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Item 8.2 Wright County SAHA Agreement Request for City Council Action DEPARTMENT INFORMATION ORIGINATING DEPARTMENT REQUESTOR: MEETING DATE: Administration City Administrator/Finance Director Flaherty July 27, 2026 PRESENTER(s) REVIEWED BY: ITEM #: Administration City Attorney Kendall 8.2 – Services Contract STRATEGIC VISION MEETS: THE CITY OF OTSEGO: Is a strong organization that is committed to leading the community through innovative communication. Has proactively expanded infrastructure to responsibly provide core services. Is committed to delivery of quality emergency service responsive to community needs and expectations in a cost-effective manner. X Is a social community with diverse housing, service options, and employment opportunities. Is a distinctive, connected community known for its beauty and natural surroundings. AGENDA ITEM DETAILS RECOMMENDATION: City staff are recommending that the City Council approve a contract with Wright County Community Action, Inc. ARE YOU SEEKING APPROVAL OF A CONTRACT? IS A PUBLIC HEARING REQUIRED? Yes No BACKGROUND/JUSTIFICATION: Background In February 2026 at the Economic Development Authority meeting, staff reviewed the Statewide Affordable Housing Aid funds received by the City. After receiving feedback at that meeting, staff have continued conversations with Wright County and other cities in the County who received this aid on partnerships to meet the criteria for use of the funds. Staff feel that this proposed services contract reflect the feedback received by providing transitional housing services to the Otsego community. The proposed agreement establishes a partnership to provide transitional housing assistance and supportive services for individuals aged 18 and older who are experiencing homelessness or are at imminent risk of homelessness. WCCA will administer the Housing Stability Program, provide housing search assistance, case management, financial literacy, employment support, and a declining rental subsidy designed to help participants achieve long-term housing stability. Participants are referred through Wright County Health & Human Services, which also determines eligibility and program priorities. The contract also requires WCCA to assist participating agencies with State Affordable Housing Aid (SAHA) reporting requirements. Financial Impact The City's maximum financial commitment under the agreement is $52,757, funded through the City's State Affordable Housing Aid (SAHA) allocation. WCCA will submit monthly invoices for eligible program expenses, and the City will reimburse only approved, eligible costs up to the maximum contract. If Otsego's allocation is exhausted, additional eligible costs may be billed to Wright County's allocation, subject to available funding. Recommendation Approval of the contract will allow the City to continue partnering with Wright County Health & Human Services and Wright County Community Action to provide housing stabilization services for eligible Otsego residents while utilizing dedicated State Affordable Housing Aid funding. The City Attorney has reviewed this contract and is agreeable to consideration of approval by the City Council. SUPPORTING DOCUMENTS ATTACHED: • Purchase of Services Contract POSSIBLE MOTION PLEASE WORD MOTION AS YOU WOULD LIKE IT TO APPEAR IN THE MINUTES: Motion to approve a Purchase of Services Contract between Wright County Community Action, Inc., Wright County, and the City of St. Michael BUDGET INFORMATION FUNDING: BUDGETED: Fund 255 – Economic Development Revolving No, however the SAHA funding allocation is available for this purpose, has time constraints and use constraints placed on it by the State, both of which can be accomplished by this proposed contract for services. WRIGHT COUNTY HEALTH & HUMAN SERVICES Purchase of Services Contract Page 1 of 14 WRIGHT COUNTY COMMUNITY ACTION INC Contract Term: August 1, 2026, through June 30, 2028 1. This Contract made by and between Wright County doing business as Wright County Health & Human Services, located at 3650 Braddock Ave NE Suite 2100, Buffalo, MN 55313, hereinafter referred to as “Agency,” and Wright County Community Action Inc located at 130 Division St W, PO Box 787, Maple Lake, MN 55358, hereinafter referred to as “Contractor,” and the City of Otsego, MN located at City Hall, 13400 90th Street NE, Otsego, MN 55330, hereinafter referred to as “Otsego,” and the City of St. Michael, MN, located at 11800 Town Center Drive NE, St. Michael, MN 55376, hereinafter referred to as “St. Michael,” and the Agency, Otsego, and St. Michael are hereinafter referred to as the “Government Parties” or individually as “Government Party,” for the purpose of providing grant funding for a transitional housing program. 2. Time Period of Contract a. The term of this Contract shall be from August 1, 2026, through June 30, 2028. b. As this Contract relates to the Agency: 1. This Contract may be terminated by the Agency or the Contractor upon thirty (30) days written notice from either party or upon immediate request of the Wright County Board. Services provided up to the date of termination will be compensated from the Agency to the Contractor. 2. This Contract may be immediately terminated for lack of funding by the Agency if it does not obtain funding from the Minnesota Legislature, Minnesota Agencies, or other funding source, or if its funding cannot be continued at a level sufficient to allow payment of the amounts due under this contract. Written notice of termination sent by the Agency to the Contractor, by mail, electronic mail, or facsimile, is sufficient notice under the terms of this Contract. The Agency will not be assessed any penalty or damages if the Contract is terminated due to lack of funding. c. As this Contract relates to Otsego: 1. This Contract may be terminated by Otsego or the Contractor upon thirty (30) days written notice from either party or upon immediate request of the Otsego City Council. Services provided up to the date of termination will be compensated from Otsego to the Contractor. 2. This Contract may be immediately terminated for lack of funding by Otsego if it does not obtain funding from the Minnesota Legislature, Minnesota Agencies, or other funding source, or if its funding cannot be continued at a level sufficient to allow payment of the amounts due under this contract. Written notice of termination sent by Otsego to the Contractor, by mail, by electronic mail, or facsimile, is sufficient notice under the terms of this Contract. Otsego will not be assessed any penalty or damages if the Contract is terminated due to lack of funding. 3. Otsego shall promptly provide notice to the Agency if this Contract between Otsego and the Contractor is being terminated or has been immediately terminated. d. As this Contract relates to St. Michael: 1. This Contract may be terminated by St. Michael or the Contractor upon thirty (30) days written notice from either party or upon immediate request of the St. Michael City Council. Services provided up to the date of termination will be compensated from St. Michael to the Contractor. 2. This Contract may be immediately terminated for lack of funding by St. Michael if it does not obtain funding from the Minnesota Legislature, Minnesota Agencies, or other funding source, WRIGHT COUNTY HEALTH & HUMAN SERVICES Purchase of Services Contract Page 2 of 14 or if its funding cannot be continued at a level sufficient to allow payment of the amounts due under this contract. Written notice of termination sent by St. Michael to the Contractor, by mail, electronic mail, or facsimile, is sufficient notice under the terms of this Contract. St. Michael will not be assessed any penalty or damages if the Contract is terminated due to lack of funding. 3. St. Michael shall promptly provide notice to the Agency if this Contract between St. Michael and the Contractor is being terminated or has been immediately terminated. 3. Contractor Responsibilities a. The Contractor verifies that they are capable and willing to provide services for recipients deemed eligible to receive service by Wright County Health & Human Services. b. The Contractor will assure that services rendered hereunder are provided in accordance with the standards required of the Minnesota Department of Human Services and Minnesota Housing. c. The Contractor shall provide any supplies, materials, or equipment necessary to perform the services under this Contract. d. The Contractor will provide transitional housing services to persons over the age of eighteen (18) experiencing homelessness or at imminent risk of homelessness including supportive services, case management, and goals for financial and housing stability as outlined in the WCCA Housing Stability Program Attachment A . e. The Contractor will provide a rent subsidy to eligible persons as outlined in Attachment A. f. The Agency, Otsego, and St. Michael will be responsible for reporting under the Statewide Affordable Housing Aid (SAHA) requirements for their respective use of their State Affordable Housing Aid (“SAHA”) funds. However, the Contractor will assist the Government Parties with this reporting responsibility by: (1) drafting reports that comply with the SAHA requirements and presenting these reports to each Government Party for its review and any modification and any required certification; and (2) filing reports in compliance with SAHA requirements. 4. Agency, Otsego, and St. Michael Responsibilities a. The Agency, Otsego, and St. Michael will review outcomes of this Contract before determining whether each will renew the Contract; b. The Agency will review with Contractor the outcomes of the Contract every six (6) months. This review process will be overseen by the Social Services Manager/Agency Director. Otsego and St. Michael may review their respective outcomes with the Contractor every six (6) months as well. c. The Agency will be responsible for the referral of eligible persons to Contractor for the Agency, Otsego, and St. Michael. Eligibility is determined by the Wright County Housing Coordinator for persons deemed to be the financial responsibility of Wright County (CFR). Client priority will be determined by the Agency. The Agency will provide to each participant a Tennessen Warning, which must provide that the data the Agency obtains from the participant will be provided to the Contractor and other Government Parties as necessary to perform their respective responsibilities under this Contract. d. The Agency will reimburse Contractor according to SAHA regulations from SAHA funds available to the Agency through SAHA funds provided to Wright County. e. Otsego will reimburse Contractor according to SAHA regulations from SAHA funds available to Otsego. f. St. Michael will reimburse Contractor according to SAHA regulations from SAHA funds available to St. Michael. 5. Reimbursement a. The total reimbursement under this Contract term will not exceed $276,427.00 at the allocations WRIGHT COUNTY HEALTH & HUMAN SERVICES Purchase of Services Contract Page 3 of 14 defined below. b. The contract maximum for rendered services will not exceed the following allocations: 1. Agency:$180,000. 2. Otsego: $52,757 3. St. Michael: $43,670 c. The Agency, Otsego, and St. Michael will individually reimburse the Contractor for prior-Agency- authorized, rendered services only. The Agency will determine if the rendered services for the Agency, Otsego, and St. Michael have been satisfactorily completed. d. The Contractor will submit monthly billing invoices, one for each of the Government Parties to the Agency only. The monthly billing invoices must be based on actual program expenses (rent subsidy paid, service hours at the established rate $54/hour), with sufficient detail, as determined by the Agency, to justify reimbursement from the Agency, Otsego, or St. Michael, as applicable. The Agency, Otsego, and St. Michael shall have the authority to review supporting documentation of services provided, and no payment shall be made without the approval of the Agency, Otsego, and St. Michael, as applicable. The Agency will obtain the billing invoices for the Agency, Otsego, and St. Michael. If the services have been prior-Agency authorized services and have been satisfactorily completed, the Agency will send the billing invoices to Otsego and St. Michael, as applicable. Otsego and St. Michael will pay the Contractor directly. The Contractor will request reimbursement, in separate billing invoices for each Government Agency, which are all three provided to the Agency for review and distribution to Otsego and St. Michael, as follows: 1. For eligible persons who are experiencing homelessness or at imminent risk of homelessness within the City of Otsego, the City of Otsego will be invoiced for such eligible persons until the funding allocated for Otsego has been depleted. After that depletion, the Agency will be invoiced for such eligible persons until the Agency’s allocation is depleted. 2. For eligible persons who are experiencing homelessness or at imminent risk of homelessness within the City of St. Michael, the City of St. Michael will be invoiced for such eligible persons until the funding allocated for St. Michael has been depleted. After that depletion, the Agency will be invoiced for such eligible persons until the Agency’s allocation is depleted. 3. For eligible persons who are experiencing homelessness or at imminent risk of homelessness outside of the cities of Otsego and St. Michael, and within Wright County, the Agency will be invoiced for such eligible persons until the funding allocated for the Agency has been depleted. 4. If the Contractor has questions regarding whether the Contractor should invoice Otsego, St. Michael, or the Agency, the Contractor shall consult with the Agency. e. The Agency will initially receive the billing invoices for the Agency, Otsego, and St. Michael. The Agency will determine if the services were approved by the Agency and if the services were satisfactorily rendered. If services allocated to Otsego were approved by the Agency and satisfactorily rendered, the Agency will promptly forward the billing invoice to Otsego for payment. If services allocated to St. Michael were approved by the Agency and satisfactorily rendered, the Agency will promptly forward the billing invoice to St. Michael for payment. The Agency, Otsego, and St. Michael will pay for rendered service within 35 days of the Agency’s receipt of an invoice from the Contractor. No payment will be made on invoices submitted more than 90 days after the WRIGHT COUNTY HEALTH & HUMAN SERVICES Purchase of Services Contract Page 4 of 14 provision of the service by the Contractor. f. It is understood and agreed by all parties that the Agency, Otsego, and St. Michael will assume no responsibility or obligation to purchase from the Contractor any minimum amount of services. g. Condition of Payment: All services provided by Contractor pursuant to this Contract shall be performed to the satisfaction of the Agency, and in accordance with all applicable federal, state, and local laws, ordinances, rules, and regulations. Payment shall be withheld for work found by the Agency to be unsatisfactory, or performed in violation of federal, state, and local laws, ordinances, rules, or regulations. 6. Contractor Debarment, Suspension, and Responsibility Certification The Contractor shall ensure that neither it nor any of its owners, managers, or employees or its Subcontractors or the owners, managers, or employees of the Subcontractors assigned to provide services pursuant to this Contract have been debarred or excluded from Medicaid or any other federally funded health care program under the provisions of the Social Security Act, 42 USC 1320a-7. If the Contractor learns of any such debarment or exclusion, the Contractor shall immediately notify the Agency in writing and immediately take steps to stop the debarred or excluded individual from performing further services under this Contract, unless the Agency otherwise directs the Contractor in writing. 7. Equal Employment Opportunity, Civil Rights, and Nondiscrimination The Contractor agrees to comply with the Civil Rights Act of 1964, Title VII (42 USC 2000e); including Executive Order No. 11246, and Title VI (42 USC 2000d); and the Rehabilitation Act of 1973 as amended by Section 504; and all applicable federal and state laws, rules, regulations, and orders prohibiting discrimination in employment, facilities, and services. Contractor shall not discriminate in employment, facilities and in the rendering of Purchased Services hereunder on the basis of race, color, religion age, sex, disability, marital status, public assistance status, creed, or national origin. 8. Indemnity Contractor does hereby agree that it will at all times hereafter, during the existence of this Contract, indemnify and hold harmless each Government Party from any and all liability, loss, damages, costs, or expenses which may be claimed against each Government Party or Contractor (1) by reason of any service client's suffering personal injury, death, or property loss or damages either while participating in or receiving from the Contractor the care and services to be furnished by the Contractor under this Contract, or while on premises owned, leased, or operated by the Contractor, or while being transported to or from said premises in any vehicle owned, operated, leased, chartered, or otherwise Contracted for by the Contractor or any officer, agent, or employee thereof; (2) by reason of any service client's causing injury to, or damage to, the property of another person during any time when the Contractor or any officer, agent, or employee thereof has undertaken or is furnishing the care and service called for under this Contract; (3) by reason of Contractor’s negligence or intentional bad acts in performing the services in this Contractor; (4) by reason of Contractor’s release of protected information that is in violation of this Contract and any privacy laws of the State of Minnesota and the federal laws; or (5) by reason of a breach of the Contract. 9. Insurance: The Contractor agrees that in order to protect itself, as well as the Government Parties and the Minnesota Department of Human Services, under the indemnity provisions set forth above, it will at all times during the term of this Agreement, keep in force the following insurance protection in the limits specified as marked with an ☒: ☒ Commercial General Liability with contractual liability coverage in the amount of the County’s tort liability limits set forth in Minnesota Statute 466.04. The minimum limits should be WRIGHT COUNTY HEALTH & HUMAN SERVICES Purchase of Services Contract Page 5 of 14 1. $1.5 million each occurrence 2. $3 million general aggregate 3. $3 million products and completed operations aggregate ☒ Contractor shall name Government Parties as additional insured. ☒ Worker’s Compensation in the statutory amount. The minimum limits should be: 4. Bodily injury by accident $500,000 each employee 5. Bodily injury by accident $1.5 million each accident 6. Bodily injury by disease $500,000 each employee 7. Bodily injury by disease $1.5 million policy limit ☐ Professional Liability (errors and omissions) insurance coverage of 8. $2 million per wrongful act or occurrence 9. $4 million annual aggregate ☐ Cyber Liability coverage of 1. $2 million per occurrence or claim 2. $4 million aggregate Contractor shall procure and maintain for the duration of the contract insurance covering claims arising out of its services and including, but not limited to, loss, damage, theft or other misuse of data, infringement of intellectual property, invasion of privacy and breach of data. ☒ Automobile liability coverage when transportation of eligible recipients is provided by the Contractor. The minimum limits should be 3. $1,500,000 per occurrence and aggregate. ☐ Contractor shall name Agency as an additional insured. ☐ Contractor will be required to maintain at all times, during the term of this Contract, a fidelity bond or insurance policy covering theft or embezzlement by the organization’s officers or employees. The minimum bonded amount must be enough to cover the average amount of money you handle for Social Security beneficiaries each month plus any conserved Social Security or SSI funds you are holding. A copy of the Contractor’s bond or insurance certificate shall be delivered to this County at the beginning of this Contract term and on an annual basis thereafter. An excess or umbrella policy may be used in conjunction with primary coverage limits to meet the minimum limit requirements for each line of coverage. The Contractor agrees as a condition subsequent to increase the required insurance coverage as the liability limits in section 466.04 increase. Failure to abide by this provision shall be deemed a substantial breach of contract. Nothing in this Agreement shall constitute a waiver by any Government Party of any statutory limits upon liability. Separate, a Certificate of Insurance naming each of the Government Parties as certificate holder shall be furnished to each respective Government Party prior to commencement of services and shall specify each of the Government Parties as an additional insured. The Contractor will furnish an original Certificate of Insurance as evidence of required coverage, showing coverage meets liability limits for the independent contractor. WRIGHT COUNTY HEALTH & HUMAN SERVICES Purchase of Services Contract Page 6 of 14 10. Independent Contractor Status It is agreed that nothing contained in the Contract is intended or should be construed as creating the relationship of co-partners, joint ventures, or an association with the Government Parties and the Contractor. The Contractor is an independent contractor and neither it, or its employees, agents, nor representatives shall be considered employees, agents, representatives of any of the Government Parties. Except as otherwise provided herein, the Contractor shall maintain in all respects its present control over the application and intake procedures and requirements to clients and the means and personnel by which this Contract is performed. From any amounts due the Contractor, there will be no deduction for Federal income tax or FICA payments nor for any State income tax, nor for any other purposes which are associated with an employer/employee relationship unless required by law. Payment of Federal income tax, FICA payments, and State income tax are the responsibility of the Contractor. 11. Subcontracting Upon approval of the Agency, the Contractor may hire employees and/or enter into subcontracts for performance of any of the services contemplated under this contract. All agreements in place with employees and subcontractors must contain provisions that make all employees and subcontractors subject to all the requirements of this contract. 12. Conflict of Interest Contractor guarantees that no officer, employee, owner, agent, subcontractor, or assignee shall have any interest in and will not acquire any interest, direct or indirect, that would conflict in any manner or degree with performance of this contract. 13. Data Privacy All data collected, created, received, maintained, or disseminated for any purposes in the course of the Contractor’s performance of this Contract is governed by the Minnesota Statute Chapter 13, or any other application State statutes, any State rules adopted to implement the Act, as well as Federal regulations on data privacy. The Contractor agrees to abide strictly by these statutes, rules, and regulations along with the attached Business Associate Agreement. 14. HIPAA Compliance Contractor agrees to comply with Health Insurance Portability and Accountability Act of 1996, Public Law 104-191 (HIPAA), the HIPAA Privacy rule (Privacy rule), 45 CFR Parts 160 and 164, and the HIPAA Security Rule (Security Rule), 45 CFR Parts 160, 162 and 164. Contractor further agrees to review and sign the “BUSINESS ASSOCIATE AGREEMENT Health Insurance Portability and Accountability Act (HIPAA)” which is attached to this contract and is incorporated herein. 15. State Audits The books, records, documents, and accounting procedures and practices of the CONTRACTOR relevant to this contract shall be subject to examination by the contracting department and the Legislative Auditor for a minimum period of six (6) years from the termination of this contract. 16. Information Sharing: Financial Statements, Policies, and Controls Contractor shall provide to the Agency: (a) its most recent unaudited financial statements immediately upon such statements becoming available, (b) annual audited financial statements promptly upon conclusion of the audit and no later than ten (10) business days after issuance by Contractor’s independent auditor, along with the Management and Compliance Report and any corrective action plan. (c) Current program policies applicable to the Services within ten (10) days of contract execution and promptly upon WRIGHT COUNTY HEALTH & HUMAN SERVICES Purchase of Services Contract Page 7 of 14 any material revision; and (d) documentation of internal controls relevant to the Services, including risk management, segregation of duties, approval/authentication processes, and system access controls, within thirty (30) days of contract execution and promptly upon any material revision. Contractor shall certify the accuracy and completeness of such materials, maintain them for at least seven (7) years, and grant the AGENCY reasonable access for verification, including audit and inspection rights. Failure to timely provide the foregoing constitutes a material breach and permits the AGENCY to withhold payment, require a corrective action plan, and/or terminate for cause. 17. Severability The provisions of this Contract shall be deemed severable. If any part of this Contract is rendered void, invalid, or unenforceable, such rendering shall not affect the validity and enforceability of the remainder of this Contract unless the part or parts that are void, invalid or otherwise unenforceable shall substantially impair the value of the entire Contract with respect to either party, in which event either party may end this Contract by written notice. 18. Entire Agreement It is understood and agreed that the entire agreement of the parties is contained herein and that this Contract supersedes all oral agreements and negotiations between the parties relating to the subject matter hereof as well as any previous agreements presently in effect between the parties relating to the subject matter hereof. Any material alterations, variations, modifications, or waivers of provisions of this Contract shall be valid only when they have been reduced to writing as an amendment and signed by the parties. 19. Cybersecurity Incident Reporting in Accordance with Minn. Stat. 16E.36 and CJI Reporting A "cybersecurity incident" is defined in Minnesota Statutes, Section 16E.36, as it may be amended from time to time. When Contractor reasonably identifies or believes that a cybersecurity incident has occurred that potentially impacts Wright County’s or the Agency’s systems, technologies, and data, Contractor will report the cybersecurity incident to the Agency within 48 hours after the identification or belief. If the incident has or may impact Criminal Justice Information (CJI), or there is a loss or theft of media containing CJI (e.g. paper, thumb drive), Contractor will report the incident, loss, or theft, to the Agency within 24 hours after the identification or belief, or the loss or theft. The report must be made by having direct verbal contact with the Director or Assistant Director of Wright County’s Information Technology Department by calling one or all of the following phone numbers: 763-760-8164 and 763-443-7357 and 763-439-9533. If there is no verbal response, Contractor must provide the following information via voicemail on one or all of those phone numbers: Contact’s Name. Service Provider’s name. Contact’s direct contact information. Brief details of the Cybersecurity Incident and impacts. Contractor will work in good faith with Wright County to submit a cybersecurity incident report into a cyber incident reporting system established by the Commissioner of Minnesota Information Technology Services. 20. By signing this Contract, Otsego and St. Michael certify that they have obtained all necessary authorizations through resolutions, motions or other means, to enter into this Contract. WRIGHT COUNTY HEALTH & HUMAN SERVICES Purchase of Services Contract Page 8 of 14 APPROVED AS TO FORM AND EXECUTION BY Carrie Tripp Date Wright County Community Action Inc ☐ Contracts under $50,000.00 Department Head or designee; ☐ Contracts $50,000.01 - $200,000.00 County Administrator or designee; ☒ Contracts over $200,000.01 County Board; Signatures: BY n/a Mike MacMillan, Interim Director Date Wright County Health & Human Services BY n/a Greg Kryzer, Wright County Administrator Date Wright County Administration Department BY Darek Vetsch, Commissioner/Chairperson Date Wright County Board BY Jessica Stockamp, Mayor Date City of Otsego BY Audra Etzel, City Clerk Date City of Otsego BY Steven Bot, City Administrator Date City of St. Michael WRIGHT COUNTY HEALTH & HUMAN SERVICES Purchase of Services Contract Page 9 of 14 BUSINESS ASSOCIATE AGREEMENT Health Insurance Portability and Accountability Act (HIPAA) Whereas, Wright County, Minnesota, City of Otsego, Minnesota, and City of St. Michael, Minnesota (Covered Entity) and Wright County Community Action Inc, Contractor (Business Associate), intend to protect the privacy and provide for the security of certain Protected Health Information (PHI) to which Business Associate may have access in order to provide services to or on behalf of Covered Entity, in accordance with the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191 (HIPAA), the HIPAA Privacy rule (Privacy rule), 45 CFR Parts 160 and 164, and the HIPAA Security Rule (Security Rule), 45 CFR Parts 160, 162 and 164. WHEREAS, Business Associate may receive PHI from Covered Entity, or may create or obtain PHI from other parties for use on behalf of Covered Entity, which PHI can be used or disclosed only in accordance with this Agreement and the standards established by HIPAA and the Privacy rule. WHEREAS, Business Associate may receive PHI from Covered Entity, or may create or obtain PHI from other parties for use on behalf of Covered Entity, that is in electronic form, which PHI must be handled in accordance with this Agreement and the standards established by HIPAA and the Security Rule, beginning as soon as practicable but in no event later than the effective date of the Security Rule. NOW, THEREFORE, Covered Entity and Business Associate agree as follows: 1. Definitions. A. “Business Associate” shall have the meaning given to such term under the Privacy and Security Rules, including but not limited to, 45 CFR §160.103. B. “Covered Entity” shall have the meaning given to such term under the Privacy and Security Rules, including, but not limited to, 45 CFR §160.103. C. “HIPAA” shall mean the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191. D. “Privacy rule” shall mean the Standards for Privacy of Individually Identifiable Health Information at 45 CFR Parts 160 and 164. E. “Protected Health Information” or “PHI” means any information, transmitted or recorded in any form or medium; (i) that relates to the past, present or future physical or mental condition of an individual; the provision of health care to an individual; or the past, present or future for the provision of health care to an individual, and (ii) that identifies the individual or with respect to which there is a reasonable basis to believe the information can be used to identify the individual, and shall have the meaning given to such term under HIPAA and the HIPAA Regulations at 45 CFR Parts 160, 162 and 164, including, but not limited to 45 CFR §164.501. F. “Security Rule” shall mean the Security Standards at 45 CFR Parts 160, 162 and 164. G. Terms used, but not otherwise defined, in this Agreement shall have the same meaning as those terms in 45 CFR Parts 160, 162 and 164. 2. Stated Purposes For Which Business Associate May Use Or Disclose PHI. Except as otherwise limited in this Agreement, Business Associate shall be permitted to use or disclose PHI provided by or obtained on behalf of Covered Entity to perform those functions, activities, or services for, or on behalf of, Covered Entity that are specified in the Statement of Work, provided that such use or disclosure would not violate the Privacy rule if done by Covered Entity or the minimum necessary policies and procedures of the Covered Entity. 3. Additional Purposes For Which Business Associate May Use Or Disclose Information. In addition to the Stated Purposes, Business Associate may use or disclose PHI provided by, created or obtained on behalf of Covered Entity for the following additional purpose(s): A. Use Of Information For Management, Administration And Legal Responsibilities. Business Associate is permitted to use PHI if necessary for the proper management and administration of Business Associate or to carry out legal responsibilities of the Business Associate, except as otherwise limited in this Agreement. B. Disclosure Of Information For Management, Administration And Legal Responsibilities. Business Associate is permitted to disclose PHI provided by, or created or obtained on behalf of Covered Entity for the proper management and administration of Business Associate or to carry out legal responsibilities of Business Associate, except as otherwise limited in this Agreement, provided: 1. The disclosure is required by law: or 2. The Business Associate obtains reasonable assurances in writing from any third party to whom the information WRIGHT COUNTY HEALTH & HUMAN SERVICES Purchase of Services Contract Page 10 of 14 is disclosed that it will be held confidentially and used or further disclosed only as required by law or for the purposes for which it was disclosed to the third party, the third party will use appropriate safeguards to prevent other use or disclosure of the information, and the third party agrees to immediately notify the Business Associate of any instance of which it is aware in which the confidentiality of the information has been breached. C. Data Aggregation Services. Business Associate may also be permitted to use or disclose PHI to provide data aggregation services, as that term is defined by 45 CFR §164.501, if specific authorization is received from the Covered Entity. 4. BUSINESS ASSOCIATE OBLIGATIONS: A. Limits On Use And Further Disclosure Established By This Agreement Or Required By Law. Business Associate hereby agrees that the PHI provided by, or created or obtained on behalf of Covered Entity shall not be further used or disclosed other than as permitted or required by this Agreement or as required by law. B. Appropriate Safeguards. Beginning as soon as practicable but in no event later than the effective date of the Security Rule, Business Associate shall establish and maintain appropriate safeguards to prevent any use or disclosure of PHI other than as provided for by this Agreement. Appropriate safeguards shall include implementing administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic PHI that is created, received, maintained, or transmitted on behalf of the Covered Entity. C. Reports Of Improper Use Or Disclosure. Business Associate hereby agrees that it shall report to the Agency Director within two (2) days of discovery any use or disclosure of PHI not provided for or allowed by this Agreement. D. Reports Of Security Incidents. Beginning as soon as practicable but in no event later than the effective date of the Security Rule, Business Associate shall report to the Agency Director within two (2) days of discovery any security incident of which it becomes aware. E. Subcontractors And Agents. Business Associate hereby agrees that any time PHI is provided or made available to any subcontractors or agents, Business Associate shall provide only the minimum necessary PHI for the purpose of the covered transaction and shall first enter into a subcontract or contract with the subcontractor or agent that contains the same terms, conditions and restrictions on the use and disclosure of PHI as contained in this Agreement. F. Right Of Access To PHI. Business Associate hereby agrees to allow an individual who is the subject of PHI maintained in a designated record set, to have access to and copy that individual’s PHI within 10 business days of receiving a written request from the Covered Entity. Business Associate shall provide PHI in the format requested, unless it cannot readily be produced in such format, in which case it shall be provided in standard hard copy. If any individual requests from Business Associate or its agents or subcontractors access to PHI, Business Associate shall notify Covered Entity of same within 5 business days. Business Associate shall further conform with and meet all of the requirements of 45 CFR §164.524. G. Amendment And Incorporation Of Amendments. Within 10 business days of receiving a request from Covered Entity for an amendment of PHI maintained in a designated record set, Business Associate shall make the PHI available and incorporate the amendment to enable Covered Entity to comply with 45 CFR §164.526. If any individual requests an amendment from Business Associate or its agents or subcontractors, Business Associate shall notify Covered Entity of same within 10 business days. H. Provide Accounting Of Disclosures. Business Associate agrees to maintain a record of all disclosures of PHI in accordance with 45 CFR §164.528. Such records shall include, for each disclosure, the date of the disclosure, the name and address of the recipient of the PHI, a description of the PHI disclosed, the name of the individual who is the subject of the PHI disclosed, the purpose of the disclosure, and shall include disclosures made on or after the date which is 6 years prior to the request or April 14, 2003, whichever is later. Business Associate shall make such record available to the individual or the Covered Entity within 10 business days of a request for an accounting of disclosures. I. Access To Books And Records. Business Associate hereby agrees to make its internal practices, books, and records relating to the use or disclosure of PHI received from, or created or received by Business Associate on behalf of the Covered Entity, available to the Secretary of Health and Human Services or designee for purposes of determining compliance with the HIPAA Privacy Regulations. J. Return Or Destruction Of PHI. At termination of this Agreement, Business Associate hereby agrees to return or destroy all PHI provided by or obtained on behalf of Covered Entity. Business Associate agrees not to retain any copies of the PHI after termination of this Agreement. If return or destruction of the PHI is not feasible, Business Associate agrees to extend the protections of this Agreement to limit any further use or disclosure until such time as the PHI may be returned or destroyed. If Business Associate elects to destroy the PHI, it shall certify to Covered Entity that the PHI has been destroyed. K. Maintenance of PHI. Notwithstanding Section 12 of this Agreement, Business Associate and its subcontractors or agents shall retain all PHI throughout the term of the Agreement and shall continue to maintain the information required under Section 12 of this Agreement for a period of six (6) years after termination of the Agreement, unless Covered Entity and Business Associate agree otherwise. L. Mitigation Procedures. Business Associate agrees to establish and to provide to Covered Entity upon request, procedures for mitigating, to the maximum extent practicable, any harmful effect from the use or disclosure of PHI in a manner contrary to this Agreement or the Privacy Rule. 45 CFR §164.530(f). Business Associate further agrees to mitigate WRIGHT COUNTY HEALTH & HUMAN SERVICES Purchase of Services Contract Page 11 of 14 any harmful effect that is known to Business Associate of a use or disclosure of PHI by Business Associate in violation of this Agreement or the Privacy rule. M. Sanction Procedures. Business Associate agrees that it shall develop and implement a system of sanctions for any employee, subcontractor or agent who violates this Agreement or the Privacy rule. N. Grounds For Breach. Any non-compliance by Business Associate with this Agreement or the Privacy or Security Rules will automatically be considered to be a breach of the Agreement, if Business Associate knew or reasonably should have known of such non-compliance and failed to immediately take reasonable steps to cure the non-compliance. O. Termination by Covered Entity. Business Associate authorizes termination of this Agreement by the Covered Entity if the Covered Entity determines, in its sole discretion, that the Business Associate has violated a material term of this Agreement. P. Failure to Perform Obligations. In the event Business Associate fails to perform its obligations under this Agreement, Covered Entity may immediately discontinue providing PHI to Business Associate. Covered Entity may also, at its option, require Business Associate to submit to a plan of compliance, including monitoring by Covered Entity and reporting by Business Associate, as Covered Entity in its sole discretion determines to be necessary to maintain compliance with this Agreement and applicable law. 5. OBLIGATIONS OF COVERED ENTITY: A. Provision of Notice of Privacy Practices. Covered Entity shall provide Business Associate with the notice of privacy practices that the Covered Entity produces in accordance with 45 CFR §164.520, as well as changes to such notice. B. Permissions. Covered Entity shall provide Business Associate with any changes in, or revocation of, permission by individual to use or disclose PHI of which Covered Entity is aware, if such changes affect Business Associate’s permitted or required uses and disclosures. C. Restrictions. Covered Entity shall notify Business Associate of any restriction to the use or disclosure of PHI that the Covered Entity has agreed to in accordance with 45 CFR §164.522, to the extent that such restriction may affect Business Associate’s use or disclosure of PHI. WRIGHT COUNTY HEALTH & HUMAN SERVICES Purchase of Services Contract Page 12 of 14 ATTACHMENT A HOUSING STABILITY PROGRAM The Housing Stability program focuses on helping those who are experiencing homelessness or at imminent risk of homelessness with the transition to being secure in their housing situation. The program connects families and individuals experiencing homelessness or at imminent risk of homelessness to permanent housing through a tailored package of assistance that may include the use of time-limited financial assistance and targeted supportive services. Housing Stability programs are designed to assist those who are ready to work toward reaching secure, stable, and sustainable housing. Service Delivery Housing Search and Placement WCCA uses a scattered site program as we do not manage property. Participants can select from an open rental anywhere within Wright County. Housing search begins with intake and placement is expected within 90 days. Type of Service Responsible Party Standard used Housing Assessment WCCA Coordinated Entry Housing search assistance WCCA, Participant Completion of rental applications WCCA, Participant Safety Inspection WCCA HUD Safety and Quality standards Tennesen Warning (Attachment B) WCCA, Participant Rent Reasonableness WCCA HUD Standard Participant Agreement (Attachment C) WCCA, Participant Lease execution Participant and Property Manager W-9 and Debarment WCCA, Property Manager Property Owner Agreement (Attachment D) WCCA, Property Manager Case Management Participants are required to meet with WCCA staff a minimum of once per month and complete case management activities. These activities include but are not limited to: Type of Service Name of Primary Service Provider Standard/curriculum used Lease Expectations WCCA Rentwise (UMN) Financial Management/Budgeting WCCA Four Corners of Financial Literacy (LSS) Job Search Assistance WCCA Global Career Development Facilitator (GCDF) WRIGHT COUNTY HEALTH & HUMAN SERVICES Purchase of Services Contract Page 13 of 14 Safety and domestic violence advocacy Rivers of Hope Benefits Assistance Wright County Human Services Energy Assistance WCCA Type of Service Name of Primary Service Provider Standard/curriculum used Quarterly Rental Inspections WCCA HUD Safety and Quality Standards Education, Employment Training Avivo, CareerForce, Goodwill Easter Seals Community Involvement/social support WCCA Mental Health Support Central Minnesota Mental Health Center Parenting training, mentoring WCCA Children’s Education WCCA Head Start Recovery Direct Recovery Support Veterans Support Wright County Veterans Services Rent Subsidy Initial costs for securing housing are covered such as: damage/security deposit and first month’s rent. Additional costs not charged to every tenant are the participant’s responsibility (i.e pet deposit.) A declining rent subsidy is utilized with the full cost of rent becoming the participants responsibility in the 12th month. Month Participant Responsibility WCCA Rent Contribution 1 - 100% 2 - 100% 3 10% 90% 4 20% 80% 5 30% 70% 6 40% 60% 7 50% 50% 8 60% 40% 9 70% 30% 10 80% 20% 11 90% 10% 12 100% - Damage / Security Deposit WRIGHT COUNTY HEALTH & HUMAN SERVICES Purchase of Services Contract Page 14 of 14 Any damage / security deposit paid by Contractor will be paid on behalf of the Participant. The Contractor must provide the Property Manager / Landlord with a lease signed by the Participant and the damage / security deposit at the same time. The damage / security deposit will be governed by Minn. Stat. sec. 504B.178, as it may be amended from time to time. In accordance with Minn. Stat. sec. 504B.178, the damage / security deposit paid to the Property Manager / Landlord will be held by the Property Manager / Landlord for the tenant; Contractor has no rights to the damage / security deposit paid to the Property Manager / Landlord. Contractor may invoice the appropriate Government Party for Contractor’s payment of the damage / security deposit. Follow Up Upon completion of the program, a housing assessment will be completed to document outcomes. An additional 6 months of support services are offered to participants after rent subsidy ends. WCCA Housing Participant Tennessen Warning (Updated March 2026) pg. 1 HOUSING STABILITY PROGRAM Attachment B TENNESSEN WARNING This sheet tells you about your rights under the Minnesota Government Data Practices Act (“the Act”). This Act protects your privacy, but also lets us give information about you to others if a law requires it AND we tell you before we do it. The information below tells why and when we will ask for and give information about you. Under the Act, information about individuals is divided into four categories: • Public information: information about you that is available to anyone. • Private data: information about you that can be shared only if you give us your permission or if a law allows or requires us to share the information. • Confidential information: information about you that can’t be shared about you. • Summary information: information about you that does NOT identify you personally, which may be shared with others, generally for reporting purposes. Generally, we only ask for two types of information from you – public and private information. We use summary information for reports, but these reports do not identify you or anyone else by name or other identifying information. We may ask you for information so we can: • Tell you from other persons by the same or similar name • Decide if you can receive services from us and what or how much you can get • Help you get financial or social services from other agencies or companies • Make reports, do research, audits, and evaluate our programs • Collect money from government(s) for help we give you Generally, you do not have to give us information. However, if you do not give us the information, we may not be able to determine whether we can help you or get help for you from other agencies. YOUR RIGHTS TO DATA PRIVACY WHAT KIND OF INFORMATION DO WE COLLECT? WHY DO WE ASK YOU FOR THIS INFORMATION? DO YOU HAVE TO ANSWER THE QUESTIONS WE ASK? WHAT WILL HAPPEN IF YOU DO NOT ANSWER THE QUESTIONS WE ASK? WCCA Housing Participant Tennessen Warning (Updated March 2026) pg. 2 We may give information about you to the following agencies, if they need it to help you or help us help you. This does not mean we always share information about you with these people. It only says that there is a law that says we may share data with these people (sometimes the law says we MUST share certain information). If you have questions about when we give these people information, ask the staff person who is working with you. • MN Department of Human Services • Other government agencies who have or may provide you help • Wright County or local governments whom we work with • Anyone else the law says we can give the information • Anyone under contract with us or a government agency to provide services • Member agencies of a local collaborative agency to provide services • Guardian, conservator, or a person who has power of attorney for you You may ask if we have any information about you. • If we have information about you, you may ask for copies. • You may give other people permission to see and have copies of private data about you. • If you do not understand the information, you may ask to have it explained to you. • You may ask for and receive a copy of this agency’s Data Practices policy. Your objection must be in writing and sent to WCCA Executive Director. You may deliver it to our offices or mail it to: WCCA 130 Division Street W PO Box 787 Maple Lake, MN 55358 You must tell us why the information is not accurate or complete. You may send your own explanation of the facts you disagree with. Your explanation will be attached any time that information is shared with another agency. For more information on how to do this, ask the staff person working with you. If you have any questions about the information on this form, ask the staff person who is working with you. Participant Name Signature Date WHOM MAY WE SHARE INFORMATION ABOUT YOU? YOU HAVE THE RIGHT TO COPIES OF INFORMATION WE HAVE ABOUT YOU HOW DO YOU APPEAL IF YOUT THINK INFORMATION IS NOT ACCURATE OR COMPLETE? WCCA Housing Stability Participant Agreement (Updated July 2025) pg. 1 HOUSING STABILITY PROGRAM Attachment C PARTICIPANT AGREEMENT This Housing Stability Program focuses on helping persons over the age of eighteen (18) who are experiencing homelessness or at imminent risk of homelessness so that they can be secure in their housing situation. These programs connect families and individuals experiencing homelessness to permanent housing through a tailored assistance that includes time-limited financial assistance and targeted supportive services. This Housing Stability Program is designed to assist those who are ready to work toward reaching secure, stable, and sustainable housing. WCCA offers a “scatter site” program which means we do not manage property. Participants can live at any location in Wright County and the lease remains between the program participant and the property owner. While receiving rental assistance, participants are expected to work with their Case Manager during monthly meetings to identify and complete priority tasks that support their long-term housing stability. HOUSING IDENTIFICATION & PLANNING ASSISTANCE WCCA does not have rental properties so you are responsible to find a location on your own. However, WCCA Housing Staff will assist you in locating housing. We help with: • Evaluating housing options • Housing search and application processes • Budgeting • Understanding your new lease • Developing a plan for moving *IMPORTANT* Once housing has been found, WCCA Housing Staff will complete an overview of the lease with the participant BEFORE the lease is signed to ensure affordability and the participant's understanding of the agreement. We will inspect the home to ensure that it meets safety standards and complete the necessary paperwork. Then, you can sign the lease! RENTAL ASSISTANCE Once approved by the rental company, WCCA pays for the security deposit and up to 100% of the first month’s rent. The program utilizes a "declining subsidy model" which allows the household to pay 100% of their rent by the time they are done with the program. This helps you establish healthy financial habits that promote housing stability. We understand that life can be unpredictable. WCCA may review the rent contribution and responsibility plans on a case by case basis. PROGRAM DESCRIPTION DESCRIPTION OF SERVICES AND ACTIVITIES WCCA Housing Stability Participant Agreement (Updated July 2025) pg. 2 CASE MANAGEMENT AND SERVICES You are required to meet with Housing Staff on a monthly basis. Additional meetings are encouraged. The Housing Staff will assist you in developing a realistic household budget and how to leverage budgeting tools that will be a lasting skill you can use after the program ends. The information gathered during the budgeting sessions help form what other support services are needed. Examples of the coaching we provide: • the development of relationships with property managers and neighbors • how to be a good tenant • lease compliance • problem-solving to maintain housing stability Housing Staff may assist and encourage you to apply for benefits such as health insurance, food supports (SNAP), and utility subsidies. They will also identify free or reduced-cost goods and services (food pantries, clothing shelves, subsidized child care, etc.) that can help with monthly costs. Participant(s) must be: • 18 years of age or older • Willing to reside in Wright County • Be one of the following: • Experiencing Homeless • At Imminent Risk of Homelessness Each situation may require a different amount of support. A maximum of 12 months of financial support (including the deposit) is anticipated with up to 18 months of Case Management and supportive services. ELIGIBILITY DURATION WCCA Housing Stability Participant Agreement (Updated July 2025) pg. 3 Rental Assistance is a privilege and not guaranteed through this program. The following expectations must be met in order to receive financial assistance throughout the duration this program. You must reside in the housing unit - Units are to be used for only residential purposes and be the only residence available to you. Participate in Case Management activities – At least once a month, you must meet with Housing Staff and participate in the activities. These include the development and progress toward goals, financial management activities, and following up on referrals. You must provide documentation on a timely basis, and not miss your scheduled appointments. In addition, you agree to use resources in the community that will help reduce your cost of living, which may include other programs currently offered throughout the Wright County. Be an Excellent Tenant – Rent is expected to be paid on-time each month. As the tenant, you should respect the property, be a good neighbor(s), avoid vacancies or evictions, and follow the expectations of the lease. This may include building relationships with property owners, managers, and neighbors. Commit to Increasing Employability, Skills, and Income – This program uses a declining subsidy model with the ultimate goal of you being able to afford 100% of the rent. Income generation is a crucial aspect of this program. You must agree to set goals that improve your employability and income. These may include: a. Improving education level or job readiness skills b. Enrolling and working cooperatively with job search assistance programs c. Attending GED or other classes d. Increasing hours at a current job e. Seeking positions with increased income *Training may be possible while participating however, it must be approved by WCCA prior to enrollment. A financial plan must be in place to assure housing stability can be achieved. The declining rent subsidy is not adjusted for participants pursuing training. • A copy of the lease agreement with the property owner/manager • Monthly financial statements, per program requirements • Information on housing history, criminal history, educational background, and work history • Any document that WCCA deems necessary to the program PROGRAM GRADUATION You may reach housing stability before the scheduled end of the program. On a quarterly basis, you and Housing Staff will assess your current situation and discuss the potential of graduating from the program. INFRACTIONS WCCA is committed to utilizing the community’s resources to the highest level of potential. If you do not meet the expectations of the program, an infraction may be citied. If you receive two infractions, this participation agreement will be terminated and you will be removed from the program. PROGRAM EXPECTATIONS REQUIRED DOCUMENTATION EXITING THE PROGRAM WCCA Housing Stability Participant Agreement (Updated July 2025) pg. 4 Infractions may be cited for the following: • Failure to abide with housing stability program rules as stated in the Participant Agreement • Failure to cooperate with Housing Staff • Failure to participate in case management activities as assigned • Non-payment of participant’s portion of rent within 2 weeks of the due date • Chronic late rental payments • Terms of lease are broken • Physical damage to property • Physical violence to people or property • Abuse of utilities provided in lease VIOLATIONS There are situations where two infractions are not required to be removed from the program. The severity of an infraction may result in a violation which terminates the agreement. Other violations include: • Not residing in the unit • Violent behavior • Abuse of any kind • Major violation of the lease with property owner/manager • Illegal activity on the leased premises, including in the unit, in the building, or on the grounds. If you feel you were not treated fairly with regards to the Wright County Community Action Program, you can file an appeal. If you disagree with a corrective action taken, including termination of participation in the program: 1. Tenants must submit the grievance in writing within five (5) business days of the incident to WCCA Housing Staff unless the complaint is with the program staff, at which point the grievance shall be filed with the Program Manager or Executive Director. The grievance must detail the action(s) of decisions(s), which the individual feels, are unfair. 2. Within ten business days of receipt of the grievance, the manager and tenant will meet to discuss and resolve the problem. 3. If the grievance(s) are a result of the termination of the tenant’s lease, the tenant may request a review by the Housing Manager to appeal the termination of the lease. The Manager will contact the Participant, review the action and issue a written decision as to the appropriateness of the action within 10 days. If a Participant disagrees with a termination action, they may initiate an appeal process by submitting a written request within 5 working days of the action taken by the WCCA Executive Director. The appeal will be reviewed by at least a two-person panel. A written decision will be provided within 10 days of request. A review panel’s decision shall be final. To manage this Housing Stability Program, WCCA uses the Client Information System, which is an internal database that allows for WCCA programs to report information as required for the program. WCCA uses Minnesota’s Homeless Management Information System (HMIS); a web-based database used by homeless service organizations across the state to collect client level data on households experiencing or at risk of homelessness. A Tennessen Warning statement with additional data privacy information will be provided to you and will be signed by you during the program application period. APPEALS PROCESS CLIENT DATA WCCA Housing Stability Participant Agreement (Updated July 2025) pg. 5 Subleasing – receiving payment to cover rent and utility costs by a person living in the unit who is not listed as a participating household member. Residing in the Unit – anyone who is expected to stay or has been in the unit for more than 10 consecutive days or 30 cumulative days within a 12-month period and anyone receiving mail at the unit. The purpose of this program is to provide housing and supportive services to those who are committed to reaching housing stability. These obligations are designed for the health and well-being of all participants. The participant(s) must: 1. Supply any information that WCCA determined to be necessary in a timely basis. 2. Allow WCCA staff access to the unit at reasonable times. 3. Provide information that is true and complete. 4. Be responsible for Housing Quality Standards. WCCA may conduct periodic inspections. Participants are responsible for keeping the unit clean and not to waste or misuse any utilities, appliances. The Participants agree to notify the Landlord in writing of any conditions that may cause injury, require repair, or affect the habitability of the residence. 5. Not interfere in the management and operation of the rental unit. 6. Not commit any serious or repeated violations of the lease with the property owner/manager. 7. Notify WCCA and the property owner/manager before moving out of the unit or terminating the lease. 8. Provide a copy of formal communication with the property owner/manager (including eviction notices) within 10 days of the receipt. 9. Use the unit for residence of the individual(s) indicated in this agreement. The unit must be the only residence. 10. The composition of the participant(s) must be approved by WCCA. The participants must notify WCCA in writing within 10 business days of the birth, adoption, or court-awarded custody of a child. The participant must request approval to add any other resident as an occupant of the unit. 11. Notify WCCA in writing within 10 days if any resident no longer lives in the unit. 12. Not sublease the unit, assign the lease, or transfer the unit without WCCA’s approval. 13. Supply any information requested by WCCA to verify that the family is living in the unit or information related to the absence from the unit. 14. Providing written notice to WCCA if any participant will be absent of the unit for any period greater than 30 calendar days. 15. Must pay utility bills and provide and maintain any appliances that the owner is not required to provide under the lease. 16. Not commit fraud, bribery, or any other corrupt or criminal act in connection with the program 17. Not engage in drug-related criminal activity, violent criminal activity or other criminal activity that threatens the health, safety, or right to peaceful enjoyment of other residents and persons residing in the immediate vicinity of the premises. 18. Not engage in abuse of alcohol in a way that that threatens the health, safety, or right to peaceful enjoyment of other residents and persons residing in the immediate vicinity of the premises. 19. Not leverage rental assistance to reside in a unit owned by a parent, child, grandparent, grandchild, sister, or brother and any member of the household. 20. Not own or have financial interest in the unit. 21. Tenants agree to provide proper supervision for their children, day and night, inside and outside. WCCA Staff are required to report suspected abuse or neglect to proper authorities. DEFINITIONS STATEMENTS OF OBLIGATIONS WCCA Housing Stability Participant Agreement (Updated July 2025) pg. 7 WCCA agrees to provide program services as defined in this agreement with cooperation of the signed participant. Beginning with the date of the signature, WCCA staff will review the progress of the Participant(s) and determine their continued participation in the program. WCCA staff always has the ability to suspend any or all rental assistance for families not making a good effort of reaching stable housing. This agreement must be signed by all household members over the age of 18. Participant Name Signature Date Participant Name Signature Date Participant Name Signature Date WCCA Staff Name Signature Date FINAL SIGNATURES Minnesota’s HMIS Data Privacy Notice & Client Release of Information_HIPAA 07-24-24 Minnesota’s HMIS Data Privacy No�ce We collect personal informa�on about the people we serve in a computer system called Minnesota’s HMIS (Homeless Management Informa�on System). Many social service agencies use this computer system, including street outreach, shelters, and housing programs. The HMIS Governing Board may amend this Data Privacy No�ce and the Release of Informa�on, at any �me without no�ce or consent. The Data Privacy No�ce and Release of Informa�on currently available can be found on the MN HMIS website at hmismn.org. What kinds of informa�on are collected in HMIS? There are two types of informa�on collected in HMIS: • Basic Informa�on: This is informa�on that rarely or never changes for an individual. This includes, but may not be limited to, Full Name, Date of Birth, Social Security Number, demographics, basic contact informa�on. Collec�on of this informa�on makes sure duplicate client records are not created in HMIS. This information is visible by default to all HMIS participating agencies. • Transac�onal Informa�on: This is informa�on about services a client receives, specific programs they are enrolled in, and more in- depth personal history about their experience of homelessness and barriers. This information is only visible to all HMIS participating agencies if the client grants consent. Why do we collect this informa�on? • To help keep this program and others like it going. We are required to use HMIS. • So we know how many people we serve and the types of people we serve at our agency and in the state. • So we all understand what people need and can plan services to meet these needs. Who can see informa�on that is in Minnesota’s HMIS? • People who work for this agency will use it to help provide services to you or your family. • Other agencies like this agency that provide services and have received permission from you to see your informa�on. The agencies that par�cipate in Minnesota’s HMIS may change from �me to �me. A copy of the current list of par�cipa�ng agencies is available upon request. • Auditors or funders who have legal rights to review the work of this agency, such as the U.S. Department of Housing and Urban Development and other state or local government en��es. • Organiza�ons that run, administer, and work on the system, such as the Ins�tute for Community Alliances or Local System Administrators. When these organiza�ons work on the system, they may see informa�on about you. • People using HMIS informa�on to do research and write reports, including, but not limited to, the Minnesota Department of Human Services (DHS). Your personally iden�fiable informa�on will never appear in research reports. • The law says we have to report physical or sexual abuse of children and vulnerable adults. If we think there is abuse or neglect in your household, we will report it to Child or Adult Protec�on. • We may release your informa�on to protect the health or safety of you or others as required by law. • Others as required by law, including officials with a valid subpoena, warrant, or court order. How is your privacy protected? • All users of data must sign an agreement to protect your privacy and comply with state and federal laws and policies before seeing any informa�on. • The computer program used for this purpose has industry standard security protocols and is updated regularly to meet these security requirements. • We will not release your informa�on for any other use unless you permit us in wri�ng. What are your rights? • If you do not want certain informa�on entered into HMIS, you may decline to respond. This agency will not refuse to help you for denying this. However, federal and state regula�ons may require limited data collec�on for funding purposes. • You have the right to request a copy of the Minnesota’s HMIS informa�on about you. • You have the right to correct mistakes in HMIS informa�on about you. • If you think this agency or Minnesota’s HMIS violated your privacy rights, you have the right to complain or appeal. Ask a staff person for a complaint and appeal form. Minnesota’s HMIS Data Privacy Notice & Client Release of Information_HIPAA 07-24-24 Minnesota’s HMIS Release of Informa�on For: Print First, Middle, Last Name (Complete one form for each adult) Date of Birth Your Basic Informa�on (as defined in the Data Privacy No�ce) will be collected in Minnesota’s HMIS and shared with other service providers/homeless agencies. Your Transac�onal Informa�on (as defined in the Data Privacy No�ce) will be collected in Minnesota’s HMIS, and with your consent, shared with other service providers/homeless agencies. If you do not give permission for this agency to share your informa�on, no other agency in the network will have access to it. Why share your informa�on? • Sharing reduces the amount of �me you have to spend answering basic ques�ons about your situa�on. • Sharing allows agencies to focus on mee�ng your unique needs more quickly. • Sharing makes it easier for mul�ple agencies to coordinate housing and services for you and your family. Reminder: The following fields are visible in HMIS by default – Name, Social Security Number, Date of Birth, Race/Ethnicity, Gender, Contact Informa�on, Family Informa�on What transac�onal informa�on might be shared within HMIS? • Reasons for seeking services • Living situa�on and housing history • Services you receive • If you are homeless or not • Your income and income sources • Public benefits you receive • History of domes�c violence • Educa�onal background • Employment status • Military history • Health informa�on, including physical health, HIV, behavioral health Please check a box: SHARE: I consent to have the Transac�onal informa�on collected about me shared through Minnesota’s HMIS with other partner agencies in order to improve services to me and the services offered to others. DO NOT SHARE: I do not want any of the Transac�onal informa�on about me in Minnesota’s HMIS shared with any other service providers/homeless agencies. I understand that not sharing my informa�on may affect the ability to quickly and appropriately iden�fy services for me. NOTE: Your Basic Informa�on will s�ll be shared. When you sign this form, it shows that you understand the following: • We will not deny you help if you do not want us to share your Transac�onal Informa�on. At the same �me, sharing data does not guarantee that you will receive assistance. • If you permit us to share your informa�on, this consent is valid un�l canceled by you. • If you permit us to share your informa�on, you may change your mind and cancel this consent at any �me. If you cancel this consent, your informa�on will no longer be shared from that date forward. • The HMIS Governing Board may amend this Release of Informa�on and the Privacy No�ce at any �me without no�ce or consent. The Release of Informa�on and Data Privacy No�ce currently available can be found on the MN HMIS website at hmismn.org. Signature of Client or Guardian Date Signature of Agency Witness Date Consent for research uses of information in Minnesota’s HMIS. Please check one: Yes, include in research. I understand that information about me that is in Minnesota’s HMIS may be used to conduct research related to homelessness and housing programs, service needs, income supports, education and employment, and program effectiveness. My name, social security number or other information that would identify me personally will never appear on a research report. No, do not include in research. I do not want my information used for research purposes. Please treat information about my children age 17 or younger the same as mine. WCCA Housing Stability Property Agreement (Updated July 2025) pg. 1 HOUSING STABILITY PROGRAM Attachment D PROPERTY OWNER AGREEMENT This Housing Stability Program focuses on helping persons over the age of eighteen (18) who are experiencing homelessness or at imminent risk of homelessness so that they can be secure in their housing situation. This is a program rapidly connects families and individuals experiencing homelessness to permanent housing through a tailored package of assistance that may include the use of time-limited financial assistance and targeted supportive services. The Housing Stability program is designed to assist those who are ready to work toward reaching secure, stable, and sustainable housing. WCCA offers a “scatter site” program which means we do not manage property –the program participant can live at any location in Wright County that they choose. The lease remains between the program participant and the property owner. The WCCA program staff will inspect the facility for safety and affordability. Often this program is misunderstood, and there is an assumption that it is just a rental assistance program. It is important that the program participants are invested in the supportive services/case management aspects of the program to ensure successful housing transition. WCCA uses a pre-calculated monthly subsidy with the remainder of the rental amount being the participant’s responsibility. A letter indicating the calculated portions of cost share will be included with each monthly check. WCCA payments will not be issued if the participant has not paid the previous month’s portion. WCCA may request documentation. We ask the property owner to notify WCCA if payments are chronically late or not paid. WCCA staff will work with participants to identify issues and coach on proper tenant responsibilities. WCCA will issue all payments to the property owner and not the program participant. Each situation may require a different amount of support. A maximum of 12 months of financial support (including the deposit) is anticipated with up to 18 months of Case Management and supportive services. PROGRAM DESCRIPTION RENT COST SHARE CALCULATIONS PROGRAM DURATION WCCA Housing Stability Property Agreement (Updated July 2025) pg. 2 WCCA will pay the damage deposit. The participant will be responsible for payment of any pet deposit. All property owners must follow state law (Minn. Stat. 504B.178) in regard to the return of the damage deposit to the participant. Lease Start Date: Lease End Date: Rental Property Address: Damage Deposit: $ Pet Deposit: $___ Monthly Rent: $ Use this information to provide detailed information on where WCCA should issue the payment. Tax ID number: (please attach a copy of your W9) Make Check payable to: Name of Rental Complex:________________________________ Name of Management Company (if applicable):__________________________ Mailing Address: Point of Contact Name: Title:_______________________________ Email Address: Phone number: Property Owner Name (Print) Property Owner Signature Date DAMAGE DEPOSIT AGREEMENT SUMMARY OF LEASE PROPERTY OWNER INFORMATION CONTACT INFORMATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 7/13/2026 Arthur J.Gallagher Risk Management Services,LLC 916 W Saint Germain St Ste 100 Saint Cloud MN 56301 Mike Schneider 320-257-2707 Mike_Schneider@ajg.com Selective Insurance Company of SE 39926 SFM Mutual Insurance Company 11347WrightCountyCommunityAction,Inc. 130 W Division St Maple Lake MN 55358 Great American Insurance Company 16691 840176171 A X 1,000,000 X 1,000,000 20,000 1,000,000 3,000,000 X Y Y S 2269042 3/1/2026 3/1/2027 3,000,000 EMPLOYEE BENEFI 3,000,000 A 1,000,000 X X X S 2269042 3/1/2026 3/1/2027 A X X 1,000,000S22690423/1/2026 3/1/2027 1,000,000 X 0 B X14584.228 3/1/2026 3/1/2027 500,000 500,000 500,000 A C Professional Student Accident S 2269042 BSR-F224326-01 3/1/2026 3/1/2026 3/1/2027 2/28/2027 $1,000,000 Limit: $3,000,000 $25,000 Wright County Health &Human Services is Additional Insured pertaining to the General Liability,per written contract.Waiver of Subrogation applies. Wright County Health &Human Services 1004 Commercial Dr Buffalo MN 55313 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 7/17/2026 Arthur J.Gallagher Risk Management Services,LLC 916 W Saint Germain St Ste 100 Saint Cloud MN 56301 Mike Schneider 320-257-2707 Mike_Schneider@ajg.com Selective Insurance Company of SE 39926 SFM Mutual Insurance Company 11347WrightCountyCommunityAction,Inc. 130 W Division St Maple Lake MN 55358 Great American Insurance Company 16691 1561848517 A X 1,000,000 X 1,000,000 20,000 1,000,000 3,000,000 X Y Y S 2269042 3/1/2026 3/1/2027 3,000,000 EMPLOYEE BENEFI 3,000,000 A 1,000,000 X X X S 2269042 3/1/2026 3/1/2027 A X X 1,000,000S22690423/1/2026 3/1/2027 1,000,000 X 0 B X14584.228 3/1/2026 3/1/2027 500,000 500,000 500,000 A C Professional Student Accident S 2269042 BSR-F224326-01 3/1/2026 3/1/2026 3/1/2027 2/28/2027 $1,000,000 Limit: $3,000,000 $25,000 City of Otsego is included blanket additional insured in regard to General Liability required by written contract.Blanket waiver of subrogation on General Liability. City of Otsego 13400 90th Street NE Otsego MN 55330 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 7/17/2026 Arthur J.Gallagher Risk Management Services,LLC 916 W Saint Germain St Ste 100 Saint Cloud MN 56301 Mike Schneider 320-257-2707 Mike_Schneider@ajg.com Selective Insurance Company of SE 39926 SFM Mutual Insurance Company 11347WrightCountyCommunityAction,Inc. 130 W Division St Maple Lake MN 55358 Great American Insurance Company 16691 1516919185 A X 1,000,000 X 1,000,000 20,000 1,000,000 3,000,000 X S 2269042 3/1/2026 3/1/2027 3,000,000 EMPLOYEE BENEFI 3,000,000 A 1,000,000 X X X S 2269042 3/1/2026 3/1/2027 A X X 1,000,000S22690423/1/2026 3/1/2027 1,000,000 X 0 B X14584.228 3/1/2026 3/1/2027 500,000 500,000 500,000 A C Professional Student Accident S 2269042 BSR-F224326-01 3/1/2026 3/1/2026 3/1/2027 2/28/2027 $1,000,000 Limit: $3,000,000 $25,000 City of St.Michael is included blanket additional insured in regard to General Liability if required by written contract.Blanket waiver of subrogation applies to General Liability. City of St.Michael 11800 Town Center Drive NE St.Michael MN 55376