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Home My WebLink AboutePact Electronic Medical Forms Summer Camp Memorandum To: Luke Stowe, City Manager From: Audrey Thompson, Director Parks and Recreation Subject: ePact Electronic Medical Forms for Summer Camp Date: June 26, 2024 Recommended Action: Staff recommends that the City Manager approve the use of ePact to provide electronic emergency/health form services for 2024 summer camp. Funding Source: The ePACT medical/emergency forms and electronic check-in/checkout for 2024 summer camp is anticipated to cost $21,700 (at $7.00 per enrollee) for all youths and will be charged to 100.30.3005.62490 which has a YTD balance of $81,336.42 Summary: In 2018, Parks, and Recreation moved from using paper emergency/medical form for all summer camps to an electronic form system through Camp Docs. Camp Docs proved to be very useful for online medical documents but the process was very cumbersome for staff. It was determined in 2019 that ePact would be highly beneficial to the City of Evanston summer camps. ePact is the only system that integrates with RecTrac directly, eliminating a number of steps that staff had to complete to enter participants into the previous online form system. With ePact as soon as an individual is registered in RecTrac, it triggers ePact to send an email to the participant to complete their online medical/emergency forms. ePact also provides an app for staff to use during the season enabling access to required emergency information remotely and electronic check-in and check-out for campers. For 2024 summer camp the medical/emergency forms and electronic check-in/checkout anticipated expense for all youth is $21,700. The expense may change based on the number of participants enrolled in summer camps. Approved: Luke Stowe, City Manager Date Review/Approved 07 / 02 / 2024 Doc ID: ff4f29c924081696633d20883e5cd3c919b4679a SOLE SOURCE JUSTIFICATION (Requester completes Section A and B) SECTION A - SOLE SOURCE PURCHASE: Complete if sole source purchase is $1,500 or over, AND competition is not available. Sole Source approvals are valid one year from approval date, unless specified elsewhere. Requisition No. (if applicable): Amount: $21700.00 Date:5/19/2024 Supplies/Services Required (be specific): Electronic Health Form System Renewal Proposed Vendor: Epact Network Vendor No:16216 Requested by: Sean Owens Dept: Parks and Rec Ext:8066 Justification prepared by: Sean Owens Dept: Parks and Rec Ext:8066 Check One: The requested supply/service is a sole source procurement due to: AVAILABILITY/ONE OF A KIND – No competitive product exists or is available from another vendor. COMPATIBILITY – Must match existing piece or brand of equipment and is available from only one vendor. REPLACEMENT/MAINTENANCE – Repair or maintenance for specific brand of existing equipment and is available from only original equipment manufacturer or designated service dealer. OTHER - Provide below full explanations, details, complete descriptions, and relevant reasons to support the sole source justification: SECTION B - REQUESTER CERTIFICATION: By submitting this request, I certify that the above justification/information is accurate and complete to the best of my knowledge and that I have no personal interests relative to this request. Sean Owens 6/26/24 (Name and Signature of Requester) (Date) SECTION C - TO BE:COMPLETED BY PURCHASING AGENT : Based on the information provided in Section A and attached supporting documents, I concur / do not concur (see below) with purchase to be a Sole Source. Do not concur for the following reason(s): (Name and Signature of Purchasing Agent or Other) (Date) 07 / 02 / 2024 Doc ID: ff4f29c924081696633d20883e5cd3c919b4679a INVOICE To City of Evanston From ePACT Network Ltd 2100 Ridge Avenue Evanston, IL 60201 CUSTOMER NO: EP-000046 c/o BrainRunner Inc 366 Adelaide St. E #411 Toronto, ON M5A 3X9 CANADA (604)210-5070 Invoice: EP000248 GST NO: 83794 3307 RT0001 Issued: 01/12/2024 Due: 01/22/2024 Description Quantity Unit Price Amount USD ePACT Enterprise Package (Rec)3100 $7.00 $21,700.00 Subtotal $21,700.00 FREIGHT $0.00 SALES TAX $0.00 Total $21,700.00 Covers 02/01/2024 - 01/31/2025 ACH/WIRE TRANSFER DETAILS: Bank Name: TD Bank Bank Address: 4 Main Street, Essex Junction, VT 05452 ABA: 021052053 International SWIFT Code: TDOMCATTTOR US SWIFT Code: NRTHUS33XXX Favor of (“F/O”): ePACT Network Ltd. Account (“A/C”): 43795719 LOCKBOX DETAILS: ePACT Network LTD CL 200061 PO Box 1327 Williston, VT 05495-1327 Annual fees are based on the number of estimated members registered with your organization. The ePACT system will monitor the number of members loaded over the course of this year, and if the number is higher than estimated, an adjustment will be made to next year’s fees. ePACT Network reserves the right to interim bill the organization if the actual number of members exceeds the original amount billed by a value of $100 or more. Doc ID: ff4f29c924081696633d20883e5cd3c919b4679a The services outlined within this invoice are subject to the terms of use found at https://www.epactnetwork.com/corp/about-us/terms-of-use unless otherwise agreed. Privacy Policy We’ve updated our Privacy Policy (located at https://www.epactnetwork.com/corp/about-us/privacy- policy/). These updates are intended to make them easier to understand and to reflect recent changes in our policies and procedures. The links above will take you to the full text of the updated documents. One thing we’re not changing? We never sell user data to anyone, for any purpose. You don’t need to do anything to accept these changes – they will automatically become effective in thirty (30) days. Doc ID: ff4f29c924081696633d20883e5cd3c919b4679a Sole Source Agreement with ePact Electronic Medical Forms... Epact_Memo__2024.pdf ff4f29c924081696633d20883e5cd3c919b4679a MM / DD / YYYY Signed 06 / 28 / 2024 11:04:38 UTC-5 Sent for signature to Alexandra Ruggie (aruggie@cityofevanston.org) and Luke Stowe (lstowe@cityofevanston.org) from lthomas@cityofevanston.org IP: 66.158.65.76 06 / 28 / 2024 11:14:42 UTC-5 Viewed by Alexandra Ruggie (aruggie@cityofevanston.org) IP: 24.13.226.57 07 / 02 / 2024 10:25:34 UTC-5 Signed by Alexandra Ruggie (aruggie@cityofevanston.org) IP: 66.158.65.76 07 / 02 / 2024 10:34:49 UTC-5 Viewed by Luke Stowe (lstowe@cityofevanston.org) IP: 66.158.65.76 07 / 02 / 2024 10:35:10 UTC-5 Signed by Luke Stowe (lstowe@cityofevanston.org) IP: 66.158.65.76 The document has been completed.07 / 02 / 2024 10:35:10 UTC-5