Backup Documents 02/24/2015 Item #16D1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO ki tj
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2.
3. County Attorney Office County Attorney Office ��� ,t
4. BCC Office Board of County `T
Commissioners \-' / z\- `'S S
5. Minutes and Records Clerk of Court's Office _,,-1� a ,�j `�•1err
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Trinity Scott& ssie Sillery Phone Number 252-5832&252-5840
Contact/ Department PTNE Dept. /
Agenda Date Item was 2-24-2015 Agenda Item Number - k to -\. /
Approved by the BCC !!��
Type of Document Agreement Number of Original
Attached Documents Attached
PO number or account PO#4500154126 --c, ?Vie•-'EX
number if document is -1t-- \poL,,]
to be recorded
Hope Hospice&Community Services,Inc.
Attn: Jack Strickling ,
9470 Healthpark Circle .cc— C.3*, `, c:51-X- , *K\N::
Fort Myers,Florida 33908
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is appropriate. Yes N/A(Not
(In' al Applicable)
1. Does the document require the chairman's original signature? `:AG,,,,,--p a‘‘...._,
2. Does the document need to be sent to another agency for additional signatures? If yes,provide the ( _V
Contact Information(Name;Agency;Address;Phone)on an attached sheet. / ��� N.-vs-Cc
3. Original document has been signed/initialed for legal sufficiency. (All documents to be signed by ' /
the Chairman,with the exception of most letters,must be reviewed and signed by the Office of the /
County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's Office and
all other parties except the BCC Chairman and the Clerk to the Board V
5. The Chairman's signature line date has been entered as the date of BCC approval of the document or % '
the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's signature and
initials are required. `/
7. In most cases(some contracts are an exception),the original document and this routing slip should
be provided to the County Attorney Office at the time the item is input into SIRE. Some documents
/
are time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's `p1
actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on,2/„29//Wand all changes made during the meeting /
Fill
have been incorporated in the attached document. The County Attorney's Office has reviewed
the changes,if applicable. � 1
9. Initials of attorney verifying that the attached document is the version approved by the BCC,all ��-
changes directed by the BCC have been made,and the document is ready for the Chairm ' ,
signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26. Revised 2.24.05; `vised 11/30/12
16 1
MEMORANDUM
Date: February 26, 2015
To: Trinity Scott, Public Transit Manager
Alternative Transportation Modes
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Coordination Agreement between Collier County and Hope
Hospice & Community Services, Inc.
Attached for your records is a copy of the fully executed agreement referenced above
(Item #16D1) approved by the Board of County Commissioners on February 24, 2015.
The original will be held on file with the Minutes and Record's Department for the
Board's Official Records.
If you have any questions or I can provide anything further, please feel free to call
me at 252-8411.
Thank you.
Attachment
1 6 0 1
MEMORANDUM
Date: February 26, 2015
To: Jack Strickling
Hope Hospice & Community Services, Inc.
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Coordination Agreement between Collier County and Hope
Hospice & Community Services, Inc.
Attached for your records is a copy of the fully executed agreement referenced above
(Item #16D1) approved by the Board of County Commissioners on February 24, 2015.
If you have any questions or I can provide anything further, please feel free to call
me at 252-8411.
Thank you.
Attachment
1601
fedex.com 1.800 GoFedEx 1800.463 3339
W N -+
c-, L. 1> .o
{ Lo <
Izg-1 ?.< ➢
s, zy u
' IF
S
4.:a a � aC ° � �a Im
ip.---OJ H b � m 3 y b
y = iD,.,
lrr''
1
CD
0 12
o lm 1 A=. m<
i ,
ts - :e_C. 1 -=1 ,-.12 i I ,.'"' ,!_—/. tn -
C 1 n -
D j�d I ,. ...
„_ v)03 P. ; If I 4.7'
n SO
cm c I° 1-.) g Bi
II
7 f
Z J- i_
g 0 N N
D � .F C r, g IW w
!W r
a In"� = gym ; 1
s ;5 @cob rr I ■IV 1 Qr.
44 C)0 a gg ( W
13 oi I:Ez iP ;2 v F 4,-,:.Z cy N z _` z g -^
ti iY a' 1 a k. m a w v a s+ F S4 Q
8 c e a ¢am C'a- = a 3''O m O
• g_ a 3 8 , a d5 . v'3s a
s ,a O
8 2 < i' Q ELT £om goa '
. o H
^ d y �` ',`-';'T _O __O '
R N e<
seD I
se°sue m 24,T k
Ism my, `°x O.. m
5 14
at zi"
1
1 6 ® 1
Coordination Agreement
1. Hope Hospice & Community Services, Inc., hereinafter, the "Grantee", agrees to
coordinate transportation services to children, young people, and the elderly who may
have mental or behavioral problems or who are at risk receiving services at facilities
operated by Grantee, as required by the Collier County Community Transportation
Coordinator, herein referred to as the"Coordinator."
2. Grantee will identify client transportation needs and refer those who are appropriate to
the Coordinator.
3. Grantee acknowledges that, if feasible, vehicles purchased with Federal funds shall be
made available to the Coordinator upon execution of a rate agreement between the
Coordinator and the Grantee.
4. Grantee shall maintain daily records of ridership and mileage and provide such to the
Coordinator monthly. Additional data may be required as specified in the FY Annual
Operating Report Instructions from the Commission for the Transportation
Disadvantaged.
5. Grantee has developed and implemented a system Safety Program Plan (SSPP) and
agrees to abide by said policy.
6. Grantee shall conduct a criminal background screening, pre-employment drug screening.
pre-employment physical for all drivers. Grantee will provide training to include safety,
vehicle operations, and passenger sensitivity in accordance with Florida Statutes 427.
7. Grantee agrees to submit the following items annually:
• Annual Operating Report—by July 15 (covering period of July 1 to June 30)
• Certifications of Compliance—by July 15 (covering period of July 1 to June 30)
• Federal Transit Adminsitration Drug and Alcohol Reports by February 1 (covering
period of January 1 to December 31)
• Quality Assurance Report — by February 1 (covering period of January 1 to
December 31)
8. To the maximum extent permitted by Florida law, the Grantee shall indemnify and hold
harmless Collier County, its officers and employees from any and all liabilities, damages,
losses and costs, including, but not limited to, reasonable attorneys' fees and paralegals'
fees, to the extent caused by the negligence, recklessness, or intentionally wrongful
conduct of the Grantee or anyone employed or utilized by the Grantee in the performance
of this Agreement. This indemnification obligation shall not be construed to negate,
abridge or reduce any other rights or remedies which otherwise may be available to an
1
1
LD1
indemnified party or person described in this paragraph. This section does not pertain to
any incident arising from the sole negligence of the County.
9. The Parties may provide any notices to one another as follows:
Grantee: Hope Hospice&Community Services, Inc.
Attn: Samira Beckwith
9470 Healthpark Circle
Fort Myers, Florida 33908
(855)454-3404
(Insert Contact Name,Address&Phone Number)
Coordinator: Collier County Board of County Commissioners
Attn: Trinity Scott, Public Transit Manager
3299 Tamiami Trail East
Naples,FL 34112
Tel: (239)252-5832
10. The Coordinator may cancel this Agreement without cause upon 30 days notice to the
Grantee. Otherwise, the Agreement may be terminated upon the mutual agreement of
both parties or when the vehicle operated by Grantee has reached its useful life or ceases
to be operated for the intended purpose of this Agreement,whichever is later.
IN WITNESS WHEREOF, the below parties hereto have caused this Agreement to be
executed by their appropriate officials,as of this` +\r', day ofFe , 2015.
ATTEST- BOARD OF COUNTY COMMISSIONERS
DWIGHT E. BROCK,Clerk COLLIER COUNTY, FLORIDA
c121-a .
11°)%a COLIAILM—C--- By: i� �-
Attest as to f hairtr ity Clerk TIM NANCE ,CHAIRMAN
signature only,
Approved as to form and legality:
[ Item# OD
Scott R. Teach
Deputy County Attorney Agenda
Gate ,p..1 lir
Datea .3.42 16
Recd
2
1 e
Deputy Clerk
1 6131
Hope Hospice&Community Services, Inc.
Grantee
,(
By: d � O '
�
ust Witness Signature
By: 11111 irYCk
Type/print witness name Samira Beckwith, CEO
/�
econd Witness
'1344 1. */
Type/print witness name
3