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1 AFFILIATION AGREEMENT BETWEEN MARICOPA COUNTY by and for its Department of Public Health AND ADELANTE HEALTHCARE, INC. FOR THE DIETETIC INTERNSHIP PROGRAM 2 THIS Affiliation Agreement (“Agreement”) is entered into by and between Maricopa County, acting by and for its Department of Public Health (referred to as “COUNTY”), whose principal office is located at 4041 N. Central Ave., Ste. 1400, Phoenix, AZ 85012 and Adelante Healthcare, Inc. (referred to as “THE AFFILIATE”), an Arizona nonprofit corporation whose principal office is located at 3033 N. Central Ave. Ste. 145, Phoenix, AZ 85012. WHEREAS, the purpose of the Agreement is to establish a program of cooperative interaction between COUNTY and THE AFFILIATE to provide dietetic interns with a dietetic internship practicum approved by the Accreditation Council for Education in Nutrition and Dietetics (“ACEND”), in an off-campus setting, in the areas of clinical, community, food management, and administrative dietetics; and WHEREAS, it is in the mutual interest and advantage of the parties that the interns be given the opportunity to utilize THE AFFILIATE'S facilities for educational and supervisory experience purposes; and WHEREAS, it is acknowledged by the parties that the dietetic interns who participate in the dietetic internship program are performing duties for a program that is sponsored by COUNTY, and that the dietetic interns will be supervised by both COUNTY and THE AFFILIATE; and WHEREAS, the dietetic internship program of COUNTY is currently accredited by the Accreditation Council for Education in Nutrition and Dietetics (ACEND), a specialized accrediting body recognized by the Council on Postsecondary Accreditation and the United States Department of Education; and COUNTY and THE AFFILIATE agree as follows: 1. RESPONSIBILITIES OF COUNTY COUNTY agrees that during the term of this Agreement, it shall: A. Designate in writing a Dietetic Internship Program Director who will be available for consultation with THE AFFILIATE on all matters of the operation of the program to include the qualification, preparation, grading, and working hours of the interns placed in the program. B. Select for potential placement in the program at THE AFFILIATE interns whose previous academic and practical experience has properly prepared them for the activities and responsibilities required by the program. C. Instruct and advise the selected interns of their obligations to THE AFFILIATE while participating in the program as those obligations are set forth in writing by THE AFFILIATE, and to comply with all written rules, regulations, and policies of THE AFFILIATE while they participate in the program. D. Provide such supervision and instruction, in addition to that made available by THE 3 AFFILIATE at its facilities, as may be agreed upon by COUNTY and THE AFFILIATE. E. Provide THE AFFILIATE'S Registered Dietitian Site Director with a written copy of the policies and rules of the Dietetic Internship Program that affect the interns and are related to their participation in the program, and keep THE AFFILIATE’S Registered Dietitian Site Director informed of any changes in these policies and rules. F. Withdraw the intern(s) from the dietetic internship program if they fail to meet such standards and criteria for participation in the program as are agreed upon by both COUNTY and THE AFFILIATE, or if they fail to comply with the written rules, regulations, and policies of THE AFFILIATE. G. Provide THE AFFILIATE'S Registered Dietitian Site Director all the rights and privileges of an adjunct faculty member. H. Notify THE AFFILIATE in writing at least 30 days prior to the interns’ anticipated start date. I. Enroll intern in the third-party platform of MyClinicalExchange (mCE) or other deemed database used by THE AFFILIATE. Annual fee to be the responsibility of the COUNTY and/or intern. J. Assist intern in providing the required clearance documents for mCE and THE AFFILIATE. Clearance documents are required to be uploaded to mCE 45 days prior to the start of rotation and include: 1. Health Center Rotation Application. 2. Signed Confidentiality Agreement. 3. Intern Resume. 4. Government Issued Identification. 5. Immunizations Records to meet THE AFFILIATE’s guidelines. 6. Completed THE AFFILIATE’s TB Screening Form. 7. Evidence of personal health insurance. 8. Level 1 Fingerprint card as applicable to THE AFFILIATE’s sites. 9. Negative Drug Screening to meet THE AFFILIATE’s guidelines. 4 10. Background Clearance. 11. Letter of Good Standing from Maricopa County Department of Public Health. 12. Current BLS Card at the provider level. 13. Proof of current malpractice insurance provided by Maricopa County Department of Public Health. 14. Annual HIPAA and OSHA (including bloodborne pathogen) training, completed within the past 12 months. 15. Attestation and Information Release and Immunity Statement. 16. National Practitioner Data Bank Query Form. 17. Clinical Learner Privileging Attestation. 18. Fitness for Duty. 19. Any other reasonably requested documents for regulatory requirements. K. Provide THE AFFILIATE with Intern’s evaluation tool. L. Additional duties of the COUNTY coordinator will be to monitor the performance of all Interns, and to field issues identified by THE AFFILIATE’s staff relating to the intern. 2. RESPONSIBILITIES OF THE AFFILIATE THE AFFILIATE agrees that during the term of this Agreement it shall: A. Provide the necessary facilities and supervisory personnel to establish and carry out the requirements of the dietetic internship program that will give the dietetic interns educational and supervisory experiences in dietetics at THE AFFILIATE site(s). B. Designate a Registered Dietitian Site Director who shall be responsible for the interns and act as the dietetic internship program coordinator with COUNTY. C. Provide to the Dietetic Internship Program Director evaluation of the interns’ performance and other such information as may be requested concerning the interns’ participation at THE AFFILIATE site(s). D. Provide such training aids and data relating to the various phases of the program as may be reasonably necessary. 5 E. Allow interns to utilize library and cafeteria facilities if available. F. Provide the Dietetic Internship Program Director with a copy of the written rules, regulations, and policies of THE AFFILIATE as it applies to the dietetic internship programmatic activities. 3. MUTUAL RESPONSIBILITIES OF COUNTY AND THE AFFILIATE Both parties agree: A. That faculty of COUNTY and faculty of THE AFFILIATE shall confer at such times as may be mutually agreed upon to evaluate the progress of the dietetic internship program and the interns. B. To cooperate to provide a sound educational environment to the interns and quality services to all clients of COUNTY and THE AFFILIATE. C. That all material and programs developed by the interns during their participation in the dietetic internship program at COUNTY shall become the joint property of COUNTY and THE AFFILIATE. D. Each party represents that it, and its staff have received the appropriate licensing and/or accreditation as verified through a credentialing process in accordance with federal, state, and local laws, and professional accrediting bodies (as applicable) and competent and fit to perform services as assessed through a privileging process. Parties will immediately notify the other party of any changes in such approvals, licensing and/or accreditation. Reasonable documentation of such credentials and/or privileging shall be provided upon written request. E. Each party represents that it, its staff, and the Intern: (1) are not currently excluded, or threatened with exclusion, from participating in any federal or state funded healthcare programs, including Medicare, Medicaid and/or Tricare; and (2) have never been subject to any sanctions by any of the above programs. Each party shall regularly monitor exclusion databases and immediately notify the other party if it becomes aware of any imposed exclusions or sanctions. If the Intern becomes excluded from participating in any federal or state funded healthcare programs, the Intern will immediately be removed from the clinical experience. 4. COMPENSATION Interns will not receive financial compensation from either COUNTY or THE AFFILIATE under the terms of this Agreement. 5. WORK STATEMENT To complete program graduation requirements, the interns will meet the core competencies 6 and most recent version of standards for the Registered Dietician Nutritionist (RDN) as set by the ACEND for the dietetic internship programs. All interns will receive a copy of these competencies. 6. NONDISCRIMINATION The parties shall not discriminate against any individual on the basis of race, color, sex, pregnancy, childbirth or medical conditions related to pregnancy or childbirth, political or religious affiliation or ideas, culture, creed, social origin or condition, genetic information, sexual orientation, gender identity or expression, national origin, ancestry, age, disability, military service or veteran status, or marital status, whether as to employees, applicants for employment, interns, or clients. To the extent applicable to this Agreement, both parties agree to comply with all state and federal laws, rules, regulations, and executive orders, including Executive Order No. 2009-09 as modified by Executive Order 2023-01, regarding equal employment opportunity and non-discrimination. 7. INSURANCE A. Each party shall have in effect at all times during the term of this Agreement insurance or comparable self-insurance which is adequate to protect the other party, its officers and employees, participants and equipment against such losses as are set forth below. B. THE AFFILIATE shall provide COUNTY, upon request, with a current Certificate of Insurance or a certified copy of the insurance policy naming Maricopa County as an additional insured under THE AFFILIATE’S commercial general liability and commercial automobile liability insurance; or, if THE AFFILIATE is self-insured, shall provide the COUNTY with current documentation of self-insurance coverage by furnishing a letter indicating such. C. The following types and amounts of insurance are required as minimums: 1. Workers’ Compensation as required by Arizona law, and Employer’s Liability Insurance of $1,000,000 each accident, and $1,000,000 disease policy limits. 2. Unemployment Insurance as required by Arizona law. 3. Commercial general liability insurance with a minimum of $1,000,000 each occurrence, and $2,000,000 general aggregate. The policy shall include coverage for public liability, bodily injury, and property damage, personal injury (including coverage for contractual and employee acts) and blanket contractual. 4. Standard minimum deductible amounts are allowable. Any losses applied against insurance deductibles are the sole responsibility of THE AFFILIATE. 7 5. Professional Liability Insurance with a minimum combined single limit of $1,000,000 for each claim and $3,000,000 aggregate. 6. Commercial Automobile Liability Insurance with a combined single limit of $1,000,000. D. THE AFFILIATE will immediately inform the Dietetic Internship Program Director of any cancellation of its insurance or any decrease in its lines of coverage at least 30 days before such action takes place. 8. PROFESSIONAL LIABILITY A. Under this Agreement, all Dietetic Interns shall have in effect at all times during their participation in the dietetic internship program professional liability insurance with a minimum of combined single limit of $1,000,000 for each claim, $3,000,000 aggregate. B. The Dietetic Interns, while providing health care, medical or professional services shall be deemed agents of the COUNTY for purposes of determining professional liability for acts rising out of the performance of this Agreement. Such professional liability coverage shall be enforced for services performed in COUNTY programs as specified in the Work Statement and in support of this Agreement. C. The scope of the COUNTY'S responsibility to the dietetic interns while providing health care, medical or professional services is pursuant to A.R.S. § 11-981, and governed, defined, and controlled by the terms of the Revised Restated Declaration of Trust for Maricopa County, Arizona Self-Insured Risk Trust Fund, approved by the Maricopa County Board of Supervisors and maintained and administered by the Maricopa County Risk Management Department. 9. NON-LIABILITY COUNTY and its officers and employees shall not be liable for any act or omission by THE AFFILIATE or any subcontractor, employee, officer, agent or representative of Contractor or subcontractors occurring outside the scope and duties of this Agreement. 10. INDEMNITY A. To the fullest extent permitted by law, THE AFFILIATE shall defend, indemnify and hold harmless the COUNTY, its agents, representatives, officers, directors, officials, and employees from and against all claims, damages, losses, and expenses (including, but not limited to attorneys' fees, court costs, expert witness fees, and the costs and attorneys' fees for appellate proceedings) arising out of, or alleged to have resulted from the negligent acts, errors, omissions, or mistakes of THE AFFILIATE, a subcontractor, any one directly or indirectly employed by them, or anyone for whose acts they may be liable, relating to the performance of this Agreement. 8 B. THE AFFILIATE's duty to defend, indemnify, and hold harmless the COUNTY, its agents, representatives, officers, directors, officials, and employees shall arise in connection with any claim, damage, loss, or expense that is attributable to bodily injury, sickness, disease, death or injury to, impairment of, or destruction of tangible property, including resulting loss of use, caused by negligent acts, errors, omissions, or mistakes in the performance of this Agreement, but only to the extent caused by the negligent acts or omissions of THE AFFILIATE, a subcontractor, any one directly or indirectly employed by them, or anyone for whose acts they may be liable, regardless of whether or not such claim, damage, loss, or expense is caused in part by an indemnified party. C. To the fullest extent permitted by law, COUNTY agrees to defend, indemnify, and hold harmless THE AFFILIATE, its agents, representatives, officers, directors, officials, and employees from and against all claims, damages, losses, and expenses (including, but not limited to, attorneys' fees, court costs, expert witness fees, and the costs and attorneys' fees for appellate proceedings) arising out of or alleged to have resulted from the negligent acts, errors, omissions, or mistakes of COUNTY, its employees, or anyone for whose acts COUNTY may be liable, in the performance of this Agreement. D. COUNTY’s indemnity obligations include coverage for bodily injury, sickness, disease, death, or injury to, impairment of, or destruction of tangible property, including resulting loss of use, caused by the negligent acts or omissions of COUNTY, its employees, or anyone for whose acts COUNTY may be liable. E. Neither party shall be liable for indemnification to the extent that any claims, damages, losses, or expenses arise from the negligence or willful misconduct of the other party, or its agents or employees. F. The amount and type of insurance coverage requirements above shall not be construed as limiting the scope of the indemnity in this section. 11. APPLICABLE LAW A. This Agreement shall be construed under the laws of the State of Arizona. Exclusive venue and jurisdiction for any actions or proceedings related to or stemming from this Agreement will be in the state or federal courts sitting in Phoenix, Arizona. B. This Agreement may be cancelled in accordance with A.R.S. § 38-511. 12. COMPLIANCE REQUIREMENTS FOR A.R.S. § 41-4401, GOVERNMENT PROCUREMENT; E-VERIFY REQUIREMENT A. THE AFFILIATE warrants compliance with all federal immigration laws and 9 regulations relating to employees and warrants its compliance with A.R.S. § 23- 214(A), which states, “After December 31, 2007, every employer, after hiring an employee, shall verify the employment eligibility of the employee through the e- verify program and shall keep a record of the verification for the duration of the employee’s employment or at least three years, whichever is longer.” B. A breach of warranty regarding compliance with immigration laws and regulations shall be deemed a material breach of this Agreement and THE AFFILIATE may be subject to penalties up to and including termination of the Agreement. C. Failure to comply with a state audit process to randomly verify the employment records of contractors and subcontractors shall be deemed a material breach of this Agreement and THE AFFILIATE may be subject to penalties up to and including termination of the Agreement. D. The State of Arizona retains the legal right to inspect the papers of any employee who works on this Agreement to ensure that the contractor or subcontractor is complying with the warranty under Paragraph 13(A). E. For questions about E-Verify THE AFFILIATE should visit the following web site: http://www.uscis.gov. 13. TERMS OF AGREEMENT A. The term of this Agreement shall be from February 1, 2025 through June 30, 2028. The Agreement may be renewed for additional terms by the mutual written consent of both parties. B. This Agreement may be terminated by either party upon 30 days prior written notice to the other party. Notwithstanding anything to the contrary this Agreement shall continue until all of those interns participating in the dietetic internship program at the time of written notice of the termination of the Agreement have completed their training experience. 14. SIGNATURE AUTHORIZATION Any individual executing this Agreement on behalf of THE AFFILIATE represents and warrants to COUNTY that they are duly authorized to execute this Agreement on behalf of THE AFFILIATE, and that upon their signature this Agreement shall be binding upon THE AFFILIATE. (signature page follows) 10 IN WITNESS WHEREOF, COUNTY and THE AFFILIATE have executed this Agreement. MARICOPA COUNTY Acting by and for its Department of Public Health ADELANTE HEALTHCARE, INC. By: By: Chairman, Maricopa County Board of Supervisors Name: Date Title: Attest: Clerk of the Board Date Approved as to Form Date Deputy County Attorney