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Backup Documents 02/24/2015 Item #16E2 ORIGINAL DOCUMENTS CHECKLIST&ROUTING SL L ©E V E___J TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATW 0 2 2015 COUNTY ATrOitritY P tqc ROUUN'G SLIP Risk ma Routed by Purchasing Department to the Office Initials Date Following Addressee(s)(In routing order) 1. Risk Management Risk 3/ (z ( L� 2. County Attorney Office County Attorney Office S\SVC 3. BCC Office Board of County \C b Commissioners / 313\\s 4. Minutes and Records Clerk of Court's Office 3 3 13 ° 5. Return to Procurement Services Procurement Services Department Contact: Diana DeLeon PRIMARY CONTACT INFORMATION Name of Primary Diana De Leon, February 34,2015 Phone Number 252-8375 Purchasing Staff Contact and Date Agenda Date Item was February 24,2015 ✓ Agenda Item Number 16.E.2 Approved by the BCC Type of Document Assumption Agreement Number of Original 2 Attached Documents Attached PO number or account N/A Solicitation/Contract 14-6248 Mother's number if document is NumberNendor Name Pharmacy to be recorded INSTRUCTIONS& CHECKLIST Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not appropriate. (Initial) Applicable) 1. Does the document require the chairman's original signature? DD 2. Does the document need to be sent to another agency for additional signatures? If yes, N/A provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. 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<-1)0/ by the Office of the County Attorney. 4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A Office and all other parties except the BCC Chairman and the Clerk to the Board 5. The Chairman's signature line date has been entered as the date of BCC approval of the N/A 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 DD signature and initials are required. 7. In most cases(some contracts are an exception),an electronic copy of the document and DD this routing slip should be provided to the County Attorney's Office before the item is input into SIRE. 8. The document was approved by the BCC on the date above and all changes made DD during the meeting have been incorporated in the attached document. The County Attorney's Office has reviewed the changes,if applicable. 9. Initials of attorney verifying that the attached document is the version approved by the A ite/Th BCC,all changes directed by the BCC have been made,and the document is ready for t Chairman's signature. l6E2 MEMORANDUM Date: March 4, 2015 To: Diana De Leon, Contracts Technician Purchasing Department From: Teresa Cannon, Deputy Clerk Minutes & Records Department Re: Contract #14-6248 - Assumption Agreement" Contractors: Mother's Pharmacy, Inc. Attached is an original of the contract referenced above, (Agenda Item #16E2) approved by the Board of County Commissioners on Tuesday, February 24, 2015. The second original will be held on file in the Minutes and Records Department for the Board's Official Record. If you have any questions, please contact me at 252-8411. Thank you. Attachment 16E2 $ ASSUMPTION AGREEMENT This Assumption Agreement is made and entered into as of '6{7 ru..0.3,-,( at( , 2015, by and between Mother's Pharmacy, Inc. ("Mother's") and Collier County, a political subdivision of the State of Florida ("County"). WHEREAS, on October 28, 2014 (Agenda Item 16.D.7), the County awarded a contract under Invitation to Bid (FIB) #14-6248 "Pharmacy Services" to Woolley's Pharmacy, Inc. ("Woolley's"), attached hereto as "Exhibit A", and hereinafter referred to as "Agreement"; and WHEREAS, Woolley's hereby represents to Collier County that by virtue of an asset purchase agreement Mother's is the successor in interest to Woolley's in relation to the Agreement; and WHEREAS, the parties wish to formalize Mother's assumption of rights and obligations under the Agreement effective as of the date first above written. NOW THEREFORE, IN CONSIDERATION of the mutual promises in this Assumption Agreement, and for other good and valuable consideration, the receipt and sufficiency of which are acknowledged by the parties, it is agreed as follows: 1. Mother's accepts and assumes all rights, duties, benefits, and obligations of the Contractor under the Agreement, including all existing and future obligations to pay and perform under the Agreement. 2. Mother's will promptly deliver to County evidence of insurance consistent with the Agreement. 3. Further supplements to, or modifications of, the Agreement shall be approved in writing by both parties. 4. Notice required under the Agreement to be sent to Contractor shall be directed to: CONTRACTOR: Mother's Pharmacy, Inc. 6350 Davis Blvd., Unit 1002 Naples, FL 34104 Phone: 239-732-7993; Fax: 239-732-7996 Email: Bernie(ii)MothersRX.com Attention: Bernard T. Renner 5. The County hereby consents to Mother's assumption of the Agreement in order to continue the services provided under Contract #14-6248 by virtue of the asset purchase. No waivers of performance or extensions of time to perfoim are granted or authorized. The County will treat Mother's as the Contractor for all purposes under the Agreement. [I 5-PRC-02839/1152366/1] 1 1 6 E 2 IN WITNESS WHEREOF, the undersigned have executed and delivered this Assumption Agreement effective as of the date first above written. COLLIER COUNTY: ATTEST:' *047,„ BOARD OF COUNTY COMMISSIONERS DWIGHT E. BROCK, Clerk COLLIER COUNTY, FLORIDA _ . . . , ................ B - 411 1 ttest as to m cha, ,,,,oputy Clerk Tim Nance. Chairman signature only. CONTRACTOR: Mother's Phan .cy Inc. Alliiquw— By: ...,<•-. .; Attest: r„40„. 41. Mai,/ &rnaral e-vvi et Vrcamf Print Name–Title Type/print name 4'' Approved, s 't ' and legality: It By. .A4k, Jeffrey A Klatzkow CountOorney 1 1 ,I. Apeavoem IItem# I 14:"E';' Agenda (9 Ii9l-k 1 iN / Ddte Date 5) Ili, R,s' a D,,puti C!slic ...— [15-PRC-0283911152366/1] 2 DeLeonDiana 1 6E From: bernie@mothersrx.com Sent: Friday, February 27, 2015 10:01 AM To: DeLeonDiana Cc: BrilhartBrenda Subject: RE: Amendment#1 to Contract#14-6248 Pharmacy Services No problem Diana! The addition of Collier County as certificate holder and additional insured is in process. This is not a difficult thing to do. However, I will say the interpretation of the requirement in our case is incorrect. We are not providing services to Collier County. It isn't like we are doing work for the county or that collier county entities are working on our premises like other services the county may contract. Collier County is providing payments for services of private patients. That being said, I know how cemented attorneys can be about what they believe the interpretation of the contract requirements to be, and we will provide what you request without a problem in that regard. As far as Worker's Comp goes, again the legal requirements are clear. A business with less than 4 employees does not require workers comp coverage. Please see requirement from http://www.myfloridacfo.com/division/wc/employer/coverage.htm#.VPCDc8toyls below: "Non-Construction Industry: An employer in the non-construction industry, who employs four or more part or full-time employees, must obtain workers' compensation coverage. " Therefore, I am attesting that Mother's Pharmacy does not employee the number of employees required to possess Worker's Comp coverage or an exemption. Please have your legal department contact me if they have any questions. The addition to our insurance policy is in process and will be submitted as soon as I get the policy update! Thank you, Bernie Renner Mothers Pharmacy 6350 Davis Blvd #1002 Naples, FL 34104 Phone: 239.732.7993 Cell: 469.273.0328 II MTHERJS PHARMACY1 2014 FLORIDA PROFIT CORPORATION ANNUAL REPORT FILED DOCUMENT# P13000018447 Apr 16, 2014 6E2 Entity Name: MOTHERS PHARMACY, INC. Secretary of State CC6657565237 Current Principal Place of Business: 6350 DAVIS BLVD SUITE 1002 NAPLES, FL 34104 Current Mailing Address: 6350 DAVIS BLVD SUITE 1002 NAPLES, FL 34104 US FEI Number: NOT APPLICABLE Certificate of Status Desired: No Name and Address of Current Registered Agent: RENNER,BERNARD T 6350 DAVIS BLVD UNIT 1002 NAPLES,FL 34104 US The above named entity submits this statement for the purpose of changing its registered office or registered agent,or both,in the State of Florida. SIGNATURE: BERNARD RENNER 04/16/2014 Electronic Signature of Registered Agent Date Officer/Director Detail : Title PRESIDENT Name RENNER,BERNARD T DR. Address 6350 DAVIS BLVD SUITE 1002 City-State-Zip: NAPLES FL 34104 I hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under oath;that lam an officer or director of the corporation or the receiver or trustee empowered to execute this report as required by Chapter 607,Florida Statutes;and that my name appears above,or on an attachment with all other like empowered. SIGNATURE:BERNARD RENNER PRESIDENT 04/16/2014 Electronic Signature of Signing Officer/Director Detail Date . Ph� Da�: QCK/2Ul�'162 HEALTHCARE PROVIDERS SERVICE �K, Ill-IPSO CIJA ORGANIZATION PURCHASING GROUP Certificate of . ��J�� n,.,*== .^..�"°,^■NA�^, .°' OC[ UREWCEPDL|CYFORk Producer Branch Prefix Policy Number Policy Period 018090 970 HPG 0615324476 from 8g/12/14tuOg/12/15at12:O1AM Standard Time Named Insured and Address: Program Administered b Mother's Pharmacy Inc. Healthcare Providers Servi e Organization 6350 Davis Blvd 159 E County Line Road Naples, FL 34104'5323 Hatboro, PA 19040-1218 1'888'288'3534 wvmw.hpsocom Medical Specialty: Code: Insurance is provided by: Pharmacist Firm 69112 American Casualty Company of Reading, Pennsylvania 333S Wabash Aveoue' Chicago, IL 60604 Exc|udeo��osm��icPnucedures Professional Liability $l.O0U.V0O each claim $3.008.UOO aggregate Your professional liabilit limits shown above include the following: • Good Samaritan Liability • k8a|p(acementUabHity • Personal Injury Liability * Sexual Misconduct Included in the PL limit shown above subject to$26.0OO aggregate subhmit Coverage Extensions License Protection S25.0OD per proceeding S 25.000 aggregate Defendant Expense Benefit S1.8OO per da limit S25.0OO aggregate Deposition Representation S1D.0O0 per deposition S10.UOO aggregate Aosaul 825.OQO per incident $ 25,OOD aggregate Includes Workplace Violence Counseling Medical Payments S25.0OO per person G100UOO aggregate First Aid S 10,000 per incident $ 10,000 aggregate Damage to Property of Others S10'08O per incident $ 10\000 aggregate lnformaton Privacy(HIPAA) Fines and Penalties S25.0OO per incident S25.UOO aggregate $150,000 Total: $ 1.061.00 Base Premium $ 2068.00 Policy Forms& Endorsements(Please see attached list for a general description of many common policy forms and endorsements.) G-121508D G3O412FL G-121801'C GSL15563 GSL15564 GSL15555 GSL171O1 GSL13424 GSL13425 G-123848'O08 GSL19904 Keep this document in a safe place it Vueryie.4.4` _ ' - ~\f,- ' « «\ /k' coonvuops �/o/�pe�my m�onootac,mevye,oauyrep'�s'u�fo�y e unless the pr*v�n �p�um full order r to activate your coverage p�anwrem�Chairman ofthe Board Secretary premium in full by the effective date of this Certificate of Insurance Master Policy 11423 G-141241-B(03/2010) Coverage Change Date, Endorsement Change Date: Feb 27 2015 10:06AM page 2 1 6 ('//�)-4,4„......,. "„..." D. MlIIISU/YYYY) CERTIFICATE OF LIABILITY INSURANCE R045 12/26/2015 THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.This CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the poiicy(Ies)must be endorsed. If SUBROGATIONIS WAIVED,subject to the terns and conditions of the policy,certain policies may require an endorsement..A statement on this certificate does not confer rights to the certificate holder In Hsu of such endorsement(s). PRODUCER- CONTACT NAME AFFINITY INS SERVICES INC/PHS PHONE t .No,Eel. (866) 467- 8730 wc,No): (B00) 308-5459 320229 P: (866) 467-8730 F: (800) 308-5459 =t8: 301 WOODS PARK DRIVE INSURER(S)AFFORDING COVERAGE MICA CLINTON NY 13323 eeJ A: Sentinel Ins Co LTD INSURED' - INSURER S: INSURER C: MOTHER'S PHARMACY INC INSURER O: 6350 DAVIS BLVD INSURERE: NAPLES FL 34104 EEURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS . CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ANSE TYPCOF INSURANCE' ADAM straw -PDLKCNUIMBER POLICE'EPP POLICY ESP ATE JOg W _WU/WITTY) , ari inDTWO LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,0 0 0,0 0 0 DAMAGE TO CLAIMS-MADE 7..... PREMISES(EaEoccu occurrence] $1,0 0 0,0 0 0 A X General Liab X 39 sT3M UL6561 01/15/2015 01/15/2016 MEDEXP{Anyone person) slO, 000 — PERSONAL 3 ADV INJURY $2,000,000 GEN1 AGGREG TE LIMIT PRO-APPLIES PER GENERAL AGGREGATE $4,000 r 0 00 POLICY J ECT © LOC PRODUCTS-COMP/OP AGO y 4 0 0 0 0 0 0 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT .--, jEs ecddent) S ANY AUTO BODILY INJURY(Per person) $ 1— ALL OWNED —SCHEDULED — �_ AUTOS ^_ AUTOS BOOILYINJURY(Peraetldsnt] g HIRER AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $1,000, 000 A ECESSLIAB CLAIMS-MADE 39 SEM UL6561 01/_5/2015 01/15/2016 AGGREGATE $1, 000, 000 DES1 X IRETENIONT 1O,0 D C S ROOM COMPENSAT1ON IPAT UTE J 10T- ' ............ ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT S OFFICERIMEMBER EXCLUDED? Li(Mandato+y In NW EL`y EL DISEASE-EA EMPLOYEE $ If yes,describe under —S DESCRIPTION OF OPERATIONS below EL DISEASE-POLICYLIMIT IESCRIPTTOArOF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Add'AbnaI RsmsrW Schedulb may be attached Minors space Is regained) Chose usual to the Insured's Operations. Certificate Holder is an Additional Ensured per the Business Liability Coverage Form SS0008 attached to this policy. CERTIFICATE HOLDER CANCELLATION • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Collier County Government BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Purchasing Department AUTHOFUZEDREPRE$ENTAT(VE 3327 TAMTAMI TRL E 70 � -* a-e-4 . ', J NAPLES, FL 34112 / "� �" . ©1988-2014 ACORD CORPORATION.All rights reserved. ;CORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 1 6 E 2 Exhibit A AGREEMENT 14-6248 for Pharmacy Services THIS AGREEMENT, made and entered into on this ,Z431 day of Cfo b<.r 2014, by and between Woolley's Pharmacy, Inc., authorized to do business in the State of Florida,whose business address is 6350 Davis Blvd., Naples, Florida 34104, (the"Contractor") and Collier County, a political subdivision of the State of Florida, (the"County"): WITNESSETH: 1. COMMENCEMENT. This Agreement shall commence on Date of Board award. 2. CONTRACT TERM. The Contract shall be for a two (2) year period, commencing on date of Board award and terminating two (years) from that date. The County may, at its discretion and with the consent of the Contractor, renew the Agreement under all of the terms and conditions contained in this Agreement for one(1)additional two(2)year period.The County shall give the Contractor written notice of the County's intention to renew the Agreement term not less than ten(10) days prior to the end of the Agreement term then in effect. The County Manager, or his designee,may,at his discretion,extend the Agreement under all of the terms and conditions contained in this Agreement for up to ninety (90) days. The County Manager, or his designee, shall give the Contractor written notice of the County's intention to extend the Agreement term not less than ten (10) days prior to the end of the Agreement term then in effect. 3. STATEMENT OF WORK. The Contractor shall provide Pharmacy Services as provided in Exhibit A - "Scope of Work," which is hereby incorporated by reference,in accordance with the terms and conditions of ITB#14-6248 and the Contractor's proposal referred to herein and made an integral part of this Agreement. County residents utilizing this contract may acquire services from either awarded Pharmacy based on convenience to their health care facility and residence. This Agreement contains the entire understanding between the parties and any modifications to this Agreement shall be mutually agreed upon in writing by the Contractor and the County Project or Contract Manager or his designee, in compliance with the County Purchasing Ordinance and Purchasing Procedures in effect at the time such services are authorized. 4. COMPENSATION. The County shall pay the Contractor for the performance of this Agreement as set forth in Exhibit B"Cost Schedule",attached to and made an integral part of this Agreement. Any item that is not included in Exhibit B"Cost Schedule" as of the effective date of this Agreement,hereinafter"Unlisted Items",shall be available for purchase when it is added to an updated list by the Contractor, and provided to the County.The Contractor may add any Unlisted Items in order to accommodate future purchases by the County. When an Unlisted Item is added to an updated list,the pricing shall be in accordance with the terms of this Agreement. (f i CA 16E2 Any County agency may purchase products and services under this contract, provided sufficient funds are included in their budget(s). Payment will be made upon receipt of a proper invoice and upon approval by the Project Manager or designee,and in compliance with Chapter 218,Fla.Stats.,otherwise known as the "Local Government Prompt Payment Act". 4.1 Payments will be made for services furnished, delivered, and accepted, upon receipt and approval of invoices submitted on the date of services or within six (6) months after completion of contract. Any untimely submission of invoices beyond the specified deadline period is subject to non-payment under the legal doctrine of "laches" as untimely submitted. Time shall be deemed of the essence with respect to the timely submission of invoices under this agreement. 4.2 The Average Wholesale Price(AWP)list will be provided with itemized invoice by the Contractor on a monthly basis. 4.3 Maximum Allowable Cost(MAC) List. If at any time after the award of this contract, the cost of the listed generic drugs have increased and exceeded the fixed price listed in Exhibit B-1, the Contractor may submit in writing, along with back-up documentation, a request for an increase or removal of item(s) from the list (MAC). The County's Project Manager,or designee,will determine if a request for cost increase is acceptable. If price increase is accepted, the item will then be invoiced per the Average Wholesale Price(AWP)markup as provided in Exhibit B-1,attached hereto. 5. SALES TAX. Contractor shall pay all sales, consumer, use and other similar taxes associated with the Work or portions thereof, which are applicable during the performance of the Work. Collier County, Florida as a political subdivision of the State of Florida, is exempt from the payment of Florida sales tax to its vendors under Chapter 212, Florida Statutes, Certificate of Exemption#85-8015966531C-2. 6. NOTICES. All notices from the County to the Contractor shall be deemed duly served if mailed or faxed to the Contractor at the following Address: Woolley's Pharmacy,Inc. 6350 Davis Blvd. Naples,FL 34104 Attention:Matthew Cainmuso Telephone:239-775-9908 Facsimile:239-775-2094 All Notices from the Contractor to the County shall be deemed duly served if mailed or faxed to the County to: Collier County Government Center Purchasing Department 3327 Tamiami Trail,East Naples,Florida 34112 Attention:Joanne Markiewicz,Director,Procurement Services Telephone: 239-252-8907 Facsimile: 239-252-6480 2 16E2 The Contractor and the County may change the above mailing address at any time upon giving the other party written notification. All notices under this Agreement must be in writing. 7. NO PARTNERSHIP. Nothing herein contained shall create or be construed as creating a partnership between the County and the Contractor or to constitute the Contractor as an agent of the County. 8. PERMITS: LICENSES: TAXES. In compliance with Section 218.80, FS., all permits necessary for the prosecution of the Work shall be obtained by the Contractor.The County will not be obligated to pay for any permits obtained by Subcontractors/Subconsultants. Payment for all such permits issued by the County shall be processed internally by the County. All non-County permits necessary for the prosecution of the Work shall be procured and paid for by the Contractor. The Contractor shall also be solely responsible for payment of any and all taxes levied on the Contractor. In addition, the Contractor shall comply with all rules,regulations and laws of Collier County,the State of Florida,or the U.S.Government now in force or hereafter adopted. The Contractor agrees to comply with all laws governing the responsibility of an employer with respect to persons employed by the Contractor. 9. NO IMPROPER USE. The Contractor will not use,nor suffer or permit any person to use in any manner whatsoever, County facilities for any improper, immoral or offensive purpose, or for any purpose in violation of any federal, state, county or municipal ordinance, rule, order or regulation, or of any governmental rule or regulation now in effect or hereafter enacted or adopted. In the event of such violation by the Contractor or if the County or its authorized representative shall deem any conduct on the part of the Contractor to be objectionable or improper,the County shall have the right to suspend the contract of the Contractor. Should the Contractor fail to correct any such violation, conduct, or practice to the satisfaction of the County within twenty-four (24) hours after receiving notice of such violation, conduct, or practice, such suspension to continue until the violation is cured. The Contractor further agrees not to commence operation during the suspension period until the violation has been corrected to the satisfaction of the County. 10. TERMINATION. Should the Contractor be found to have failed to perform his services in a manner satisfactory to the County as per this Agreement, the County may terminate said agreement for cause; further the County may terminate this Agreement for convenience with a ten (10) day written notice. The County shall be sole judge of non- performance. In the event that the County terminates this Agreement,Contractor's recovery against the County shall be limited to that portion of the Contract Amount earned through the date of termination. The Contractor shall not be entitled to any other or further recovery against the County, including, but not limited to, any damages or any anticipated profit on portions of the services not performed. 11. NO DISCRIMINATION. The Contractor agrees that there shall be no discrimination as to race,sex,color,creed or national origin. 3 �..J 16E2 12. INSURANCE. The Contractor shall provide insurance as follows: A. Commercial General Liability: Coverage shall have minimum limits of $2,000,000 Per Occurrence, $2,000,000 aggregate for Bodily Injury Liability and Property Damage Liability. This shall include Premises and Operations; Independent Contractors;Products and Completed Operations and Contractual Liability. Workers' Compensation: Insurance covering all, employees meeting Statutory Limits in compliance with the applicable state and federal laws. The coverage must include Employers'Liability with a minimum limit of$500,000 for each accident. C. Professional Liability: Shall be maintained by the Contractor to ensure its legal liability for claims arising out of the performance of professional services under this Agreement. Contractor waives its right of recovery against County as to any claims under this insurance. Such insurance shall have limits of not less than $1,000,000 each claim and in the aggregate. Special Requirements: Collier County Government shall be listed as the Certificate Holder and included as an Additional Insured on the Comprehensive General Liability Policy. Current, valid insurance policies meeting the requirement herein identified shall be maintained by Contractor during the duration of this Agreement. The Contractor shall provide County with certificates of insurance meeting the required insurance provisions. Renewal certificates shall be sent to the County ten(10) days prior to any expiration date. Coverage afforded under the policies will not be canceled or allowed to expire until the greater of: ten (10) days prior written notice, or in accordance with policy provisions. Contractor shall also notify County, in a like manner,within twenty-four (24) hours after receipt, of any notices of expiration, cancellation, non-renewal or material change in coverage or limits received by Consultant from its insurer, and nothing contained herein shall relieve Contractor of this requirement to provide notice. Contractor shall ensure that all subcontractors/Consultants comply with the same insurance requirements as the awarded firm. 13. INDEMNIFICATION. To the maximum extent permitted by Florida law, the Contractor 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, whether resulting from any claimed breach of this Agreement by Contractor, any statutory or regulatory violations, or from personal injury, property damage,direct or consequential damages,or economic loss,to the extent caused by the negligence, recklessness, or intentionally wrongful conduct of the Contractor or anyone employed or utilized by the Contractor 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 indemnified party or person described in this paragraph. This section does not pertain to any incident arising from the sole negligence of Collier County. 13.1 The duty to defend under this Article 13 is independent and separate from the a./ duty to indemnify,and the duty to defend exists regardless of any ultimate liability of the 4 CA Z ' Contractor, County and any indemnified party. The duty to defend arises immediately upon presentation of a claim by any party and written notice of such claim being provided to Contractor. Contractor's obligation to indemnify and defend under this Article 13 will survive the expiration or earlier termination of this Agreement until it is determined by final judgment that an action against the County or an indemnified party for the matter indemnified hereunder is fully and finally barred by the applicable statute of limitations. 14. CONTRACT ADMINISTRATION. This Agreement shall be administered on behalf of the County by the Department of Housing, Human and Veteran Services/Social Services Program. 15. CONFLICT OF INTEREST: Contractor represents that it presently has no interest and shall acquire no interest, either direct or indirect, which would conflict in any manner with the performance of services required hereunder. Contractor further represents that no persons having any such interest shall be employed to perform those services. 16. COMPONENT PARTS OF THIS CONTRACT. This Contract consists of the following component parts, all of which are as fully a part of the contract as if herein set out verbatim: Exhibit A - "Scope of Work," Exhibit B - "Cost Proposal," Exhibit C - "Supplemental General Grant Terms and Conditions,"and Insurance Certificate(s). 17. SUBJECT TO APPROPRIATION. It is further understood and agreed by and between the parties herein that this agreement is subject to appropriation by the Board of County Commissioners. 18. PROHIBITION OF GIFTS TO COUNTY EMPLOYEES. No organization or individual shall offer or give, either directly or indirectly, any favor, gift, loan, fee, service or other item of value to any County employee, as set forth in Chapter 112, Part III, Florida Statutes, Collier County Ethics Ordinance No. 2004-05, as amended, and County Administrative Procedure 5311. Violation of this provision may result in one or more of the following consequences: a. Prohibition by the individual, firm, and/or any employee of the firm from contact with County staff for a specified period of time;b.Prohibition by the individual and/or firm from doing business with the County for a specified period of time,including but not limited to:submitting bids,RFP,and/or quotes;and,c.immediate termination of any contract held by the individual and/or firm for cause. 19. IMMIGRATION LAW COMPLIANCE. By executing and entering into this agreement, the Contractor is formally acknowledging without exception or stipulation that it agrees to comply, at its own expense, with all federal, state and local laws, codes, statutes, ordinances, rules, regulations and requirements applicable to this Agreement, including but not limited to those dealing with the Immigration Reform and Control Act of 1986 as located at 8 U.S.C. 1324, et seq. and regulations relating thereto, as either may be amended; taxation,workers' compensation,equal employment and safety (including,but not limited to,the Trench Safety Act,Chapter 553,Florida Statutes),and the Florida Public Records Law Chapter 119 (including specifically those contractual requirements at F.S. § 119.0701(2)(a)-(d) and (3))). If Contractor observes that the Contract Documents are at variance therewith, it shall promptly notify the County in writing. Failure by the Contractor to comply with the laws referenced herein shall constitute a breach of this agreement and the County shall have the discretion to unilaterally terminate this agreement immediately. 5 cro 16E2 20. AGREEMENT TERMS. If any portion of this Agreement is held to be void, invalid, or otherwise unenforceable, in whole or in part, the remaining portion of this Agreement shall remain in effect. 21. ADDITIONAL ITEMS/SERVICES. Additional items and/or services may be added to this Agreement in accordance with the Purchasing Ordinance and Purchasing Procedures 22. DISPUTE RESOLUTION. Prior to the initiation of any action or proceeding permitted by this Agreement to resolve disputes between the parties,the parties shall make a good faith effort to resolve any such disputes by negotiation. The negotiation shall be attended by representatives of Contractor with full decision-making authority and by County's staff person who would make the presentation of any settlement reached during negotiations to County for approval. Failing resolution,and prior to the commencement of depositions in any litigation between the parties arising out of this Agreement, the parties shall attempt to resolve the dispute through Mediation before an agreed-upon Circuit Court Mediator certified by the State of Florida. The mediation shall be attended by representatives of Contractor with full decision-making authority and by County's staff person who would make the presentation of any settlement reached at mediation to County's board for approval. Should either party fail to submit to mediation as required hereunder, the other party may obtain a court order requiring mediation under section 44.102,Fla.Stet. 23. VENUE. Any suit or action brought by either party to this Agreement against the other party relating to or arising out of this Agreement must be brought in the appropriate federal or state courts in Collier County, Florida, which courts have sole and exclusive jurisdiction on all such matters. 24. CONTRACT STAFFING. The Contractor's personnel and management to be utilized for this project shall be knowledgeable in their areas of expertise. The County reserves the right to perform investigations as may be deemed necessary to ensure that competent persons will be utilized in the performance of the contract.The Contractor shall assign as many people as necessary to complete the required services on a timely basis, and each person assigned shall be available for an amount of time adequate to meet the required service delivery dates. 25. ORDER OF PRECEDENCE. In the event of any conflict between or among the terms of any of the Contract Documents,the terms of the Agreement shall take precedence over the terms of all other Contract Documents,except the terms of any Supplemental Conditions shall take precedence over the Agreement. To the extent any conflict in the terms of the Contract Documents cannot be resolved by application of the Supplemental Conditions,if any, or the Agreement, the conflict shall be resolved by imposing the more strict or costly obligation under the Contract Documents upon the Contractor at County's discretion. 26. ASSIGNMENT: Contractor shall not assign this Agreement or any part thereof, without the prior consent in writing of the County. Any attempt to assign or otherwise transfer this Agreement or any part herein, without the County's consent, shall be void. If Contractor does,with approval, assign this Agreement or any part thereof,it shall require that its assignee be bound to it and to assume toward Contractor all of the obligations and responsibilities that Contractor has assumed toward the County. 0/7' 6 CI) __ _ 16E2 IN WITNESS WHEREOF,the parties hereto,have each,respectively,by an authorized person or agent,have executed this Agreement on the date and year first written above. BOARD OF COUNTY COMMISSIONERS ATTEST: COLLIER COUNTY,FLORIDA Dwight E.Brock,Clerk of Courts / By: 4 t �' .,:?!j 0 s : . ,/ Iii . ` Tom Henning, .irman Dated i ego r sy is avian signature,016? Woolley's Pharmacy,Inc. t` ' ° -,,, Contractor ,,,,IIII .. .-1 ; �� B B . ,+ 2- --a----.. First Witness :ignature O P k ;24,.befb, c - Po,.1/4)1 'cvv-nly\v 3C) i 0 L t1e t' TType p 'nt wit, namer TType/print signature and titlet Second Witness -7 (/i f� �, Tt lr..�uti.. �3 L f ar t -i..Le `� .." / /19,4/ TType/print witness nameT v�ROTARY PUBLIC-STATE OF FLORIDA esiiiiti missio.h#EE085897 Expires, APR,20,2015 8%„„„„, ONDF.D M HZ C ATL A\TIC"_2CVDIYG CO,MC. ef-if A pproved as to Form and Legality: e.," -% CO ' sistant = ntyt omey rint Name tte 14-6248"Pharmacy Services" EXHIBIT A "SCOPE OF WORK" 1 6 E 1. Each of the Contracted pharmacists must possess a current license from the Florida State Board of Pharmacy in accordance with Revised Statutes of the State of Florida, and shall maintain said license in good standing for the duration of the contract. 2. The Contractor must be able to fill outpatient prescriptions as needed each day for the duration of the contract within the normal work hours of 8:30 am to 5:00 pm,M-F. 3. The Contractor shall provide at no additional cost to the County, pharmacy services at locations in areas which are not evacuated during a disaster, and be prepared to accept telephonic requests from the County Emergency Operations Center and fill such requests. Collier County Housing, Human and Veteran Services Department/Social Services Program will be responsible for the pick-up and delivery of any such prescriptions. 4. The Contractor shall be able to provide Generic equivalent drugs when one is available to fill the prescriptions.Prescriptions are limited to a 30-day supply. 5. The Contractor shall provide electronic transfer of invoices (billing) to a designated email address at least monthly per Clerk of Court's Finance standards. Such electronic data transfer capability shall be operational at contract start-up and the first billing shall be forthcoming within four(4)weeks after start up of contract.The Contractor shall provide a contact name and phone number for technical assistance when file format problems arise. 6. All of the Contractor's pharmacy locations shall be connected on a common network using the same database in order to monitor patient information and manage the formulary. In addition, all locations must be connected to the central system that contains client information. All clients will be given a voucher to provide to the pharmacy. Any physician can write a prescription; this includes Primary Care, specialists, emergency room physicians, dentists, etc. Collier County Housing and Human Services/Social Services will not pay for prescriptions if the client does not present a voucher which shows a valid begin and end date of eligibility. 7. Under the Health Insurance Portability and Accountability Act (HIPAA) of 1996, Contractor is expected to adhere to the same standards as the County and other HIPAA covered entities regarding the protection and non- authorized disclosure of Protected Health Information (PHI). The Contractor shall use File Transfer Protocol (FTP), or other HIPAA compliant compatible programs to transfer encrypted client information (automatically) to pharmacy database at least twice daily, without breaking security; full file transfer shall be done weekly.Contractor must comply with HIPAA 834 file format. 8. It is highly desirable that the Contract Manager be a pharmacist. 9. The Contractor shall identify rebates that are forthcoming and any savings realized from manufacturer's rebates shall be credit against the County's monthly invoice. A-I 16E2 , 10. Payments shall be made in accordance with the Local Government Prompt Payment Act from a joint revolving account for the payment of services provided. 11. The Contractor shall fill all medications to patients for self-administration in accordance with all applicable Federal,State and Local laws. 12. The Contractor shall update and make readily retrievable at any time, all outpatient and drug data within the outpatient profile as each prescription is filled or refilled. The contractor shall automatically monitor drug allergies and interactions according to data available for each patient 13. The Contractor shall provide monthly Utilization and Administrative reports including number of prescriptions filled, covered individuals, utilizing individuals including physician dispensing profiles and other reports. 14. The Contractor must immediately advise the County whenever abuse, drug seeking or fraudulent behavior is suspected. 15. The Contractor shall provide to the County any manufacturer's no cost, discounted or promotional health care items, which may be provided to them during the period of the contract. 16. The Contractor shall be available for periodic site visits by Collier County staff, to any of their locations,in order to monitor the quality of services provided. 17. The Contractor must respond within twenty-four (24) hours in writing via fax, email or letter, to all questions presented by the Collier County Housing, Human and Veteran Services Department. 18. The Contractor shall provide outpatient-packaging materials, including labeling, that meets all applicable laws and regulations. Labeling for outpatient packaging shall include: a. Patient Name b. Date of Dispensing c. Prescription Number d. Physician's Name e. Instructions for Patient Use f. Name and Strength of Drug g. Number of Doses Dispensed 19. The contractor shall maintain all outpatient drug profiles on a computerized dispersing system.Each outpatient drug profile must include: a. Patient Name b. Address/ Phone d. Birth Date/Social Security Number e. Sex f. Allergies g. Prescription Number Drug data within each outpatient drug profile must include: a. Drug Name 2 �y 16E2H b. Drug Strengths c. Amount Ordered d. Amount Dispensed e. Instructions for Use f. Refills Authorized g. Physician Information h. Times and Dates Filled Electronic invoice data must include,but may not be limited to: a. Patient's Identification Number assigned by HHVS b. Control# c. Medication name d. Strength e. Quantity f. Date Filled (MM/DD/YY) g. Generic h. Retail Price i. Cost j. Total Price Due 3 C� . 16 ` 2 14-6248"Pharmacy Services" EXHIBIT B "COST SCHEDULE" 1. The following generic drugs will be offered at $4.00 per 30 day dose (See attached list following this page,as Exhibit B-1). 2. All Drugs not listed on Exhibit B-1 shall be priced according to the following formulas based on McKesson Average Wholesale Price(AWP): Brand Name Medications: AWP minus 7.5% (-7.5%) Generic Medication: AWP minus 12.5% (-12.5%) B-] cq EXHIBIT B-1 1 2 f 'etaiI �rescri 3tion Program Drug List Revised 9/5/2014 k ,,, .. 1,;1 'r' 1, .....ill1: .t I " .3'.3.31 nartcornlpl„i,mary 1 t i ter 4�30-ray 310,90-tlay Allergies&Cold and Flu Arthritis&Pain Benzonatate 100mg cap 14 . 42 Ailopurinol 100mg tab 30 90 Loratadine 10mg tab 30 90 Allopurinol 300mg tab 30 90 Promethazine DM syrup 120m1. 360m1 Baclofen 10mg tab" 30 90 Cyciobenzaprine 5mg tab 30 90 Antibiotic Treatments Cyclobenzaprine 10mg tab 30 90 Amoxicillin 125mg/5m!susp(80m!bottle)* 1 3 Dexamethasone 0Smg tab 30 90 Amoxicillin 125mg/5mI susp(100m1 bottle)' 1 3 Dexamethasone 0.75mg tab 12 36 Amoxicillin 125mg/5ml susp(150m1 bottle)' 1 3 Dexamethasone 4mg tab 6 18 Amoxicillin 200mg/5m1 susp(50m1 bottle)* 1 3 Diclofenac DR 75mg tab" 60 180 Amoxicillin 200mg/5m1 susp'(7Sml bottle)+ 1 . . .3 Ibuprofen 100mg/5m1 susp' 120m1. .. .360m1 Amoxicillin 200mg/5m1 susp'(100m1 bottle)' 1 , . . 3 ibuprofen 400mg tab 90 .270 Amoxicillin 250mg/5ml susp(80m1 bottle)' 1 3 Ibuprofen 600mg tab' 60 • 180 Amoxicillin 250mg/5ml susp(100m1 bottle)' 1 3 Ibuprofen 800mg tab 30 90 Amoxicillin 250mg/Sml susp(150m1 bottle)' 1 3 Indomethacin 25mg cap' 60 180 Amoxicillin 400mg/5ml susp(50mI bottle)+ 1 . . . 3 Meloxicam 7.5mg tab 30 90 Amoxicillin 400mg/Sm1 susp'(75m1 bottle)' 1 3 Meloxicam 15mg tab 30 90 Amoxicillin 400mg/5m1 susp'(100m1 bottle)' 1 . . . 3 Naproxen 375mg tab' 60 180 Amoxicillin 250mg cap 30 . . . 90 Naproxen 500mg tab' 60 180 Amoxicillin 500mg cap 30 90 Cephalexin 250mg cap 28 84 Asthma Cephalexin 500mg cap 30 90 Albuterol 2mg tab 90 270 Ciprofloxacin 250mg tab 14 42 Albuterol 4mg tab 60 180 Clprofloxadn 500mg tab 20 60 Albuterol 2mg/5ml syrup 120m1 . . .360m1 Penicillin VK 250mg tab 28 84 Albuterol 0.083%nebulizer soln' (25x3m1 vials)' 1 3 Penicillin VK 125mg/5m1 susp(100m1 bottle)' 1 3 '9/30-day Penicillin VK 125mg/5mI susp(200m1 bottle)' 1 3 1 Albuterol 05%:nebuilzers4ln';(20m1bottle)'. . .. . .,r.;1 Penicillin VK 250mg/5m1 susp(100m1 bottle)' 1 , 3 Ipratroplum 0.02%nebulizer soln'(25x2Sm1 vials)' .1 3 SMZ-TMP 400mg-80mg tab 28 , . . 84 SMZ-TMP DS 800mg-160mg tab 20 60 • • Prescription Program includes up to a 30-day supply for$4 and a 90-day supply for$10 of lam.covered generic drugs at commonly prescribed dos ages.Higher dosages cost more.Prices for some drugs covered by the Presniptlon Program may be higher and may vary In same states.Restrictions apply.See Program Details or your Wyman Pharmacist for details.Free language assistance services available for prescription drug Information at Waimart and Sams Club pharmacies in New York.Contact your Walmart or Sam's Club pharmacy for details. Revised 9/5/2014 •Prices may be higher In CA HI,MN,MT,PA.TN and Vet ••Home Delivery Service Is not available through SamsClub.can. 'Prepackaged drugs are covered only In unit sizes specified on Drug List.See Program Details or your Walmart Pharmacist for details. 0.-/// Walmart`'' ), SuIN 021)14 Wal-Mart Stores,tnc.)Paget of 5 sava....asr.tvrw. �ti�4 e,, 16E2 . . . $4.30-day $10,90-day 44,30-day $10,90-day Cholesterol Ranitidine 300mg tab 30 90 Lovastatin 10mg tab 30 90 Lovastatin 20mg tab* 30 90 Glaucoma&Eye Care Atropine Sulfate 1%op.sole"(5m1 bottle)/ 1 3 Diabetes Erythromycin op.ointment(3.5gm tube)** 1 3 Glimepiride 1 mg tab 30 90 Gentak 0.3%op.soin 5 15 Glimepiride 2mg tab 30 90 Gentamicin 0.3%op.soin(5m1 bottle)/ 1 3 Glimepiride 4mg tab 30 90 Levobunolol 05%op soin(5m1 bottle)/ 1 3 Glipizide 5mg tab 3090 Neomycin/Polymyxin/Dexamethasone Glipizide 10mg tab* 60 180 0.1%op.ointment*(3.5gm tube)/ 1 • 3 Glyburlde 2.5mg tab 30 90 Neomycin/Polymyxin/Dexamethasone Glybu ride Smg tab(blue) 30 90 0.1%op.susp*(5m1 bottle)* 1 3 Glyburide 5mg tab(green) 30 90 Pilocarpine 1%op.soin*(15m1 bottle)' 1 3 Glyburide,micronized 3mg tab 30 90 Pilocarpine 2%op.sale*(15m1 bottle)/ 1 3 Glyburide,micronized 6mg tab 30 90 Polymyxin Sulfate/TMP op.soin*(10mi bottle)/. . . . 1. . . . . . . 3 Metformin 500mg tab 60 180 Sulfacet Sodium 10%op.soin*(15m1 bottle)/ 1 3 Metformin 850mg tab 60 180 Timolol Maleate 0.25%op.sole(5m1 bottle)/ 1 3 Metformin 1000mg tab* 60 180 Timolol Maleate 0.5%op soin(5ml bottle)/ 1 3 Metformin 500mg ER tab* 60 180 Tobramycin 0.3%op.soin(Sml bottle)/ 1 3 Ear Health Heart Health&Blood Pressure Antipyrine/Benzocaine otic*(15ml bottler 1 3 Atenolol-Chiorthalidone 100mg 30 90 Atenolol 25mg tab 30 90 Fungal Infections Atenolol 50mg tab 30 90 Fluconazole 150mg tab 1 3 Atenolol 100mg tab 30 90 Nystatin cream*(15gm tube)/ 1 3 Benazepril 5mg tab 30 90 Nystatin cream*(30gm tube)' 1 3 Benazepril 10mg tab 30 90 Terbinafine 250mg tab* 30 90' Benazepril 20mg tab 30 ' 90 Benazepril 40mg tab 30 90 Gastrointestinal Health Bisoprolol-HCTZ 2.5mg-6.25mg tab 30 90 Cimetidine 800mg tab* 30 90 Bisoprolol-HCTZ 5mg-6.25mg tab 30 90 Cytra2 solution 180m1. . . .540m1 Bisoprolol-HCTZ 10mg-6.25mg tab 30 90 Dicyctomine 10mg cap 270 Carvedilol 3.125mg tab 60 . . .180 Dtcydomine 20mg tab 60 180 Carvedilol 6.25mg tab 60 180 Famotidine 20mg tab 60 180 Carvedilol 12.5mg tab 60 180 Lactulose syrup* 236m1. . . .708m1 Carvedilol 25mg tab 60 .180 Metoclopramide 10mg tab 60 180 Clonldine 0.1 mg tab 30 90 Metoclopramide syrup 60m1. . . .180ml Cianidine 02mg tab 30 90 Promethazine 25mg tab* 12 34 Enalaprit-HCTZ 5mg-12.5mg tab* 30 90 Promethazine plain syrup* 180m1. . . .540m1 Enalapfi{2.5mg tab 30 90 Ranitidine 150mg tab 60 180 Enatapril 5mg tab 30 90 Prescrlptlon Program Includes up to a XI-day supply for S4 and a 90-day supply for S10 of some covered generic drugs at commonly prescribed dosages.Higher dosages cost more.Prices for some drugs covered by the Prescription Program may be higher and may vary In some states.Restrictions apply.See Program Details or your Willman Pharmacist for details.Free language assistance services available for prescription drug Information at'Reiman and Sam's Club pharmacies in New York.Contact your Walmart or Samk Club pharmacyfor details. Revised 9/5/2014 •Prices may be higher in CA.HI,MN,MT.PA,TN and WI. ••Home Delivery Service is not available through SamsClub,cosr 'Prepackaged drugs are covered only In unit sizes specified on Drug list.See Program Details or your Wilmot Pharmacist for details. Walmart:i:. �• ,, 0,/". 02014 Wal-Mart Stores,Inc.I Page 2 of 5 seee..eee.uv.a.w, S I wre.r 0 .. 1 6 E 2 4 $4,30-day 40,90-day . . t4.30-day 510,90-day Enalapril 10mg tab* 30 90 Warfarin 2mg tab 30 90 Enalaprfl 20mg tab* 30 90 Warfarin 2.5mg tab 30 90 Furosemide 20mg tab 30 90 Warfarin 3mg tab 30 90 Furosemide 40mg tab 30 90 Warfarin 4mg tab 30 90 Furosemide 80mg tab 30 90 Warfarin 5mg tab* 30 90 Guanfacine 1 mg tab 30 90 Warfarin 6mg tab 30 90 Hydralazine 10mg tab 30 90 Warfarin 7.5mg tab . .30. 90 Hydralazine 25mg tab 30 90 Warfarin 10mg tab 30 90 Hydrochlorothiazide(HCTZ)12.5mg cap 30 . . . 90 Hydrochlorothiazide(HCTZ)25mg tab 30 90 Men's Health '9/30-day Hydrochlorothiazide(HCTZ)50mg tab 30 . 90 t Flnaster)de.5mg . . . .. : 30 Indapamide 1.25mg tab 30 90 Indapamide 2.5mg tab 30 90 Mental Health • Isosorbide Mononitrate 30mg ER tab* 30 90 Amttriptyline 10mg tab 30 90 Isosorbide Mononitrate 60mg ER tab* 30 90 Amitriptyline 25mg tab 30 90 Lisinopril-HCTZ 10mg-12Smg tab 30 . , . . . 90 Amitriptyline 50mg tab 30 90 Lisinopri!-HCTZ 20mg-12.5mg tab* 30 90 Amhriptyline 75mg tab 30 90 Lisinopril-HCTZ 20mg-25mg tab* 30 90 Amitriptyllne 100mg tab 30 90 Lisinopri!2.5mg tab 30 90 Benztropine 2mg tab 30 90 Usinopril 5mg tab 30 90 Buspirone 5mg tab 60 180 Lisinopril 10mg tab 30 90 Lisinopril 20mg tab 30 90 Buspirone 10mg tab* 60 . . .180 Methyldopa 250mg tab* 60 180 Carbamazepine 200mg tab" 60 180 MetoprololTartrate 25mg tab 60 180 Cftalopram 20mg tab 30 90 Metoprofol Tartrate 50mg tab 60 180 Citalopram 40mg tab 30 90 Metoproloi Tartrate 100mg tab* 60 180 Fluphenazine 1mg tab 30 90 Propranolol 10mg tab 60 180 Haloperidoi 0Smg tab 30 90 Propranolol 20mg tab 60 180 HaloperidoI 1mg tab 30 90 Propranolol 40mg tab 60 180 Hatoperidoi 2mg tab 30 . . . 90 Propranolol 80mg tab 60 180 Haloperidoi 5mg tab 30 90 Sotalol HCL 80mg tab* 30 90 Lithium Carbonate 300mg cap* 90 . . .270 Spironotactone 25mg tab* 30 90 Nortriptyline 10mg cap 30 90 Terazosin 1mg cap 30 90 Nortrtptyline 25mg cap 30 . . . 90 I Terazosin 2mg cap 30 90 Paroxetine 10mg tab* 30 . . . 90 Terazosin 5mg cap 30 90 Paroxetine 20mg tab* 30 90 Terazosin 10mg cap 30 90 Prochlorperazine 10mg tab 30 90 i .Triamterene-HCTZ 75mg-50mg tab 30 90 Trazodone 50mg tab 30 90 Triamterene-HCTZ 37.5mg-25mg tab 30 90 Trazodone 100mg tab 30 90 Verapamil 80mg tab 30 . . . 90 Trazodone 150mg tab 30 90 Verapamil 120mg tab 30 90 Trihexyphenidyl 2mg tab 60 180 Warfarin 1mg tab 30 90 • Prescription Program includes up to a 30-day supply for$4 and a 90-day supply for Mar some coveted generic drugs at commonly prescribed dosages.Higher dosages cost more.Prices for some drugs covered by the Prescription Program may be higher and may vary in some states.Restrictions apply See Program Details or your Walmart Pharmacist for details.Free language assistance services available for prescription drug lnrarmatl n at Waltman and Sams Club pharmacies In New York.Contact your Walmart or Sam's Club pharmacy tor details. Revised 9/5/2014 •Prices may be higher In CA,HI,MN,MT,PA.Tel and WI. ••Home Delivery Service is not available through SamsCtrbsom. r Prepackaged drugs are covered only in unit sizes specified on Drug List.See Program Details or your Walmart Pharmacist for details. Walmart:;;. i 0/ 02014 Wal-Mart Stores,Inc(Page 3 of 5 s...« .,uwaw,.. • ••• C 16E2 .. . . , . . . . '4,30-day '10,90-day a4,30-day '10,90-day Skin Conditions Estradiol 2mg tab 30 90 Gentamicin 0.1%cream(15gm tube)' 1 3 MedroxyprogesteroneAcetate 23mg tab 30 90 Gentamicin 0.196 ointment(15gm tube)' 1 3 Medroxyprogesterone Acetate 5mg tab 30 - 90 Hydrocortisone 1%cream(28.35-30g tube)/ 1 3 Medroxyprogesterone Acetate 10mg tab 10 30 Hydrocortisone 23%cream(30gm tube)/ 1 3 oral Contraceptives `9,28-day SiiverSuifadiazine 1%cream*(50gm tube)/ 1 3 E ` CevongrgestreVEthEnyf y1 Estradiol.. 28 Triamcinolone 0.025%cream(15gm tube)/ 1 3 KurYelo 28 Triamcinolone 0.025%cream(80gm tube)/ 1 3 Norethindrone USP 035mg 28' .Triamcinolone 0.1%cream(15gm tube)/ 1 3 Enskyce ; 28 Triamcinolone 0.1%cream(80gm tube)/ 1 3 Jenf ycla 28 Triamcinolone 0.1%ointment(15g m tube)/ 1 3 Pirmella 1/35 . . 28 Triamcinolone 01%ointment(80gm tube)/ 1 3 Pfrmelia 7/7/7. 28 Triamcinolone 0.5%cream(15gm tube)/ 1 3 Spnntec :;28 Tr1-Sprintec. . . , 28. Thyroid Conditions _ Levothyroxine 25mcg tab 30 90 '9 30 day 24 90-day Levothyroxine 50mcg tab 30 90 AlendranateSpD35mg.tab ' : 4. •: 12 AlendronateSOD70mg tab ;R 4 . .; 12 Levothyroxine 75mcg tab 30 90 vClomiphene50mgtab ,: .{. ' 5 ' 15 Levothyroxlne 88mcg tab 30 90 Levothyroxine 100mcg tab 30 90 Levothyroxine 112mcg tab 30 90 Other Medical Conditions Levothyroxine 125mcg tab 30 90 Chiorhexidine Giuconate 0.12%solo(473m1 bottle)'. . .1 3 Levothyroxine 137mcg tab 30 90 isoniazid 300mg tab 30 90 Levothyroxine 150mcg tab 30 90 Lidocaine 2%viscous solution(100mi bottle)* 1 3 Levothyroxine 175mcg tab* 30 90 Megestrol 20mg tab* 30 90 Levothyroxine 200mcg tab* 30 90 Phenazopyridine 100mg tab* 6 18 Prednisone 2.5mg tab* 30 90 Viruses Prednisone 5mg tab* 30 90 Acyclovir 200mg cap 30 90 Vitamins&Nutritional Health Folic Acid 1mg tab 30 90 Mag 64 64mg tab* 60 180 Magnesium Oxide 400mg tab 30 90 Prenatal Plus qty 30* 30 90 Sodium Fluoride.25mg chewable*(120ct bottle)/. . 1. . . . . N/A Women's Health Estradiol 0.5mg tab 30 90 Estradiol 1mg tab 30 90 Prescription Program Includes up to a 10-day supply for$4 and a 90-day supply for St 0 of some covered generic drugs at commonly proscribed dos ages.Higher dosages cost mare.Prices for same drugs covered by the Presoiption Program may be higher and may vary to some states.Restrictions apply.See Program Detail or your Waimart Pharmacist for details.free language assistance services available for prescription drug information at Walmart and Sam's Club pharmacies In New tork.Contact your Walmart or Sam's Club pharmacy for details. Revised 9/5/2014 r Prices may be higher In CA,H.MN,MT,PA,TN and WI. 'r Home Delivery Service Is not available through SamsClub.com. s Prepackaged drugs are covered only in unit sizes specified on Drug Ust.See Program Details or your Walmart Pharmacist for details. Waimart.:::. 0/ 02014 Wal-Mart Stores,Inc I Page 4 of 5 sNww,a.n.uraa.rs r. • 1 E 2 Walmartrs Prescription Program Details 1. Walmares Presaipdon Program(the'Programl's available at all Walmart Sam's Program").Not aN drugs covered by the$10 Retail Program are covered by the 510 Club and Neighborhood Market pharmaces In the United States("Mined Retail Mai Service Program;not all drugs covered bythe 524 Retail Program are covered Phamnadesy,except in North Dakota,as set forth below in Sections 3 and 4.The by the$24 Mail Service Program.See Mall Service Drug List fora 1st of drugs Program isaiso available through Walmart Mail Service('Nrairnart Mail Service,as set covered bythe$10 Mali Service Program and$24 Mail Service Program.Walmart forth below in Section 5. Mall Servke covers both initial Rils and refills Delueryof covered drugsisavailable 2. The Program applies onlyto certain generic dugs at commonly prescribed only through Waknart Mall Service and is not available at Walmart,Sam's Club,and dosages.Higher dosages cost more.You may obtain a list of generic drugs and Neighborhood Market retail pharmacies.Delveryunderthe Program through dosages covered under the Program at Walmart Retail Pharmacies(the'Aetal Ong Warmer Anil Service is limited to US.addresses by Rrst-Gass Mail;expedited Usfl and through Walmart Mall Service(the'Mali Service Drug Use,on Waimart. delivery Is also available for an additional charge.Some health plans do not cover corn oat Walmart Retail Pharmacies.The Retail Drug list and Mall Service Drug List Wahman Mail Service or90day supplies,Prices for quantities greater than a 90-day may change and also may vary by state.Not all formulations of a dnsg(for example supply of drys covered by the$10 Mall Service Program and the$24 Mal Service Prices enteric-coated.extended or timed release formulations)are covered underthe for Rogram are prorated �� 4�Program under respectively.Mal Program.Program pricing not available when a covered drug Is dispensed as part of a compound. Service Prograrnor the$24 Mail Service Program.Prorated pricing is not available 3. Under the Program at Waknan Retail Pharmacies.$4 is the price for up to a 30day under the eel drug fore prepackaged 6. drugs.For ixidrtg policies relating to supply of certain covered generic drugs at commonly prescribed dosages(the"S4 �drugs,set & Retail Program").$10 is the price of a 93-day supply of certain covered generic 6. Prepackaged drugs are covered under the Program only In the unit sines specified drugs at commonly prescribed dosages(the 110 Retail Program).Not al drugs on the Retail Drug List and Mail Service Drug List Prepackaged drugs are dispensed covered by the 54 Retail Program are covered by the$10 Program Prices for based on the quantities pre 'bed and unit sines in stock et the dispensing quantities between a 30-day supply and a 90-day supply of drugs covered by both pharmacy.Unit sizes not specified on the Retail Drug List or Mail Service Drug Ust the 54 Retail Program and$10 Retail Program are prorated based on the$4 Program are not covered under the Program.Multi-snit purchases are charged at a per unit price,but MN not exceed$10.Prices for quantities greater than a90day supply of price,basad on the price per unit size clispensed,unless otherwise specified. drugs covered by the$10 Retail Program are prorated based on the$10 Program Prepackaged dings dispensed In unit sizes not spec/lied on the Retail Drug List and price.Prorated pelting is not available under the Program for prepackaged drugs. Mali Service Drug Us may be priced higher,even if equlealent quantities of the For priding policies relating to prepackaged drugs Nucor as tubes.vials or bottles). drug are available in specified unit sires.Prorated pricing is not available under the see Section 6. Program for p1epadth9eddrugs. 4. Under the Program at Walmart Retail Pharmacies,59 is the price for up to a 30-day 7. Prices of certain drugs covered bythe Program map be higher in some states,as supply of certainwomern health and other covered generic drugs at commonly noted on the Retail Drug Use and Mall Service Drug list prescribed dosages(the"59 Retail Program').$24 Is the price for a 90-day supply of & Program pricimg maybe limited to select manufacturers of a covered drug and is +Ij certain woment health and other covered generic drugs at commonly prescribed available as long as supplies from such manufacturers are In stodcatthe dispensing dosages(the•S24 Retail Program').Natal drugs covered by the 59 Retail Program pharmacy. are covered by the 524 Retail Program.Prices for quantities between a 30-day supply g. You may pay less or more than the Program price,depending on the terms d you and a 90-day supply of drugs covered by both the$9 Program and$24 Retail health plan.Ptesaiberpermisskn maybe required to change a 30-day prescription Program are prorated based on the$9 Program price,but will not exceed$24.Prices toa 90-day prescription.Certain plans,including government-funded programs, for quantities greater than a SO-day supply ddrugscoveredbythe$24Retai may not cover a90daysupply,$24 Program peke.Prorated pricing is not Program are Pr based on available under the Program for prepadmged drugs.For priding potties relating to 10.For purchases made at Walmart Retail Pharmacies,prescriptions must initia*y be . prepackaged drugs,see Section 6. tilled in person,and refills must be picked up in store.There are no substitutions. • 5. Under the Program through Walmart Mail Service$10 Is the price for mall delivery Purchases made through Waimart Mail Service may be ordered at Wairnart Retail Pharmacies,by of a90day supply of cerWngeneric drugs at commonly prescribed dosages r$10 phone othrayhwatmartcom. Mail Service Programl.$24 Is the price for mail delivery of certain women's health 11.These Program Details are subject to change without advance notice.Changes to and certain other covered thugs at commonly prescribed dosages($24 Mal Service these Program Details may be made only in writing. i4 Prescription Program Includes up to a 30-day supply for$4 and a 90-day supply for$10 of some covered generic drugs at commonly prescribed dosages.Higher dosage lost more.Prices for some thugs covered by the Prescription Program may be higher and may vary In some states.Restrictions apply.See Program Details or your Waknar Pharmacist for details.Free language assistance services available for prescription drug Information at Waitron and Sam's Club pharmacies in New York Comics your Walmart or Sam's Club pharmacy for details. •Prices may be higher In CA.HI,MN,MT,PROW and Wu Revised 9/5/2014 *Home Delivery Service is not available through SamaClub.com 'Repackaged drugs are covered only In unit sizes spedfled on Drug t.ist See Program Details or your Walmart Pharmacist for details. Watrnart.f. 0 (1"' 2014 Wal-Mart Stores,Inc Page 5 of 5 swerwr.wwe... �r E2 14-6248"Pharmacy Services" EXHIBIT C "Supplemental General Grant Terms and Conditions" (Following this page) C-I 0 6E 2 Exhibit C Supplemental General Grant Terms and Conditions The supplemental conditions contained in this section are intended to cooperate with, to supplement, and to modify the general conditions and other specifications. In cases of disagreement with any other section of this contract, the Supplemental Conditions shall govern. Flow Down of Terms and Conditions from the Grant Agreement Subcontracts: If the vendor subcontracts any of the work required under this Agreement, a copy of the signed subcontract must be forwarded to the Department for review and approval. The vendor agrees to include in the subcontract that (1) the subcontractors is bound by the terms of this Agreement, (ii) the subcontractor is bound by all applicable state and federal laws and regulations,and(iii)the subcontractor shall hold the Department and Recipient harmless against all claims of whatever nature arising out of the subcontractors performance of work under this Agreement, to the extent allowed and required by law. The recipient shall document in the quarterly report the subcontractor's progress in performing Its work under this agreement. For each subcontract, the Recipient shall provide a written statement to the Department as to whether the subcontractor is a minority vendor as defined In Section 288.703, Fla.Stat. 16E2 Ex C 2 Supplemental General Grant Terms and Conditions 1. Administrative, 2. contractual, or legal remedies Unless otherwise provided in this contract, all claims, counter-claims, disputes and other matters in question between the local government and the contractor,arising out of or relating to this contract, or the breach of It, will be decided by arbitration, if the parties mutually agree,or in a Florida court of competent jurisdiction. 3. Energy Conservation Requirements - The Energy Conservation requirements are applicable to all contracts and subcontracts. The Contractor shall comply with any mandatory standards and policies relating to energy efficiency contained in the State Energy Conservation Plan issued in compliance with the Energy Policy and Conservation Act(42 U.S.C. Section 6201) 4. Access.to Records and Reports-The vendor agrees to maintain all books, records, accounts and reports required under this contract for a period of not less than three years after the date of termination or expiration of this contract, except in the event of litigation or settlement of claims arising from the performance of this contract, in which case Vendor agrees to maintain same until the Purchaser, the Grantor Administrator, the Comptroller General, or any of their duly authorized representatives, have disposed of all such litigation, appeals, claims or exceptions related thereto. 5. No Government Obligation to Third Parties - Applies to all contracts. The Purchaser and Vendor acknowledge and agree that, notwithstanding any concurrence by the Federal Government in or approval of the solicitation or award of the underlying contract, absent the express written consent by the Federal Government, the Federal Government is not a party to this contract and shall not be subject to any obligations or liabilities to the Purchaser,Vendor, or any other party(whether or not a party to that contract)pertaining to any matter resulting from the underlying contract. It is further agreed that the clause shall not be modified, except to iidentify the subcontract who will be subject to its provisions. 6. Clean Air Act, Federal Water Pollution Control Act, Executive Order 11738, and US EPA Regulations- Contracts and subgrants of amounts in excess of$100,000 shall contain a provision that requires the Contractor or recipient to comply with all applicable standards, orders, or requirements issued pursuant to the Clean Air Act (42 U.S.C. 7401-7671q) and the Federal Water Pollution Control Act as amended (33 U.S.C. 1251-1387). Violations must be reported to the Federal awarding agency and the Regional Office of the Environmental Protection Agency(EPA). 7. Energy Policy and Conservation Act- The contractor shall comply with any mandatory standards and policies relating to energy efficiency which are contained In the Florida state energy conservation plan issued in compliance with the Energy Policy and Conservation Act(Pub.L.94-163,89 Stat.871). 8. Debarment and Suspension (Executive Orders 12549 and 12689)- Contract awards that exceed the small purchase threshold and certain other contract awards shall not be made to parties listed on the government wide Excluded Parties List System in the System for Award Management (SAM), in accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR Part 1986 Comp., p. 189)and 12689(3 CFR Part 1989 Comp.,p.235),"Debarment and Suspension,"The Excluded Parties List System in SAM contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared Ineligible under statutory or regulatory authority other than Executive Order 12549. 9. Byrd Anti-Lobbying Amendment(31 U.S.C. 1352) - Vendors must certify it will not and has not used Federal appropriated funds have been paid or will be paid, by or to any person or organization for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan,the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. The.certification includes any lobbying with non-Federal funds that takes place in connection with obtaining any Federal award. �=Ar { 6C2 Exhibit C Supplemental General Grant Terms and Conditions 10. Procurement of Recovered Materials-(a)In accordance with Section 6002 of the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act, the Contractor shall procure items designated in guidelines of the Environmental Protection Agency(EPA) at 40 CFR Part 247 that contain the highest percentage of recovered materials practicable, consistent with maintaining a satisfactory level of competition.The Contractor shall procure items designated in the EPA guidelines that contain the highest percentage of recovered materials practicable unless the Contractor determines that such items:(1)are not reasonably available in a reasonable period of time; (2)fail to meet reasonable performance standards,which shall be determined on the basis of the guidelines of the National Institute of Standards and Technology, if applicable to the item; or (3) are only available at an unreasonable price. (b) Paragraph (a)of this clause shall apply to items purchased under this contract where: (1) the Contractor purchases In excess of$10,000 of the item under this contract; or(2)during the preceding Federal fiscal year, the Contractor: (I) purchased any amount of the items for use under a contract that was funded with Federal appropriations and was with a Federal agency or a State agency or agency of a political subdivision of a State;and(ii)purchased a total of in excess of$10,000 of the item both under and outside that contract. 11. Disadvantaged Business Enterprise (DBE) - Vendors shall not discriminate on the basis of race, color, national origin, or sex in the performance of this contract. Vendors shall make a good faith effort to assure that registered disadvantaged business enterprises are used as sources of supplies,equipment,construction,and services as much as possible. Each vendor shall identify the anticipated level of participation by DBE's in the project and report its actual DBE participation (if any)." The offeror will be required to report its DBE participation obtained through race-neutral means throughout the period of performance and required to convey all changes in anticipated levels of participation to the County in a timely manner. The vendor is required to pay its DBE subcontractors performing work related to this contract for satisfactory performance of that work no later than 30 days after the vendor's receipt of payment for that work from Collier County. In addition, the vendor is required to return any retainage payments to those subcontractors within thirty (30) days after the subcontractor's work related to this contract Is satisfactorily completed. The vendor must promptly notify Collier County,whenever a DBE subcontractor performing work related to this contract is terminated or fails to complete its work,and must make good faith efforts to engage another DBE subcontractor to perform at least the same amount of work. The vendor may not terminate any DBE subcontractor and perform that work through its own forces or those of an affiliate without prior written consent of Collier County, 12. Equal Employment Opportunity - Except as otherwise provided under 41 CFR Part 60, all contracts that meet the definition of "federally assisted construction contract" in 41 CFR Part 60-1.3 must include the equal opportunity clause provided under 41 CFR 60-1.4(b), in accordance with Executive Order 11246,"Equal Employment Opportunity"(30 FR 12319, 12935, 3 CFR Part, 1964— 1965 Comp., p. 339),as amended by Executive Order 11375, "Amending Executive Order 11246 Relating to Equal Employment Opportunity,"and implementing regulations at 41 CFR part 60, "Office of Federal Contract Compliance Programs, Equal Employment Opportunity, Department of Labor." §60-4.3 Equal opportunity clauses. (a)The equal opportunity clause published at 41 CFR 60-1.4(a)of this chapter is required to be included In, and is part of, all nonexempt Federal contracts and subcontracts, including construction contracts and subcontracts.The equal opportunity clause published at 41 CFR 60-1.4(b)is required to be included in, and is a part of, all nonexempt federally assisted construction contracts and subcontracts. In addition to the clauses described above,all Federal contracting officers, all applicants and all nonconstruction contractors, as applicable, shall include the specifications set forth In this section in all Federal and federally assisted construction contracts in excess of$10,000 to be performed in geographical areas designated by the Director pursuant to §60-4.6 of this part and in construction subcontracts in excess of$10,000 necessary in whole or in part to the performance of nonconstruction Federal contracts and subcontracts covered under the Executive order. STANDARD FEDERAL EQUAL EMPLOYMENT OPPORTUNITY CONSTRUCTION CONTRACT SPECIFICATIONS(EXECUTIVE ORDER 11246) 1.As used in these specifications: a."Covered area"means the geographical area described in the solicitation from which this contract resulted; 3 16E2 Exhibit C Su. .lemental General Grant Terms and Conditions b."Director"means Director, Office of Federal Contract Compliance Programs, United States Department of Labor, or any person to whom the Director delegates authority; c. "Employer Identification number" means the Federal Social Security number used on the Employer's Quarterly Federal Tax Return, U.S.Treasury Department Form 941. d,"Minority"includes; (1)Black(all persons having origins in any of the Black African racial groups not of Hispanic origin); (ii) Hispanic (all persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish Culture or origin,regardless of race); (iii)Asian.and Pacific Islander(all persons having origins in any of the original peoples of the Far East,Southeast Asia, the Indian Subcontinent,or the Pacific Islands);and (iv)American Indian or Alaskan Native(all persons having origins in any of the original peoples of North America and maintaining identifiable tribal affiliations through membership and participation or community identification). 2. Whenever the Contractor, or any Subcontractor at any tier, subcontracts a portion of the work involving any construction trade, it shall physically include in each subcontract in excess of $10,000 the provisions of these specifications and the Notice which contains the applicable goals for minority and female participation and which is set forth in the solicitations from which this contract resulted. 3.If the Contractor is participating(pursuant to 41 CFR 6¢-4.5)in a Hometown Plan approved by the U.S. Department of Labor in the covered area either Individually or through an association, Its affirmative action obligations on all work in the Plan area(including goals and timetables) shall be in accordance with that Plan for those trades which have unions participating in the Plan. Contractors must be able to demonstrate their participation in and compliance with the provisions of any such Hometown Plan. Each Contractor or Subcontractor participating in an approved Plan is individually required to comply with its obligations under the EEO clause, and to make a good faith effort to achieve each goal under the Plan in each trade in which it has employees. The overall good faith performance by other Contractors or Subcontractors toward a goal In an approved Plan does not excuse any covered Contractor's or Subcontractor's failure to take good faith efforts to achieve the Plan goals and timetables. 4. The Contractor shall implement the specific affirmative action standards provided in paragraphs 7 a through p of these. specifications. The goals set forth in the solicitation from which this contract resulted are expressed as percentages of the total hours of employment and training of minority and female utilization the Contractor should reasonably be able to achieve in each construction trade in which It has employees in the covered area. Covered Construction contractors performing construction work in geographical areas where they do not have a Federal or federally assisted constuction contract shall apply the minority and female goals established for the geographical area where the work is being performed. Goals are published periodically in the Federal Register in notice form, and such notices may be obtained from any Office of Federal Contract Compliance Programs office or from Federal procurement contracting officers. The Contractor is expected to make substantially uniform progress in meeting its goals in each craft during the period specified. 5. Neither the provisions of any collective bargaining agreement, nor the failure by a union with whom the Contractor has a collective bargaining agreement, to refer either minorities or women shall excuse the Contractor's obligations under these specifications, Executive Order 11246,or the regulations promulgated pursuant thereto. 6. In order for the nonworking training hours of apprentices and trainees to be counted in meeting the goals, such apprentices and trainees must be employed by the Contractor during the training period, and the Contractor must have made a commitment to employ the apprentices and trainees at the completion of their training, subject to the availability of employment opportunities.Trainees must be trained pursuant to training programs approved by the U.S. Department of Labor. 7. The Contractor shall take specific affirmative actions to ensure equal employment opportunity.The evaluation of the Contractor's compliance with these specifications shall be based upon its effort to achieve maximum results from its actions. The Contractor shall document these efforts fully, and shall implement affirmative action steps at least as extensive as the following: . a. Ensure and maintain a working environment free of harassment, intimidation, and coercion at all sites, and in all facilities at which the Contractor's employees are assigned to work.The Contractor,where possible, will assign two or more women to each construction project.The Contractor shall specifically ensure that all foremen, superintendents, and other on-site supervisory personnel are aware of and carry out the Contractor's obligation to maintain such a working environment,with specific attention to minority or female individuals working at such sites or in such facilities. b. Establish and maintain a current list of minority and female recruitment sources, provide written notification to minority and female recruitment sources and to community organizations when the Contractor or its unions have 4 16E2 . Exhibit Supplemental General Grant Terms and Conditions employment opportunities available,and maintain a record of the organizations'responses. c. Maintain a current file of the names, addresses and telephone numbers of each minority and female off-the-street applicant and minority or female referral from a union, a recruitment source or community organization and of what action was taken with respect to each such individual. If such individual was sent to the union hiring hall for referral and was not referred back to the Contractor by the union or, If referred, not employed by the Contractor, this shall be documented in the file with the reason therefor, along with whatever additional actions the Contractor may have taken. d. Provide immediat3e written notification to the Director when the union or unions with which the Contractor has a collective bargaining agreement has not referred to the Contractor a minority person or woman sent by the Contractor,or when the Contractor has other information that the union referral process has Impeded the Contractor's efforts to meet its obligations. e. Develop on-the-job training opportunities and/or participate in training programs for the area which expressly include minorities and women, including upgrading programs and apprenticeship and trainee programs relevant to the Contractor's employment needs, especially those programs funded or approved by the Department of Labor. The Contractor shall provide notice of these programs to the sources complied under lb above. f. Disseminate the Contractor's EEC policy by providing notice of the policy to unions and training programs and requesting their cooperation in assisting the Contractor in meeting its EEO obligations; by including It in any policy manual and collective bargaining agreement; by publicizing it In the company newpaper, annual report, etc.; by specific review of the policy with all management personnel and with all minority and female employees at least once a year; and by posting the company EEO policy on bulletin boards accessible to all employees at each location where construction work is performed. g. Review, at least annually, the company's EEC policy and affirmative action obligations under these specifications with all employees having any responsibility for hiring, assignment, layoff, termination or other employment decisions including specific review of these items with onsite supervisory personnel such as Superintendents, General Foremen, etc., prior to the initiation of construction work at any job site. A written record shall be made and maintained identifying the time and place of these meetings, persons attending, subject matter discussed, and disposition of the subject matter. h. Disseminate the Contractor's EEO policy externally by including it in any advertising in the news media, specifically including minority and female news media, and providing written notification to and discussing the Contractor's EEO policy with other Contractors and Subcontractors with whom the Contractor does or anticipates doing business. I. Direct its recruitment efforts, both oral and written, to minority, female and community organizations, to schools with minority and female students and to minority and female recruitment and training organizations serving the Contractor's recruitment area and employment needs. Nat later than one month prior to the date for the acceptance of applications for apprenticeship or other training by any recruitment source, the Contractor shall send written notification to organizations such as the above,describing the openings, screening procedures,and tests to be used in the selection process. j. Encourage present minority and female employees to recruit other minority persons and women and, where reasonable, provide after school,summer and vacation employment to minority and female youth both on the site and in other areas of a Contractor's work force. k. Validate all tests and other selection requirements where there is an obligation to do so under 41 CFR Part 60-3. I. Conduct,at least annually, an inventory and evaluation at least of all minority and female personnel for promotional opportunities and encourage these employees to seek or to prepare for, through appropriate training, etc., such opportunities. • m. Ensure that seniority practices,job classifications, work assignments and other personnel practices, do not have a discriminatory effect by continually monitoring all personnel and employment related activities to ensure that the EEO policy and the Contractor's obligations under these specifications are being carried out. n. Ensure that all facilities and company activities are nonsegregated except that separate or single-user toilet and necessary changing faciliities shall be provided to assure privacy between the sexes. o. Document and maintain a record of all solicitations of offers for subcontracts from minority and female construction contractors and suppliers, including circulation of solicitations to minority and female contractor associations and other business associations. p. Conduct a review, at least annually, of all supervisors' adherence to and performance under the Contractor's EEO policies and affirmative action obligations. 8. Contractors are encouraged to participate in voluntary associations which assist in fulfilling one or more of their 5 C. 16E2 Exhibit C Supplemental General Grant Terms and Conditions affirmative action obligations(7a through p).The efforts of a contractor association,joint contractor-union,contractor- community, or other similar group of which the contractor is a member and participant, may be asserted as fulfilling any one or more of its obligations under 7a through p of these Specifications provided that the contractor actively participates In the group, makes every effort to assure that the group has a positive impact on the employment of minorities and women in the industry, ensures that the concrete benefits of the program are reflected in the Contractor's minority and female workforce participation, makes a good faith effort to meet its individual goals and timetables,and can provide access to documentation which demonstrates the effectiveness of actions taken on behalf of the Contractor, The obligation to comply, however, is the Contractor's and failure of such a group to fulfill an obligation shall not be a defense for the Contractor's noncompliance. 9. A single goal for minorities and a separate single goal for women have been established.The Contractor, however, is required to provide equal employment opportunity and to take affirmative action for all minority groups, both male and female,and all women, both minority and non-minority. Consequently, the Contractor may be in violation of the Executive Order if a particular group is employed in a substantially disparate manner(for example, even though the Contractor has achieved its goals for women generally, the Contractor may be in violation of the Executive Order if a specific minority group of women is underutilized). 10.The Contractor shall not use the goals and timetables or affirmative action standards to discriminate against any person because of race,color, religion,sex,or national origin. 11.The Contractor shall not enter into any Subcontract with any person or firm debarred from Government contracts pursuant to Executive Order 11246. 12. The Contractor shall carry out such sanctions and penalties for violation of these specifications and of the Equal Opportunity Clause, including suspension,termination and cancellation of existing subcontracts as may be imposed or ordered pursuant to Executive Order 11246, as amended, and its implementing regulations, by the Office of Federal Contract Compliance Programs.Any Contractor who fails to carry out such sanctions and penalties shall be In violation of these specifications and Executive Order 11246,as amended. 13. The Contractor, in fulfilling its obligations under these specifications, shall implement specific affirmative action steps, at least as extensive as those standards prescribed in paragraph 7 of these specifications, so as to achieve maximum results from its efforts to ensure equal employment opportunity. If the Contractor fails to comply with the requirements of the Executive Order, the implementing regulations, or these specifications, the Director shall proceed in accordance with 41 CFR 6Q-4.8. 14. The Contractor shall designate a responsible official to monitor all employment related activity to ensure that the company EEO policy is being carried out,to submit reports relating to the provisions hereof as may be required by the Government and to keep records. Records shall at least include for each employee the name, address, telephone numbers, construction trade, union affiliation if any, employee identification number when assigned, social security number, race, sex, status (e.g., mechanic, apprentice trainee, helper, or laborer), dates of changes in status, hours worked per week in the indicated trade, rate of pay, and locations at which the work was performed. Records shall be maintained in an easily understandable and retrievable form; however, to the degree that existing records satisfy this requirement,contractors shall not be required to maintain separate records. 15. Nothing herein provided shall be construed as a limitation upon the application of other laws which establish different standards of compliance or upon the application of requirements for the hiring of local or other area residents (e.g., those under the Public Works Employment Act of 1977 and the Community Development Block Grant Program). 13. Termination i. TERMINATION FOR DEFAULT. 1. Contractor shall be considered in material default of the Agreement and such default shall be considered cause for Owner to terminate the Agreement, in whole or in part,as further set forth in this Section, if Contractor: (1) fails to begin the Work under the Contract Documents within the time specified herein; or (2) fails to properly and timely perform the Work as directed by the Project Manager or as provided for in the approved Progress Schedule; or (3) performs the Work unsuitably or neglects or refuses to remove materials or to correct or replace such Work as may be rejected as unacceptable or unsuitable;or(4)discontinues the prosecution of the Work; or(5)falls to resume Work which has been suspended within a reasonable time after being notified to do so; or(6) becomes insolvent or is declared bankrupt, or commits any act of bankruptcy; or (7)allows any final judgment to stand against It unsatisfied for more than ten (10) days; or (8) makes an assignment for the benefit of creditors; or (9) fails to obey any applicable codes, laws, ordinances, rules or regulations with respect to the Work; or (10) materially breathes any other provision of the Contract Documents. 6 ��Cr. 16E2 Exhibit C Supplemental General Grant Terms and Conditions 2. Owner shall notify Contractor in writing of Contractor's default(s). If Owner determines that Contractor has not remedied and cured the default(s) within seven(7) calendar days following receipt by Contractor of said written notice or such longer period of time as may be consented to by Owner in writing and in its sole discretion, then Owner,at its option,without releasing or waiving its rights and remedies against the Contractor's sureties and without prejudice to any other right or remedy it may be entitled to hereunder or by law, may terminate Contractor's right to proceed under the Agreement, in whole or in part, and take possession of all or any portion of the Work and any materials, tools, equipment, and appliances of Contractor, take assignments of any of Contractor's subcontracts and purchase orders, and complete all or any portion of Contractor's Work by whatever means, method or agency which Owner,in its sole discretion, may choose. 3. If Owner deems any of the foregoing remedies necessary, Contractor agrees that it shall not be entitled to receive any further payments hereunder until after the Project is completed. All moneys expended and all of the costs, losses, damages and extra expenses, including all management, administrative and other overhead and other direct and indirect expenses (including Design Professional and attorneys' fees) or damages incurred by Owner incident to such completion,shall be deducted from the Contract Amount,and if such expenditures exceed the unpaid balance of the Contract Amount, Contractor agrees to pay promptly to Owner on demand the full amount of such excess, including costs of collection, attorneys' fees (including appeals) and interest thereon at the maximum legal rate of interest until paid. If the unpaid balance of the Contract Amount exceeds all such costs, expenditures and damages incurred by the Owner to complete the Work,such excess shall be paid to the Contractor. The amount to be paid to the Contractor or Owner,as the case may be,shall be approved by the Project Manager,upon application,and this obligation for payment shall survive termination of the Agreement. 4. The liability of Contractor hereunder shall extend to and include the full amount of any and all sums paid, expenses and losses incurred, damages sustained, and obligations assumed by Owner in good faith under the belief that such payments or assumptions were necessary or required, in completing the Work and providing labor, materials, equipment, supplies, and other items therefore or re-letting the Work, and in settlement, discharge or compromise of any claims, demands, suits,and judgments pertaining to or arising out of the Work hereunder. 5. If, after notice of termination of Contractor's right to proceed pursuant to this Section, it is determined for any reason that Contractor was not in default, or that its default was excusable, or that Owner is not entitled to the remedies against Contractor provided herein, then the termination will be deemed a termination for convenience and Contractor's remedies against Owner shall be the same as and limited to those afforded Contractor under Section 19 below. 6. In the event(1) Owner fails to make any undisputed payment to Contractor within thirty(30)days after such payment is due or Owner otherwise persistently fails to fulfill some material obligation owed by Owner to Contractor under this Agreement, and (ii)Owner has failed to cure such default within fourteen (14) days of receiving written notice of same from Contractor, then Contractor may stop its performance under this Agreement until such default is cured, after giving Owner a second fourteen (14) days written notice of Contractor's intention to stop performance under the Agreement. If the Work is so stopped for a period of one hundred and twenty (120) consecutive days through no act or fault of the Contractor or its Subcontractors or their agents or employees or any other persons performing portions of the Work under contract with the Contractor or any Subcontractor, the Contractor may terminate this Agreement by giving written notice to Owner of Contractor's intent to terminate this Agreement, If Owner does not cure its default within fourteen(14)days after receipt of Contractor's written notice, Contractor may, upon fourteen (14) additional days' written notice to the Owner, terminate the Agreement and recover from the Owner payment for Work performed through the termination date, but In no event shall Contractor be entitled to payment for Work not performed or any other damages from Owner. 2. TERMINATION FOR CONVENIENCE AND RIGHT OF SUSPENSION. 1. Owner shalt have the right to terminate this Agreement without cause upon seven (7)calendar days written notice to Contractor. In the event of such termination for convenience, Contractor's recovery against Owner shall be limited to that portion of the Contract Amount earned through the date of termination, together with any retainage withheld and reasonable termination expenses incurred, but Contractor shall not be entitled to any other or further recovery against Owner, including, but not limited to, damages or any anticipated profit on portions of the Work not performed. 2. Owner shall have the right to suspend all or any portions of the Work upon giving Contractor not less than two (2) calendar days' prior written notice of such suspension. If all or any portion of the Work is so suspended, 7 get 16E2 Exhibit. C Supplemental General.Grant Terms and Conditions Contractor's sole and exclusive remedy shall be to seek an extension of time to its schedule in accordance with the procedures set forth in the Contract Documents. In no event shall the Contractor be entitled to any additional compensation or damages. Provided,however,if the ordered suspension exceeds six(6)months,the Contractor shall have the right to terminate the Agreement with respect to that portion of the Work which is subject to the ordered suspension. CERTIFICATIONS AND FORMS THE FOLLOWING DOCUMENTS NEED TO BE RETURNED WITH SOLICIA1TON DOCUMENTS BY DEADLINE TO BE CONSIDERED RESPONSIVE 1. Certification Regarding Debarment, Suspension, and Other Responsibility Matters Primary Covered Transactions 2. General Grant Clauses 3. Disclosure of Lobbying Activities 8 1 16E2 2 Exhibit C Supplemental General Grant Terms and Conditions 7 (1) The prospective primary participant certifies to the best of its knowledge and belief,that it and its principals: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; (b) Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements,or receiving stolen property; (c) Are not presently Indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local)with commission of any of the offenses enumerated in paragraph (IXb)of this certification;and (d) Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal,State or local)terminated for cause or default. (Z) Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. tilok.'"‘"c Name Project Name Title Project Number Firm Tax ID Number Street Address DUNS Number a `es L 34 11 z City,State, Zip 9 (Q(,, 16E2 Exhibit C Supplemental General Grant Terms and Conditions General Grant Clauses On behalf of my firm,I acknowledge, and agree to perform all of the specifications and grant requirements identified in this solicitation document(s). Vendor/Contractor Name w.► - �, •. - 2474_6 f i cI Authorized Signature- I CF�IJI kNPN4v�SSC) Address 4-t e k w u-� M i 1 ) 'e s i F '34 1 1 Orr Or Solicitation Contract # /16rl1 1 NOTARY PUBLIC-STANCE OF FLORIDA •" Mary L.Chacko-Minor .•nay, :Commission 4 EE085897 ,•. „ Expires: APR.20,2015 BONLE1.)TFI:<t ATT.A-71C:,i NDEtic CO.,INC, 10 16E2 Exhibit C Supplemental General Grant Terms and Conditions CERTIFICATION REGARDING LOBBYING (To be submitted with each bid or offer exceeding$100,000) The undersigned, (Contractor)certifies,to the best of his or her knowledge and belief,that: (1) No Federal appropriated funds have been paid or will be paid,by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan,or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for making lobbying contacts to an officer or employee of any agency,a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form--LLL, "Disclosure Form to Report Lobbying," in accordance with Its instructions [as amended by "Government wide Guidance for New Restrictions on Lobbying," 61 Fed. Reg. 1413 (1/19/96). Note: Language In paragraph (2) herein has been modified in accordance with Section 10 of the Lobbying Disclosure Act of 1995(P.L. 104-65, to be codified at 2 U.S.C. 1601, et seq.)] (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements)and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31, U.S.C. g 1352 (as amended by the Lobbying Disclosure Act of 1995). Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure, [Note: Pursuant to 31 U.S.C. § 1352(c)(1)-(2)(A), any person who makes a prohibited expenditure or falls to file or amend a required certification or disclosure form shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such expenditure or failure.] The Contractor, , ce••r: or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if a • a•• an, the Contractor understands and agrees that the provisions of 31 U.S.C.A 3801, et . , .p ly to t• s rti .Rion and disclosure, if any. Al107 ature of Contractor's Authorized Official AOP Name and Title of Contractor's Authorized Official 1 (a..,(..0 t Lb r Date .7\" ck\i C / 11 trar.ARY pt oxinA ;!,'Ia. ;:_:go-Minor ' r. Corr-11,z, _ x .085 INC,C INC, 43ii r, DeC 08 1411:55a State Farm 2399475484 16E 2 • DALE tmer,DenYYYY) A L� CERTIFICATE OF LIABILITY INSURANCE 12t08/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT.AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is-an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms'and conditions of the policy,certain policies may require en endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements). TSOB ,� N INSURANCE STATE FARM PRfl0UC9i Bobby Pittman State Farm insurance ""E 'I FAX 239 947 3931 9126 �0} 238 947'01IIt t& wo1 Sfa Fa:�I Bonita Bonita Beach Road .BOBBY,PITTMAN.BXD5@STATEFARM.COM Bonita Springs, FL 34135 INSURER(S)AFFORDING NAICr A. Phone#239-947-0101 Fax#239-947-3931 INSURER'A:SLIM SLIM Form Florida Insurance Company 139 INSURED WOOLLEY'S PHARMACY INC INSURER s: _ __.__ _ 3761 EAST TAMIAM I TRAIL INSURER C: — NAPLES FL 34112 INNSURER0: __-- — INSURER E: _ ^ INSURER P: - COVERAGES CERTIFICATE NUMBER: REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 'INDICATED. NOTWITHSTANDING ANY REQUIREMENT,-TERM OR CONDITION OF AMr CONTRACT OR OTHER DOCUMENT WMTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY.PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED. HEREIN 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND.CONDITIONS OF SUCH POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Thall r::,rah�-.'ii�:i1.-" ISO LVYTY IIMUOD/TYY TYPE DP INSURANCE- r �"�!7 POLICY NDRISER 1NIr,10DIYYYYI InrAUODJYYYYS 2,000,000 .X QOMMERCIAL GENERAL UAINLITY 988-i6-86Q0-5 B 1213112014 1213112015 EACH OCCURRENCE S ENTER $ �� CLAIMS-MACE I I OCCUR 12113112013 9213112014 PREuaSm lEe omrrenv kM EXP IAny one person) 5 5,000 PERSONAL I.ATV INJURY :S "- GaiL AGGREGATE LIMIT APPUFSPER: GENER"JAiGiEGATE I+ 4,000,000-1 PPS TS-CpNP!DP AGO s 4,000,000 X IY I �i=R°Cr ( 'LOO _.._... aTHER: ! I COMBINED SINGLE Limit q AUTOMOBILE LIABILITY `/Ea accident) i BODILY INJURY(Per person) 5 ^ANYAUTO ' BODILY INJURY IPxasziden@ L All.OWN ED —I_SCHEDULED - 'YiOPERTY DAMAGE AUTOS AUTrOWNEO I {peracrxlant) $ HIRED AUTOS AUTOS I 5 I i EACH OCCURRENCE J UMBRELLA UAB 1 'OccuR EXCESS t" I CLAIMS-MACE AGGREGATE S - I S DED 4ETEW 7ION S IWOPINE.RSCOMPENSATION i._-s ATUTB. • it 0T ._...-- IANO EMPLOYEf:7..LIABILITY YIN. c t,EACH ACCIDENT 5 ZANY PROPRIETOR/PARTNER/EXECUTIVE N f A l OFF,CER/MEMBER EXCLUDED? I E.L th9EASE-EA EMPLaYEE S j(Manoatorr In NH) 1 {held,descrbc�rde E.L.CISEAS£-POLICY UNIT S • 17cSERIPTION aF OPLRA TIONS below DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES LACORO 1C1,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION ADDITIONAL INSURED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION .DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE SUM!THE Y PROVISIONS. COLLIER COUNTY BOARD OF COUNTSUM! POLIC COMMISSIONERS AUTHORIZED REPRESENTATIVE .3327 TAMIAMI TRAIL E. 1 3`+ Q 6-4(----• NAPLES,FLA.34112 15 1 ©146 2014 ACORD CORPORATION.All rights reserved ACORD 25(2014/011 The ACORD name and logo are registered ACORD 100i48s 132849.9 72-04-2014 1 6 E 2 blaze term thoncia insurance L.ompany KtNtWAL cti-filtricA i t ----- . , .,., 7401 akrress Garden*Bibv 1P-0-I iMiUMBE*' ' s*J6-86436-5, Wortitor Pavel',FL 88-LOG? ;Business Poticy DEC 31 2013 to DEC 31 2014 - IOATEduE — ." - i,- CAMMUSO, PAUL !DEC 31 2013 $6,299,56 i DBA WOOLEY'5 PHARMACY I Coverages and Limits vr,.., 9168 THE L N 4- .4 NAPLES FL 34109-1561 : Section I I A Buildings Exc I uded I S Business Peisonal PrOperly 205,200 C Loss of Income Actual Loss .., Deductibles-Section 1 , Baslc Dt A„.., • Hurricwie 10.00% Other deductibles may apply - refer to policy , 1 Location• 3761 EAST TAMIAMI 7733 NAPLES FL 34112-6'215 . Section II • , L Business ...lability $2,000,00r:. ti,4 Medical Payments” 5,00t; Gen Aggregate(Other than PCO) 4,000,000 Products-Completed Operations 4,000,000 (POO Aggregate) Annual Premium $4,701 .0( Forms,Opts,&Endrsmnt 58.Of Bus Liability -Coy L 1,3290( Forms, Options,and Endorsements FL EMPA ASSESSMENT 4 l7i: Special Form 3 FP-6153 FL TRUST FUND 6. ;.:. Money&Secur$100041000 OPT MO Fi-iCF ASSESSMENT 79.9: Amendatory Endorsement FE-6210.3 2005 CITIZENS-EM 61 .41 Business Policy Endorsement FE-6464 Amount Due $6,299.5f ee Debris Removal FE-6451 Retail Drug Store Endorsement FE-6435 Glass Deductible Deletion FE-6538, 1 Premium Reductions -4umcane Deductible FE-6537,4 Renewal Year Discount "tbditiOr 141 Insured Endorsement . FE-6494 Yrs in Business Discount Fungus (Including Mold) Excl FE-6566 Prot Devices Discount Suocontractor Pd Exclusion FE-6598 Sprinkler Discount Amendatory Collapse FE-6839 Claim Record Discount Coy A -inflation Index N/A Continued on back of page Coy B -Consumer Price: 234 1 —__ .....,._ - + or the full name of each assessment entity and the dollar amount, please see the Florida Assessment Page. ,.., -, NOTICE Information concerning changes in your policy language is included. Please cat your agent if you have any questions .,.: .... ,-- •: .., ; 477 4 i Ailoving 7 See your State Farm agent 0y-iieri ,44.stivesox. sae reverse for Important information. ' sole 1 Agent BOBBY PITTMAN Prepared Telephone (239)947-0101 or (800)634-2339 ;Ea OCT 31 2013 M 4098 f DECLARATIONS(CONTINUED) 1 Drug Store Policy for WOOLLEY'S PHARMACY INC Policy Number 9846-8600.5 Utility Interruption-Loss Of Income $10,000 Loss Of Income And Extra Expense Actual LP`ss Sustained-12 Months SECTION Ii- IABtLITY LIMIT OF COVERAGE INSURANCE Coverage L-Business Liability $2,000,0.00 Coverage M -Medical Expenses (Any One Person) $5,000 Damage To.Premises Rented To You $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate $4,000,000 General Aggregate $4,000,000 Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual period.Please refer to Section II -Liability in the Coverage Form and any attached endorsements. Your policy consists of these Declarations,the BUSINESSOWNERS COVERAGE FORM shown below,and any other forms and endorsements that apply,including those shown below as well as those issued subsequent to the issuance of this policy. FORMS AND ENDORSEMENTS CMP-4100 'Businessowners Coverage Form CMP-4259 *Amendatory Endorsement £MP-4874 `FL Cat Ground Cover Collapse CfvIP-4561 *Policy Endorsernent27 CMP-4879 II `Pharmacist Liability CMP-4522 `Loss of Income at Extra Expense CIO P-4710 `Employee Dishonesty CMP-4825 *'Brands and Labels CM.P-4738 *Hurricane Deductible ,Prepare OCT 17 2014 Copyright,State Farm Mutual Automobile Insurance Company,2008 Includes copyrighted material of Insurance Services Office,Inc., ith CMP-4000 py its permission. 000102 291 Continued on Reverse Side of Page Page 5 of 6 16E2 Am, TRAVELERS) WORKERS COMPENSATION AND ONE TOWER WARE HARTFORD, CT 06183 EMPLOYERS LIABILITY POLILY CHANGE DOCUMENT WC 9999 98 MI POLICY NUMBER: (I HUB-91 78R 14-9-14)' CHANGE EFFECTIVE DATE: 09-01 -1 4 1.dCC1 CO CODE: 13439 INSURER: THE TRAVELERS INDEMNITY COMPANY OF AMERICA INSURED'S NAME: WOOLLEY'S PHARMACY This change is issued by that member of The Travelers Insurance Companies which issued the policy and forms a part of the policy. It is agreed that the policy is amended as follows: An absence of an entry in the premium spaces below means that the premium adjustment. if any,will be made at time of audit. ADDITIONAL PREMIUM $ NIL RETURN PREMIUM $300 ADDITIONAL NON-PREMIUM $ NIL RETURN NON-PREMIUM $ NIL The following premium basis is amended to read: STATE OF FL LOCATION 001 01 _—� ESTIMATED ANNUAL M' CLASSIFICATION CODE PREM. BASIS RATE PREMIUM STORE-DRUG-RETAIL 8045 90180 0.57 514 The Terrorism charge has been amended as follows: STATE ESTIMATED PREMIUM. FL is jggrt The following endorsements are added: WC 89 08 14 (40)-001 WC 89 04 15 (00)-001 DATE OF ISSUE: 11-04-14 GS CHANGE NO: 001 PAGE 001 OF LAST POL.EFF.DATE: 09-01 -1 4 POL. EXP, DATE: 09-01 -i 5 OFFICE: PAYROLL 70A PRODUCER: AP INTEGO INS GROUP LLC X9275 ,� ; COUNTERSIGNED AGENT 16E2 TRAVELERS WORKERS COMPENSATION AND ONE TOWER SQUARE NARTFORD1 CT 06183 EMPLOYERS LiABILITY POLICY ENDORSEMENT WC 89 04 15(00)— 001 POLICY NUMBER: (IHUB-at 73R14-9-1 4) POLICY INFORMATION PAGE ENDORSEMENT Item #4 Is changed to the following: PREMIUM BASIS Total Estimated Rate Per Code Annual $100 of Estimated Classifications No, Remuneration Remuneration Annual Premium STATE OF FL LOCATION 001 STORE-DRUG-RETAIL 8045 90180 0.57 514 gaig asae o.�. mmemm ZMMM amommom ,mumoMM r =.. Total Estimated Annual Premium $ "' ' Minimum Premium$ Deposit Premium$ ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED, DATE OF ISSUE:11-04-14 ST ASSIGN: