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Backup Documents 01/12/2016 Item #16D 8 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 16 n o THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE U Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later than Monday preceding the Board meeting. **NEW** ROUTING SLIP Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office. Route to Addressee(s) (List in routing order) Office Initials Date 1. 2. 3. County Attorney Office County Attorney Office JAB j3 1/12/16 4. BCC Office Board of County Commissioners ViNc/ t ll3`kte, 5. Minutes and Records Clerk of Court's Office 3 (1 (, 3:�s PRIMARY CONTACT INFORMATION Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees above,may need to contact staff for additional or missing information. Name of Primary Staff Jennifer Bel dio,Assistant County CAO 252-8400 Contact/ Department Attorney Agenda Date Item was 1/12/16 ' Agenda Item Number 16D8 Approved by the BCC Type of Document Contract between BCC and State of Florida Number of Original Three Attached Department of Health Documents Attached PO number or account n/a number if document is to be recorded INSTRUCTIONS & CHECKLIST Initial the Yes column or mark"N/A" in the Not Applicable Colum, •'chever is Yes N/A(Not appropriate. (Initial) Applicable) 1. Does the document require the chairman's original signatur: STAMP OK JAB 2. Does the document need to be sent to another agency for additiona signatures? If yes, TIQ provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. S LE_+.+4itc 4d p( 3. Original document has been signed/initialed for legal sufficiency. (All documents to be JAB signed by the Chairman,with the exception of most letters,must be reviewed and signed "tea 61 by the Office of the County Attorney. 4. All handwritten strike-through and revisions have been initialed by the County Attorney's JAB 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 JAB 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 JAB signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip JAB should be provided to the County Attorney Office at the time the item is input into SIRE. Some documents are time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's actions are nullified. Be aware of your deadlines! 8. The document was approved by the BCC on 12/8/15 and all changes made durin!. e JAB meeting have been incorporated in the attached document. The County Attor y's ti � Office has reviewed the changes,if applicable, p' ay \p x u 9. \\� \ I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12 Co y, f C lier 1608 CLERK OF THE C RC IT COURT COLLIER COUNT I OUR OUSE 3315 TAMIAMI TRL E STE 102 Dwight E.Brock- r"+ -rk of ircuit Court P.O.BOX 413044 NAPLES,FL 34112-5324 NAPLES,FL 34101-3044 Clerk of Courts • Comptroller • Auditor C stodian of County Funds January 14, 2016 Beth Benton Senior Health Budget Analyst Office of Budget and Revenue Management Florida Department of Health Ms. Benton, Enclosed are three original contracts that were approved by the Board of County Commissioners for Collier County on Tuesday, January 12, 2016 during Regular Session. Please forward for additional signatures and return a fully executed original back to my office at the address below. Any questions please contact me. Thank you, OktickAAA.4),1 Teresa Cannon, Deputy Clerk 239-252-8411 Board's Minutes & Records Department 3299 Tamiami Trail East, Suite #401 Naples, FL 34112 Phone- (239) 252-2646 Fax- (239) 252-2755 Website- www.CollierClerk.com Email- CollierClerk@collierclerk.com CONTRACT BETWEEN COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS AND STATE OF FLORIDA DEPARTMENT OF HEALTH FOR OPERATION OF THE COLLIER COUNTY HEALTH DEPARTMENT CONTRACT YEAR 2015-2016 This contract is made and entered into between the State of Florida, Department of Health ("State") and the Collier County Board of County Commissioners ("County"), through their undersigned authorities, effective October 1, 2015. RECITALS A. Pursuant to Chapter 154, Florida Statutes, the intent of the legislature is to "promote, protect, maintain, and improve the health and safety of all citizens and visitors of this state through a system of coordinated county health department services." B. County Health Departments were created throughout Florida to satisfy this legislative intent through "promotion of the public's health, the control and eradication of preventable diseases, and the provision of primary health care for special populations." C. Collier County Health Department ("CHD") is one of the created County Health Departments. D. It is necessary for the parties hereto to enter into this contract in order to ensure coordination between the State and the County in the operation of the CHD. NOW THEREFORE, in consideration of the mutual promises set forth herein, the sufficiency of which are hereby acknowledged, the parties hereto agree as follows: 1. RECITALS. The parties mutually agree that the forgoing recitals are true and correct and incorporated herein by reference. 2. TERM. The parties mutually agree that this contract shall be effective from October 1, 2015, through September 30, 2016, or until a written contract replacing this contract is entered into between the parties, whichever is later, unless this contract is otherwise terminated pursuant to the termination provisions set forth in paragraph 8. below. 3. SERVICES MAINTAINED BY THE CHD. The parties mutually agree that the CHD shall provide those services as set forth on Part III of Attachment II hereof, in order to maintain the following three levels of service pursuant to section 154.01(2), Florida Statutes, as defined below: a. "Environmental health services" are those services which are organized and operated to protect the health of the general public by monitoring and regulating activities in the environment which may contribute to the occurrence or transmission of disease. 1 16 0 8 Environmental health services shall be supported by available federal, state and local funds and shall include those services mandated on a state or federal level. Examples of environmental health services include, but are not limited to, food hygiene, safe drinking water supply, sewage and solid waste disposal, swimming pools, group care facilities, migrant labor camps, toxic material control, radiological health, and occupational health. b. "Communicable disease control services" are those services which protect the health of the general public through the detection, control, and eradication of diseases which are transmitted primarily by human beings. Communicable disease services shall be supported by available federal, state, and local funds and shall include those services mandated on a state or federal level. Such services include, but are not limited to, epidemiology, sexually transmissible disease detection and control, HIV/AIDS, immunization, tuberculosis control and maintenance of vital statistics. c. "Primary care services" are acute care and preventive services that are made available to well and sick persons who are unable to obtain such services due to lack of income or other barriers beyond their control. These services are provided to benefit individuals, improve the collective health of the public, and prevent and control the spread of disease. Primary health care services are provided at home, in group settings, or in clinics. These services shall be supported by available federal, state, and local funds and shall include services mandated on a state or federal level. Examples of primary health care services include, but are not limited to; first contact acute care services; chronic disease detection and treatment; maternal and child health services; family planning; nutrition; school health; supplemental food assistance for women, infants, and children; home health; and dental services. 4. FUNDING. The parties further agree that funding for the CHD will be handled as follows: a. The funding to be provided by the parties and any other sources is set forth in Part II of Attachment II hereof. This funding will be used as shown in Part I of Attachment II. !. The State's appropriated responsibility (direct contribution excluding any state fees, Medicaid contributions or any other funds not listed on the Schedule C) as provided in Attachment II, Part II is an amount not to exceed $ 5,330,128 (State General Revenue, State Funds, Other State Funds and Federal Funds listed on the Schedule c). The State's obligation to pay under this contract is contingent upon an annual appropriation by the Legislature. ii. The County's appropriated responsibility (direct contribution excluding any fees, other cash or local contributions) as provided in Attachment II, Part II is an amount not to exceed $ 1,378,200 (amount listed under the "Board of County Commissioners Annual Appropriations section of the revenue attachment). b. Overall expenditures will not exceed available funding or budget authority, whichever is less, (either current year or from surplus trust funds) in any service category. Unless requested otherwise, any surplus at the end of the term of this contract in the County Health 2 16 8 Department Trust Fund that is attributed to the CHD shall be carried forward to the next contract period. c. Either party may establish service fees as allowed by law to fund activities of the CHD. Where applicable, such fees shall be automatically adjusted to at least the Medicaid fee schedule. d. Either party may increase or decrease funding of this contract during the term hereof by notifying the other party in writing of the amount and purpose for the change in funding. If the State initiates the increase/decrease, the CHD will revise the Attachment II and send a copy of the revised pages to the County and the Department of Health, Office of Budget and Revenue Management. If the County initiates the increase/decrease, the County shall notify the CHD. The CHD will then revise the Attachment II and send a copy of the revised pages to the Department of Health, Office of Budget and Revenue Management. e. The name and address of the official payee to whom payments shall be made is: County Health Department Trust Fund Collier County 3339 E. Tamiami Trail, Suite 145 Naples, FL 34112 5. CHD DIRECTOR/ADMINISTRATOR. Both parties agree the director/administrator of the CHD shall be a State employee or under contract with the State and will be under the day-to-day direction of the Deputy Secretary for County Health Systems. The director/administrator shall be selected by the State with the concurrence of the County. The director/administrator of the CHD shall ensure that non-categorical sources of funding are used to fulfill public health priorities in the community and the Long Range Program Plan. A report detailing the status of public health as measured by outcome measures and similar indicators will be sent by the CHD director/administrator to the parties no later than October 1 of each year (This is the standard quality assurance "County Health Profile"report located on the Division of Public Health Statistics and Performance Management Intranet site). 6. ADMINISTRATIVE POLICIES AND PROCEDURES. The parties hereto agree that the following standards should apply in the operation of the CHD: a. The CHD and its personnel shall follow all State policies and procedures, except to the extent permitted for the use of County purchasing procedures as set forth in subparagraph b., below. All CHD employees shall be State or State-contract personnel subject to State personnel rules and procedures. Employees will report time in the Health Management System compatible format by program component as specified by the State. b. The CHD shall comply with all applicable provisions of federal and state laws and regulations relating to its operation with the exception that the use of County purchasing procedures shall be allowed when it will result in a better price or service and no statewide Department of Health purchasing contract has been implemented for those goods or services. In such cases, the CHD director/administrator must sign a justification therefore, and all County purchasing procedures must be followed in their entirety, and such 3 1608 compliance shall be documented. Such justification and compliance documentation shall be maintained by the CHD in accordance with the terms of this contract. State procedures must be followed for all leases on facilities not enumerated in Attachment IV. c. The CHD shall maintain books, records and documents in accordance with the Generally Accepted Accounting Principles (GAAP), as promulgated by the Governmental Accounting Standards Board (GASB), and the requirements of federal or state law. These records shall be maintained as required by the Department of Health Policies and Procedures for Records Management and shall be open for inspection at any time by the parties and the public, except for those records that are not otherwise subject to disclosure as provided by law which are subject to the confidentiality provisions of paragraph 6.1., below. Books, records and documents must be adequate to allow the CHD to comply with the following reporting requirements: 1. The revenue and expenditure requirements in the Florida Accounting Information Resource (FLAIR) System; ii. The client registration and services reporting requirements of the minimum data set as specified in the most current version of the Client Information System/Health Management Component Pamphlet; iii. Financial procedures specified in the Department of Health's Accounting Procedures Manuals, Accounting. memoranda, and Comptroller's memoranda; iv. The CHD is responsible for assuring that all contracts with service providers include provisions that all subcontracted services be reported to the CHD in a manner consistent with the client registration and service reporting requirements of the minimum data set as specified in the Client Information System/Health Management Component Pamphlet. d. All funds for the CHD shall be deposited in the County Health Department Trust Fund maintained by the state treasurer. These funds shall be accounted for separately from funds deposited for other CHDs and shall be used only for public health purposes in Collier County. e. That any surplus/deficit funds, including fees or accrued interest, remaining in the County Health Department Trust Fund account at the end of the contract year shall be credited/debited to the State or County, as appropriate, based on the funds contributed by each and the expenditures incurred by each. Expenditures will be charged to the program accounts by State and County based on the ratio of planned expenditures in this contract and funding from all sources is credited to the program accounts by State and County. The equity share of any surplus/deficit funds accruing to the State and County is determined each month and at contract year-end. Surplus funds may be applied toward the funding requirements of each participating governmental entity in the following year. However, in each such case, all surplus funds, including fees and accrued interest, shall remain in the trust fund until accounted for in a manner which clearly illustrates the amount which has been credited to each participating governmental entity. The planned use of surplus funds shall be. 4 16 08 reflected in Attachment II, Part I of this contract, with special capital projects explained in Attachment V. f. There shall be no transfer of funds between the three levels of services without a contract amendment unless the CHD director/administrator determines that an emergency exists wherein a time delay would endanger the public's health and the Deputy Secretary for County Health Systems has approved the transfer. The Deputy Secretary for County Health Systems shall forward written evidence of this approval to the CHD within 30 days after an emergency transfer. g. The CHD may execute subcontracts for services necessary to enable the CHD to carry out the programs specified in this contract. Any such subcontract shall include all aforementioned audit and record keeping requirements. h. At the request of either party, an audit may be conducted by an independent CPA on the financial records of the CHD and the results made available to the parties within 180 days after the close of the CHD fiscal year. This audit will follow requirements contained in OMB Circular A-133 and may be in conjunction with audits performed by County government. If audit exceptions are found, then the director/administrator of the CHD will prepare a corrective action plan and a copy of that plan and monthly status reports will be furnished to the contract managers for the parties. i. The CHD shall not use or disclose any information concerning a recipient of services except as allowed by federal or state law or policy. j. The CHD shall retain all client records, financial records, supporting documents, statistical records, and any other documents (including electronic storage media) pertinent to this contract for a period of five (5) years after termination of this contract. If an audit has been initiated and audit findings have not been resolved at the end of five (5) years, the records shall be retained until resolution of the audit findings. k. The CHD shall maintain confidentiality of all data, files, and records that are confidential under the law or are otherwise exempted from disclosure as a public record under Florida law. The CHD shall implement procedures to ensure the protection and confidentiality of all such records and shall comply with sections 384.29, 381.004, 392.65 and 456.057, Florida Statutes, and all other state and federal laws regarding confidentiality, All confidentiality procedures implemented by the CHD shall be consistent with the Department of Health Information Security Policies, Protocols, and Procedures. The CHD shall further adhere to any amendments to the State's security requirements and shall comply with any applicable professional standards of practice with respect to client confidentiality. I. The CHD shall abide by all State policies and procedures, which by this reference are incorporated herein as standards to be followed by the CHD, except as otherwise permitted for some purchases using County procedures pursuant to paragraph 6.b. 5 16g 3 m. The CHD shall establish a system through which applicants for services and current clients may present grievances over denial, modification or termination of services. The CHD will advise applicants of the right to appeal a denial or exclusion from services, of failure to take account of a client's choice of service, and of his/her right to a fair hearing to the final governing authority of the agency. Specific references to existing laws, rules or program manuals are included in Attachment I of this contract. n. The CHD shall comply with the provisions contained in the Civil Rights Certificate, hereby incorporated into this contract as Attachment III. o. The CHD shall submit quarterly reports to the County that shall include at least the following: 1. The DE385L1 Contract Management Variance Report and the DE580L1 Analysis of Fund Equities Report; ii. A written explanation to the County of service variances reflected in the DE385L1 report if the variance exceeds or falls below 25 percent of the planned expenditure amount. ' However, if the amount of the service specific variance between actual and planned expenditures does not exceed three percent of the total planned expenditures for the level of service in which the type of service is included, a variance explanation is not required. A copy of the written explanation shall be sent to the Department of Health, Office of Budget and Revenue Management. p. The dates for the submission of quarterly reports to the County shall be as follows unless the generation and distribution of reports is delayed due to circumstances beyond the CHD's control: I. March 1, 2016 for the report period October 1, 2015 through December 31, 2015; ii. June 1, 2016 for the report period October 1, 2015 through March 31, 2016; iii. September 1, 2016 for the report period October 1, 2015 through June 30, 2016; and iv. December 1, 2016 for the report period October 1, 2015 through September 30, 2016. 7. FACILITIES AND EQUIPMENT. The parties mutually agree that: a. CHD facilities shall be provided as specified in Attachment IV to this contract and the County shall own the facilities used by the CHD unless otherwise provided in Attachment IV. 6 1608 4: b. The County shall ensure adequate fire and casualty insurance coverage for County- owned CHD offices and buildings and for all furnishings and equipment in CHD offices through either a self-insurance program or insurance purchased by the County. c. All vehicles will be transferred to the ownership of the County and registered as County vehicles, The County shall ensure insurance coverage for these vehicles is available through either a self-insurance program or insurance purchased by the County. All vehicles will be used solely for CHD operations. Vehicles purchased through the County Health Department Trust Fund shall be sold at fair market value when they are no longer needed by the CHD and the proceeds returned to the County Health Department Trust Fund. 8. TERMINATION. a. Termination at Will. This contract may be terminated by either party without cause upon no less than one-hundred eighty (180) calendar days notice in writing to the other party unless a lesser time is mutually agreed upon in writing by both parties. Said notice shall be delivered by certified mail, return receipt requested, or in person to the other party's contract manager with proof of delivery. b. Termination Because of Lack of Funds. In the event funds to finance this contract become unavailable, either party may terminate this contract upon no less than twenty-four (24) hours notice. Said notice shall be delivered by certified mail, return receipt requested, or in person to the other party's contract manager with proof of delivery. c. Termination for Breach. This contract may be terminated by one party, upon no less than thirty (30) days notice, because of the other party's failure to perform an obligation hereunder. Said notice shall be delivered by certified mail, return receipt requested, or in person to the other party's contract manager with proof of delivery. Waiver of breach of any provisions of this contract shall not be deemed to be a waiver of any other breach and shall not be construed to be a modification of the terms of this contract. 9. MISCELLANEOUS. The parties further agree: a. Availability of Funds. If this Agreement, any renewal hereof, or any term, performance or payment hereunder, extends beyond the fiscal year beginning July 1, 2015, it is agreed that the performance and payment under this Agreement are contingent upon an annual appropriation by the Legislature, in accordance with section 287.0582, Florida Statutes. b. Contract Managers. The name and address of the contract managers for the parties under this contract are as follows: For the State: For the County: Stephanie Vick, M.S.,B.S.N., R.N. Steve Carnell Name Name Administrator, Florida Department of Public Services Division Administrator Health in Collier County 7 1608 Title Title 3339 E. Tamiami Trail, Suite 145 3339 E. Tamiami Trail, Suite 217 Naples, Florida 34112 Naples, Florida 34112 Address Address (239) 252-5332 (239) 252-8468 Telephone Telephone If different contract managers are designated after execution of this contract, the name, address and telephone number of the new representative shall be furnished in writing to the other parties and attached to originals of this contract. c. Captions. The captions and headings contained in this contract are for the convenience of the parties only and do not in any way modify, amplify, or give additional notice of the provisions hereof. In WITNESS THEREOF, the parties hereto have caused this 19 page contract, with its attachments as referenced, including Attachment I (two pages), Attachment II (six pages), Attachment III (one page), Attachment IV (one page), and Attachment V (one page), to be executed by their undersigned officials as duly authorized effective the 1St day of October, 2015. BOARD OF COUNTY COMMISSIONERS STATE OF FLORIDA FOR COLLIER COUNTY DEPARTMENT OF HEALTH SIGNED BY/ ,lfrG�. SIGNED BY: NAME: Ti NA I] A NLS NAME: John H. Armstrong, MD TITLE: C}lA t I M4 TITLE: Surgeon General/Secretary of Health DATE: t DATE: ATTESTED TO' SIGNED SIGNED BY: NAME: l f LSc C-4-rtnon NAME: Stephanie Vick, M.S., B.S.N., R.N. TITLE: U. 'LtTITLE: CHD Director/Administrator . .: DATE: � �.;� � DATE: Attest as to C ailan's sir utureor* :, Approved as to fgrtn and legality 8 Assistant County Attorney , „ ' il�z 16 08 ATTACHMENT I COLLIER COUNTY HEALTH DEPARTMENT PROGRAM SPECIFIC REPORTING REQUIREMENTS AND PROGRAMS REQUIRING COMPLIANCE WITH THE PROVISIONS OF SPECIFIC MANUALS Some health services must comply with specific program and reporting requirements in addition to the Personal Health Coding Pamphlet(DHP 50-20), Environmental Health Coding Pamphlet(DHP 50-21)and FLAIR requirements because of federal or state law,regulation or rule. If a county health department is funded to provide one of these services,it must comply with the special reporting requirements for that service. The services and the reporting • requirements are listed below: Service Requirement 1. Sexually Transmitted Disease Requirements as specified In F.A.C.64D-3,F.S.381 and F.S. Program 384. 2. Dental Health Periodic financial and programmatic reports as specified by the program office. 3. Special Supplemental Nutrition Service documentation and monthly financial reports as specified Program for Women,Infants and In DHM 150-24*and all federal,state and county requirements Children(including the WIC detailed In program manuals and published procedures. Breastfeeding Peer Counseling Program) 4. Healthy Start/Improved Pregnancy Requirements as specified in the 2007 Healthy Start Standards Outcome and Guidelines and as specified by the Healthy Start Coalitions in contract with each county health department. 5. Family Planning Requirements as specified in Public Law 91-572,42 U.S.C.300, et seq.,42 CFR part 59,subpart A,45 CFR parts 74&92,2 CFR 215(OMB Circular A-110)OMB CircularA-102,F,S.381.0051, F.A,C.64F-7,F.A,C.64F-16,and F.A.C.64F-19. Requirements and Guidance as specified in the Program Requirements for Title X Funded Family Planning Projects(Title X Requirements)(2014) and the Providing Quality Family Planning Services(QFP): Recommendations of CDC and the U.S.Office of Population Affairs published on the Office of Population Affairs website. Programmatic annual reports as specified by the program office as specified In the annual programmatic Scope of Work for Family Planning and Maternal Child Health Services,including the Family Planning Annual Report(FPAR),and other minimum guidelines as specified by the Policy Web Technical Assistance Guidelines. 6, Immunization Periodic reports as specified by the department pertaining to Immunization levels in kindergarten and/or seventh grade pursuant to instructions contained in the Immunization Guidelines- Florida Schools,Childcare Facilities and Family Daycare Homes (DH Form 150-615)and Rule 64D-3.046,F.A.C. In addition, periodic reports as specified by the department pertaining to the surveillance/investigation of reportable vaccine-preventable diseases,adverse events,vaccine accountability,and assessment of Immunization ATTACHMENT I(Continued) Attachment_I-Page 1 of 2 1608 levels as documented in Florida SHOTS and supported by CHD Guidebook policies and technical assistance guidance. 7. Environmental Health Requirements as specified in Environmental Health Programs Manual 150-4*and DHP 50-21' 8. HIV/AIDS Program Requirements as specified in F.S.384.25 and F.A.C.64D-3.030 and 64D-3.031.Case reporting should be on Adult HIV/AIDS Confidential Case Report CDC Form DH2139 and Pediatric HIV/AIDS Confidential Case Report CDC Form DH2140. Requirements as specified in F.A.C.64D-2 and 64D-3,F.S.381 and F.S.384. Soclo-demographic and risk data on persons tested for HIV in CHD clinics should be reported on Lab Request DH Form 1628 in accordance with the Forms Instruction Guide. Requirements for the HIV/AIDS Patient Care programs are found in the Patient Care Contract Administrative Guidelines. 9. School Health Services Requirements as specified in the Florida School Health Administrative Guidelines(May 2012). Requirements as specified in F.S.381.0056,F.S.381.0057,F.S.402.3026 and F.A.C.64F-6. 10. Tuberculosis Tuberculosis Program Requirements as specified in F.A.C.64D-3 and F.S.392. 11. General Communicable Disease Carry out surveillance for reportable communicable and other Control acute diseases,detect outbreaks,respond to Individual cases of reportable diseases,investigate outbreaks,and carry out communication and quality assurance functions,as specified in F.A.C.64D-3, F.S.381,F.S.384 and the CHD Epidemiology Guide to Surveillance and Investigations. 12. Refugee Health Program Programmatic and financial requirements as specified by the program office. 'or the subsequent replacement if adopted during the contract period. 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CD O 3 0 -71 o CCU o co _. _ U 12 o0 v) O (CO f0 �U a) O. r CV c`') t7 cn ATTACHMENT II 2 A COLLIER.COIJNTXHEALTH DEPARTMENT f I g4t dart R Sources of Contributions to County Health Department October 1,2016 to September 30 2016 Y s 3 State CHO County Total CHI) i Trust Fund CHD TrustFund Other ' ii _. ... _,_., .__,_ __.,_..•__..__. _.. v...__�..::,._ _._,_ _..__ ,.__.. :._ __....:.{eneh),r-_._._,TruetFund_,.�...icasli) _....,__Coatriliutioa TotaL, _ 1.GENERAL REVENUE-STATE 016040 AIDS PATIENT CARE 140,000 0 140,000 0 140,000 015040 AIDS PREVENTION&SURVEILLANCE•GENERAL REVENUE 69,571 0 69,671 0 69,671. 015040 CHD•TB COMMUNITY PROGRAM 218,724 0 218,724 0 218,724 015040 DENTAL SPECIAL INITIATIVE PROJECTS 5,477 0 5,477 0 5,477 016040 FAMILY PLANNING GENERAL REVENUE 60,550 0 60,650 0 60,660 016040 HEPATITIS AND LIVER FAILURE PREVENTION&CONTROL 89,286 0 89,286 0 89,286 016040 MIGRANT LABOR CAMP SANITATION 74,533 0 74,533 0 74,633 015040 PRIMARY CARE PROGRAM 313,432 0 313,432 0 313,132 015040 SCHOOL HEALTH SERVICES•GENERAL REVENUE 218,073 0 218,073 0 218,073 016040 DOH RESPONSE TO TERRORISM 73,643 0 73,643 0 73,643 016050 CHD GENERAL REVENUE NON-CATEGORICAL 1,742,380 0 1,742,380 0 1,742,380 GENERAL REVENUE TOTAL 3,005,669 0 3,006,669 0 3,005,669 2.NON GENERAL REVENUE-STATE 016010 ENVIRONMENTAL BIOMEDICAL WASTE PROGRAM 14,038 0 14,038 0 14,038 015010 TOBACCO STATE AND COMMUNITY INTERVENTIONS I83,886 0 183,886 0 183,885 NON GENERAL REVENUE TOTAL 197,923 0 197,923 0 197,923 3.FEDERAL FUNDS-STATE • 007000 AIDS DRUG ASSISTANCE PROGRAM ADMIN 60,763 0 60,763 0 60,763 007000 AIDS DRUG ASSISTANCE PROGRAM ADMIN HQ 19,918 0 19,918 0 19,918 007000 BIOTERRORISM HOSPITAL PREPAREDNESS 20,2.13 0 20,243 0 20,243 007000 WIC BREASTFEEDING PEER COUNSELING PROG 67,672 0 G7,672 0 67,672 007000 COASTAL BEACH WATER QUALITY MONITORING 17,114 0 17,144 0 17,144 007000 COMPREHENSIVE COMMUNITY CARDIO•PHBG 40,000 0 40,000 0 40,000 007000 FAMILY PLANNING TITLE X•GRANT 106,689 0 106,589 0 106,589 007000 IMMUNIZATION ACTION PLAN 72,652 0 72,652 0 72,652 007000 MCH SPECIAL PROJECT PRAMS 27,529 0 27,529 0 27,629 007000 HPP AND PREP COOP AGRMT PHEP EBOLA SUPPLEMENT 142 8,956 0 8,956 0 8,956 007000 PHP PUBLIC HEALTH PREPAREDNESS BASE ALLOC 132,101 0 132,101 0 132,101 007000 AIDS PREVENTION 234,788 0 234,788 0 234,788 007000 IMPROVING STD PROGRAMS 5,624 0 5,624 0 5,624 007000 WIC PROGRAM ADMINISTRATION 1,376,111 0 1,375,111 0 1,376,111 016076 INSPECTIONS OF SUMMER FEEDING PROGRAM•DOE 1,600 0 1,600 0 1,500 015076 SUPPLEMENTAL SCHOOL HEALTH 33,690 0 33,690 0 33,690 016076 REFUGEE HEALTH SCREENING REIMBURSEMENT 633,000 0 533,000 0 533,000 FEDERAL FUNDS TOTAL 2,767,180 0 2,757,180 0 2,757,180 4.FEES ASSESSED BY STATE OR FEDERAL RULES•STATE 001020 CHD STATEWIDE ENVIRONMENTAL FEES 424,342 0 424,342 0 424,342 001092 CHD STATEWIDE ENVIRONMENTAL FEES 100,660 0 100,650 0 100,660 001206 ON SITE SEWAGE DISPOSAL PERMIT FEES 6,000 0 6,000 0 6,000 001206 SANITATION CERTIFICATES(FOOD INSPECTION) 3,000 0 3,000 0 3,000 001206 SEPTIC TANK RESEARCH SURCHARGE 800 0 800 0 800 001206 PUBLIC SWIMMING POOL PERMIT FEES-1094 HQ TRANSFER 30,000 0 30,000 0 30,000 001206 DRINKING WATER PROGRAM OPERATIONS 1,200 0 . 1,200 0 1,200 AttachmeM_II_Part_II-Page 1 of 3 1 6 0 8 :.,,.,,.,:,„,:,,,„,„,.:,,„„,.„..,,,,,:,..,_„,„.„,„:„.„,,,,,,„,,,,„:„:„,,,:„,.,:,..,..,„,,,„„„,,.„,„,„,,,:;,„„,:,,,,,_,„,„:„.,.„,.,,,,:,„,:,„.„„,,:,,,,,:,,,,,,,.„.,,..,:,,,,,f,„„,...,,..: 4 ATTACHMENT II S ,„-„,„,„„,„.,,,,,.,.:„.,„,,,,„,„,„„,„,,„„„::,,„,„:„,,,„,:,,,„,,,-,-,-„„.„..,„tiEC-04 , COLLIER COUNTY HEALTH DEPARTMENT PartII Sources of Contnbutaons to CountyHealthepartment October 1 2016 to Septambor 30,2016.: County Tola10HD $ Sfste CHD r TruatEund CHD TruatFund ,_ Other .M w__�,.___, .-...._�__ , ___ -,�...�.._._.,.._...... . ..... . �,. _.....dcash)_ .Trust Fund.=_ _. -(cdek? _<.,:;Contiibution_ .� otal__,�.. 001206 REGULATION OF BODY PIERCING SALONS 30 0 30 0 30 001206 TANNING FACILITIES 350 0 360 0 360 001206 ONSITE SEWAGE TRAINING CENTER 1,000 0 1,000 0 1,000 001206 TATTO PROGRAM ENVIRONMENTAL HEALTH 1,000 0 1,000 0 1,000 001206 MOBILE HOME&RV PARK FEES 2,000 0 2,000 0 2,000 FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 670,372 0 670,372 0 570,372 5.O'1'lie,R CASH CONTRIBUTIONS•STATE: 0 0 0 0 0 090001 DRAW DOWN FROM PUBLIC HEALTH UNIT 169,143 0 159,143 0 159,143 017i>JR CASH CONTRIBUTION TOTAL 159,143 0 159,143 0 169,193 6.MEDICAID•STATE/COUNTY: 001057 CHD CLINIC FEES 0 76,100 76,100 0 76,100 001148 CHD CLINIC FEES 0 1,019,600 1,019,600 0 1,019,600 MEDICAID TOTAL 0 1,096,700 1,095,700 0 1,095,700 7.ALLOCABLE REVENUE-STATE: 018000 CHD CLINIC FEES 1,000 0 1,000 0 1,000 ALLOCABLE REVENUE TOTAL 1,000 0 1,000 0 1,000 8.OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND-STATE ADAP 0 0 0 1,887,361 1,987,361 PHARMACY DRUG PROGRAM 0 0 0 144,248 144,298 MC PROGRAM 0 0 0 5,731,922 6,731,922 BUREAU OF PUBLIC HEALTH LABORATORIES 0 0 0 52,359 62,359 IMMUNIZATIONS 0 0 0 956,39.1 955,394 OTHER STATE CONTRIBUTIONS TOTAL 0 0 0 8,871,264 8,871,284 9.DIRECT LOCAL CONTRIBUTIONS•BCC/TAX DISTRICT 008005 CHD LOCAL REVENUE&EXPENDITURES 0 1,378,200 1,378,200 0 1,378,200 DIRECT COUNTY CONTRIBUTIONS TOTAL 0 1,378,200 1,378,200 0 1,378,200 10.FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION•COUNTY 001077 CHD CLINIC FEES 0 217,830 217,830 0 217,830 001077 GENERAL CLINIC RABIES SERVICES&DRUG PURCHASES 0 9,400 9,400 0 9,400 001094 CHD LOCAL ENVIRONMENTAL FEES 0 501,700 594,700 0 694,700 001110 VITAL STATISTICS CERTIFIED RECORDS 0 335,000 336,000 0 336,000 FEES AUTHORIZED BY COUNTY TOTAL 0 1,156,930 1,166,930 0 1,156,930 11.OTHER CASH AND LOCAL CONTRIBUTIONS-COUNTY 001029 CHD CLINIC FEES 0 37,100 37,100 0 37,100 001029 GENERAL CLINIC RABIES SERVICES&DRUG PURCHASES 0 3,000 3,000 0 3,000 001090 CHD CLINIC FEES 0 43,000 43,000 0 43,000 001090 GENERAL CLINIC RABIES SERVICES&DRUG PURCHASES 0 600 600 0 G00 010303 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 0 G00 600 0 G00 010600 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 0 3,000 3,000 0 3,000 011000 RYAN WHITE0 282,692 282,692 0 282,692 Attachment_II Part_II-Page 2 of 3 - 1 0 8 ATTACHMENT TI , COLLIER COUNTYIREALTR DEPARTMENT L ry -Part.lt,Sources of Cont*-isutions to County;-Health Dopartmon11t October 1,2016 to Septombor 30 2016: Stats CHD County Total CHD Trust.Fund CRD Trust Fund Other laeh).,..._- fii .und., .,-(cash),_._._.,Contiitintion-.,._.,_:Total.._',._: 011000 CHD CASH DONATION/NON•SPECIFIC 0 2,100 2,100 0 2,100 011000 EARLY LEARNING COALITION OF SOUTHWEST FLORIDA 0 60,900 60,900 0 60,900 011000 CHD LOCAL REVENUE&EXPENDITURES 0 252,720 262,720 0 252,720 011001 CHD HEALTHY START COALITION CONTRACT 0 644,950 644,960 0 544,950 090002 DRAW DOWN FROM PUBLIC HEALTH UNIT 0 216,025 216,025 0 216,0:5 OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 0 1,446,687 1,445,687 0 1,446,687 12.ALLOCABLE REVENUE-COUNTY 018000 CHD CLINIC FEES 0 1,000 1,000 0 1,000 COUNTY ALLOCABLE REVENUE TOTAL 0 1,000 1,000 0 1,000 13.BUILDINGS•COUNTY ANNUAL RENTAL EQUIVALENT VALUE 0 0 0 626,018 525,048 IT ALLOCATION&GOLDEN GATE RENTAL 0 0 0 83,100 83,100 UTILITIES 0 0 0 193,800 193,800 BUILDING MAINTENANCE 0 0 0 0. 0 GROUNDS MAINTENANCE 0 0 0 195,149 195,149 INSURANCE 0 0 0 0 0 OTHER(Specify) 0 0 0 0 0 OTHER(Specify) 0 0 0 0 0 BUILDINGS TOTAL 0 0 0 997,097 097,097 19.OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND•COUNTY EQUIPMENT!VEHICLE PURCHASES 0 0 0 0 0 VEHICLE INSURANCE 0 0 0 16,300 16,300 VEHICLE MAINTENANCE 0 0 0 0 0 OTHER COUNTY CONTRIBUTION(SPECIFY) 0 0 0 0 0 OTHER COUNTY CONTRIBUTION(SPECIFY) 0 0 0 0 0 OTHER COUNTY CONTRIBUTIONS TOTAL 0 0 0 16,300 16,300 GRAND TOTAL CHD PROGRAM 6,691,287 5,077,617 11,768,804 9,884,681 21,653,485 Attachmont_II_Part II-Page 3 of 3 I 16 0 8 ATTACHMENT 11 T COLLIER COUNTY ALTRDEEARTMENT z A .. s 4, ..,3 ~ P.xt IIfT.lanned Staft'ing Cbental Servlcea and EzpondltureaByProgram Sar ce.Aioa`1VrtlnnEach.Leve1 of Sornce l October 1 2015 W Sepfamber_30-2016 ' fi K � Quarterly Eipenditina Plan I s T.TE'lt Clients Service♦! 1at 2nd ' '" 8rd` AEh - GranE (0 00) Unite Vrejta 11,57,ha1e dollars only) State County Total 1 A. COMMUNICABLE DISEASE CONTROL' IMMUNIZATION (101) 11.88 9,205 12,242 162,283 189,284 162,283 189,284 404.620 298.614 703,154 SEXUALLY TRANS.DIS. (102) 5.37 1,2I2 2,186 76,948 88,685 75,948 88,585 179,767 149,299 329,068 HIV/MDS PREVENTION(03AI) 4.52 1,380 1,633 66,873 78,000 66,573 78,000 281,746 8,000 289,746 HIV/AIDS SURVEILLANCE(03A2) 1.24 33 3G 17,265 20,138 17,205 20,137 74,805 0 74,805 HIVIAIDS PATIENT CARE (03A3) 7.68 460 2,350 120,028 146,996 126,028 146,995 211,342 334,705 546,047 ADAP(03A1) 2.24 7 91 32,220 37,588 32,226 37,588 139,628 0 139,623 TUBERCULOSIS (104) 7.13 828 4,000 110,309 136,660 116,309 135,660 318,728 185,210 603,938 COMM.DIS.SURV. (100) 6.31 1 2,762 100,906 124,093 106,900 124,692 293,18G 170,011 463,197 HEPATITIS (100) 2.14 2,322 3,084 35,255 41,121 35,265 41,121 152,582 170 162,752 PREPAREDNESS AND RESPONSE (110) 5,03 0 39 88,820 103,598 88,820 103,599 398,026 86,811 384,837 REFUGEE HEALTH (118) 8.47 1,680 6,035 187,209 218,357 187,209 218,357 781,132 90,000 811,192 VITALRECORDS (180) 2.35 8,723 34,433 30,785 35,906 30,785 35,906 0 133,382 133,382 COMMUNICABLE DISEASE SUBTOTAL 64,28 26,899 68,421 1,045,907 1,219,926 1,046,007 1,219,924 3,135.562 1,396,102 4,531,964 B, PRIMARY CARE: CHRONIC DISEASE PREVENTION PRO (210) 1.41 8 291 . 21,218 24,748 21,218 24,749 40,000 61,933 91,933 WIC (21W1) 29.75 24,078 104,844 388,015 462,572 988,015 462,673 1,681,175 0 1,681,176 TOBACCO USE INTERVENTION (212) 3.17 0 232 47,448 65,343 47,448 66,343 163,885 21,697 205,682 WIC BREASTFEEDING PEER COUNSELING (21W2) 2.18 0 3,487 20,197 23,658 20.297 23,558 87,510 0 87,510 FAMILY PLANNING (223) 1,28 1,613 1,704 43,194 50,380 43,194 50,380 187,148 0 187,148 IMPROVED PREGNANCY OUTCOME (225) 0.74 023 627 83,076 97,597 83,676 97,597 27,529 335,016 362,644 HEALTHY START PRENATAL (227) 11.71 1,969 7,697 175,370 204,648 176,370 204,547 156,718 603,119 769,835 COMPREHENSIVE CHILD HEALTH(229) 2,09 962 691 31,880 37,184 31,880 97,184 0 138,128 138,128 HEALTHY START CHILD(291) 4.71 618 4,069 69,355 80,895 69,356 80,89G 160,000 150,503 300,503 SCHOOL HEALTH(234) 9.24 0 440,311 120,435 140,472 120,435 140,472 361,651 160,163 521,814 COMPREHENSIVE ADULT HEALTH (237) 6,69 2,847 4,021 127,601 148,831 127,601 148,832 148,377 404,488 552,865 COMMUNITY HEALTH DEVELOPMENT(238) 1.64 0 90 23,750 27,702 23,760 27,702 0 102,904 102,904 DENTAL HEALTH (240) 15.80 4,689 9,625 276,85D 521,756 276,859 321,766 5,477 1,189,753 1,195,230 PRIMARY CARE SUBTOTAL 90.45 30,207 577,539 1,427,998 1,606,588 1,427,998 1,665,589 3,029,168 3,157,703 0,187,171 C. ENVIRONMENTAL HEALTH: Watar and Omits Sewage Programa COSTAL BEACH MONITORING (347) 0.11 381 361 2,702 3,161 2,702 3,150 11,705 0 11,705 LIMITED USE PUBLIC WATER SYSTEMS (367) 0.44 400 1,734 8,472 9,882 8,472 9,881 10,000 26,707 90,707 PUDLIC WATER SYSTEM (358) 0.00 0 0 12 14 12 13 0 51 51 PRIVATE WATER SYSTEM (369) 0.14 0 400 1,848 2,156 1,848 2,150 0 8,008 8,008 ONSITE SEWAGE TREATMENT&DISPOSAL(301) 4,56 1,186 5,402 70,568 82,309 70,508 82,308 96,000 209,763 305,753 Groap Total 6.25 1,953 5,903 83,602 07,612 83,002 97.508 117.705 244.519 362,224 Facility Programs TATTOO FACILITY SERVICES (344) 0.25 0 62 3,659 4,268 3,659 4,267 7,000 8.853 16,853 FOOD HYGIENE (348) 0.79 09 465 13,010 16,176 13,010 15,179 28,900 27,471 36.371 BODY PIERCING FACILITIES SERVICES(349) 0.00 0 0 67 67 57 G8 249 0 249 A5aWnenl II Pa1t_tl1.Pape 1 of 2 D8 ATTACHMENT II sT s Y COLLIER COUNTYHEAU2HDEPARTMENT i Part III PlinnedStIEug Clients Se>yvlcee andr Epend2turea0y Program Service Area Withmiech Leval of 8ery of Octoborl 2016 to Soptemben B0 2016 . r - QuarterlyEipendtture Plan 1: L'a Clients Servu es/ 1st 2nd _. _ AAAARrd_ ' 4th SAA ..._ �t. Oraild i . 1 , _ (G;DOUnta Avisit . A _ oe 7olar � __ yate Couny`s Toal- GROUP CARE FACILITY(351) 0,37 113 183 5,790 6,763 5,790 6,752 0 25,085 26,086 MIGRANT LABOR CAMP (3521 2.40 140 925 36,305 42,346 36,305 42,346 113.148 44,152 167,300 ROUSING&PUB.BLDG. (353) 0.00 0 0 0 0 0 0 0 0 0 MOBILE HOME AND PARK(354) 0.43 102 317 0,288 7,335 6,288 7,335 27,246 0 27,246 POOLS/BATHING PLACES (360) 3.23 1,490 15,870 5-1,163 63,174 54,163 63,174 97,139 137,535 234,674 BIOMEDICAL WASTE SERVICES (364) 1.29 850 899 20,700 24,151 20,706 224,151 89,714 0 89,714 TANNING FACILITY SERVICES (309) 0.02 8 22 364 424 364 424 1,670 0 1,578 Group Total 8,78 2,80G 18,733 140,342 163,692 140,342 163,692 361,972 243,096 608,068 Groundwater Contamination STORAGE TANK COMPLIANCE SERVICES (355) 0.00 0 0 0 0 .0 0 0 0 0 SUPER ACT SERVICES (356) 0.0-1 17 20 622 728 022 727 0 2,097 2,697 Group Total 0.04 17 20 G22 720 622 727 0 2,697 2,607 Community Hygiene COMMUNITY ENVIR.HEALTH (346) 0.00 0 0 0 0 0 0 0 0 0 INJURY PREVENTION (346) 0,49 0 0 7,346 8,669 7,346 8,569 0 31,830 31,830 LEAD MONITORING SERVICES (3501 0.00 0 0 2 2 2 3 0 9 9 PUBLIC SEWAGE (362) 0.00 0 0 0 0 0 0 0 0 0 SOLID WASTE DLSPOSAL SERVICE (363) 0.00 0 0 0 0 0 0 0 0 0 SANITARY NUISANCE (366) 0.01 0 3 2.36 276 236 276 0 1,023 1,023 RABIES SURVEILLANCE (360) 0.00 0 0 22 26 22 27 0 97 97 ARBORVIRUS SURVEIL. (387) 0.00 0 0 0 0 0 0 0 0 0 RODENT/ARTHROPOD CONTROL(368) 0,00 0 0 0 0 0 0 0 0 0 WATER POLLUTION (370) 0.00 0 0 0 0 0 0 0 0 0 INDOOR AIR (371) 0.00 0 0 10 11 10 11 0 42 42 RADIOLOGICAL HEALTH (372) 0.00 0 0 92 107 92 108 0 399 999 TOXIC SUBSTANCES (373) 0,00 0 0 0 0 0 0 D 0 0 Group Total 0.50 0 9 7,708 8,090 7,708 8,994 0 33,400 33,400 ENVIRONMENTAL HEALTH SUBTOTAL 14.67 4,770 24,659 232,274 270,020 232,274 270,921 482,077 523,712 1,000,389 D. NONOPERATIONAL COSTS: NON-OPERATIONAL COSTS (6991 0.00 0 0 0 0 0 0 0 0 0 ENVIRONMENTAL HEALTH SURCHARGE (399) 0.00 0 0 10,058 11,732 10,058 11,732 43,580 0 43,580 MEDICAID BUYBACK(611) 0.00 0 0 0 0 0 0 0 0 0 NONOPERATIONAL COSTS SUBTOTAL 0.00 0 0 10,058 11,732 10.058 11,732 43,680 0 43,680 TOTAL CONTRACT 169.28 66,822 670,619 2,716,237 3,108,104 2,716,237 3,168,166 6,691,287 5,077,517 11,768,804 attadimonl 9 PaJ1_III-Pape 2 012 1608 ATTACHMENT IIi COLLIER COUNTY HEALTH DEPARTMENT CIVIL RIGHTS CERTIFICATE The applicant provides this assurance in consideration of and for the purpose of obtaining federal grants,loans, contracts(except contracts of insurance or guaranty),property,discounts,or other federal financial assistance to programs or activities receiving or benefiting from federal financial assistance, The provider agrees to complete the Civil Rights Compliance Questionnaire, DH Forms 946 A and B(or the subsequent replacement if adopted during the contract period),if so requested by the department. The applicant assures that it will comply with: 1. Title VI of the Civil Rights Act of 1964, as amended,42 U.S.C.,2000 Et seq.,which prohibits discrimination on the basis of race,color or national origin In programs and activities receiving or benefiting from federal financial assistance. 2. Section 504 of the Rehabilitation Act of 1973,as amended,29 U.S.C. 794,which prohibits discrimination on the basis of handicap in programs and activities receiving or benefiting from federal financial assistance. 3. Title iX of the Education Amendments of 1972,as amended,20 U.S.C. 1681 et seq.,which prohibits discrimination on the basis of sex in education programs and activities receiving or benefiting from federal financial assistance. 4. The Age Discrimination Act of 1975,as amended,42 U.S.C, 6101 et seq.,which prohibits discrimination on the basis of age in programs or activities receiving or benefiting from federal financial assistance. 5. The Omnibus Budget Reconciliation Act of 1981,P.L.97-35,which prohibits discrimination on the basis of sex and religion in programs and activities receiving or benefiting from federal financial assistance. 6. All regulations,guidelines and standards lawfully adopted under the above statutes.The applicant agrees that compliance with this assurance constitutes a condition of continued receipt of or benefit from federal financial assistance,and that it is binding upon the applicant,its successors,transferees,and assignees for the period during which such assistance is provided. The applicant further assures that all contracts, subcontractors,subgrantees or others with whom it arranges to provide services or benefits to participants or employees in connection with any of Its programs and activities are not discriminating against those participants or employees in violation of the above statutes,regulations,guidelines,and standards. In the event of failure to comply,the applicant understands that the grantor may,at its discretion, seek a court order requiring compliance with the terms of this assurance or seek other appropriate judicial or administrative relief,to include assistance being terminated and further assistance being denied. Attachment_Ilt-Page 1 of 1 6 o 8 ATTACHMENT IV COLLIER COUNTY HEALTH DEPARTMENT FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT Facility Description Location Owned By COLLIER COUNTY HEALTH 3339 E.Tamlami Trail,Building H, Naples Collier County DEPARTMENT&PUBLIC SERVICES BUILDING H IMMOKALEE SATELLITE 419 North First Srteet, Immokalee Collier County GOLDEN GATE WIC OFFICE 4945 Golden Gate Parkway,Unit 102, Benderson Development Naples CCHD Annex 3205 Beck Blvd, Naples Florida Department of Environmental Protection Attachment_IV-Page 1 of 1 ATTACHMENT V16 08 COLLIER COUNTY HEALTH DEPARTMENT SPECIAL PROJECTS SAVINGS PLAN CASH RESERVED OR ANTICIPATED TO BE RESERVED FOR PROJECTS CONTRACT YEAR STATE COUNTY TOTAL 20142015' $ 0 $ 0 $ 0 2015-2016" $ 0 $ 0 $ 0 2016-2017"* S 0 $ 0 $ 0 2017-2018"* $ 0 $ 0 $ 0 PROJECT TOTAL $ 0 $ 0 $ 0 SPECIAL PROJECTS CONSTRUCTION/RENOVATION PLAN PROJECT NUMBER: PROJECT NAME: LOCATION/ADDRESS: PROJECT TYPE: NEW BUILDING ROOFING RENOVATION PLANNING STUDY NEW ADDITION OTHER SQUARE FOOTAGE: 0 PROJECT SUMMARY: Describe scope of work in reasonable detail. START DATE (Intliat expenditure of funds) COMPLETION DATE: DESIGN FEES: $ 0 CONSTRUCTION COSTS: $ 0 FURNITUREJEQUIPMENT: $ 0 TOTAL PROJECT COST: $ 0 COST PER SQ FOOT: $ 0 Special Capital Projects are new construction or renovation projects and new furniture or equipment associated with these projects and mobile health vans, Cash balance as of 9/30/15 "Cash to be transferred to FCO account. '•'Cash anticipated for future contract years. Attachment_V•Page 1 of 10 long ng ADDENDUM I TO CONTRACT BETWEEN COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS AND STATE OF FLORIDA DEPARTMENT OF HEALTH FOR OPERATION OF THE COLLIER COUNTY HEALTH DEPARTMENT CONTRACT YEAR 2015-2016 This Addendum is made this 'A.41 day of pig , 201&-and is added to and amends the Contract Between Collier County Board of CountyCommissioners and State of Florida Department of Health for Operation of the Collier County Health Department Contract Year 2015-2016 ("Contract"). The following underlined provision is added to Section 4 of the Contract to include non- recurring funding by the County to fill a funding gap resulting from loss of Low Income Pool funds previously provided by the Agency for Health Care Administration.: 4. FUNDING. The parties further agree that funding for the CHD will be handled as follows: a. The funding to be provided by the parties and any other sources is set forth in Part II of Attachment II hereof. This funding will be used as shown in Part I of Attachment II. * * * iii. The County's supplemental funding as provided in Attachment II, Part Ih in an amount not to exceed $249,220(amount included in the calculation under the CHD Local Revenue &Expenditures section of the revenue attachment). IN WITNESS WHEREOF, the State and County have hereto executed this Addendum the day and year first above written. AS TO THE STATE: STATE OF FLORIDA DEPARTMENT OF HEALTH SIGNED BY: NAME: John H. Armstrong, MD TITLE: Surgeon General/Secretary of Health DATE: 1 of 2 1608 SIGNED BY: NAME: Stephanie Vick, M.S., B.S.N., R.N. TITLE: CHD Director/Administrator DATE: AS TO THE COUNTY: Attest: BOARD OF COUNTY COMMISSIONERS FOR DWIGHT E. BROCK, Clerk COLLIER COUNTY A. Pp B ei� By: Attest as toghaiiikirtsity Clerk TIM NANCE, CHAIRMAN signat SK flay • Approved as to form and legality: AIL Jennifer A.`=.elpedio, Assista County Attorney 2 of 2 16DLi Rick Scott Mission: Governor To protect,promote&improve the health of all people in Florida through integrated 01'110 John H.Armstrong, MD, FACS state,county&community efforts. HEALTH State Surgeon General&Secretary Collier County Vision:To be the Healthiest State in the Nation INTEROFFICE MEMORANDUM zrri DATE: February 2, 2016 2rn -„ cn TO: Teresa L. Cannon , n• �© Collier County Government Grte- N FROM: Alan Portis Florida Department of Health in Collier County J SUBJECT: FY 2015-2016 Core Contract Attached forY our records is the original of the contract referenced above, (Item #46D25) approved by the Board of County Commissioners December 08, 2015. If you have any questions, please contact me at (239) 252-8206. Sincerely, Alan L. Portis Finance and Accounting Director Enclosure Cc: Teresa Cannon, Collier County Minutes and Records Department— (1) original Steve Carnell, Public Services — (1) copy Maggie Lopez, Community and Human Services — (1) copy Florida Department of Health www.FloridasHealth.com in COLLIER COUNTY•Office of the Director TWITTER:HealthyFLA 3339 East Tamiami Trail,Ste 145•Naples,Florida 34112 FACEBOOK:FLDepartmentofHealth PHONE:239/252-8200•FAX:2391774-5653 YOUTUBE:fldoh 1 6 El Y CONTRACT BETWEEN COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS AND STATE OF FLORIDA DEPARTMENT OF HEALTH FOR OPERATION OF THE COLLIER COUNTY HEALTH DEPARTMENT CONTRACT YEAR 2015-2016 This contract is made and entered into between the State of Florida, Department of Health ("State") and the Collier County Board of County Commissioners ("County"), through their undersigned authorities, effective October 1, 2015. RECITALS A. Pursuant to Chapter 154, Florida Statutes, the intent of the legislature is to "promote, protect, maintain, and improve the health and safety of all citizens and visitors of this state through a system of coordinated county health department services." B. County Health Departments were created throughout Florida to satisfy this legislative intent through "promotion of the public's health, the control and eradication of preventable diseases, and the provision of primary health care for special populations." C. Collier County Health Department ("CHD") is one of the created County Health Departments. D. It is necessary for the parties hereto to enter into this contract in order to ensure coordination between the State and the County in the operation of the CHD. NOW THEREFORE, in consideration of the mutual promises set forth herein, the sufficiency of which are hereby acknowledged, the parties hereto agree as follows: 1. RECITALS. The parties mutually agree that the forgoing recitals are true and correct and incorporated herein by reference. 2. TERM. The parties mutually agree that this contract shall be effective from October 1, 2015, through September 30, 2016, or until a written contract replacing this contract is entered into between the parties, whichever is later, unless this contract is otherwise terminated pursuant to the termination provisions set forth in paragraph 8. below. 3. SERVICES MAINTAINED BY THE CHD. The parties mutually agree that the CHD shall provide those services as set forth on Part III of Attachment 11 hereof, in order to maintain the following three levels of service pursuant to section 154.01(2), Florida Statutes, as defined below: a. "Environmental health services" are those services which are organized and operated to protect the health of the general public by monitoring and regulating activities in the environment which may contribute to the occurrence or transmission of disease. 8 _ 1 Environmental health services shall be supported by available federal, state and local funds and shall include those services mandated on a state or federal level. Examples of environmental health services include, but are not limited to, food hygiene, safe drinking water supply, sewage and solid waste disposal, swimming pools, group care facilities, migrant labor camps, toxic material control, radiological health, and occupational health. b. "Communicable disease control services" are those services which protect the health of the general public through the detection, control, and eradication of diseases which are transmitted primarily by human beings. Communicable disease services shall be supported by available federal, state, and local funds and shall include those services mandated on a state or federal level. Such services include, but are not limited to, epidemiology, sexually transmissible disease detection and control, HIV/AIDS, immunization, tuberculosis control and maintenance of vital statistics. c. "Primary care services" are acute care and preventive services that are made available to well and sick persons who are unable to obtain such services due to lack of income or other barriers beyond their control. These services are provided to benefit individuals, improve the collective health of the public, and prevent and control the spread of disease. Primary health care services are provided at home, in group settings, or in clinics. These services shall be supported by available federal, state, and local funds and shall include services mandated on a state or federal level. Examples of primary health care services include, but are not limited to: first contact acute care services; chronic disease detection and treatment; maternal and child health services; family planning; nutrition; school health; supplemental food assistance for women, infants, and children; home health; and dental services. 4. FUNDING. The parties further agree that funding for the CHD will be handled as follows: a. The funding to be provided by the parties and any other sources is set forth in Part II of Attachment II hereof. This funding will be used as shown in Part I of Attachment II. i. The State's appropriated responsibility (direct contribution excluding any state fees, Medicaid contributions or any other funds not listed on the Schedule C) as provided in Attachment II, Part II is an amount not to exceed $ 5,330,128 (State General Revenue, State Funds, Other State Funds and Federal Funds listed on the Schedule C). The State's obligation to pay under this contract is contingent upon an annual appropriation by the Legislature. ii. The County's appropriated responsibility (direct contribution excluding any fees, other cash or local contributions) as provided in Attachment II, Part II is an amount not to exceed $ 1,378,200 (amount listed under the "Board of County Commissioners Annual Appropriations section of the revenue attachment). b. Overall expenditures will not exceed available funding or budget authority, whichever is less, (either current year or from surplus trust funds) in any service category. Unless requested otherwise, any surplus at the end of the term of this contract in the County Health 2 1608 8 Department Trust Fund that is attributed to the CHD shall be carried forward to the next contract period. c. Either party may establish service fees as allowed by law to fund activities of the CHD. Where applicable, such fees shall be automatically adjusted to at least the Medicaid fee schedule. d. Either party may increase or decrease funding of this contract during the term hereof by notifying the other party in writing of the amount and purpose for the change in funding. If the State initiates the increase/decrease, the CHD will revise the Attachment II and send a copy of the revised pages to the County and the Department of Health, Office of Budget and Revenue Management. If the County initiates the increase/decrease, the County shall notify the CHD. The CHD will then revise the Attachment II and send a copy of the revised pages to the Department of Health, Office of Budget and Revenue Management. e. The name and address of the official payee to whom payments shall be made is: County Health Department Trust Fund Collier County 3339 E. Tamiami Trail, Suite 145 Naples, FL 34112 5. CHD DIRECTOR/ADMINISTRATOR. Both parties agree the director/administrator of the CHD shall be a State employee or under contract with the State and will be under the day-to-day direction of the Deputy Secretary for County Health Systems. The director/administrator shall be selected by the State with the concurrence of the County. The director/administrator of the CHD shall ensure that non-categorical sources of funding are used to fulfill public health priorities in the community and the Long Range Program Plan. A report detailing the status of public health as measured by outcome measures and similar indicators will be sent by the CHD director/administrator to the parties no later than October 1 of each year (This is the standard quality assurance "County Health Profile"report located on the Division of Public Health Statistics and Performance Management Intranet site). 6. ADMINISTRATIVE POLICIES AND PROCEDURES. The parties hereto agree that the following standards should apply in the operation of the CHD: a. The CHD and its personnel shall follow all State policies and procedures, except to the extent permitted for the use of County purchasing procedures as set forth in subparagraph b., below. All CHD employees shall be State or State-contract personnel subject to State personnel rules and procedures. Employees will report time in the Health Management System compatible format by program component as specified by the State. b. The CHD shall comply with all applicable provisions of federal and state laws and regulations relating to its operation with the exception that the use of County purchasing procedures shall be allowed when it will result in a better price or service and no statewide Department of Health purchasing contract has been implemented for those goods or services. In such cases, the CHD director/administrator must sign a justification therefore, and all County purchasing procedures must be followed in their entirety, and such 3 ij compliance shall be documented. Such justification and compliance documentation shall be maintained by the CHD in accordance with the terms of this contract. State procedures must be followed for all leases on facilities not enumerated in Attachment IV. c. The CHD shall maintain books, records and documents in accordance with the Generally Accepted Accounting Principles (GAAP), as promulgated by the Governmental Accounting Standards Board (GASB), and the requirements of federal or state law. These records shall be maintained as required by the Department of Health Policies and Procedures for Records Management and shall be open for inspection at any time by the parties and the public, except for those records that are not otherwise subject to disclosure as provided by law which are subject to the confidentiality provisions of paragraph 6.i., below. Books, records and documents must be adequate to allow the CHD to comply with the following reporting requirements: i. The revenue and expenditure requirements in the Florida Accounting Information Resource (FLAIR) System; ii. The client registration and services reporting requirements of the minimum data set as specified in the most current version of the Client Information System/Health Management Component Pamphlet; iii. Financial procedures specified in the Department of Health's Accounting Procedures Manuals, Accounting memoranda, and Comptroller's memoranda; iv. The CHD is responsible for assuring that all contracts with service providers include provisions that all subcontracted services be reported to the CHD in a manner consistent with the client registration and service reporting requirements of the minimum data set as specified in the Client Information System/Health Management Component Pamphlet. d. All funds for the CHD shall be deposited in the County Health Department Trust Fund maintained by the state treasurer. These funds shall be accounted for separately from funds deposited for other CHDs and shall be used only for public health purposes in Collier County. e. That any surplus/deficit funds, including fees or accrued interest, remaining in the County Health Department Trust Fund account at the end of the contract year shall be credited/debited to the State or County, as appropriate, based on the funds contributed by each and the expenditures incurred by each, Expenditures will be charged to the program accounts by State and County based on the ratio of planned expenditures in this contract and funding from all sources is credited to the program accounts by State and County. The equity share of any surplus/deficit funds accruing to the State and County is determined each month and at contract year-end. Surplus funds may be applied toward the funding requirements of each participating governmental entity in the following year. However, in each such case, all surplus funds, including fees and accrued interest, shall remain in the trust fund until accounted for in a manner which clearly illustrates the amount which has been credited to each participating governmental entity. The planned use of surplus funds shall be 4 1608 • reflected in Attachment II, Part I of this contract, with special capital projects explained in Attachment V. f. There shall be no transfer of funds between the three levels of services without a contract amendment unless the CHD director/administrator determines that an emergency exists wherein a time delay would endanger the public's health and the Deputy Secretary for County Health Systems has approved the transfer. The Deputy Secretary for County Health Systems shall forward written evidence of this approval to the CHD within 30 days after an emergency transfer. g. The CHD may execute subcontracts for services necessary to enable the CHD to carry out the programs specified in this contract. Any such subcontract shall include all aforementioned audit and record keeping requirements. h. At the request of either party, an audit may be conducted by an independent CPA on the financial records of the CHD and the results made available to the parties within 180 days after the close of the CHD fiscal year. This audit will follow requirements contained in OMB Circular A-133 and may be in conjunction with audits performed by County government. If audit exceptions are found, then the director/administrator of the CHD will prepare a corrective action plan and a copy of that plan and monthly status reports will be furnished to the contract managers for the parties. i. The CHD shall not use or disclose any information concerning a recipient of services except as allowed by federal or state law or policy. j. The CHD shall retain all client records, financial records, supporting documents, statistical records, and any other documents (including electronic storage media) pertinent to this contract for a period of five (5) years after termination of this contract. If an audit has been initiated and audit findings have not been resolved at the end of five (5) years, the records shall be retained until resolution of the audit findings. k. The CHD shall maintain confidentiality of all data, files, and records that are confidential under the law or are otherwise exempted from disclosure as a public record under Florida law. The CHD shall implement procedures to ensure the protection and confidentiality of all such records and shall comply with sections 384.29, 381.004, 392.65 and 456.057, Florida Statutes, and all other state and federal laws regarding confidentiality. All confidentiality procedures implemented by the CHD shall be consistent with the Department of Health Information Security Policies, Protocols, and Procedures. The CHD shall further adhere to any amendments to the State's security requirements and shall comply with any applicable professional standards of practice with respect to client confidentiality. I. The CHD shall abide by all State policies and procedures, which by this reference are incorporated herein as standards to be followed by the CHD, except as otherwise permitted for some purchases using County procedures pursuant to paragraph 6.b. 5 1 608 m. The CHD shall establish a system through which applicants for services and current clients may present grievances over denial, modification or termination of services. The CHD will advise applicants of the right to appeal a denial or exclusion from services, of failure to take account of a client's choice of service, and of his/her right to a fair hearing to the final governing authority of the agency. Specific references to existing laws, rules or program manuals are included in Attachment I of this contract. n. The CHD shall comply with the provisions contained in the Civil Rights Certificate, hereby incorporated into this contract as Attachment III. o. The CHD shall submit quarterly reports to the County that shall include at least the following: i. The DE385L1 Contract Management Variance Report and the DE580L1 Analysis of Fund Equities Report; ii. A written explanation to the County of service variances reflected in the DE385L1 report if the variance exceeds or falls below 25 percent of the planned expenditure amount. ' However, if the amount of the service specific variance between actual and planned expenditures does not exceed three percent of the total planned expenditures for the level of service in which the type of service is included, a variance explanation is not required. A copy of the written explanation shall be sent to the Department of Health, Office of Budget and Revenue Management. p. The dates for the submission of quarterly reports to the County shall be as follows unless the generation and distribution of reports is delayed due to circumstances beyond the CHD's control: i. March 1, 2016 for the report period October 1, 2015 through December 31, 2015; ii. June 1, 2016 for the report period October 1, 2015 through March 31, 2016; iii. September 1, 2016 for the report period October 1, 2015 through June 30, 2016; and iv. December 1, 2016 for the report period October 1, 2015 through September 30, 2016. 7. FACILITIES AND EQUIPMENT. The parties mutually agree that: a. CHD facilities shall be provided as specified in Attachment IV to this contract and the County shall own the facilities used by the CHD unless otherwise provided in Attachment IV. 6 1 6 0 8 b. The County shall ensure adequate fire and casualty insurance coverage for County- owned CHD offices and buildings and for all furnishings and equipment in CHD offices through either a self-insurance program or insurance purchased by the County. c. All vehicles will be transferred to the ownership of the County and registered as County vehicles. The County shall ensure insurance coverage for these vehicles is available through either a self-insurance program or insurance purchased by the County. All vehicles will be used solely for CHD operations. Vehicles purchased through the County Health Department Trust Fund shall be sold at fair market value when they are no longer needed by the CHD and the proceeds returned to the County Health Department Trust Fund. 8. TERMINATION. a. Termination at Will. This contract may be terminated by either party without cause upon no less than one-hundred eighty (180) calendar days notice in writing to the other party unless a lesser time is mutually agreed upon in writing by both parties. Said notice shall be delivered by certified mail, return receipt requested, or in person to the other party's contract manager with proof of delivery. b. Termination Because of Lack of Funds. In the event funds to finance this contract become unavailable, either party may terminate this contract upon no less than twenty-four (24) hours notice. Said notice shall be delivered by certified mail, return receipt requested, or in person to the other party's contract manager with proof of delivery. c. Termination for Breach. This contract may be terminated by one party, upon no less than thirty (30) days notice, because of the other party's failure to perform an obligation hereunder. Said notice shall be delivered by certified mail, return receipt requested, or in person to the other party's contract manager with proof of delivery. Waiver of breach of any provisions of this contract shall not be deemed to be a waiver of any other breach and shall not be construed to be a modification of the terms of this contract. 9. MISCELLANEOUS. The parties further agree: a. Availability of Funds. If this Agreement, any renewal hereof, or any term, performance or payment hereunder, extends beyond the fiscal year beginning July 1, 2015, it is agreed that the performance and payment under this Agreement are contingent upon an annual appropriation by the Legislature, in accordance with section 287.0582, Florida Statutes. b. Contract Managers. The name and address of the contract managers for the parties under this contract are as follows: For the State: For the County: Stephanie Vick, M.S.,B.S.N., R.N. Steve Carnell Name Name Administrator, Florida Department of Public Services Division Administrator Health in Collier County 7 1 6 0 8 Title Title 3339 E. Tamiami Trail, Suite 145 3339 E. Tamiami Trail, Suite 217 Naples, Florida 34112 Naples, Florida 34112 Address Address (239) 252-5332 (239) 252-8468 Telephone Telephone If different contract managers are designated after execution of this contract, the name, address and telephone number of the new representative shall be furnished in writing to the other parties and attached to originals of this contract. c. Captions. The captions and headings contained in this contract are for the convenience of the parties only and do not in any way modify, amplify, or give additional notice of the provisions hereof. In WITNESS THEREOF, the parties hereto have caused this 19 page contract, with its attachments as referenced, including Attachment I (two pages), Attachment II (six pages), Attachment Ill (one page), Attachment IV (one page), and Attachment V (one page), to be executed by their undersigned officials as duly authorized effective the 1st day of October, 2015. BOARD OF COUNTY COMMISSIONERS STATE OF FLORIDA FOR COLLIER COUNTY DEPARTMENT OF HEALTH At SIGNED BY: l SIGNED NAME: Ti N C.f NAME: John H. Armstrong, MD TITLE: CATIA t R..M'A ll� TITLE: Surgeon General/Secretary of Health I DATE• �,��-- �� CQ DATE: ! p(;LS( (ti ATTESTED T•. SIGNEDAliSIGNED BY: #4 A ; NAME: el—e-`C-e-- : rv"‘On NAME: Stephanie Vick, M.S., B.S.N., R.N. TITLE: �: �e-'' �— _ TITLE: CHD Director/Administrator DATE: V . ,` � (P DATE: — %� �� 4 0 airman s / signature only. Approved as to form and legality \ Vis' • 8 lam _ Assiitint County Attirney �a,� ‘2* HIS 1 6D 8 ATTACHMENT I COLLIER COUNTY HEALTH DEPARTMENT PROGRAM SPECIFIC REPORTING REQUIREMENTS AND PROGRAMS REQUIRING COMPLIANCE WITH THE PROVISIONS OF SPECIFIC MANUALS Some health services must comply with specific program and reporting requirements in addition to the Personal Health Coding Pamphlet(DHP 50-20), Environmental Health Coding Pamphlet(DHP 50-21)and FLAIR requirements because of federal or state law,regulation or rule. If a county health department is funded to provide one of these services,it must comply with the special reporting requirements for that service. The services and the reporting requirements are listed below: Service Requirement 1. Sexually Transmitted Disease Requirements as specified in F.A.C.64D-3, F.S.381 and F.S. Program 384. 2. Dental Health Periodic financial and programmatic reports as specified by the program office. 3. Special Supplemental Nutrition Service documentation and monthly financial reports as specified Program for Women,Infants and in OHM 150-24*and all federal,state and county requirements Children(including the WIC detailed in program manuals and published procedures. Breastfeeding Peer Counseling Program) 4. Healthy Start/Improved Pregnancy Requirements as specified in the 2007 Healthy Start Standards Outcome and Guidelines and as specified by the Healthy Start Coalitions in contract with each county health department. 5. Family Planning Requirements as specified in Public Law 91-572,42 U.S.C.300, et seq.,42 CFR part 59,subpart A,45 CFR parts 74&92,2 CFR 215(OMB Circular A-110)OMB Circular A-102,F.S.381.0051, F.A.C.64F-7, F.A.C.64F-16,and F.A.C.64F-19. Requirements and Guidance as specified in the Program Requirements for Title X Funded Family Planning Projects(Title X Requirements)(2014) and the Providing Quality Family Planning Services(QFP): Recommendations of CDC and the U.S. Office of Population Affairs published on the Office of Population Affairs website. Programmatic annual reports as specified by the program office as specified in the annual programmatic Scope of Work for Family Planning and Maternal Child Health Services, including the Family Planning Annual Report(FPAR),and other minimum guidelines as specified by the Policy Web Technical Assistance Guidelines. 6. Immunization Periodic reports as specified by the department pertaining to immunization levels in kindergarten and/or seventh grade pursuant to instructions contained in the Immunization Guidelines- Florida Schools,Childcare Facilities and Family Daycare Homes (OH Form 150-615)and Rule 64D-3.046,F.A.C. In addition, periodic reports as specified by the department pertaining to the surveillance/investigation of reportable vaccine-preventable diseases,adverse events,vaccine accountability,and assessment of immunization ATTACHMENT I(Continued) Attachment_I-Page 1 of 2 1 0 8 levels as documented in Florida SHOTS and supported by CHD Guidebook policies and technical assistance guidance. 7. Environmental Health Requirements as specified in Environmental Health Programs Manual 150-4*and DHP 50-21' 8. HIV/AIDS Program Requirements as specified in F.S.384.25 and F.A.C.64D-3.030 and 64D-3.031,Case reporting should be on Adult HIV/AIDS Confidential Case Report CDC Form DH2139 and Pediatric HIV/AIDS Confidential Case Report CDC Form DH2140. Requirements as specified in F.A.C.64D-2 and 64D-3, F.S.381 and F.S.384. Socio-demographic and risk data on persons tested for HIV in CHD clinics should be reported on Lab Request DH Form 1628 in accordance with the Forms Instruction Guide. Requirements for the HIV/AIDS Patient Care programs are found in the Patient Care Contract Administrative Guidelines. 9. School Health Services Requirements as specified in the Florida School Health Administrative Guidelines(May 2012). Requirements as specified in F.S.381.0056, F.S.381.0057,F.S.402.3026 and F.A.C.64F-6. 10. Tuberculosis Tuberculosis Program Requirements as specified in F.A.C.64D-3 and F.S.392. 11. General Communicable Disease Carry out surveillance for reportable communicable and other Control acute diseases,detect outbreaks,respond to Individual cases of reportable diseases,investigate outbreaks,and carry out communication and quality assurance functions,as specified in F.A.C.64D-3,F.S.381,F.S.384 and the CHD Epidemiology Guide to Surveillance and Investigations. 12. Refugee Health Program Programmatic and financial requirements as specified by the program office. *or the subsequent replacement if adopted during the contract period. Attachment,I-Page 2 of 2 / \ - \ \ p 2 $ a. \ co Co E Cl) at _ \ a) / E co g & co 7 N. 2 0 co @ 0 Q / LLJ z 0. CO - k O fl U- § ? m # I— 9 c ' z / / 2 0 W i \ \ j \ ce W to co c CO 0 � / a) k \ ƒ = c < cv T- / I— III t W I / k ' < 7 \ IL = 2 = m # ct M 0 S c Q 2 mIU _ et q 7 \ k $ Q Q cm = g \ § / kj k Cl) = CD S > \ 0 a © \ 0 \ © t 7 m 2 I- . % \ CJ >� 2 a. E / Q k § / / � � \ /) 3 —co % e — R in 0) \ / . c \ ƒ 7 6 -• \ 41) $ $ ca / 0o � � ƒ \ a) # - 7 / } \ g ) @ _ iii c - m - _ / 2 § \ - / S > a 0 72 � g E2 CO c � I 00 2/ d / \ & w Cl)w ATTACHMENT.TI , COLLIER COUNTY HEALTH DEPARTMENT Part II;Sources of Contributions.to;County health Department October 1,20;16 to September:80 2016: State CAD County Total CHD Trust Fund CHD Trust Fund Other i £cash)''.;' Trust•Fund..r_ -.::(cash) .._:Contribution .:`.Tota1.,t. 1.GENERAL REVENUE•STATE 015040 AIDS PATIENT CARE 140,000 0 140,000 0 140,000 015040 AIDS PREVENTION&SURVEILLANCE-GENERAL REVENUE 69,571 0 69,671 0 69,571 015040 CHD•TB COMMUNITY PROGRAM 218,724 0 218,724 0 218,724 015040 DENTAL SPECIAL INITIATIVE PROJECTS 5,477 0 5,477 0 6,477 015040 FAMILY PLANNING GENERAL REVENUE 60,550 0 60,550 0 60,660 016040 HEPATITIS AND LIVER FAILURE PREVENTION&CONTROL 89,286 0 89,286 0 89,286 015010 MIGRANT LABOR CAMP SANITATION 71,633 0 74,533 0 74,533 016040 PRIMARY CARE PROGRAM 313,432 0 313,432 0 313,132 015040 SCHOOL HEALTH SERVICES•GENERAL REVENUE 218,073 0 218,073 0 218,073 015040 DOH RESPONSE TO TERRORISM 73,643 0 73,643 0 73,643 016050 CHD GENERAL REVENUE NON•CATEGORICAL 1,742,380 0 1,742,380 0 1,742,380 GENERAL REVENUE TOTAL 3,005,669 0 3,005,669 0 3,005,669 2.NON GENERAL REVENUE•STATE 015010 ENVIRONMENTAL BIOMEDICAL WASTE PROGRAM 14,038 0 14,038 0 14,038 015010 TOBACCO STATE AND COMMUNITY INTERVENTIONS 183,885 0 183,885 0 183,885 NON GENERAL REVENUE TOTAL 197,923 0 197,923 0 197,923 3.FEDERAL FUNDS•STATE 007000 AIDS DRUG ASSISTANCE PROGRAM ADMIN 60,763 0 60,763 0 60,763 007000 AIDS DRUG ASSISTANCE PROGRAM ADMIN HQ 19,918 0 19,918 0 19,918 007000 1310TERRORISNI HOSPITAL PREPAREDNESS 20,243 0 20,243 0 20,2.43 007000 WIC BREASTFEEDING PEER COUNSELING PROG 67,672 0 67,672 0 67,672 007000 COASTAL BEACH WATER QUALITY MONITORING 17,144 0 17,144 0 17,144 007000 COMPREHENSIVE COMMUNITY CARDIO•PHBG 40,000 0 40,000 0 40,000 007000 FAMILY PLANNING TITLE X•GRANT 106,589 0 106,589 0 106,689 007000 IMMUNIZATION ACTION PLAN 72,552 0 72,662 0 72,552 007000 MCH SPECIAL PROJECT PRAMS 27,629 0 27,529 0 27,529 007000 HPP AND PHEP COOP AGRriTF PREP EBOLA SUPPLEMENT#12 8,956 0 8,956 0 8,956 007000 PHP PUBLIC HEALTH PREPAREDNESS BASE ALLOC 132,101 0 132,101 0 132,101 007000 AIDS PREVENTION 234,788 0 234,788 0 234,788 007000 IMPROVING STD PROGRAMS 6,621 0 5,624 0 5,624 007000 WIC PROGRAM ADMINISTRATION 1,375,111 0 1,375,111 0 1,376,111 015075 INSPECTIONS OF SUMMER FEEDING PROGRAM•DOE 1,500 0 1,500 0 1,500 015075 SUPPLEMENTAL SCHOOL HEALTH 33,690 0 33,690 0 33,690 015075 REFUGEE HEALTH SCREENING REIMBURSEMENT 533,000 0 533,000 0 533,000 FEDERAL FUNDS TOTAL 2,757,180 0 2,757,180 0 2,757,180 4.FEES ASSESSED BY STATE OR FEDERAL RULES•STATE 001020 CHD STATEWIDE ENVIRONMENTAL FEES 424,342 0 424,342 0 424,342 001092 CHD STATEWIDE ENVIRONMENTAL FEES 100,650 0 100,650 0 100,660 001206 ON SITE SEWAGE DISPOSAL PERMIT FEES 6,000 0 6,000 0 6,000 001206 SANITATION CERTIFICATES(FOOD INSPECTION) 3,000 0 3,000 0 3,000 001206 SEPTIC TANK RESEARCH SURCHARGE 800 0 800 0 800 001206 PUBLIC SWIMMING POOL PERMIT FEES-I0%HQ TRANSFER 30,000 0 30,000 0 30,000 001206 DRINKING WATER PROGRAM OPERATIONS 1,200 0 1,200 0 1,200 Attachment_II Part_II•Pape 1 013 . ... „. . ..... ..„,.........,........ „... .....„..„.......,.. ..„.„... ,...:.,.„............ .,.. ..:.:.„...:,„„ ,„,:.,„,,,,.,:,:„,:„„,„,,,„„,:.,,.,,,,„„,,,,,,.:.,.::„,„,,,,,„,„.,,,,„,„,„,.,,,:...,,,... ,„„:....,:,.,::„,.::.,..,.,.„:„...„„,:.: r.,.,......,:,„„,::...... 1 608 TTACHMENT II f „.„.„,,,,„:„.,„„,„:„,:,.,„„„,:,,,,,,„„,,,„,„„,„:„,„„,„„,,,,,,,,,,,,,„:„:„,,,,„:„,„„,„,•:,,,„,„„„:,,,„:„:„.„,:,,::,:,„,,,„,..„,„.„,„„,::„,„,„,,„,,,:,,:„,,,=„,,,,,,,::„,,,,,,,,,,,,,:,:,„„,,,,,,,:c.o..,:,,,,,,,,,, c').uNIT4t*:#4',17g041*Ntiiziogiougtiafig:SiiNit.tgoomaggigegitatim Part`II,Sources of Contributions,to County Health Department October 1,2016 to Septm ebr 3 e0,2016 State CHD County ,'; Total;,CU D Trust Fund CHD Trust Fund Other ....." ...(cash),I,....Trust.Fund .(cae`b}_ _ Contributon. Total 001206 REGULATION OF BODY PIERCING SALONS 30 0 30 0 30 001206 TANNING FACILITIES 350 0 350 0 350 001206 ONSITE SEWAGE TRAINING CENTER 1,000 0 1,000 0 1,000 001206 TATTO PROGRAM ENVIRONMENTAL HEALTH 1,000 0 1,000 0 1,000 001206 MOBILE HOME&RV PARK FEES 2,000 0 2,000 0 2,000 FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 570,372 0 670,372 0 670,372 5.OTHER CASH CONTRIBUTIONS•STATE: 0 0 0 0 0 090001 DRAW DOWN FROM PUBLIC HEALTH UNIT 159,143 0 159,143 0 159,143 OTHER CASH CONTRIBUTION TOTAL 159,143 0 159,143 0 159,143 6.MEDICAID-STATE/COUNTY: 001057 CHD CLINIC FEES 0 76,100 76,100 0 76,100 001148 CHD CLINIC FEES 0 1,019,600 1,019,600 0 1,019,600 MEDICAID TOTAL 0 1,095,700 1,095,700 0 1,095,700 7.ALLOCABLE REVENUE•STATE: 018000 CHD CLINIC FEES 1,000 0 1,000 0 1,000 ALLOCABLE REVENUE TOTAL 1,000 0 1,000 0 1,000 8.OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND•STATE ADAP 0 0 0 1,987,361 1,987,361 PHARMACY DRUG PROGRAM 0 0 0 144,248 144,248 WIC PROGRAM 0 0 0 5,73I,922 5,731,922 BUREAU OF PUBLIC HEALTH LABORATORIES 0 0 0 52,359 62,359 IMMUNIZATIONS 0 0 0 956,39.1 955,394 OTHER STATE CONTRIBUTIONS TOTAL 0 0 0 8,871,284 8,871,284 9.DIRECT LOCAL CONTRIBUTIONS•BCCITAX DISTRICT 008005 CHD LOCAL REVENUE&EXPENDITURES 0 1,378,200 1,378,200 0 1,378,200 DIRECT COUNTY CONTRIBUTIONS TOTAL 0 1,378,200 1,378,200 0 1,378,200 10.FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION-COUNTY 001077 CHD CLINIC FEES 0 217,830 217,830 0 217,830 001077 GENERAL CLINIC RABIES SERVICES&DRUG PURCHASES 0 9,400 9,400 0 9,400 001094 CHD LOCAL ENVIRONMENTAL FEES 0 594,700 594,700 0 594,700 001110 VITAL STATISTICS CERTIFIED RECORDS 0 335,000 335,000 0 335,000 FEES AUTHORIZED BY COUNTY TOTAL 0 1,156,930 1,156,930 0 1,156,930 11.OTHER CASH AND LOCAL CONTRIBUTIONS-COUNTY 001029 CHD CLINIC FEES 0 37,100 37,100 0 37,100 001029 GENERAL CLINIC RABIES SERVICES&DRUG PURCHASES 0 3,000 3,000 0 3,000 001090 CHD CLINIC FEES 0 43,000 43,000 0 43,000 001090 GENERAL CLINIC RABIES SERVICES&DRUG PURCHASES 0 600 600 0 600 010303 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 0 600 600 0 600 010500 CHI)SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 0 3,000 3,000 0 3,000 011000 RYAN WHITE 0 282,692 282,692 0 282,692 Attachment_II Part_II-Page 2 of 3 ATTACHMENT II e :COLLIER COUNTY HEALTH DEPARTMENT y i Part II;Sources'of"Contributions to:County Health Department Octob©r 1,.2016 to Septomber,30 2016 State.CHD County Tatal CHD T et Fuad 'CHD ! Trtiet Fund Otber - . .... .> (cash). ... T..ust.Fund {cash). ... �Coatriiiution TntaL!. 011000 CHD CASH DONATION/NONSPECIFIC 0 2,100 2,100 0 2,100 011000 EARLY LEARNING COALITION OF SOUTHWEST FLORIDA 0 60,900 60,900 0 60,900 011000 CHI)LOCAL REVENUE&EXPENDITURES 0 252,720 252,720 0 262,720 011001 CHD HEALTHY START COALITION CONTRACT 0 644,960 644,960 0 644,950 090002 DRAW DOWN FROM PUBLIC HEALTH UNIT 0 216,026 216,025 0 215,025 OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 0 1,446,687 1,446,687 0 1,445,687 12.ALLOCABLE REVENUE•COUNTY 018000 CHD CLINIC FEES 0 1,000 1,000 0 1,000 COUNTY ALLOCABLE REVENUE TOTAL 0 1,000 1,000 0 1,000 13.BUILDINGS•COUNTY ANNUAL RENTAL EQUIVALENT VALUE 0 0 0 626,048 525,048 IT ALLOCATION&GOLDEN GATE RENTAL 0 0 0 83,100 83,100 UTILITIES 0 0 0 193,800 193,800 BUILDING MAINTENANCE 0 0 0 0 0 GROUNDS MAINTENANCE 0 0 0 195,149 195,149 INSURANCE 0 0 0 0 0 OTHER(Specify) 0 0 0 0 0 OTHER(Specify) 0 0 0 0 0 BUILDINGS TOTAL 0 0 0 997,097 997,097 14.OTHER COUNTY CONTRIBUTIONS NOT IN CUD TRUST FUND•COUNTY EQUIPMENT/VEHICLE PURCHASES 0 0 0 0 0 VEHICLE INSURANCE 0 0 0 16,300 16,300 VEHICLE MAINTENANCE 0 0 0 0 0 OTHER COUNTY CONTRIBUTION(SPECIFY) 0 0 0 0 0 OTHER COUNTY CONTRIBUTION(SPECIFY) 0 0 0 0 0 OTHER COUNTY CONTRIBUTIONS TOTAL 0 0 0 16,300 16,300 GRAND TOTAL CHD PROGRAM 6,691,287 5,077,517 11,768,804 9,884,681 21,653,485 Attachment_II_Part 8-Page 3 of 3 . . . . . . , .. 1 6 D ATTACHMENT:TT COLLIER COUNTY HEALTH DEPARTMENT Part III Planned Staffing es a Client',Services "Expenditures By,Program Service Area Within Each Level of Service • :.Cctober 1,.2015 to September 30,2016 Quarterly Expenditure Plan FTE's Clients.Services/ let 2nd i 3rd. 4th (0,00) ,Units Visits " (Whale,dollars only) State County • Total A. COMMUNICABLE DISEASE CONTROL- IMMUNIZATION (101) 11.88 9,205 12,242 162,283 189,284 162,283 189,28.4 404,620 298,614 703,13-1 SEXUALLY TRANS.DIS. (102) 6.97 I,212 2,186 76,948 88,685 75,948 88,685 179,767 149,299 329,066 HIV/A1DSPREVENTION(03A1) .1.52 1,380 1,633 66,873 78,000 66,873 78,000 28I,7.46 8,000 289,746 HIV/AIDS SURVEILLANCE (0312) 1.24 33 36 17,265 20.138 17,206 20,137 74,805 0 74,805 HIV/AIDS PATIENT CARE (0313) 7.58 460 2,350 120,028 146,996 126,028 146,995 211,342 331,705 6.16,047 ADAP(03A4) 2.24 7 31 32,220 37,588 32,226 37,588 139,628 0 139,628 TUBERCULOSIS (104) 7.13 826 4,000 116,309 136,660 116,309 135,660 318,728 185,210 603,938 COMM.DIS.SURV. (106) 6.31 1 2,762 100,900 12.1,693 106,906 124,692 293,18G 170,011 463,197 HEPATITIS (100) 2.14 2,322 3,084 35,266 41,121 35,256 41,121 152,682 170 152,752 PREPAREDNESS AND RESPONSE (110) 5.03 0 39 88,820 103,598 88,820 103,599 298,026 86,811 384,837 REFUGEE HEALTH (118) 8.47 1,680 5,035 187,209 218,357 187,209 218,367 781,132 30,000 811,132 VITAL RECORDS(180) 2.35 8,723 34,433 30,785 35.906 30,785 35,906 0 133,382 133,382 COMMUNICABLE DISEASE SUBTOTAL G4,26 25,830 68,421 1,045,907 1,219,926 1,0-15,997 1,219,924 3,185,662 1,396,102 4,631,664 B. PRIMARY CARE: CHRONIC DISEASE PREVENTION PRO (210) 1.41 8 291 21,218 24,748 21,218 24,749 40,000 51,933 91,933 WIC (21W1) 29.75 24,078 104,844 388,015 452,672 388,015 452,573 1,681,175 0 1,681,175 TOBACCO USE INTERVENTION(212) 3.17 0 232 47,448 55,343 47,448 66,343 183,885 21,697 205,682 WIC BREASTFEEDING PEER COUNSELING (21W2) 2.18 0 3,437 20,197 23,558 20,197 23,658 87,510 0 87,510 FAMILY PLANNING (223) 1,25 1,613 1,704 43,I94 60,380 43,194 50,380 187,148 0 187,148 IMPROVED PREGNANCY OUTCOME (225) 0.74 623 827 83,675 97,597 83,675 97,697 27,629 335,016 362,644 1-IEALTHY START PRENATAL (227) 11.71 1,369 7,697 176,370 204,548 175,370 204.647 166,718 603,119 759,835 COMPREHENSIVE CHILD HEALTH(229) 2,09 362 591 31,880 37,184 31.880 37,18-4 0 138,128 138,128 HEALTHY START CHILD(291) 4.71 618 4,069 69,356 80,995 69,366 80,896 150.000 150,503 300,603 SCHOOL HEALTH (234) 9.24 0 440,311 120,435 140,472 120,435 240,472 361,651 160,163 621,814 COMPREHENSIVE ADULT HEALTH (237) 6.59 2,847 4,021 127,601 148,831 127,601 148,832 148,377 404,488 552,865 COMMUNITY HEALTH DEVELOPMENT(238) 1.04 0 90 23,750 27,702 23,750 27,702 0 102,904 102,904 DENTAL HEALTH (240) 16.80 4,689 9,625 276,859 921,756 276,859 321,766 5,477 1,189,753 1,195,230 PRIMARY CARE SUBTOTAL 90.45 30,207 577,639 1,427,998 1,665,586 1,427,998 1,665,689 3,029,468 3,157,703 0,187,171 C. ENVIRONMENTAL HEALTH: Water and Onsite Sewage Program' COSTAL BEACH MONITORING (347) 0.11 861 361 2,702 3,151 2,702 3,160 11,705 0 11,705 LI1.1ITED USE PUBLIC WATER SYSTEMS (35 7) 0.44 400 1,734 8,472 9,882 8.472 0,881 10,000 26,707 96,707 PUBLIC WATER SYSTEM (358) 0.00 0 0 12 14 12 13 0 51 51 PRIVATE WATER SYSTEM (369) 0.14 0 400 1,848 2,166 1,848 2,156 0 8,008 8,008 ONSITE SEWAGE TREATMENT&DISPOSAL(301) 4,56 1,186 3,402 70,568 82,309 70,608 82,308 96,000 209,753 305,753 Group Total 6.25 1,953 5,903 83,602 07,512 83,502 97,508 117.705 244,519 362,224 Facility Programs TATTOO FACILITY SERVICES (344) 0.25 0 62 3,659 4,268 3,659 4,267 7,000 8.863 15,853 FOOD HYGIENE (348) 0.79 09 455 13,010 15,176 13,010 15,17G 28,900 27,471 66,371 BODY PIERCING FACILITIES SERVICES(349) 0.00 0 0 67 67 57 68 249 0 249 Aeacthment II Pnrt_tll•Page 1 o12 ATTACHMENT II COLLIER C0UNTYHEALTIIDEPARTMENT Part III,Pl•anned Stalling Clients,Services and Expendituiea By,Program,Service Area,Within,Each Level of Service,': October 1;2016 to September 80, QuarterlyEzpenditure Plan 3 B'll:'e Clulnta Services/ , t ..let 2nd' 8rd 9th ,Grand (0 OD) Unita Visite (Whole'dollara only) State County 1'otai ._' GROUP CARE FACILITY(351) 0.37 113 183 5,700 6,753 5,790 6,752 0 25,085 25085 MIGRANT LABOR CAMP (352) 2.40 140 925 36,305 42,345 36,305 42,345 113,148 44,152 157,300 HOUSING&PUB.BLDG. (353) 0.00 0 0 0 0 0 0 0 0 0 MOBILE HOME AND PARK(354) 0,43 102 317 6,288 7,935 6,288 7,335 27,246 0 27,246 POOLS/BATHING PLACES(360) 3.23 1,496 15,870 54,169 63,174 5-1,163 63,174 97,139 137,535 234,674 BIOMEDICAL WASTE SERVICES (364) 1.29 850 899 20,706 24,I51 20,706 24,151 89,714 0 89,714 TANNING FACILITY SERVICES (309) 0.02 6 22 364 424 364 424 1,570 0 1,576 Group Total 8.78 2,80G 18,733 140,342 163,692 140,342 163,692 364,972 243,096 608,068 Groundwater Contamination STORAGE TANK COMPLIANCE SERVICES (355) 0.00 0 0 0 0 0 0 0 0 0 SUPER ACT SERVICES (356) 0.04 17 20 622 726 622 727 0 2.697 2,697 Group Total 0.04 17 20 622 726 622 727 0 2,697 2,697 Community Hygiene COMMUNITY ENVIR.HEALTH (345) 0.00 0 0 0 0 0 0 0 0 0 INJURY PREVENTION (346) 0.49 0 0 7,34G 8,569 7,346 8,569 0 31,830 31,830 LEAD MONITORING SERVICES (350) 0.00 0 0 2 2 2 3 0 9 9 PUBLIC SEWAGE (362) 0.00 0 0 0 0 0 0 0 0 0 SOLID WASTE DISPOSAL SERVICE (363) 0.00 0 0 0 0 0 0 0 0 0 SANITARY NUISANCE (365) 0.01 0 3 236 275 236 276 0 1,023 1,023 RABIES SURVEILLANCE (366) 0.00 0 0 22 26 22 27 0 97 97 ARBORVIRUS SURVEIL. (367) 0.00 0 0 0 0 0 0 0 0 0 RODENT/ARTHROPOD CONTROL (368) 0,00 0 0 0 0 0 0 0 0 0 WATER POLLUTION (370) 0.00 0 0 0 0 0 0 0 0 0 INDOOR AIR (371) 0.00 0 0 10 11 10 11 0 42 42 RADIOLOGICAL HEALTH (372) 0.00 0 0 92 107 92 108 0 390 399 TOXIC SUBSTANCES (373) 0,00 0 0 0 0 0 0 0 0 0 Group Total 0.50 0 3 7,708 8,990 7,708 8,994 0 33.400 33,400 ENVIRONMENTAL HEALTH SUBTOTAL 14.67 4,776 24,659 232,274 270,920 232.274 270,021 482,677 523,712 1,006,389 D, NON-OPERATIONAL COSTS: NON-OPERATIONAL COSTS (599) 0.00 0 0 0 0 0 0 0 0 0 ENVIRONMENTAL HEALTH SURCHARGE (399) 0.00 0 0 10,058 11,732 10,058 I1,732 43,580 0 43,580 MEDICAID BUYBACK(611) 0,00 0 0 0 0 0 0 0 0 0 NON-OPERATIONAL COSTS SUBTOTAL 0.00 0 0 10,058 11,732 10,058 11,732 43,680 0 43,580 TOTAL CONTRACT 169.28 66,822 670,619 2,716,237 3,168,164 2,716,237 3,168,166 6,691,287 5,077,517 11,768,804 Attathrnont_e Part_tll-Page 2 of 2 1610 ATTACHMENT III COLLIER COUNTY HEALTH DEPARTMENT CIVIL RIGHTS CERTIFICATE The applicant provides this assurance in consideration of and for the purpose of obtaining federal grants,loans, contracts(except contracts of insurance or guaranty),property,discounts,or other federal financial assistance to programs or activities receiving or benefiting from federal financial assistance. The provider agrees to complete the Civil Rights Compliance Questionnaire, DH Forms 946 A and B(or the subsequent replacement if adopted during the contract period),if so requested by the department. The applicant assures that it will comply with: 1. Title VI of the Civil Rights Act of 1964, as amended,42 U.S.C.,2000 Et seq.,which prohibits discrimination on the basis of race, color or national origin in programs and activities receiving or benefiting from federal financial assistance. 2. Section 504 of the Rehabilitation Act of 1973,as amended,29 U.S.C.794,which prohibits discrimination on the basis of handicap in programs and activities receiving or benefiting from federal financial assistance. 3. Title IX of the Education Amendments of 1972,as amended,20 U.S.C. 1681 et seq.,which prohibits discrimination on the basis of sex in education programs and activities receiving or benefiting from federal financial assistance. 4. The Age Discrimination Act of 1975, as amended,42 U.S.C.6101 et seq.,which prohibits discrimination on the basis of age in programs or activities receiving or benefiting from federal financial assistance. 5. The Omnibus Budget Reconciliation Act of 1981,P.L.97-35,which prohibits discrimination on the basis of sex and religion in programs and activities receiving or benefiting from federal financial assistance. 6. All regulations,guidelines and standards lawfully adopted under the above statutes.The applicant agrees that compliance with this assurance constitutes a condition of continued receipt of or benefit from federal financial assistance,and that it is binding upon the applicant,its successors,transferees,and assignees for the period during which such assistance is provided. The applicant further assures that all contracts, subcontractors,subgrantees or others with whom it arranges to provide services or benefits to participants or employees in connection with any of its programs and activities are not discriminating against those participants or employees in violation of the above statutes,regulations,guidelines,and standards. In the event of failure to comply,the applicant understands that the grantor may,at its discretion,seek a court order requiring compliance with the terms of this assurance or seek other appropriate judicial or administrative relief,to include assistance being terminated and further assistance being denied, Attachment._Ifl-Page 1 of 1 1 6 0 8 ATTACHMENT IV COLLIER COUNTY HEALTH DEPARTMENT FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT Facility Description Locatiop Owned By COLLIER COUNTY HEALTH 3339 E.Tamlami Trail,Building N, Naples Collier County DEPARTMENT&PUBLIC SERVICES BUILDING H IMMOKALEE SATELLITE 419 North First Srteet, Immokalee Collier County GOLDEN GATE WIC OFFICE 4945 Golden Gate Parkway,Unit 102, Benderson Development Naples CCHD Annex 3205 Beck Blvd, Naples Florida Department of Environmental Protection Attachment_IV-Page 1 of 1 ATTACHMENT V 160 8 COLLIER COUNTY HEALTH DEPARTMENT SPECIAL PROJECTS SAVINGS PLAN CASH RESERVED OR ANTICIPATED TO BE RESERVED FOR PROJECTS CONTRACT YEAR STATE COUNTY TOTAL 2014-2015' $ 0 $ 0 $ 0 2015-2018" $ 0 $ 0 $ 0 2018-2017"' $ 0 $ 0 $ 0 2017-2018"' $ 0 $ 0 $ 0 PROJECT TOTAL $ 0 $ 0 $ 0 SPECIAL PROJECTS CONSTRUCTION/RENOVATION PLAN PROJECT NUMBER: PROJECT NAME: LOCATION/ADDRESS: PROJECT TYPE: NEW BUILDING ROOFING RENOVATION PLANNING STUDY NEW ADDITION OTHER SQUARE FOOTAGE: 0 PROJECT SUMMARY: Describe scope of work in reasonable detail. START DATE (Initial expenditure of funds) COMPLETION DATE: DESIGN FEES: $ 0 CONSTRUCTION COSTS: $ 0 FURNITURE/EQUIPMENT: $ 0 TOTAL PROJECT COST: $ 0 COST PER SQ FOOT: $ 0 Special Capital Projects are new construction or renovation projects and new furniture or equipment associated with these projects and mobile health vans. Cash balance as of 9/30/15 "Cash to be transferred to FCO account. ""Cash anticipated for future contract years. Attachment_V•Page 1 of 10 I 60 8 ADDENDUM I TO CONTRACT BETWEEN COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS AND STATE OF FLORIDA DEPARTMENT OF HEALTH FOR OPERATION OF THE COLLIER COUNTY HEALTH DEPARTMENT CONTRACT YEAR 2015-2016 This Addendum is made this I o'‘ day of � , 20 .51-and is added to and amends the Contract Between Collier County Board of Coun Commissioners and State of Florida Department of Health for Operation of the Collier County Health Department Contract Year 2015-2016 ("Contract"). The following underlined provision is added to Section 4 of the Contract to include non- recurring funding by the County to fill a funding gap resulting from loss of Low Income Pool funds previously provided by the Agency for Health Care Administration.: 4. FUNDING. The parties further agree that funding for the CHD will be handled as follows: a. The funding to be provided by the parties and any other sources is set forth in Part II of Attachment II hereof. This funding will be used as shown in Part I of Attachment II. * * * iii. The County's supplemental funding as provided in Attachment II, Part IL in an amount not to exceed $249,220(amount included in the calculation under the CHD Local Revenue & Expenditures section of the revenue attachment). IN WITNESS WHEREOF, the State and County have hereto executed this Addendum the day and year first above written. AS TO THE STATE: STATE OF FLORIDA DEPARTMENT OF HEALTH SIGNED BY: r NAME: John H. Armstrong, MD TITLE: Surgeon ene al/Secretary of Health DATE: l ILL 1 of 2 r 6 8 4 \ SIGNED BY: NAME: Stephanie I is d, M.S., B.S.N., R.N. TITLE: CHD Direct r/Administrator DATE: I a II , AS TO THE COUNTY: Attest: BOARD OF COUNTY COMMISSIONERS FOR DWIGHT E. BROCK, Clerk COLLIER COUNTY syCrUA--11-1)A_ B ea4rGe_. A las to Chaic&f5dly Clerk TIM NANCE, CHAIRMAN si ,t'a :,4 01114., Approved as to form and legality: OLAttfe•L‘› Jenni er A. Belpedio, Assistant County Attorney (� 2 of 2