Participation Agreement Instructions

PARTICIPATION AGREEMENT INSTRUCTIONS

The steps in the Participation Agreement process ensure that organizations are properly verified, informed and protected before joining the VCCIE.

1. Fill Out the Outside Party Information Sheet (OPIS)

The purpose of the OPIS is to confirm that your organization is eligible to enter a legal agreement with PHI and to identify the official representatives who will handle all communications. It also designates the Authorized Signer who will sign the Agreement on your behalf.

≈ 15 minutes
• Go to https://formstack.io/1DC9E and complete the form.
• Save a copy of the submitted form for your records.

When filling out the form, use the following information:

PHI Program: “Ventura County CIE”
PHI contact: Tarah Ranke
Contact email: Tranke@phi.org

The OPIS confirms your organization is allowed to enter a legal agreement with PHI. You may need to submit a new OPIS if it has been over one year since the last one or if major changes occurred, for example a change in CEO.

The OPIS gives PHI and VCCIE key details about your organization, including:

• Legal name and DBA
• Entity type
• Address
• Unique Entity Identifier if applicable
• Entity representatives
• Authorized Signer

The Authorized Signer is the person who will sign the Participation Agreement for your organization. The representatives listed on the OPIS will be the only people who receive communications from PHI about the Participation Agreement, though you may forward the information to others as needed.

2. Review the Participation Agreement

The purpose of reviewing the Participation Agreement is to give your team time to fully understand the responsibilities, data protections and expectations involved in participating in the VCCIE.

≈ 2 weeks

Download the corresponding Participation Agreement PDF below, key personnel at your organization should review the Agreement:

3. Sign the Participation Agreement

The purpose of the signing stage is to formally establish the legal relationship between your organization and PHI. This step ensures both parties have acknowledged, agreed to and documented the terms.

≈ 2–3 weeks
PHI will email the Participation Agreement to the entity representatives listed on your OPIS.

Have your Authorized Signer follow the instructions in the email to sign and return it. PHI will countersign and email back a fully executed copy — typically within two business days.

4. Submit Your Certificate of Insurance

The purpose of submitting your Certificate of Insurance is to show that your organization has the required liability coverage to participate safely. This protects both your organization and PHI, and ensures compliance with the insurance standards set for VCCIE partners.

≈ 1 week
Once the Participation Agreement is signed, send a copy of your Certificate of Insurance. Coverage should include general, professional and cyber liability (if applicable). Add Public Health Institute fbo VCCIE as an additional insured.

Coverage limits:
• Each occurrence: $1,000,000
• Products/completed operations aggregate: $2,000,000
• Personal and advertising injury: $1,000,000
• Professional liability: $1,000,000
• Cyber liability with extortion coverage: $500,000
• General aggregate: $3,000,000

PHI Additional Insured Information

Public Health Institute fbo VCCIE
555 12th Street
Suite 600
Oakland CA 94607
Attn: Tarah Ranke Tranke@phi.org