsecured protected health information has been or is reasonably believed by the Vendor to have been, accessed, acquired, used or disclosed as a result of such breach. Such notification shall be in writing by first-class mail to the individual (or the next of kin if the individual is deceased) at the last known address of the individual or next of kin, respectively, or, if specified as a preference by the individual, by electronic mail. Where there is insufficient, or out-of-date contact information (including a phone number, email address, or any other form of appropriate communication) that precludes written (or, if specifically requested, electronic) notification to the individual, a substitute form of notice shall be provided, including, in the case that there are 10 or more individuals for which there is insufficient or out-of-date contact information, a conspicuous posting for a period of at least 90 days on the Web site of the covered entity involved or notice in major print or broadcast media, including major media in the geographic areas where the individuals affected by the breach likely reside. In any case deemed by the Vendor to require urgency because of possible imminent misuse of unsecured protected health information, the Vendor may also provide information to individuals by telephone or other means, as appropriate.

c. To Media. In the case of a breach of protected health information discovered by the Vendor where the unsecured protected health information of more than 500 persons is reasonably believed to have been, accessed, acquired, used, or disclosed, after prior review by the Agency, the Vendor shall provide notice to

AHCA Contract No. FP083, Attachment II-A, Page 3 of 5

BUSINESS ASSOCIATE AGREEMENT

prominent media outlets serving the State, relevant portion of the State, or jurisdiction involved.

d. To Secretary of Health and Human Services (HHS). The Vendor shall cooperate with the Agency to provide notice to the Secretary of HHS of unsecured protected health information that has been acquired or disclosed in a breach.

i. Vendors Who Are Covered Entities. In the event of a breach by the Vendor, or a contractor or subcontractor of the Vendor, and the Vendor is a HIPM covered entity, the Vendor, not the Agency, shall be considered the covered entity for purposes of notification to the Secretary of HHS pursuant to 45 CFR 164.408. The Vendor shall be responsible for filing the notification to the Secretary of HHS and will identify itself as the covered entity in the notice. If the breach was with respect to 500 or more individuals, at least 5 business days prior to filing notice with the Secretary of HHS the Vendor shall provide a copy of the notice and breach risk assessment to the Agency for review. Upon prior review by the Agency of the notice and breach risk assessment, the Vendor shall file the notice with the Secretary of HHS within the notification timeframe imposed by 45 C.F.R. 164.408(b) and contemporaneously submit a copy of said notification to the Agency. If the breach was with respect to less than 500 individuals, the Vendor shall notify the Secretary of HHS within the notification timeframe imposed by 45 C.F.R. 164.408(c) and shall contemporaneously submit a copy of said notification to the Agency.

e. Content of Notices. All notices required under this Attachment shall include the content set forth in 42 U.S.C. 17932(f) and 45 C.F.R. 164 Subpart D, except that references therein to a "covered entity" shall be read as references to the Vendor.

f. Financial Responsibility. The Vendor shall be responsible for all costs related to the notices required under this Attachment.

g. Other Reporting. The Vendor shall comply with any other applicable reporting requirements in conformity with federal and state laws. If notifications are made under any such laws, copies of said notifications shall be provided contemporaneously to the Agency.

12. Mitigation. Vendor shall mitigate, to the extent practicable, any harmful effect that is known to the Vendor of a use or disclosure of protected health information in violation of this Attachment.

13. Termination. Upon the Agency's discovery of a material breach of this Attachment, the Agency shall have the right to assess liquidated damages as specified elsewhere in the contract to which this Attachment is included, and/or to terminate this Contract.

14. Effect of Termination. At the termination of this Contract, the Vendor shall return all protected health information that the Vendor still maintains in any form, including any copies or hybrid or merged databases made by the Vendor; or with prior written approval of the Agency, the protected health information may be destroyed by the Vendor after its use. If the protected health information is destroyed pursuant to the Agency's prior written

AHCA Contract No. FP083, Attachment II-A, Page 4 of 5

BUSINESS ASSOCIATE AGREEMENT

approval, the Vendor must provide a written confirmation of such destruction to the Agency. If return or destruction of the protected health information is determined not feasible by the Agency, the Vendor agrees to protect the protected health information and treat it as strictly confidential.

The Vendor has caused this Attachment to be signed and delivered by its duly authorized representative, as of the date set forth below.

CAREPLUS HEALTH PLANS, INC

SIGNED

BY:

NAME: George Renaudin

DATE: 6/17/2025

TITLE: President, Medicare and Medicaid

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FP083, Attachment II-A, Page 5 of 5

AHCA Form 2100..0017, Revised (SEP 2024)

ATTACHMENT V

AGENCY APPROVED MODIFICATIONS AND ADDITIONS

TO THE AGENCY STANDARD CONTRACT

The following amendments are made to the Agency Standard Contract:

1. Section I., THE VENDOR HEREBY AGREES, Sub-Section HH., Forced Labor Vendor List, is hereby added as follows:

HH. Forced Labor Vendor List

In accordance with section 287.1346, F.S., the Agency may terminate the Contract if the Vendor is placed on the forced labor vendor list.

2. Section I., THE VENDOR HEREBY AGREES, Sub-Section II., PUR 1000, General Contract Conditions, is hereby added as follows:

II. PUR 1000, General Contract Conditions

In accordance with Rule 60A-1.002, F.A.C., PUR 1000, General Contract Conditions, is hereby incorporated and made part of this Contract. In the event of any conflict between the PUR 1000 and the terms and conditions of the Agency's Standard Contract, the Agency's Standard Contract will take precedence over the PUR 1000, unless the conflicting term in the PUR 1000 is required by law, in which case the term contained in the PUR 1000 will take precedence.

3. Section I., THE VENDOR HEREBY AGREES, Sub-Section JJ., Vendor Verification Form PUR7801 ), is hereby added as follows:

JJ. Vendor Certification Form (PUR 7801)

In accordance with Rule 60A-1.002, F.A.C., Attachment VI, Vendor Certification Form (PUR7801 ), is hereby incorporated and made part of this Contract. Upon the execution date of the Contract, and each year on the anniversary date of the Contract, the Vendor shall submit to the Agency a completed Attachment VI, Vendor Certification Form.

In the event of any conflict between the PUR 7801 and the terms and conditions of the Agency's Standard Contract, the Agency's Standard Contract will take precedence over the PUR 7801, unless the conflicting term in the PUR 7801 is required by law, in which case the term contained in the PUR 7801 will take precedence.

4. Section I., THE VENDOR HEREBY AGREES, Sub-Section KK., Use of Funds for Diversity, Equity, and Inclusion Prohibited, is hereby added as follows:

KK. Use of Funds for Diversity, Equity, and Inclusion Prohibited

No State funding under this Contract is being provided for, promoting, advocating for, or providing training or education on "Diversity, Equity, and Inclusion" (DEi).

DEi is any program, activity, or policy that classifies individuals on the basis of race, color, sex, national origin, gender identity, or sexual orientation and promotes differential or preferential treatment of individuals on the basis of such

AHCA Contract No. FP083, Attachment V, Page 1 of 2

ATTACHMENT V

AGENCY APPROVED MODIFICATIONS AND ADDITIONS

TO THE AGENCY STANDARD CONTRACT

classification, or promotes the position that a group or an individual's action is inherently, unconsciously, or implicitly biased on the basis of such classification.

5. Section 111., THE VENDOR AND AGENCY HEREBY MUTUALLY AGREE, Sub-Section B., Contract Managers, Item 3. is hereby deleted in its entirety and replaced as follows:

3. The Vendor shall notify the Agency Contract Manager in writing within five (5) business days of a Contract Manager change. Either party may notify the other by email of a change to a designated Contract Manager and provide the contact information for the newly designated contact. Such notice is sufficient to effectuate this change without requiring a written amendment to the Contract.

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

AHCA Contract No. FP083, Attachment V, Page 2 of 2

Agency for Health Care Administration

Attachment VI

Vendor Certification Form

I hereby certify the following on behalf of the vendor identified below:

Customer Vendor Indicator Indicator (Required, (Certified, NIA, NIA)

Determined by Vendor) Required Certified

Required Certified

Required Certified

Form PUR 7801 (07/2024)

AHCA (10124)

Certification

Regardless of the dollar value of the goods or services provided, in accordance with the requirements of section 287.135(5), F.S., the vendor is not participating in a boycott of Israel and is not on the State Board of Administration's "Quarterly List of Scrutinized Companies that Boycott Israel," available at httns:llwww.sbafla.com/1mvemancel!!lobal-l!ovemance-mandatesl If the goods or services to be provided are $1 million or more, in accordance with the requirements of section 287.135, F.S., the vendor is not on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Terrorism Sectors List (collectively, "Scrutinized List of Prohibited Companies"); does not have business operations in Cuba or Syria; and is not on the State Board of Administration's "Scrutinized List of Prohibited Companies" available under the quarterly reports section at httns:I lwww .sbafla.corn/reoortirn!I

The vendor is not on the Suspended Vendor List; it and its suppliers, subcontractors, or consultants to be utilized under the contract are not on the Convicted Vendor, Discriminatory Vendor, or Antitrust Violator Vendor Lists; and there is no pending or threatened action, proceeding, or investigation, or any other legal or financial condition, that would in any way prohibit, restrain, or diminish the vendor's ability to satisfy the contract obligations.

The vendor is hereby informed of the provisions of sections 287.133(2)(a), 287.134(2)(a), and 287.137(2)(a), F.S., that identify the impacts to the vendor's ability or its affiliates' ability to respond to the competitive solicitations of a public entity; to be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with a public entity; or to transact business with a public entity if it, or its affiliates, are placed on the Convicted Vendor, Discriminatory Vendor, or Antitrust Violator Vendor Lists of the Department of Management Services. The vendor is hereby further informed of the provisions of section 287.1351, F.S., that identify the impacts to the vendor's ability to enter into or renew a contract with an agency, as defined in section 287.012, F.S., if it is placed on the Suspended Vendor List of the Department of Management Services.

Page 1 of3 Rule 60A-1.002, F.A.C.

Required Certified

NIA NIA

Required Certified

Required Certified

Required Certified

NIA NIA

Form PUR 7801 (07/2024)

AHCA (10124)

If the contract grants the vendor access to an individual's personal identifying information, the vendor is not prohibited from entering into the contract pursuant to section 287.138, F.S., and has completed the Form PUR 1355, "Foreign Country of Concern Attestation Form," available at htm:I lwww .flrules.orgLGatewaylreference.as2?No=Ref- 15843, and submitted it to the Agency.

If the vendor is a common carrier, as defined in section 908.111, F.S., or a contracted carrier, it is not prohibited from entering into the contract pursuant to section 908.111, F.S., and has completed the Form PUR 1808, "Common Carrier or Contracted Carrier Attestation Form," available at htm:I lwww.flrules.orgLGatewaylreference.as2?No=Ref-14614, and submitted it to the Agency.

The vendor is registered with, and uses, the E-Verify system for all newly hired employees in accordance with section 448.095, F.S.; and has not, within the last year, had a contract terminated under section 448.095(5)(c), F.S. , by a public employer, contractor, or subcontractor, as defined by section 448.095(1 ), F.S.

The vendor is in compliance with all applicable disclosure requirements set forth in section 286.101, F.S., and has not been deemed ineligible for a grant or contract funded by a state agency pursuant to section 286.101(7), F.S.

If the contract is between a nongovernmental entity and a governmental entity, in accordance with section 787.06, F.S., the vendor has completed an affidavit signed by an officer or a representative of the vendor under penalty of perjury attesting that the vendor does not use coercion for labor or services as defined in section 787.06, F.S.

To fulfill this requirement, the vendor has completed Form PUR 2024, "Part A: Use of Coercion for Labor and Services," and submitted it to the Agency.

If the Contract is for the provision of commodities, in accordance with section 287.1346, F.S. , the vendor, and any entity under the control of vendor, has not been placed on the Forced Vendor List within the past 365 days or, if placed on the Forced Vendor List, has been removed pursuant to section 287.1346(5)(d), F.S.

If the Contract is for the provision of commodities, the Contractor will submit, prior to entering into or renewing the Contract, a written certification from senior management, as defined in section 287.1346(1)(c), F.S., which certifies to the best of their knowledge the commodities being offered pursuant to this solicitation have not been produced, in whole or in part, by forced labor.

To fulfill this requirement, the vendor has completed Form PUR 2024, "Part B: Provision of Commodities Produced by Forced Labor," and submitted it to the Agency.

Page 2 of3 Rule 60A-1.002, F.A.C.

The vendor is hereby informed of the provisions of section 287 .1346, F.S., that identify the impacts to a vendor's ability to respond to the competitive solicitations of a state agency; to be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with a state agency; or to transact business for the provision of commodities with a state agency if it, or entities under the control of the vendor, is placed on the forced labor list in accordance with section 287.1346, F.S.

By signing below, I certify that I am authorized to complete and submit this Vendor Certification Form on behalf of the vendor.

Vendor Information Signatory

CAREPLUS HEAL TH PLANS, INC. Signature Date

FEIN Typed or Printed Name

Title

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

Form PUR 7801 (07/2024)

AHCA (10/24)

Page 3 of3 Rule 60A-1.002, F.A.C.