Common use of Certification Regarding Suspension or Debarment Clause in Contracts

Certification Regarding Suspension or Debarment. Contractor certifies under the pains and penalties of perjury that, as of the date this SOW Agreement is signed, neither Contractor nor Contractor’s principals (officers, directors, owners, or partners) are presently debarred, suspended, proposed for debarment, declared ineligible or excluded from participation in federal programs, or programs supported in whole or in part by federal funds. Contractor further certifies under pains and penalties of perjury that, as of the date this SOW Agreement is signed, Contractor is not presently debarred, suspended, nor named on the State’s debarment list at: xxxx://xxx.xxxxxxx.xxx/purchasing/debarment. Child Support (Applicable to natural persons only; not applicable to corporations, partnerships or LLCs). Contractor certifies that it is under no obligation to pay child support or is in good standing with respect to or in full compliance with a plan to pay any and all child support payable under a support order as of the date of this amendment. REQUIRED PRIOR APPROVALS All SOW Agreements, regardless of value, shall be approved by the Vermont Chief Information Officer/Secretary of the Agency of Digital Services prior to execution. CIO Approval Date All SOW Agreements valued at $25,000 or more per year shall be certified by the Vermont Office of the Attorney General in accordance with 3 V.S.A. § 342 prior to execution. Further, there shall be no limitation of liability, including a waiver of consequential, indirect, special, punitive or exemplary damages, or disclaimers of warranty without approval from the Office of the Attorney General. Certified by Date WE THE UNDERSIGNED PARTIES AGREE TO BE BOUND BY THIS SOW AGREEMENT. <Insert SOW contractor Name> Signature Date STATE OF VERMONT, <Insert Requesting Agency or business unit> Signature Date Attachment D3: Form SOW Amendment SOW AMENDMENT SOW-AGREEMENT #_ PRE-QUALIFICATION CONTRACT # Amendment No. (“Master Agreement”) It is hereby agreed by and between the State of Vermont, AGENCY/DEPARTMENT (the "State") and CONTRACTOR NAME, with a principal place of business in CITY, STATE (the "Contractor") that the above SOW Agreement between them originally dated as of SOW START DATE, as amended to date, (the “SOW Agreement”) is hereby amended as follows: REMOVE/EXPAND/REVISE THE BELOW AMENDMENT ITEMS, AS APPLICABLE

Certification Regarding Suspension or Debarment. Contractor certifies under the pains and penalties of perjury that, as of the date this SOW Agreement Amendment is signed, neither Contractor nor Contractor’s principals (officers, directors, owners, or partners) are presently debarred, suspended, proposed for debarment, declared ineligible or excluded from participation in federal programs, or programs supported in whole or in part by federal funds. Contractor further certifies under pains and penalties of perjury that, as of the date this SOW Agreement Amendment is signed, Contractor is not presently debarred, suspended, nor named on the State’s debarment list at: xxxx://xxx.xxxxxxx.xxx/purchasing/debarment. Child Support (Applicable to natural persons only; not applicable to corporations, partnerships or LLCs). Contractor certifies that it is under no obligation to pay child support or is in good standing with respect to or in full compliance with a plan to pay any and all child support payable under a support order as of the date of this amendment. REQUIRED PRIOR APPROVALS All This SOW Agreements, regardless of value, Amendment shall not be valid unless approved by the Vermont Chief Information Officer/Secretary of the Agency of Digital Services prior to execution. CIO Approval Date All This document consists of pages. Except as modified by this SOW Agreements valued at $25,000 or more per year shall be certified by the Vermont Office Amendment No. , all provisions of the Attorney General SOW Agreement remain in accordance with 3 V.S.A. § 342 prior to executionfull force and effect. Further, there shall be no limitation of liability, including a waiver of consequential, indirect, special, punitive or exemplary damages, or disclaimers of warranty without approval from the Office of the Attorney General. Certified by Date WE THE UNDERSIGNED PARTIES AGREE TO BE BOUND BY THIS AMENDMENT TO THE SOW AGREEMENT. <Insert SOW contractor Contractor Name> Signature Date STATE OF VERMONT, <Insert Requesting Agency or business unitAgency/Dept> Signature Date Attachment D3: Form SOW Amendment SOW AMENDMENT SOW-E BUSINESS ASSOCIATE AGREEMENT #_ PRE-QUALIFICATION CONTRACT # Amendment No. THIS BUSINESS ASSOCIATE AGREEMENT (“Master AgreementAGREEMENT”) It is hereby agreed by IS ENTERED INTO BY AND BETWEEN THE STATE OF VERMONT AGENCY OF HUMAN SERVICES, OPERATING BY AND THROUGH ITS [INSERT NAME OF AHS DEPARTMENT, OFFICE OR DIVISION] (“COVERED ENTITY”) AND [INSERT NAME OF CONTRACTOR/GRANTEE] (“BUSINESS ASSOCIATE”) AS OF (“EFFECTIVE DATE”). THIS AGREEMENT SUPPLEMENTS AND IS MADE A PART OF THE CONTRACT/GRANT TO WHICH IT IS ATTACHED. Covered Entity and between Business Associate enter into this Agreement to comply with standards promulgated under the State Health Insurance Portability and Accountability Act of Vermont1996 (“HIPAA”), AGENCY/DEPARTMENT including the Standards for the Privacy of Individually Identifiable Health Information, at 45 CFR Parts 160 and 164 (“Privacy Rule”), and the "State") Security Standards, at 45 CFR Parts 160 and CONTRACTOR NAME, with a principal place of business in CITY, STATE 164 (the "Contractor") that the above SOW Agreement between them originally dated as of SOW START DATE“Security Rule”), as amended to dateby Subtitle D of the Health Information Technology for Economic and Clinical Health Act (HITECH), (the “SOW Agreement”) is hereby amended and any associated federal rules and regulations. The parties agree as follows: REMOVE/EXPAND/REVISE THE BELOW AMENDMENT ITEMS, AS APPLICABLE:

Certification Regarding Suspension or Debarment. Contractor certifies under the pains and penalties of perjury that, as of the date this SOW Agreement Amendment is signed, neither Contractor nor Contractor’s principals (officers, directors, owners, or partners) are presently debarred, suspended, proposed for debarment, declared ineligible or excluded from participation in federal programs, or programs supported in whole or in part by federal funds. Contractor further certifies under pains and penalties of perjury that, as of the date this SOW Agreement Amendment is signed, Contractor is not presently debarred, suspended, nor named on the State’s debarment list at: xxxx://xxx.xxxxxxx.xxx/purchasing/debarment. Child Support (Applicable to natural persons only; not applicable to corporations, partnerships or LLCs). Contractor certifies that it is under no obligation to pay child support or is in good standing with respect to or in full compliance with a plan to pay any and all child support payable under a support order as of the date of this amendment. REQUIRED PRIOR APPROVALS All This SOW Agreements, regardless of value, Amendment shall not be valid unless approved by the Vermont Chief Information Officer/Secretary of the Agency of Digital Services prior to execution. CIO Approval Date All This document consists of pages. Except as modified by this SOW Agreements valued at $25,000 or more per year shall be certified by the Vermont Office Amendment No. , all provisions of the Attorney General SOW Agreement remain in accordance with 3 V.S.A. § 342 prior to executionfull force and effect. Further, there shall be no limitation of liability, including a waiver of consequential, indirect, special, punitive or exemplary damages, or disclaimers of warranty without approval from the Office of the Attorney General. Certified by Date WE THE UNDERSIGNED PARTIES AGREE TO BE BOUND BY THIS AMENDMENT TO THE SOW AGREEMENT. <Insert SOW contractor Contractor Name> Signature Date STATE OF VERMONT, <Insert Requesting Agency or business unitAgency/Dept> Signature Date Attachment D3: Form SOW Amendment SOW AMENDMENT SOW-ATTACHMENT E BUSINESS ASSOCIATE AGREEMENT #_ PRE-QUALIFICATION CONTRACT # Amendment No. (“Master Agreement”VT ADS/AHS) It is hereby agreed by and between the State of VermontRevised MAY 23, AGENCY/DEPARTMENT 2019 SOV Contractor or Vendor (the "State") and CONTRACTOR NAME, with a principal place of business in CITY, STATE (the "Contractor") that the above SOW Agreement between them originally dated as of SOW START DATE, as amended to date, (the “SOW Agreement”) is hereby amended as follows: REMOVE/EXPAND/REVISE THE BELOW AMENDMENT ITEMS, AS APPLICABLEContractor Business Associate):

Certification Regarding Suspension or Debarment. Contractor certifies under the pains and penalties of perjury that, as of the date this SOW Agreement is signed, neither Contractor nor Contractor’s principals (officers, directors, owners, or partners) are presently debarred, suspended, proposed for debarment, declared ineligible or excluded from participation in federal programs, or programs supported in whole or in part by federal funds. Contractor further certifies under pains and penalties of perjury that, as of the date this SOW Agreement is signed, Contractor is not presently debarred, suspended, nor named on the State’s debarment list at: xxxx://xxx.xxxxxxx.xxx/purchasing/debarment. Child Support (Applicable to natural persons only; not applicable to corporations, partnerships or LLCs). Contractor certifies that it is under no obligation to pay child support or is in good standing with respect to or in full compliance with a plan to pay any and all child support payable under a support order as of the date of this amendment. REQUIRED PRIOR APPROVALS All SOW Agreements, regardless of value, shall be approved by the Vermont Chief Information Officer/Secretary of the Agency of Digital Services prior to execution. CIO Approval Date All SOW Agreements valued at $25,000 or more per year shall be certified by the Vermont Office of the Attorney General in accordance with 3 V.S.A. § 342 prior to execution. Further, there shall be no limitation of liability, including a waiver of consequential, indirect, special, punitive or exemplary damages, or disclaimers of warranty without approval from the Office of the Attorney General. Certified by Date WE THE UNDERSIGNED PARTIES AGREE TO BE BOUND BY THIS SOW AGREEMENT. <Insert SOW contractor Name> Signature Date STATE OF VERMONT, <Insert Requesting Agency or business unit> Signature Date Attachment D3: Form SOW Amendment SOW AMENDMENT SOW-AGREEMENT #_ PRE-QUALIFICATION CONTRACT # Amendment No. (“Master Agreement”) It is hereby agreed by and between the State of Vermont, AGENCYAttorney General Office (only when required) Signature Date ATTACHMENT E BUSINESS ASSOCIATE AGREEMENT THIS BUSINESS ASSOCIATE AGREEMENT (“AGREEMENT”) IS ENTERED INTO BY AND BETWEEN THE STATE OF VERMONT AGENCY OF HUMAN SERVICES, OPERATING BY AND THROUGH ITS [INSERT NAME OF AHS DEPARTMENT, OFFICE OR DIVISION] (“COVERED ENTITY”) AND [INSERT NAME OF CONTRACTOR/DEPARTMENT GRANTEE] (“BUSINESS ASSOCIATE”) AS OF (“EFFECTIVE DATE”). THIS AGREEMENT SUPPLEMENTS AND IS MADE A PART OF THE CONTRACT/GRANT TO WHICH IT IS ATTACHED. Covered Entity and Business Associate enter into this Agreement to comply with standards promulgated under the "State") Health Insurance Portability and CONTRACTOR NAMEAccountability Act of 1996 (“HIPAA”), with a principal place including the Standards for the Privacy of business in CITYIndividually Identifiable Health Information, STATE at 45 CFR Parts 160 and 164 (“Privacy Rule”), and the "Contractor") that the above SOW Agreement between them originally dated as of SOW START DATESecurity Standards, at 45 CFR Parts 160 and 164 (“Security Rule”), as amended to dateby Subtitle D of the Health Information Technology for Economic and Clinical Health Act (HITECH), (the “SOW Agreement”) is hereby amended and any associated federal rules and regulations. The parties agree as follows: REMOVE/EXPAND/REVISE THE BELOW AMENDMENT ITEMS, AS APPLICABLE:

Certification Regarding Suspension or Debarment. Contractor certifies under the pains and penalties of perjury that, as of the date this SOW Agreement contract amendment is signed, neither Contractor nor Contractor’s 's principals (officers, directors, owners, or partners) are presently debarred, suspended, proposed for debarment, declared ineligible or excluded from participation in federal programs, or programs supported in whole or in part by federal funds. Contractor further certifies under pains and penalties of perjury that, as of the date this SOW Agreement contract amendment is signed, Contractor is not presently debarred, suspended, nor named on the State’s 's debarment list at: xxxx://xxx.xxxxxxx.xxx/purchasing/debarment. Child Support (Applicable to natural persons only; not applicable to corporations, partnerships or LLCs)xxxx://xxx.xxxxxxx.xxx/purchasing-contracting/debarment State and Federal Terms for Products and Services related the 2020 Covid-19 Pandemic. Contractor certifies agrees that it "STATE OF VERMONT- FEDERAL TERMS SUPPLEMENT (Non-Construction) for all Contracts and Purchases of Products and Services Connected with 2020 Pandemic" which is under no obligation attached as Attachment D to pay child support this amendment, applies to any products or is services provided to the State, at any time, in good standing connection with respect to or the 2020 Pandemic. This document consists of 4 pages. Except as modified by this Amendment No.1, all provisions of the Contract remain in full compliance with a plan to pay any force and all child support payable under a support order as of the date of this amendmenteffect. REQUIRED PRIOR APPROVALS All SOW Agreements, regardless of value, shall be approved by the Vermont Chief Information Officer/Secretary of the Agency of Digital Services prior to execution. CIO Approval Date All SOW Agreements valued at $25,000 or more per year shall be certified by the Vermont Office of the Attorney General in accordance with 3 V.S.A. § 342 prior to execution. Further, there shall be no limitation of liability, including a waiver of consequential, indirect, special, punitive or exemplary damages, or disclaimers of warranty without approval from the Office of the Attorney General. Certified by Date WE THE UNDERSIGNED PARTIES AGREE TO BE BOUND BY THIS SOW AGREEMENT. <Insert SOW contractor CONTRACT By the STATE of VERMONT By the CONTRACTOR Date: Signature: Name> Signature Date : Date: Signature: Name: Title: Email: Title: Email: Attachment D STATE OF VERMONTVERMONT- FEDERAL TERMS SUPPLEMENT (Non-Construction) for all Contracts and Purchases1 of Products and Services Connected with 2020 Pandemic XXXX ANTI-LOBBYING AMENDMENT Contractors who apply or bid for an award of $100,000 or more certify that each tier certifies to the tier above that it will not and has not used Federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or employee of any agency, <Insert Requesting Agency a Member of Congress, officer or business unit> Signature Date Attachment D3: Form SOW Amendment SOW AMENDMENT SOWemployee of Congress, or an employee of a Member of Congress in connection with obtaining any Federal contract, grant, or any other award covered by 31 U.S.C. § 1352. Each tier shall also disclose any lobbying with non-AGREEMENT #_ PREFederal funds that takes place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to tier, up to the recipient who in turn will forward the certification(s) to the awarding agency PROCUREMENT OF RECOVERED MATERIALS In the performance of this contract, the Contractor shall make maximum use of products containing recovered materials that are EPA-QUALIFICATION CONTRACT # Amendment No. (“Master Agreement”) It is hereby agreed by and between designated Items unless the State of Vermont, AGENCY/DEPARTMENT (the "State") and CONTRACTOR NAME, with a principal place of business in CITY, STATE (the "Contractor") that the above SOW Agreement between them originally dated as of SOW START DATE, as amended to date, (the “SOW Agreement”) is hereby amended as follows: REMOVE/EXPAND/REVISE THE BELOW AMENDMENT ITEMS, AS APPLICABLEproducts cannot be acquired-

Certification Regarding Suspension or Debarment. Contractor certifies under the pains and penalties of perjury that, as of the date this SOW Agreement is signed, neither Contractor nor Contractor’s principals (officers, directors, owners, or partners) are presently debarred, suspended, proposed for debarment, declared ineligible or excluded from participation in federal programs, or programs supported in whole or in part by federal funds. Contractor further certifies under pains and penalties of perjury that, as of the date this SOW Agreement is signed, Contractor is not presently debarred, suspended, nor named on the State’s debarment list at: xxxx://xxx.xxxxxxx.xxx/purchasing/debarment. Child Support (Applicable to natural persons only; not applicable to corporations, partnerships or LLCs). Contractor certifies that it is under no obligation to pay child support or is in good standing with respect to or in full compliance with a plan to pay any and all child support payable under a support order as of the date of this amendment. REQUIRED PRIOR APPROVALS All SOW Agreements, regardless of value, shall be approved by the Vermont Chief Information Officer/Secretary of the Agency of Digital Services prior to execution. _____________________________________ _____________________ CIO Approval Date All SOW Agreements valued at $25,000 or more per year shall be certified by the Vermont Office of the Attorney General in accordance with 3 V.S.A. § 342 prior to execution. Further, there shall be no limitation of liability, including a waiver of consequential, indirect, special, punitive or exemplary damages, or disclaimers of warranty without approval from the Office of the Attorney General. _____________________________________ _____________________ Certified by Date WE THE UNDERSIGNED PARTIES AGREE TO BE BOUND BY THIS SOW AGREEMENT. <Insert SOW contractor Name> _____________________________________ ____________________________ Signature Date STATE OF VERMONT, <Insert Requesting Agency or business unit> Signature Date Attachment D3: Form SOW Amendment SOW AMENDMENT SOW-AGREEMENT #_____________________________________ PRE-QUALIFICATION CONTRACT # Amendment No. (“Master Agreement”) It is hereby agreed by and between the State of Vermont, AGENCY/DEPARTMENT (the "State") and CONTRACTOR NAME, with a principal place of business in CITY, STATE (the "Contractor") that the above SOW Agreement between them originally dated as of SOW START DATE, as amended to date, (the “SOW Agreement”) is hereby amended as follows: REMOVE/EXPAND/REVISE THE BELOW AMENDMENT ITEMS, AS APPLICABLE____________________________

Certification Regarding Suspension or Debarment. Contractor certifies under the pains and penalties of perjury that, as of the date this SOW Agreement is signed, neither Contractor nor Contractor’s principals (officers, directors, owners, or partners) are presently debarred, suspended, proposed for debarment, declared ineligible or excluded from participation in federal programs, or programs supported in whole or in part by federal funds. Contractor further certifies under pains and penalties of perjury that, as of the date this SOW Agreement is signed, Contractor is not presently debarred, suspended, nor named on the State’s debarment list at: xxxx://xxx.xxxxxxx.xxx/purchasing/debarment. Child Support (Applicable to natural persons only; not applicable to corporations, partnerships or LLCs). Contractor certifies that it is under no obligation to pay child support or is in good standing with respect to or in full compliance with a plan to pay any and all child support payable under a support order as of the date of this amendment. REQUIRED PRIOR APPROVALS All SOW Agreements, regardless of value, shall be approved by the Vermont Chief Information Officer/Secretary of the Agency of Digital Services prior to execution. CIO Approval Date All SOW Agreements valued at $25,000 or more per year shall be certified by the Vermont Office of the Attorney General in accordance with 3 V.S.A. § 342 prior to execution. Further, there shall be no limitation of liability, including a waiver of consequential, indirect, special, punitive or exemplary damages, or disclaimers of warranty without approval from the Office of the Attorney General. Certified by Date WE THE UNDERSIGNED PARTIES AGREE TO BE BOUND BY THIS SOW AGREEMENT. <Insert SOW contractor Name> Signature Date STATE OF VERMONT, <Insert Requesting Agency or business unit> Signature Date Attachment D3: Form SOW Amendment SOW AMENDMENT SOW-ATTACHMENT E BUSINESS ASSOCIATE AGREEMENT #_ PRE-QUALIFICATION CONTRACT # Amendment No. THIS BUSINESS ASSOCIATE AGREEMENT (“Master AgreementAGREEMENT”) It is hereby agreed by IS ENTERED INTO BY AND BETWEEN THE STATE OF VERMONT AGENCY OF HUMAN SERVICES, OPERATING BY AND THROUGH ITS [INSERT NAME OF AHS DEPARTMENT, OFFICE OR DIVISION] (“COVERED ENTITY”) AND [INSERT NAME OF CONTRACTOR/GRANTEE] (“BUSINESS ASSOCIATE”) AS OF (“EFFECTIVE DATE”). THIS AGREEMENT SUPPLEMENTS AND IS MADE A PART OF THE CONTRACT/GRANT TO WHICH IT IS ATTACHED. Covered Entity and between Business Associate enter into this Agreement to comply with standards promulgated under the State Health Insurance Portability and Accountability Act of Vermont1996 (“HIPAA”), AGENCY/DEPARTMENT including the Standards for the Privacy of Individually Identifiable Health Information, at 45 CFR Parts 160 and 164 (“Privacy Rule”), and the "State") Security Standards, at 45 CFR Parts 160 and CONTRACTOR NAME, with a principal place of business in CITY, STATE 164 (the "Contractor") that the above SOW Agreement between them originally dated as of SOW START DATE“Security Rule”), as amended to dateby Subtitle D of the Health Information Technology for Economic and Clinical Health Act (HITECH), (the “SOW Agreement”) is hereby amended and any associated federal rules and regulations. The parties agree as follows: REMOVE/EXPAND/REVISE THE BELOW AMENDMENT ITEMS, AS APPLICABLE:

Certification Regarding Suspension or Debarment. Contractor certifies under the pains and penalties of perjury that, as of the date this SOW Agreement is signed, neither Contractor nor Contractor’s principals (officers, directors, owners, or partners) are presently debarred, suspended, proposed for debarment, declared ineligible or excluded from participation in federal programs, or programs supported in whole or in part by federal funds. Contractor further certifies under pains and penalties of perjury that, as of the date this SOW Agreement is signed, Contractor is not presently debarred, suspended, nor named on the State’s debarment list at: xxxx://xxx.xxxxxxx.xxx/purchasing/debarment. Child Support (Applicable to natural persons only; not applicable to corporations, partnerships or LLCs). Contractor certifies that it is under no obligation to pay child support or is in good standing with respect to or in full compliance with a plan to pay any and all child support payable under a support order as of the date of this amendment. REQUIRED PRIOR APPROVALS All SOW Agreements, regardless of value, shall be approved by the Vermont Chief Information Officer/Secretary of the Agency of Digital Services prior to execution. CIO Approval Date All SOW Agreements valued at $25,000 or more per year shall be certified by the Vermont Office of the Attorney General in accordance with 3 V.S.A. § 342 prior to execution. Further, there shall be no limitation of liability, including a waiver of consequential, indirect, special, punitive or exemplary damages, or disclaimers of warranty without approval from the Office of the Attorney General. Certified by Date WE THE UNDERSIGNED PARTIES AGREE TO BE BOUND BY THIS SOW AGREEMENT. <Insert SOW contractor Name> Amendment #1 Signature Date STATE OF VERMONT, <Insert Requesting Agency or business unit> Signature Date Attachment D3: Form SOW Amendment SOW AMENDMENT Contract #33921 Amendment #1 SOW-AGREEMENT #_ PRE-QUALIFICATION CONTRACT # Amendment No. (“Master Agreement”) It is hereby agreed by and between the State of Vermont, AGENCY/DEPARTMENT (the "State") and CONTRACTOR NAME, with a principal place of business in CITY, STATE (the "Contractor") that the above SOW Agreement between them originally dated as of SOW START DATE, as amended to date, (the “SOW Agreement”) is hereby amended as follows: REMOVE/EXPAND/REVISE THE BELOW AMENDMENT ITEMS, AS APPLICABLE

Certification Regarding Suspension or Debarment. Contractor certifies under the pains and penalties of perjury that, as of the date this SOW Agreement Amendment is signed, neither Contractor nor Contractor’s principals (officers, directors, owners, or partners) are presently esently debarred, suspended, proposed for debarment, declared ineligible or excluded from participation in federal programs, or programs supported in whole or in part by federal funds. Contractor further certifies under pains and penalties of perjury that, as of the date this SOW Agreement Amendment is signed, Contractor is not presently debarred, suspended, nor named on the State’s no debarment list at: xxxx://xxx.xxxxxxx.xxx/purchasing/debarment. Child Support (Applicable to natural persons only; not applicable to corporations, partnerships or LLCs). Contractor certifies that it is under no obligation to pay child support or is in good standing with respect to or in full compliance with a plan to pay any and all child support payable under a support order as of the date of this amendment. REQUIRED PRIOR APPROVALS All This SOW Agreements, regardless of value, Amendment shall not be valid unless approved by the Vermont Chief Information Officer/Secretary of the Agency of Digital Services prior to execution. CIO Approval Date All This document consists of pages. Except as modified by this SOW Agreements valued at $25,000 or more per year shall be certified by the Vermont Office Amendment No. , all provisions of the Attorney General SOW Agreement remain in accordance with 3 V.S.A. § 342 prior to executionfull force and effect. Further, there shall be no limitation of liability, including a waiver of consequential, indirect, special, punitive or exemplary damages, or disclaimers of warranty without approval from the Office of the Attorney General. Certified by Date WE THE UNDERSIGNED PARTIES AGREE TO BE BOUND BY THIS AMENDMENT TO THE SOW AGREEMENT. <Insert SOW contractor Contractor Name> Signature Date STATE OF VERMONT, <Insert Requesting Agency or business unitAgency/Dept> Signature Date Attachment D3ATTACHMENT E BUSINESS ASSOCIATE AGREEMENT (VT ADS/AHS) Revised MAY 23, 2019 SOV Contractor or Vendor (Contractor Business Associate): _ _ _ SOV Contract Number: Form SOW Amendment SOW AMENDMENT SOW-AGREEMENT #_ PRE-QUALIFICATION CONTRACT # Amendment No. (“Master Agreement”) It Date of Contract: Agency of Digita Contractor or Vendor e party identified in this Agreement above as supplements and is hereby agreed by made a part ADS and between Contractor Business Associate enter into this Agreement to comply with the State of Vermont, AGENCY/DEPARTMENT (the "State") and CONTRACTOR NAME, with a principal place of business in CITY, STATE (the "Contractor") that the above SOW Business Associate Agreement between them originally dated as of SOW START DATECovered Entity and ADS, as amended to dateand with standards promulgated under the Health Insurance Ident at 45 CFR Part Technology for Economic and Clinical Health Act (HITECH), (the “SOW Agreement”) is hereby amended and any associated federal rules and regulations. The parties agree as follows: REMOVE/EXPAND/REVISE THE BELOW AMENDMENT ITEMS, AS APPLICABLE:

Certification Regarding Suspension or Debarment. Contractor certifies under the pains and penalties of perjury that, as of the date this SOW Agreement Amendment is signed, neither Contractor nor Contractor’s principals (officers, directors, owners, or partners) are presently debarred, suspended, proposed for debarment, declared ineligible or excluded from participation in federal programs, or programs supported in whole or in part by federal funds. Contractor further certifies under pains and penalties of perjury that, as of the date this SOW Agreement Amendment is signed, Contractor is not presently debarred, suspended, nor named on the State’s debarment list at: xxxx://xxx.xxxxxxx.xxx/purchasing/debarment. Child Support (Applicable to natural persons only; not applicable to corporations, partnerships or LLCs). Contractor certifies that it is under no obligation to pay child support or is in good standing with respect to or in full compliance with a plan to pay any and all child support payable under a support order as of the date of this amendment. REQUIRED PRIOR APPROVALS All This SOW Agreements, regardless of value, Amendment shall not be valid unless approved by the Vermont Chief Information Officer/Secretary of the Agency of Digital Services prior to execution. CIO Approval Date All This document consists of pages. Except as modified by this SOW Agreements valued at $25,000 or more per year shall be certified by the Vermont Office Amendment No. , all provisions of the Attorney General SOW Agreement remain in accordance with 3 V.S.A. § 342 prior to executionfull force and effect. Further, there shall be no limitation of liability, including a waiver of consequential, indirect, special, punitive or exemplary damages, or disclaimers of warranty without approval from the Office of the Attorney General. Certified by Date WE THE UNDERSIGNED PARTIES AGREE TO BE BOUND BY THIS AMENDMENT TO THE SOW AGREEMENT. <Insert SOW contractor Contractor Name> Signature Date STATE OF VERMONT, <Insert Requesting Agency or business unitAgency/Dept> Signature Date Attachment D3: Form SOW Amendment SOW AMENDMENT SOW-E BUSINESS ASSOCIATE AGREEMENT #_ PRE-QUALIFICATION CONTRACT # Amendment No. THIS BUSINESS ASSOCIATE AGREEMENT (“Master AgreementAGREEMENT”) It is hereby agreed by IS ENTERED INTO BY AND BETWEEN THE STATE OF VERMONT AGENCY OF HUMAN SERVICES, OPERATING BY AND THROUGH ITS [INSERT NAME OF AHS DEPARTMENT, OFFICE OR DIVISION] (“COVERED ENTITY”) AND [INSERT NAME OF CONTRACTOR/GRANTEE] (“BUSINESS ASSOCIATE”) AS OF (“EFFECTIVE DATE”). THIS AGREEMENT SUPPLEMENTS AND IS MADE A PART OF THE CONTRACT/GRANT TO WHICH IT IS ATTACHED. Covered Entity and between Business Associate enter into this Agreement to comply with standards promulgated under the State Health Insurance Portability and Accountability Act of Vermont1996 (“HIPAA”), AGENCY/DEPARTMENT including the Standards for the Privacy of Individually Identifiable Health Information, at 45 CFR Parts 160 and 164 (“Privacy Rule”), and the "State") Security Standards, at 45 CFR Parts 160 and CONTRACTOR NAME, with a principal place of business in CITY, STATE 164 (the "Contractor") that the above SOW Agreement between them originally dated as of SOW START DATE“Security Rule”), as amended to dateby Subtitle D of the Health Information Technology for Economic and Clinical Health Act (HITECH), (the “SOW Agreement”) is hereby amended and any associated federal rules and regulations. The parties agree as follows: REMOVE/EXPAND/REVISE THE BELOW AMENDMENT ITEMS, AS APPLICABLE:

Certification Regarding Suspension or Debarment. Contractor certifies under the pains and penalties of perjury that, as of the date this SOW Agreement is signed, neither Contractor nor Contractor’s principals (officers, directors, owners, or partners) are presently debarred, suspended, proposed for debarment, declared ineligible or excluded from participation in federal programs, or programs supported in whole or in part by federal funds. Contractor further certifies under pains and penalties of perjury that, as of the date this SOW Agreement is signed, Contractor is not presently debarred, suspended, nor named on the State’s debarment list at: xxxx://xxx.xxxxxxx.xxx/purchasing/debarment. Child Support (Applicable to natural persons only; not applicable to corporations, partnerships or LLCs). Contractor certifies that it is under no obligation to pay child support or is in good standing with respect to or in full compliance with a plan to pay any and all child support payable under a support order as of the date of this amendment. REQUIRED PRIOR APPROVALS All SOW Agreements, regardless of value, shall be approved by the Vermont Chief Information Officer/Secretary of the Agency of Digital Services prior to execution. CIO Approval Date All SOW Agreements valued at $25,000 or more per year shall be certified by the Vermont Office of the Attorney General in accordance with 3 V.S.A. § 342 prior to execution. Further, there shall be no limitation of liability, including a waiver of consequential, indirect, special, punitive or exemplary damages, or disclaimers of warranty without approval from the Office of the Attorney General. Certified by Date WE THE UNDERSIGNED PARTIES AGREE TO BE BOUND BY THIS SOW AGREEMENT. <Insert SOW contractor Name> Contract #32114 Amendment #1 Signature Date STATE OF VERMONT, <Insert Requesting Agency or business unit> Signature Date Attachment D3Xxxxxxxx #00000 Xxxxxxxxx #0 Xxxxxxxxxx X0: Form SOW Amendment SOW AMENDMENT SOW-AGREEMENT #_ PRE-QUALIFICATION CONTRACT # Amendment No. (“Master Agreement”) It is hereby agreed by and between the State of Vermont, AGENCY/DEPARTMENT (the "State") and CONTRACTOR NAME, with a principal place of business in CITY, STATE (the "Contractor") that the above SOW Agreement between them originally dated as of SOW START DATE, as amended to date, (the “SOW Agreement”) is hereby amended as follows: REMOVE/EXPAND/REVISE THE BELOW AMENDMENT ITEMS, AS APPLICABLE

Certification Regarding Suspension or Debarment. Contractor certifies under the pains and penalties of perjury that, as of the date this SOW Agreement contract amendment is signed, neither Contractor nor Contractor’s 's principals (officers, directors, owners, or partners) are presently debarred, suspended, proposed for debarment, declared ineligible or excluded from participation in federal programs, or programs supported in whole or in part by federal funds. Contractor further certifies under pains and penalties of perjury that, as of the date this SOW Agreement contract amendment is signed, Contractor is not presently debarred, suspended, nor named on the State’s 's debarment list at: xxxx://xxx.xxxxxxx.xxx/purchasing/debarment. Child Support (Applicable to natural persons only; not applicable to corporations, partnerships or LLCs). Contractor certifies that it is under no obligation to pay child support or is in good standing with respect to or in full compliance with a plan to pay any and all child support payable under a support order as of the date of this amendment. REQUIRED PRIOR APPROVALS All SOW Agreements, regardless of value, shall be approved by the Vermont Chief Information Officer/Secretary of the Agency of Digital Services prior to execution. CIO Approval Date All SOW Agreements valued at $25,000 or more per year shall be certified by the Vermont Office of the Attorney General in accordance with 3 V.S.A. § 342 prior to execution. Further, there shall be no limitation of liability, including a waiver of consequential, indirect, special, punitive or exemplary damages, or disclaimers of warranty without approval from the Office of the Attorney General. Certified by Date xxxx://xxx.xxxxxxx.xxx/purchasing-contracting/debarment Unit Max Max Line # Item ID Item Desc UOM Price Qty Amt WE THE UNDERSIGNED PARTIES AGREE TO BE BOUND BY THIS SOW AGREEMENT. <Insert SOW contractor CONTRACT By the STATE of VERMONT By the CONTRACTOR Date: Signature: Name> Signature Date : Date: Signature: Name: Title: Email: Title: Email: STATE OF VERMONTVERMONT- FEDERAL TERMS SUPPLEMENT (Non-Construction) for all Contracts and Purchases of Products and Services Connected with 2020 Pandemic XXXX ANTI-LOBBYING AMENDMENT Contractors who apply or bid for an award of $100,000 or more certify that each tier certifies to the tier above that it will not and has not used Federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or employee of any agency, <Insert Requesting Agency a Member of Congress, officer or business unit> Signature Date Attachment D3: Form SOW Amendment SOW AMENDMENT SOWemployee of Congress, or an employee of a Member of Congress in connection with obtaining any Federal contract, grant, or any other award covered by 31 U.S.C. § 1352. Each tier shall also disclose any lobbying with non-AGREEMENT #_ PREFederal funds that takes place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to tier, up to the recipient who in turn will forward the certification(s) to the awarding agency PROCUREMENT OF RECOVERED MATERIALS In the performance of this contract, the Contractor shall make maximum use of products containing recovered materials that are EPA-QUALIFICATION CONTRACT # Amendment No. (“Master Agreement”) It is hereby agreed by and between designated Items unless the State of Vermont, AGENCY/DEPARTMENT (the "State") and CONTRACTOR NAME, with a principal place of business in CITY, STATE (the "Contractor") that the above SOW Agreement between them originally dated as of SOW START DATE, as amended to date, (the “SOW Agreement”) is hereby amended as follows: REMOVE/EXPAND/REVISE THE BELOW AMENDMENT ITEMS, AS APPLICABLEproducts cannot be acquired-

Certification Regarding Suspension or Debarment. Contractor certifies under the pains and penalties of perjury that, as of the date this SOW Agreement Amendment is signed, neither Contractor nor Contractor’s principals (officers, directors, owners, or partners) are presently debarred, suspended, proposed for debarment, declared ineligible or excluded from participation in federal programs, or programs supported in whole or in part by federal funds. Contract #33921 Amendment #1 Contractor further certifies under pains and penalties of perjury that, as of the date this SOW Agreement Amendment is signed, Contractor is not presently debarred, suspended, nor named on the State’s debarment list at: xxxx://xxx.xxxxxxx.xxx/purchasing/debarment. Child Support (Applicable to natural persons only; not applicable to corporations, partnerships or LLCs). Contractor certifies that it is under no obligation to pay child support or is in good standing with respect to or in full compliance with a plan to pay any and all child support payable under a support order as of the date of this amendment. REQUIRED PRIOR APPROVALS All This SOW Agreements, regardless of value, Amendment shall not be valid unless approved by the Vermont Chief Information Officer/Secretary of the Agency of Digital Services prior to execution. CIO Approval Date All This document consists of pages. Except as modified by this SOW Agreements valued at $25,000 or more per year shall be certified by the Vermont Office Amendment No. , all provisions of the Attorney General SOW Agreement remain in accordance with 3 V.S.A. § 342 prior to executionfull force and effect. Further, there shall be no limitation of liability, including a waiver of consequential, indirect, special, punitive or exemplary damages, or disclaimers of warranty without approval from the Office of the Attorney General. Certified by Date WE THE UNDERSIGNED PARTIES AGREE TO BE BOUND BY THIS AMENDMENT TO THE SOW AGREEMENT. <Insert SOW contractor Contractor Name> Signature Date STATE OF VERMONT, <Insert Requesting Agency or business unit> Signature Date Attachment D3: Form SOW Amendment SOW AMENDMENT SOW-AGREEMENT #_ PRE-QUALIFICATION CONTRACT # Amendment No. (“Master Agreement”) It is hereby agreed by and between the State of Vermont, AGENCYAgency/DEPARTMENT (the "State") and CONTRACTOR NAME, with a principal place of business in CITY, STATE (the "Contractor") that the above SOW Agreement between them originally dated as of SOW START DATE, as amended to date, (the “SOW Agreement”) is hereby amended as follows: REMOVE/EXPAND/REVISE THE BELOW AMENDMENT ITEMS, AS APPLICABLEDept>

Certification Regarding Suspension or Debarment. Contractor certifies under the pains and penalties of perjury that, as of the date this SOW Agreement is signed, neither Contractor nor Contractor’s principals (officers, directors, owners, or partners) are presently debarred, suspended, proposed for debarment, declared ineligible or excluded from participation in federal programs, or programs supported in whole or in part by federal funds. Contractor further certifies under pains and penalties of perjury that, as of the date this SOW Agreement is signed, Contractor is not presently debarred, suspended, nor named on the State’s debarment list at: xxxx://xxx.xxxxxxx.xxx/purchasing/debarment. Child Support (Applicable to natural persons only; not applicable to corporations, partnerships or LLCs). Contractor certifies that it is under no obligation to pay child support or is in good standing with respect to or in full compliance with a plan to pay any and all child support payable under a support order as of the date of this amendment. REQUIRED PRIOR APPROVALS All SOW Agreements, regardless of value, shall be approved by the Vermont Chief Information Officer/Secretary of the Agency of Digital Services prior to execution. CIO Approval Date All SOW Agreements valued at $25,000 or more per year shall be certified by the Vermont Office of the Attorney General in accordance with 3 V.S.A. § 342 prior to execution. Further, there shall be no limitation of liability, including a waiver of consequential, indirect, special, punitive or exemplary damages, or disclaimers of warranty without approval from the Office of the Attorney General. Certified by Date WE THE UNDERSIGNED PARTIES AGREE TO BE BOUND BY THIS SOW AGREEMENT. <Insert SOW contractor Name> Contract #32139 Amendment #1 Signature Date STATE OF VERMONT, <Insert Requesting Agency or business unit> Signature Date Attachment D3Xxxxxxxx #00000 Xxxxxxxxx #0 Xxxxxxxxxx X0: Form SOW Amendment SOW AMENDMENT SOW-AGREEMENT #_ PRE-QUALIFICATION CONTRACT # Amendment No. (“Master Agreement”) It is hereby agreed by and between the State of Vermont, AGENCY/DEPARTMENT (the "State") and CONTRACTOR NAME, with a principal place of business in CITY, STATE (the "Contractor") that the above SOW Agreement between them originally dated as of SOW START DATE, as amended to date, (the “SOW Agreement”) is hereby amended as follows: REMOVE/EXPAND/REVISE THE BELOW AMENDMENT ITEMS, AS APPLICABLE

Certification Regarding Suspension or Debarment. Contractor certifies under the pains and penalties of perjury that, as of the date this SOW Agreement Amendment is signed, neither Contractor nor Contractor’s principals (officers, directors, owners, or partners) are presently debarred, suspended, proposed for debarment, declared ineligible or excluded from participation in federal programs, or programs supported in whole or in part by federal funds. Contract #33881 Amendment #1 Contractor further certifies under pains and penalties of perjury that, as of the date this SOW Agreement Amendment is signed, Contractor is not presently debarred, suspended, nor named on the State’s debarment list at: xxxx://xxx.xxxxxxx.xxx/purchasing/debarment. Child Support (Applicable to natural persons only; not applicable to corporations, partnerships or LLCs). Contractor certifies that it is under no obligation to pay child support or is in good standing with respect to or in full compliance with a plan to pay any and all child support payable under a support order as of the date of this amendment. REQUIRED PRIOR APPROVALS All This SOW Agreements, regardless of value, Amendment shall not be valid unless approved by the Vermont Chief Information Officer/Secretary of the Agency of Digital Services prior to execution. CIO Approval Date All This document consists of pages. Except as modified by this SOW Agreements valued at $25,000 or more per year shall be certified by the Vermont Office Amendment No. , all provisions of the Attorney General SOW Agreement remain in accordance with 3 V.S.A. § 342 prior to executionfull force and effect. Further, there shall be no limitation of liability, including a waiver of consequential, indirect, special, punitive or exemplary damages, or disclaimers of warranty without approval from the Office of the Attorney General. Certified by Date WE THE UNDERSIGNED PARTIES AGREE TO BE BOUND BY THIS AMENDMENT TO THE SOW AGREEMENT. <Insert SOW contractor Contractor Name> Signature Date STATE OF VERMONT, <Insert Requesting Agency or business unitAgency/Dept> Signature Date Attachment D3: Form SOW Amendment SOW AMENDMENT SOW-AGREEMENT #_ PRE-QUALIFICATION CONTRACT # Amendment No. (“Master Agreement”) It is hereby agreed by and between the State of Vermont, AGENCY/DEPARTMENT (the "State") and CONTRACTOR NAME, with a principal place of business in CITY, STATE (the "Contractor") that the above SOW Agreement between them originally dated as of SOW START DATE, as amended to date, (the “SOW Agreement”) is hereby amended as follows: REMOVE/EXPAND/REVISE THE BELOW AMENDMENT ITEMS, AS APPLICABLEDate

Certification Regarding Suspension or Debarment. Contractor certifies under the pains and penalties of perjury that, as of the date this SOW Agreement Amendment is signed, neither Contractor nor Contractor’s principals (officers, directors, owners, or partners) are presently debarred, suspended, proposed for debarment, declared ineligible or excluded from participation in federal programs, or programs supported in whole or in part by federal funds. Contractor further certifies under pains and penalties of perjury that, as of the date this SOW Agreement Amendment is signed, Contractor is not presently debarred, suspended, nor named on the State’s debarment list at: xxxx://xxx.xxxxxxx.xxx/purchasing/debarment. Child Support (Applicable to natural persons only; not applicable to corporations, partnerships or LLCs). Contractor certifies that it is under no obligation to pay child support or is in good standing with respect to or in full compliance with a plan to pay any and all child support payable under a support order as of the date of this amendment. REQUIRED PRIOR APPROVALS All This SOW Agreements, regardless of value, Amendment shall not be valid unless approved by the Vermont Chief Information Officer/Secretary of the Agency of Digital Services prior to execution. CIO Approval Date All This document consists of pages. Except as modified by this SOW Agreements valued at $25,000 or more per year shall be certified by the Vermont Office Amendment No. , all provisions of the Attorney General SOW Agreement remain in accordance with 3 V.S.A. § 342 prior to executionfull force and effect. Further, there shall be no limitation of liability, including a waiver of consequential, indirect, special, punitive or exemplary damages, or disclaimers of warranty without approval from the Office of the Attorney General. Certified by Date WE THE UNDERSIGNED PARTIES AGREE TO BE BOUND BY THIS AMENDMENT TO THE SOW AGREEMENT. <Insert SOW contractor Contractor Name> Signature Date STATE OF VERMONT, <Insert Requesting Agency or business unitAgency/Dept> Signature Date Attachment D3: Form SOW Amendment SOW AMENDMENT SOW-ATTACHMENT E BUSINESS ASSOCIATE AGREEMENT #_ PRE-QUALIFICATION CONTRACT # Amendment No. (“Master Agreement”VT ADS/AHS) It is hereby agreed by and between the State of VermontRevised MAY 23, AGENCY/DEPARTMENT 2019 SOV Contractor or Vendor (the "State") and CONTRACTOR NAME, with a principal place of business in CITY, STATE (the "Contractor") that the above SOW Agreement between them originally dated as of SOW START DATE, as amended to date, (the “SOW Agreement”) is hereby amended as follows: REMOVE/EXPAND/REVISE THE BELOW AMENDMENT ITEMS, AS APPLICABLEContractor Business Associate):

Certification Regarding Suspension or Debarment. Contractor certifies under the pains and penalties of perjury that, as of the date this SOW Agreement is signed, neither Contractor nor Contractor’s principals (officers, directors, owners, or partners) are presently esently debarred, suspended, proposed for debarment, declared ineligible or excluded from participation in federal programs, or programs supported in whole or in part by federal funds. Contractor further certifies under pains and penalties of perjury that, as of the date this SOW Agreement is signed, Contractor is not presently debarred, suspended, nor named on the State’s i debarment list at: xxxx://xxx.xxxxxxx.xxx/purchasing/debarment. Child Support (Applicable to natural persons only; not applicable to corporations, partnerships or LLCs). Contractor certifies that it is under no obligation to pay child support or is in good standing with respect to or in full compliance with a plan to pay any and all child support payable under a support order as of the date of this amendment. REQUIRED PRIOR APPROVALS All SOW Agreements, regardless of value, shall be approved by the Vermont Chief Information Officer/Secretary of the Agency of Digital Services prior to execution. CIO Approval Date All SOW Agreements valued at $25,000 or more per year shall be certified by the Vermont Office of the Attorney General in accordance with 3 V.S.A. § 342 prior to execution. Further, there shall be no limitation of liability, including a waiver of consequential, indirect, special, punitive or exemplary damages, or disclaimers of warranty without approval from the Office of the Attorney General. Certified by Date WE THE UNDERSIGNED PARTIES AGREE TO BE BOUND BY THIS SOW AGREEMENT. <Insert SOW contractor Name> Signature Date STATE OF VERMONT, <Insert Requesting Agency or business unit> Signature Date Attachment D3: Form SOW Amendment SOW AMENDMENT SOW-AGREEMENT #_ PRE-QUALIFICATION CONTRACT # Amendment No. (“Master Agreement”) _ It is hereby agreed by and between the State of Vermont, AGENCY/DEPARTMENT (the "State") and CONTRACTOR NAME, with a principal place of business in CITY, STATE (the "Contractor") that the above SOW Agreement between them originally dated as of SOW START DATE, as amended to date, (the “DATE SOW Agreement”) is hereby amended as follows: Agreement REMOVE/EXPAND/REVISE THE BELOW AMENDMENT ITEMS, AS APPLICABLE

Certification Regarding Suspension or Debarment. Contractor certifies under the pains and penalties of perjury that, as of the date this SOW Agreement Amendment is signed, neither Contractor nor Contractor’s principals (officers, directors, owners, or partners) are presently debarred, Contract #32114 Amendment #1 suspended, proposed for debarment, declared ineligible or excluded from participation in federal programs, or programs supported in whole or in part by federal funds. Contractor further certifies under pains and penalties of perjury that, as of the date this SOW Agreement Amendment is signed, Contractor is not presently debarred, suspended, nor named on the State’s debarment list at: xxxx://xxx.xxxxxxx.xxx/purchasing/debarment. Child Support (Applicable to natural persons only; not applicable to corporations, partnerships or LLCs). Contractor certifies that it is under no obligation to pay child support or is in good standing with respect to or in full compliance with a plan to pay any and all child support payable under a support order as of the date of this amendment. REQUIRED PRIOR APPROVALS All This SOW Agreements, regardless of value, Amendment shall not be valid unless approved by the Vermont Chief Information Officer/Secretary of the Agency of Digital Services prior to execution. CIO Approval Date All This document consists of pages. Except as modified by this SOW Agreements valued at $25,000 or more per year shall be certified by the Vermont Office Amendment No. , all provisions of the Attorney General SOW Agreement remain in accordance with 3 V.S.A. § 342 prior to executionfull force and effect. Further, there shall be no limitation of liability, including a waiver of consequential, indirect, special, punitive or exemplary damages, or disclaimers of warranty without approval from the Office of the Attorney General. Certified by Date WE THE UNDERSIGNED PARTIES AGREE TO BE BOUND BY THIS AMENDMENT TO THE SOW AGREEMENT. <Insert SOW contractor Contractor Name> Signature Date STATE OF VERMONT, <Insert Requesting Agency or business unit> Signature Date Attachment D3: Form SOW Amendment SOW AMENDMENT SOW-AGREEMENT #_ PRE-QUALIFICATION CONTRACT # Amendment No. (“Master Agreement”) It is hereby agreed by and between the State of Vermont, AGENCYAgency/DEPARTMENT (the "State") and CONTRACTOR NAME, with a principal place of business in CITY, STATE (the "Contractor") that the above SOW Agreement between them originally dated as of SOW START DATE, as amended to date, (the “SOW Agreement”) is hereby amended as follows: REMOVE/EXPAND/REVISE THE BELOW AMENDMENT ITEMS, AS APPLICABLEDept>

Certification Regarding Suspension or Debarment. Contractor certifies under the pains and penalties of perjury that, as of the date this SOW Agreement is signed, neither Contractor nor Contractor’s principals (officers, directors, owners, or partners) are presently debarred, suspended, proposed for debarment, declared ineligible or excluded from participation in federal programs, or programs supported in whole or in part by federal funds. Contractor further certifies under pains and penalties of perjury that, as of the date this SOW Agreement is signed, Contractor is not presently debarred, suspended, nor named on the State’s debarment list at: xxxx://xxx.xxxxxxx.xxx/purchasing/debarment. Child Support (Applicable to natural persons only; not applicable to corporations, partnerships or LLCs). Contractor certifies that it is under no obligation to pay child support or is in good standing with respect to or in full compliance with a plan to pay any and all child support payable under a support order as of the date of this amendment. REQUIRED PRIOR APPROVALS All SOW Agreements, regardless of value, shall be approved by the Vermont Chief Information Officer/Secretary of the Agency of Digital Services prior to execution. CIO Approval Date All SOW Agreements valued at $25,000 or more per year shall be certified by the Vermont Office of the Attorney General in accordance with 3 V.S.A. § 342 prior to execution. Further, there shall be no limitation of liability, including a waiver of consequential, indirect, special, punitive or exemplary damages, or disclaimers of warranty without approval from the Office of the Attorney General. Certified by Date WE THE UNDERSIGNED PARTIES AGREE TO BE BOUND BY THIS SOW AGREEMENT. <Insert SOW contractor Name> Contract #33881 Amendment #1 Signature Date STATE OF VERMONT, <Insert Requesting Agency or business unit> Signature Date Attachment D3: Form SOW Amendment SOW AMENDMENT Contract #33881 Amendment #1 SOW-AGREEMENT #_ PRE-QUALIFICATION CONTRACT # Amendment No. (“Master Agreement”) It is hereby agreed by and between the State of Vermont, AGENCY/DEPARTMENT (the "State") and CONTRACTOR NAME, with a principal place of business in CITY, STATE (the "Contractor") that the above SOW Agreement between them originally dated as of SOW START DATE, as amended to date, (the “SOW Agreement”) is hereby amended as follows: REMOVE/EXPAND/REVISE THE BELOW AMENDMENT ITEMS, AS APPLICABLE

Certification Regarding Suspension or Debarment. Contractor certifies under the pains and penalties of perjury that, as of the date this SOW Agreement Amendment is signed, neither Contractor nor Contractor’s principals (officers, directors, owners, or partners) are presently debarred, suspended, proposed for debarment, declared ineligible or excluded from participation in federal programs, or programs supported in whole or in part by federal funds. Contractor further certifies under pains and penalties of perjury that, as of the date this SOW Agreement Amendment is signed, Contractor is not presently debarred, suspended, nor named on the State’s debarment list at: xxxx://xxx.xxxxxxx.xxx/purchasing/debarment. Child Support (Applicable to natural persons only; not applicable to corporations, partnerships or LLCs). Contractor certifies that it is under no obligation to pay child support or is in good standing with respect to or in full compliance with a plan to pay any and all child support payable under a support order as of the date of this amendment. REQUIRED PRIOR APPROVALS All This SOW Agreements, regardless of value, Amendment shall not be valid unless approved by the Vermont Chief Information Officer/Secretary of the Agency of Digital Services prior to execution. CIO Approval Date All This document consists of pages. Except as modified by this SOW Agreements valued at $25,000 or more per year shall be certified by the Vermont Office Amendment No. , all provisions of the Attorney General SOW Agreement remain in accordance with 3 V.S.A. § 342 prior to executionfull force and effect. Further, there shall be no limitation of liability, including a waiver of consequential, indirect, special, punitive or exemplary damages, or disclaimers of warranty without approval from the Office of the Attorney General. Certified by Date WE THE UNDERSIGNED PARTIES AGREE TO BE BOUND BY THIS AMENDMENT TO THE SOW AGREEMENT. <Insert SOW contractor Contractor Name> Signature Date STATE OF VERMONT, <Insert Requesting Agency or business unitAgency/Dept> Signature Date Attachment D3: Form SOW Amendment SOW AMENDMENT SOW-E BUSINESS ASSOCIATE AGREEMENT #_ PRE-QUALIFICATION CONTRACT # Amendment No. THIS BUSINESS ASSOCIATE AGREEMENT (“Master AgreementAGREEMENT”) It is hereby agreed by IS ENTERED INTO BY AND BETWEEN THE STATE OF VERMONT AGENCY OF HUMAN SERVICES, OPERATING BY AND THROUGH ITS [INSERT NAME OF AHS DEPARTMENT, OFFICE OR DIVISION] (“COVERED ENTITY”) AND [INSERT NAME OF CONTRACTOR/GRANTEE] (“BUSINESS ASSOCIATE”) AS OF _ (“EFFECTIVE DATE”). THIS AGREEMENT SUPPLEMENTS AND IS MADE A PART OF THE CONTRACT/GRANT TO WHICH IT IS ATTACHED. Covered Entity and between Business Associate enter into this Agreement to comply with standards promulgated under the State Health Insurance Portability and Accountability Act of Vermont1996 (“HIPAA”), AGENCY/DEPARTMENT including the Standards for the Privacy of Individually Identifiable Health Information, at 45 CFR Parts 160 and 164 (“Privacy Rule”), and the "State") Security Standards, at 45 CFR Parts 160 and CONTRACTOR NAME, with a principal place of business in CITY, STATE 164 (the "Contractor") that the above SOW Agreement between them originally dated as of SOW START DATE“Security Rule”), as amended to dateby Subtitle D of the Health Information Technology for Economic and Clinical Health Act (HITECH), (the “SOW Agreement”) is hereby amended and any associated federal rules and regulations. The parties agree as follows: REMOVE/EXPAND/REVISE THE BELOW AMENDMENT ITEMS, AS APPLICABLE:

Certification Regarding Suspension or Debarment. Contractor certifies under the pains and penalties of perjury that, as of the date this SOW Agreement Amendment is signed, neither Contractor nor Contractor’s principals (officers, directors, owners, or partners) are presently debarred, suspended, proposed for debarment, declared ineligible or excluded from participation in federal programs, or programs supported in whole or in part by federal funds. Contractor further certifies under pains and penalties of perjury that, as of the date this SOW Agreement Amendment is signed, Contractor is not presently debarred, suspended, nor named on the State’s debarment list at: xxxx://xxx.xxxxxxx.xxx/purchasing/debarment. Child Support (Applicable to natural persons only; not applicable to corporations, partnerships or LLCs). Contractor certifies that it is under no obligation to pay child support or is in good standing with respect to or in full compliance with a plan to pay any and all child support payable under a support order as of the date of this amendment. REQUIRED PRIOR APPROVALS All This SOW Agreements, regardless of value, Amendment shall not be valid unless approved by the Vermont Chief Information Officer/Secretary of the Agency of Digital Services prior to execution. CIO Approval Date All This document consists of pages. Except as modified by this SOW Agreements valued at $25,000 or more per year shall be certified by the Vermont Office Amendment No. , all provisions of the Attorney General SOW Agreement remain in accordance with 3 V.S.A. § 342 prior to executionfull force and effect. Further, there shall be no limitation of liability, including a waiver of consequential, indirect, special, punitive or exemplary damages, or disclaimers of warranty without approval from the Office of the Attorney General. Certified by Date WE THE UNDERSIGNED PARTIES AGREE TO BE BOUND BY THIS AMENDMENT TO THE SOW AGREEMENT. <Insert SOW contractor Contractor Name> Signature Date STATE OF VERMONT, <Insert Requesting Agency or business unitAgency/Dept> Signature Date Attachment D3: Form SOW Amendment SOW AMENDMENT SOW-ATTACHMENT E BUSINESS ASSOCIATE AGREEMENT #_ PRE-QUALIFICATION CONTRACT # Amendment No. (“Master Agreement”) It is hereby agreed by and between the State of Vermont, AGENCYSOV CONTRACTOR/DEPARTMENT (the "State") and CONTRACTOR NAME, with a principal place of business in CITY, STATE (the "Contractor") that the above SOW Agreement between them originally dated as of SOW START DATE, as amended to date, (the “SOW Agreement”) is hereby amended as follows: REMOVEGRANTEE/EXPAND/REVISE THE BELOW AMENDMENT ITEMS, AS APPLICABLEBUSINESS ASSOCIATE:

Certification Regarding Suspension or Debarment. Contractor certifies under the pains and penalties of perjury that, as of the date this SOW Agreement Amendment is signed, neither Contractor nor Contractor’s principals (officers, directors, owners, or partners) are presently debarred, Contract #32139 Amendment #1 suspended, proposed for debarment, declared ineligible or excluded from participation in federal programs, or programs supported in whole or in part by federal funds. Contractor further certifies under pains and penalties of perjury that, as of the date this SOW Agreement Amendment is signed, Contractor is not presently debarred, suspended, nor named on the State’s debarment list at: xxxx://xxx.xxxxxxx.xxx/purchasing/debarment. Child Support (Applicable to natural persons only; not applicable to corporations, partnerships or LLCs). Contractor certifies that it is under no obligation to pay child support or is in good standing with respect to or in full compliance with a plan to pay any and all child support payable under a support order as of the date of this amendment. REQUIRED PRIOR APPROVALS All This SOW Agreements, regardless of value, Amendment shall not be valid unless approved by the Vermont Chief Information Officer/Secretary of the Agency of Digital Services prior to execution. CIO Approval Date All This document consists of pages. Except as modified by this SOW Agreements valued at $25,000 or more per year shall be certified by the Vermont Office Amendment No. , all provisions of the Attorney General SOW Agreement remain in accordance with 3 V.S.A. § 342 prior to executionfull force and effect. Further, there shall be no limitation of liability, including a waiver of consequential, indirect, special, punitive or exemplary damages, or disclaimers of warranty without approval from the Office of the Attorney General. Certified by Date WE THE UNDERSIGNED PARTIES AGREE TO BE BOUND BY THIS AMENDMENT TO THE SOW AGREEMENT. <Insert SOW contractor Contractor Name> Signature Date STATE OF VERMONT, <Insert Requesting Agency or business unit> Signature Date Attachment D3: Form SOW Amendment SOW AMENDMENT SOW-AGREEMENT #_ PRE-QUALIFICATION CONTRACT # Amendment No. (“Master Agreement”) It is hereby agreed by and between the State of Vermont, AGENCYAgency/DEPARTMENT (the "State") and CONTRACTOR NAME, with a principal place of business in CITY, STATE (the "Contractor") that the above SOW Agreement between them originally dated as of SOW START DATE, as amended to date, (the “SOW Agreement”) is hereby amended as follows: REMOVE/EXPAND/REVISE THE BELOW AMENDMENT ITEMS, AS APPLICABLEDept>