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Backup Documents 02/09/2016 Item #16E1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP R p , u c f TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGN• lea 1 2016 .. V° t. Routed by Procurement Services to the Office Initials Date Following Addressee(s) (hi routing order) 1. Risk Manage Risk *Rebecca `N�& Jeff Walker CY-1-11► 2. County Attorney Office County Attorney Office 00(9 3 .27.14 3. BCC Office Board of County Commissioners \ 4. Minutes and Records Clerk of Court's Office 3'� /�6 3 2�t—FM*Please return an electronic copy �I 5. Return to Procurement Services Procurement Services Division Contact: Diana De Leon PRIMARY CONTACT INFORMATION Name of Primary Diana De Leon for Jason Crouch Phone Number 252-8375 Procurement Staff February 9,2016 Marc 1,2016 Contact and Date Agenda Date Item was February 9,2016 Agenda Item Number 16.E.1 Approved the BCC Type of f Document Contract&BA Agreement Number of Original Attached Documents Attached _ PO number or account N/A Solicitation/Contract 15-6474R Advance number if document is Number/Company Medical to be recorded Name INSTRUCTIONS & CHECKLIST Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not appropriate. (Initial) Ap licable) 1. Does the document require the chairman's original signature? - 1,1 2. Does the document need to be sent to another agency for additional signatures? If yes, N/A provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. 3. Original document has been signed/initialed for legal sufficiency. (All documents to be signed by the Chairman,with the exception of most letters,must be reviewed and signed 4,'A" by the Office of the County Attorney. 4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A Office and all other parties except the BCC Chairman and the Clerk to the Board 5. The Chairman's signature line date has been entered as the date of BCC approval of the N/A document or the final negotiated contract date whichever is applicable. 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's DD signature and initials are required. 7. In most cases(some contracts are an exception),an electronic copy of the document and DD this routing slip should be provided to the County Attorney's Office before the item is input into SIRE. 8. The document was approved by the BCC on the date above and all changes made DD during the meeting have been incorporated in the attached document. The County Attorney's Office has reviewed the changes,if applicable. 9. Initials of attorney verifying that the attached document is the version approved by the BCC,all changes directed by the BCC have been made, and the document is ready for the Chairman's signature. 16E1 MEMORANDUM Date: March 23, 2016 To: Diana De Leon, Contracts Technician Purchasing Department From: Ann Jennejohn, Deputy Clerk Minutes & Records Department Re: Agreement #15-6474R: Medical Oversight Physician for Collier County and Employment Physicals & Drug Testing Provider: Advance Medical of Naples, LLC Attached please find an original copy of agreement referenced above, (Item #16E1) approved by the Board of County Commissioners on Tuesday, February 9, 2016. The second original will be held in the Minutes and Records Department for the Board's Official Record. If you have any questions, please contact me at 252-8406. Thank you. Attachment Detail by Entity Name 16E1 Previous On List Next On List Return to List advance medical of naples,llc Home Contact Us E-Filing Services Document Searches Forms �N No Events No Name History Search Detail by Entity Name Florida Limited Liability Company ADVANCE MEDICAL OF NAPLES, LLC Filing Information Document NumberL 11000079031 FEI/EIN Number45-3131576 Date Filed07/11/2011 StateFL StatusACTIVE Principal Address 720 GOODLETTE ROAD NORTH SUITE 500 NAPLES, FL 34102 Changed: 07/25/2014 Mailing Address 720 GOODLETTE ROAD NORTH SUITE 500 NAPLES, FL 34102 Changed: 07/25/2014 Registered Agent Name& Address PARRISH, JON D 3431 PINE RIDGE RD. 101 NAPLES, FL 34109 Authorized Person(s)Detail Name & Address Title MGRM JACKSON, PATRICIA 3431 PINE RIDGE RD. NAPLES,FL 34109 Annual Reports Report Year Filed Date 2013 04/22/2013 2014 04/17/2014 2015 04/23/2015 Document Images 04/23/2015 --ANNUAL REPORT View image in PDF format 04/17/2014 --ANNUAL REPORT View image in PDF format 04/22/2013 --ANNUAL REPORT View image in PDF format 04/24/2012 -- ANNUAL REPORT View image in PDF format 07/11/2011 --Florida Limited Liability View image in PDF format http://search.sunbiz.org/...ce%20medical%20of%20naples%2C%2011c&listNameOrder=ADVANCEMEDICALNAPLES%20L110000790310[8/10/2015 1:28:40 PM] Detail by Entity Name 16E1 Previous On List Next On List Return to List advance medical of naples,llc I No Events No Name History seareh Home I Contact us I Document Searches I E-Filing Services Forms Help Copytight©and Privacy Policies State of Florida, Department of State http://search.sunbiz.org/...ce%20medical%2oof%20naples%2C%2011c&listNameorder=ADVANCEMEDICALNAPLES%20L110000790310[8/10/2015 1:28:40 PM] 16E1 AGREEMENT15-6474R for "Medical Director for Collier County and Employment Physicals and Drug Testing" THIS AGREEMENT, made and entered into on this 9th day of February 2016,by and between Advance Medical of Naples, LLC, authorized to do business in the State of Florida, whose business address is 720 Goodlette Road, N. Suite 500, Naples, FL 34102 (the ,.Provider")and Collier County,a political subdivision of the State of Florida, (the "County"): WITNESSETH: 1. CONTRACT TERM. The contract shall be for a one (1) year period, commencing on date of Board of County Commissioners approval and terminating on one (1)year from that date or until all outstanding Purchase Orders issued prior to the expiration of the Agreement period have been completed or terminated,not to exceed six(6)months. The County may, at its discretion and with the consent of the Provider, renew the Agreement under all of the terms and conditions contained in this Agreement for three (3)additional one(1)year periods. The County shall give the Provider written notice of the County's intention to renew the Agreement term not less than ten (10)days prior to the end of the Agreement term then in effect. The County Manager, or his designee, may, at his discretion, extend the Agreement under all of the terms and conditions contained in this Agreement for up to one hundred and eighty (180) days. The County Manager, or his designee, shall give the Provider written notice of the County's intention to extend the Agreement term not less than thirty (30) days prior to the end of the Agreement term then in effect. 2, COMMENCEMENT. The Provider shall commence services upon the issuance of Purchase Order. 3. STATEMENT OF WORK. The Provider shall provide Medical Director for the Collier County Occupational Health Program (Part A) and Employment Physicals and Drugs Testing (Part B) services in accordance with Exhibit A, Scope of Services, attached • hereto, the terms and conditions of 1113#15-6474R and the Provider's proposal,referred to herein and made an integral part of this Agreement. 16E1 This Agreement contains the entire understanding between the parties and any modifications to this Agreement shall be mutually agreed upon in writing by the Parties, in compliance with the County Purchasing Ordinance, as amended, and Procurement Procedures in effect at the time such services are authorized. 4. THE CONTRACT SUM. The County shall pay the Provider a not-to-exceed annual amount of Ten Thousand Dollars ($10,000.00), to be billed and paid in the form of monthly lump sum installments for services related to Medical Director of Collier County Occupational Health Program (Part A). For Employment Physicals and Drugs Testing (Part B), the County shall pay the Provider for the services provided to the County, in accordance with the attached Exhibit B - Price Schedule. 4.1. Payment(s) will be made upon receipt of a proper invoice and in compliance with Chapter 218, Fla. Stats., otherwise known as the "Local Government Prompt Payment Act". 4.2. Payments will be made for services furnished, delivered, and accepted, upon receipt and approval of invoices submitted on the date of services or within six (6) months after completion of contract. Any untimely submission of invoices beyond the specified deadline period is subject to non-payment under the legal doctrine of "laches" as untimely submitted. Time shall be deemed of the essence with respect to the timely submission of invoices under this Agreement. 5. SALES TAX. Provider shall pay all sales, consumer, use and other similar taxes associated with the Work or portions thereof, which are applicable during the performance of the Work. Collier County, Florida as a political subdivision of the State of Florida, is exempt from the payment of Florida sales tax to its vendors under Chapter 212, Florida Statutes, Certificate of Exemption# 85-8015966531C-2. 6. NOTICES. All notices from the County to the Provider shall be deemed duly served if mailed or faxed to the Provider at the following Address: Advance Medical of Naples, LLC 720 Goodlette Road, N. Suite 500 Naples, FL 34102 Telephone: 239-566-7676 Facsimile: 239-254-3105 All Notices from the Provider to the County shall be deemed duly served if mailed or faxed to the County to: 41.7 16E1 Collier County Government Center Procurement Services Division 3327 Tamiami Trail, East Naples, Florida 34112 Attention: Joanne Markiewicz, Director, Procurement Services Division Telephone: 239-252-8407 Facsimile: 239-252-6480 The Provider and the County may change the above mailing address at any time upon giving the other party written notification. All notices under this Agreement must be in writing. 7, NO PARTNERSHIP. Nothing herein contained shall create or be construed as creating a partnership between the County and the Provider or to constitute the Provider as an agent of the County. 8. PERMITS: LICENSES: TAXES. In compliance with Section 218.80, F.S., all permits necessary for the prosecution of the Work shall be obtained by the Provider. The County will not be obligated to pay for any permits obtained by SubProviders/SubProviders. Payment for all such permits issued by the County shall be processed internally by the County. All non-County permits necessary for the prosecution of the Work shall be procured and paid for by the Provider. The Provider shall also be solely responsible for payment of any and all taxes levied on the Provider. In addition, the Provider shall comply with all rules, regulations and laws of Collier County, the State of Florida, or the U. S. Government now in force or hereafter adopted. The Provider agrees to comply with all laws governing the responsibility of an employer with respect to persons employed by the Provider. 9. NO IMPROPER USE. The Provider will not use, nor suffer or permit any person to use in any manner whatsoever, County facilities for any improper, immoral or offensive purpose, or for any purpose in violation of any federal, state, county or municipal ordinance, rule, order or regulation, or of any governmental rule or regulation now in effect or hereafter enacted or adopted. In the event of such violation by the Provider or if the County or its authorized representative shall deem any conduct on the part of the Provider to be objectionable or improper, the County shall have the right to suspend the contract of the Provider. Should the Provider fail to correct any such violation, conduct, or practice to the satisfaction of the County within twenty-four (24) hours after receiving notice of such violation, conduct, or practice, such suspension to continue until the violation is cured. The Provider further agrees not to commence operation during the suspension period until the violation has been corrected to the satisfaction of the County. 3 16E1 10. TERMINATION. Should the Provider be found to have failed to perform his services in a manner satisfactory to the County as per this Agreement,the County may terminate said Agreement for cause; further the County may terminate this Agreement for convenience with a thirty (30) day written notice. The County shall be sole judge of non-performance. In the event that the County terminates this Agreement,Provider's recovery against the County shall be limited to that portion of the Contract Amount earned through the date of termination. The Provider shall not be entitled to any other or further recovery against the County,including, but not limited to, any damages or any anticipated profit on portions of the services not performed. 11. NO DISCRIMINATION. The Provider agrees that there shall be no discrimination as to race,sex,color,creed or national origin. 12. INSURANCE. The Provider shall provide insurance as follows: A. Commercial General Liability: Coverage shall have minimum limits of$500,000 Per Occurrence, $2,000,000 aggregate for Bodily Injury Liability and Property Damage Liability. This shall include Premises and Operations; Independent Contractors; Products and Completed Operations and Contractual Liability. B. Business Auto Liability: Coverage shall have minimum limits of $500,000 Per Occurrence, Combined Single Limit for Bodily Injury Liability and Property Damage Liability. This shall include: Owned Vehicles, Hired and Non-Owned Vehicles and Employee Non-Ownership. C. Workers' Compensation: Insurance covering all employees meeting Statutory Limits in compliance with the applicable state and federal laws. The coverage must include Employers' Liability with a minimum limit of $500,000 for each accident. D. Medical Professional Liability: Coverage shall have minimum limits of $250,000 Per Occurrence,$750,000 aggregate. E. Medical Malpractice: Coverage shall have minimum limits of $1,000,000 Per Occurrence. Special Requirements: Collier County Government shall be listed as the Certificate Holder and included as an Additional Insured on the Comprehensive General Liability Policy. Current, valid insurance policies meeting the requirement herein identified shall be maintained by Provider during the duration of this Agreement. The Provider shall 4 (2) 16E1 provide County with certificates of insurance meeting the required insurance provisions. Renewal certificates shall be sent to the County ten (10) days prior to any expiration date. Coverage afforded under the policies will not be canceled or allowed to expire until the greater of: ten (10) days prior written notice, or in accordance with policy provisions. Provider shall also notify County, in a like manner, within twenty- four (24) hours after receipt, of any notices of expiration, cancellation, non-renewal or material change in coverage or limits received by Provider from its insurer, and nothing contained herein shall relieve Provider of this requirement to provide notice. Provider shall ensure that all subProviders/sub-Providers comply with the same insurance requirements that he is required to meet. 13. INDEMNIFICATION. To the maximum extent permitted by Florida law, the Provider shall indemnify and hold harmless Collier County, its officers and employees from any and all liabilities, damages, losses and costs, including, but not limited to, reasonable attorneys' fees and paralegals' fees, whether resulting from any claimed breach of this Agreement by Provider, any statutory or regulatory violations, or from personal injury, property damage, direct or consequential damages, or economic loss, to the extent caused by the negligence, recklessness, or intentionally wrongful conduct of the Provider or anyone employed or utilized by the Provider in the performance of this Agreement. This indemnification obligation shall not be construed to negate, abridge or reduce any other rights or remedies which otherwise may be available to an indemnified party or person described in this paragraph. This section does not pertain to any incident arising from the sole negligence of Collier County. 13.1 The duty to defend under this Article 13 is independent and separate from the duty to indemnify, and the duty to defend exists regardless of any ultimate liability of the Provider, County and any indemnified party. The duty to defend arises immediately upon presentation of a claim by any party and written notice of such claim being provided to Provider's obligation to indemnify and defend under this Article 13 will survive the expiration or earlier termination of this Agreement until it is determined by final judgment that an action against the County or an indemnified party for the matter indemnified hereunder is fully and finally barred by the applicable statute of limitations. 14. CONTRACT ADMINISTRATION. This Agreement shall be administered on behalf of the County by the Risk Management Division. 15. CONFLICT OF INTEREST. Provider represents that it presently has no interest and shall acquire no interest, either direct or indirect, which would conflict in any manner with the performance of services required hereunder. Provider further represents that no persons having any such interest shall be employed to perform those services. 16E1 16. COMPONENT PARTS OF THIS CONTRACT. This Contract consists of the following component parts, all of which are as fully a part of the contract as if herein set out verbatim: Provider's Proposal, Insurance Certificate(s), Bid #15-6474R Scope of Services, any Addendum/Addenda, Exhibit A, Scope of Services, Exhibit B- Price Schedule, and Exhibit C, Business Associate Agreement. 17. SUBJECT TO APPROPRIATION. It is further understood and agreed by and between the parties herein that this Agreement is subject to appropriation by the Board of County Commissioners. 18. PROHIBITION OF GIFTS TO COUNTY EMPLOYEES. No organization or individual shall offer or give, either directly or indirectly, any favor, gift, loan, fee, service or other item of value to any County employee, as set forth in Chapter 112, Part III, Florida Statutes, Collier County Ethics Ordinance No. 2004-05, as amended, and County Administrative Procedure 5311. Violation of this provision may result in one or more of the following consequences: a. Prohibition by the individual, firm, and/or any employee of the firm from contact with County staff for a specified period of time; b. Prohibition by the individual and/or firm from doing business with the County for a specified period of time, including but not limited to: submitting bids, RFP, and/or quotes; and, c. immediate termination of any contract held by the individual and/or firm for cause. 19. COMPLIANCE WITH LAWS. By executing and entering into this agreement, the Provider is formally acknowledging without exception or stipulation that it agrees to comply, at its own expense, with all federal, state and local laws, codes, statutes, ordinances, rules, regulations and requirements applicable to this Agreement, including but not limited to those dealing with the Immigration Reform and Control Act of 1986 as located at 8 U.S.C. 1324, et seq. and regulations relating thereto, as either may be amended; taxation, workers' compensation, equal employment and safety (including, but not limited to, the Trench Safety Act, Chapter 553, Florida Statutes), and the Florida Public Records Law Chapter 119, including specifically those contractual requirements at F.S. § 119.0701(2)(a)-(d) and (3) stated as follows: (2) In addition to other contract requirements provided by law, each public agency contract for services must include a provision that requires the Provider to comply with public records laws, specifically to: (a) Keep and maintain public records that ordinarily and necessarily would be required by the public agency in order to perform the service. (b) Provide the public with access to public records on the same terms and conditions that the public agency would provide the records and at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law. 6 v 16E1 (c) Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law. (d) Meet all requirements for retaining public records and transfer, at no cost, to the public agency all public records in possession of the Provider upon termination of the contract and destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. All records stored electronically must be provided to the public agency in a format that is compatible with the information technology systems of the public agency. (3) If a contractor does not comply with a public records request, the public agency shall enforce the contract provisions in accordance with the contract. If Provider observes that the Contract Documents are at variance therewith, it shall promptly notify the County in writing. Failure by the Provider to comply with the laws referenced herein shall constitute a breach of this Agreement and the County shall have the discretion to unilaterally terminate this Agreement immediately. 20. OFFER EXTENDED TO OTHER GOVERNMENTAL ENTITIES. Collier County encourages and agrees to the successful proposer extending the pricing, terms and conditions of this solicitation or resultant contract to other governmental entities at the discretion of the successful proposer. 21. AGREEMENT TERMS. If any portion of this Agreement is held to be void, invalid, or otherwise unenforceable, in whole or in part, the remaining portion of this Agreement shall remain in effect. 22. ADDITIONAL ITEMS/SERVICES. Additional items and/or services may be added to this contract in compliance with the Purchasing Ordinance, as amended, and Purchasing Procedures. 23. DISPUTE RESOLUTION. Prior to the initiation of any action or proceeding permitted by this Agreement to resolve disputes between the parties, the parties shall make a good faith effort to resolve any such disputes by negotiation. The negotiation shall be attended by representatives of Provider with full decision-making authority and by County's staff person who would make the presentation of any settlement reached during negotiations to County for approval. Failing resolution, and prior to the commencement of depositions in any litigation between the parties arising out of this Agreement, the parties shall attempt to resolve the dispute through Mediation before an agreed-upon Circuit Court Mediator certified by the State of Florida. The mediation shall be attended by representatives of Provider with full decision-making authority and by County's staff person who would make the presentation of any settlement reached at 7 16E1 mediation to County's board for approval. Should either party fail to submit to mediation as required hereunder, the other party may obtain a court order requiring mediation under section 44.102, Fla. Stat. 24. VENUE. Any suit or action brought by either party to this Agreement against the other party relating to or arising out of this Agreement must be brought in the appropriate federal or state courts in Collier County, Florida, which courts have sole and exclusive jurisdiction on all such matters. 25. KEY PERSONNEL. The Provider personnel and management to be utilized for this Agreement shall be knowledgeable in their areas of expertise. The County reserves the right to perform investigations as may be deemed necessary to ensure that competent persons will be utilized in the performance of the Agreement. The Provider shall assign as many people as necessary to complete the services on a timely basis, and each person assigned shall be available for an amount of time adequate to meet the required services. The Provider shall not change Key Personnel, including the Medical Director, unless the following conditions are met: (1) Proposed replacements have substantially the same or better qualifications and/or experience; and (2) that the County is notified in writing as far in advance as possible. The Provider shall make commercially reasonable efforts to notify Collier County within seven (7) days of the change. The County retains final approval of proposed replacement personnel. 26. ORDER OF PRECEDENCE. In the event of any conflict between or among the terms of any of the Contract Documents, the terms of the ITB 15-6474R, the Provider's Proposal, and/or the County's Board approved Executive Summary, the Contract Documents shall take precedence. 27. ASSIGNMENT. Provider shall not assign this Agreement or any part thereof, without the prior consent in writing of the County. Any attempt to assign or otherwise transfer this Agreement, or any part herein, without the County's consent, shall be void. If Provider does, with approval, assign this Agreement or any part thereof, it shall require that its assignee be bound to it and to assume toward Provider all of the obligations and responsibilities that Provider has assumed toward the County. 8 16E1 IN WITNESS WHEREOF, the parties hereto, have each, respectively, by an authorized person or agent, have executed this Agreement on the date and year first written above. BOARD OF COUNTY COMMISSIONERS ATPEST: COLLIER COUNTY, FLORIDA Dwight E. Brock, Clerk sI Courts . By '' -0 A C � .� B y f ,ef' Donna Fiala, Chairman Dated: rs /. s i �O (SE sig ature only.. Advance Medical of Naples, LLC Provider 0/0.0 a/44 au By: as...4Z 7».(510.004.-,--- rrt Wi ess Si ature l +�Al �' l,/ pkt nC a_ n9. kill/J.101- tzuir-tr- PTType/print wiliess ameT TType/print signature and titleT 6 « Second Witness IUCiteS TType/print witness nameT Approved as to Form and Legality: r(410 PI r)(YijeULL_, Assistant oun��A�rney cAl 6y eene Print Name Item# WOE �j y.. Date 1) 6 i Date 37-a-a--1 t tyk• Dep Clerk 9 16E1 EXHIBIT A SCOPE OF SERVICES The services to be provided by the Provider shall include, but are not limited to those listed below. The County shall order services as required, but makes no guarantee as to the quantity,number and type of services that will be ordered or required by this agreement. The services to be provided by the Provider for Medical Director for Collier County (Part A)consist of: Part A: The Provider shall provide Medical Director Services for the Collier County Occupational Health Program as may be required by the Collier County Manager's Agency and its participating agencies, located in Naples, Florida These programs are be available to all Regular, Temporary and Seasonal Employees of the County Manager's Agency of Collier County and its participating agencies,which currently include,but are not limited to: County Attorney, Airport Authority, and Pelican Bay Services. This contract does not include the Collier County Sheriff's Staff and employees nor the Collier County Clerk of the Court's staff as they have separate contracts. The County has a total of approximately one thousand nine hundred and forty(1,940)employees,subject to change. The Provider shall ensure that the physician providing services is a licensed doctor of medicine or osteopathy who has completed residency training in an accredited medical training program and/or is American Boards of Medical Specialties (ARMS) or American Osteopathic Association (AOA) certified, and must possess certification as a Medical Review Officer (MRO). The physician shall be knowledgeable and/or have a background that includes, but is not limited to;Occupational Medicine,OSHA Standards, NFPA 1582 and 1583 Standards, Florida Workers' Compensation Statutes, DOT Agencies-FAA/r'i'A/FMCA and USCG drug and alcohol testing regulations. In the event that the Provider to provide listed services is unavailable,an on call physician of similar qualifications shall be designated to provide such services. The services to be provided by the Provider also include,but are not limited to the following: 1. Review,recommend&approve standing medical orders&protocols. 2. Provide a written recommendation for an employee or prospective job candidate's ability to wear a respirator based on OSHA's Respiratory Protection Standard - CFR1910.134. 3. Provide services per OSHA's Occupational Noise Exposure Standard-CFR 1910.95. 4. Consult and recommend pre-placement evaluation criteria&findings. 5. Consult on work related injuries &illnesses. 6. Consult on"fitness for duty" evaluations. 10 11/1 16E1 7. Medical Review Officer (MRO): review and consultation of drug related tests. Reports and Records: All medical reports shall be the sole property of Collier County and may not be used or reproduced in any form without the explicit written permission of the County. The Provider shall maintain complete records on each individual examined/treated. Such records shall remain confidential in compliance with all HIPPA regulations and will be made available only to the County's representative and/or the individual. No information, record, report or data derived, compiled, obtained, prepared or developed by the Provider from work performed pursuant to the contract may be released, disseminated or disclosed without written consent of the County. All medical reports and records shall be formally transferred to the County by the Provider within five (5) working days after the receipt of a contract termination notice. The services to be provided by the Provider for Employment Physicals and Drug Testing (Part B) consist of: Part B: A comprehensive pre-employment physical and drug testing program to benefit Collier County and reduce liability to the County. This program will ensure the proper placement of employees based upon physical capabilities related to essential functions of County positions. Also included will be reassessment of appropriate County employees on a designated basis. This program will ensure the health of County employees and potential County employees. The Provider shall ensure that the physician providing and/or overseeing services is a licensed doctor of medicine or osteopathy who has completed residency training in an accredited medical training program and/or is American Boards of Medical Specialties (ABMS) or American Osteopathic Association (AOA) certified. The physician shall be knowledgeable and/or have a background that includes, but is not limited to; Occupational Medicine, OSHA Standards, NFPA 1582 and 1583 Standards, Florida Workers' Compensation Statutes, DOT Agencies - FAA/FTA/FMCA and USCG drug and alcohol testing regulations. Specific requirements include: 1. The Occupational Medical Services Program will be designed to provide the medical services listed. The Provider shall provide weekend and extended hours of operation and shall be staffed with appropriately trained and qualified medical personnel. 2. Clinical Activities: The following are the activities that shall be required of the Provider. This list includes the core function and major emphasis of clinical activities to be performed. Lab results, medical findings and recommendations shall be reviewed with the examinee. 11 16E1 A. Pre-Placement Employment Physical: A basic occupational and medical history is reviewed with an occupational physical exam. (A Respirator Medical Clearance Evaluation may also be required based on job classification.) The medical determination of ability to work is assessed based on the job classification specifications. A vision exam (near & far acuity, color, depth perception) will be conducted with this physical at no charge. Ancillary tests to determine medical clearance (i.e., drug testing, blood alcohol, CBC, lipid panel) are reimbursed per fee schedule. B. Pre-Placement Physical W/CDL Physical: The candidate's medical history is reviewed. (A Respirator Medical Clearance Evaluation may also be required based on job classification.) The medical examiner, conducts a physical that evaluates the candidate's medical condition for employment and CDL medical certification. The physician completes the pre-employment physical form and the Department of Transportation medical physical form. Laboratory results are reviewed. A vision screen and urine dipstick is conducted at no additional charge. The DOT card is issued. C. Firefighter Physical: A comprehensive medical history review and physical evaluation is conducted in accordance with the recommendations of NFPA 1582. (A Respirator Medical Clearance Evaluation and Fitness Plan per NFPA 1582 Guidelines, is included as part of the physical evaluation.) This physical shall be conducted in a manner that permits the physician to review the findings of all components (labs, tests...etc) of the physical and review those findings and any recommendations with the firefighter candidate / employee. D. Respirator Medical Clearance Evaluation: A respiratory health questionnaire and medical history is reviewed by a physician, nurse practitioner or physician's assistant per the OSHA Standard - CFR 1910.134. The physical examination with interpretation of spirometry and ancillary tests will assess the ability to wear a respirator. A written medical recommendation shall be provided per the OSHA Standard - CFR 1910.134. A vision exam will be included at no charge. Spirometry testing is included. Ancillary tests at the published fee schedule can augment this physical assessment. E. SCUBA Diving Medical Examination and Certification: A medical history is reviewed and a physical examination with required ancillary testing is conducted to determine issuance of a diving certification. F. CDL Physical (DOT): The Department of Transportation Medical Examination Report for commercial driver fitness determination is conducted in accordance with DOT regulations and requirements. A Medical Examiners Certificate (DOT Card) will be issued after successful completion of this physical. G. Fitness for Duty.Examination: The selected vendor shall perform any fitness for duty examinations requested by the County Occupational Health Nurse or County Human Resources Department. The fitness for duty examination content shall be determined by the physician based on the job classification requirements. A complete medical report shall be 12 4,) 16E1 forwarded to the County Occupational Health Nurse within one (1) working day of the completion of the examination. H. Asbestos Medical Examinations and Consultations: The selected vendor shall provide medical examinations and consultations following the requirements of the Asbestos Standard CFR 1926.1101. This examination shall include a Respirator Medical Clearance Evaluation. I. Laboratory Work:The following tests shall be performed for an all-inclusive fee: • Comprehensive Metabolic Panel with Lipids • Complete Blood Count(CBC)w/Platelet,Auto Differential • Urinalysis Chemistry • Creatinine • BUN • TSH Levels Test • C-Reactive Protein • Heavy Metals Test-Blood Panel Test(Arsenic,Cadmium, Lead, Mercury) • Heavy Metals Test-Blood-Aluminum • Heavy Metals Test-Antimony • Heavy Metals Test-Blood-Bismuth • Heavy Metals Test-Blood-Chromium • Heavy Metals Test-Blood-Copper • Heavy Metals Test-Blood-Nickel • Heavy Metals Test-Blood Zinc • HbAlc • RBC Cholinesterase • Polychlorinated Biphenyls • Blood Alcohol Test • Breath Alcohol Test- (Administered by a Breath Alcohol Technician meeting DOT Qualifications Only) • Arsenic-Urine • Mercury-Urine • PPD Testing w/Reading(Induration measurement) • Chest x-ray (2-view) • Chest x-ray (4-view) • Chest CT w/contrast • Chest CT without contrast • Audiometric Screening Test (pure tone air only) with interpretation (Audiogram) per OSHA's Occupational Noise Exposure Standard-CFR 1910.95. • Pulmonary Function Test(with interpretation) • Drug Screen w/MR0 - DOT 5 Panel (Collected per DOT Urine Specimen Collection Guidelines-49 CFR Part 40) • Drug Screen w/MR0-HRS 5 Panel • Drug Screen w/MRO- HRS 10 Panel 13 16E1 „ • Hepatitis Panel Test • Measles, Mumps, Rubella Vaccination (MMR) • MMR Titer • Mumps Vaccination • Mumps Titer • Measles Vaccination • Measles Titer • Varicella Vaccination(Price per injection) • Varicella Titer • Hepatitis A Vaccination Series (Price per injection) • Hepatitis B Vaccination Series (Price per injection) • Hepatitis Titer (if previously immunized) • HIV 1 &2 Antibody Test • Pre-exposure Rabies Vaccination Series (Price per injection) • Rabies Titer (if previously immunized) • Tetanus/diphtheria Vaccination • Tdap Vaccination • EKG -12 Lead (with interpretation and physician confirmation) • Cardiac Stress Test (with interpretation and physician confirmation) • Echocardiogram (with interpretation and physician confirmation) • Prostate Exam • PAP Test J. Medical Services Not Listed: Medical services (labs, tests, immunizations, etc) not listed in this document shall be permitted upon review and authorization by the County Occupational Health Nurse. K. Pre-employment Physical Examinations: Pre-employment examinations will usually be scheduled on short notice. Appointments may be requested for the same day or the following business day. The medical examination and review of the collected medical and occupational history must be performed by a licensed physician, nurse practitioner or physician's assistant, preferably experienced in occupational health. Routine measurements, laboratory specimens and x-rays may be taken by paramedical personnel. Written confirmation of the examination results must be provided to the County Occupational Health Nurse, or designated person, within twenty-four (24) hours. This confirmation must identify any concerns and/or accommodation recommendations. L. Reports and Records: All medical reports shall be the sole property of Collier County and may not be used or reproduced in any form without the explicit written permission of the County. The Provider shall maintain complete records on each individual examined/treated. Such records shall remain confidential in compliance with all HIPPA 14 16E1 regulations, including Exhibit C "HIPPA Business Associate Agreement," and will be made available only to the County's representative and/or the individual. No information, record, report or data derived, compiled, obtained, prepared or developed by the Provider from work performed pursuant to the contract may be released, disseminated or disclosed without written consent of the County. All medical reports and records shall be formally transferred to the County by the Provider within five (5) working days after the receipt of a contract termination notice. 15 16E1 EXHIBIT B PRICE SCHEDULE (following this page) 16 16E1 EXHIBIT B -PRICE PART A: Medical Director Services Annual Cost Annual Cost $ 10,000.00 PART B: Testing Types Unit of Price Each Measure Pre-Placement Employment Physical ea $ 80.00 Pre-Placement Physical W/CDL Physical ea $ 85.00 _ Firefighter Physical.. ea $ 80.00 Respirator Medical Clearance Evaluation ea $ 110.00 SCUBA Diving Medical Examination and Certification ea $ 80.00 CDL Physical (DOT) ea $ 90.00 Fitness for Duty Examination ea $ 170.00 Asbestos Medical Examinations and Consultations ea $ 150.00 Laboratory Work ea $ 15.00 Creatinine ea $ 0.50 BUN ea $ 0.50 TSH Levels Test ea $ 10.00 C-Reactive Protein ea $ 8.00 Heavy Metals Test - Blood Panel Test (Arsenic, Cadmium, ea $ 125.00 Lead, Mercury) Heavy Metals Test -Blood- Aluminum ea $ 18.00 Heavy Metals Test-Blood- Antimony ea $ 89.00 Heavy Metals Test-Blood- Bismuth ea $ 81.00 Heavy Metals Test-Blood- Chromium ea $ 23.00 Heavy Metals Test-Blood- Copper ea $ 9.00 Heavy Metals Test-Blood- Nickel ea $ 79.00 Heavy Metals Test-Blood-Zinc ea $ 9.00 HbAlc ea $ 8.00 RBC Cholinesterase ea $ 27.00 Polychlorinated Biphenyls ea $ 35.00 Blood Alcohol Test ea $ 45.00 Breath Alcohol Test- (Administered by a Breath Alcohol ea $ 45.00 Technician meeting DOT Qualifications Only) Arsenic -Urine ea $ 17.00 Mercury-Urine ea $ 37.00 PPD Testing w/Reading (Induration measurement) ea $ 10.00 Chest x-ray (2-view) ea $ 50.00 Chest x-ray (4-view) ea $ 95.00 Chest CT w/contrast ea $ 475.00 17 V 16E1 Chest CT without contrast ea $ 450.00 Audiometric Screening Test (pure tone air only) with ea $ 1.00 interpretation (Audiogram) per OSHA's Occupational Noise Exposure Standard- CFR 1910.95. Pulmonary Function Test (with interpretation) ea $ 30.00 Drug Screen w/MRO - DOT 5 Panel (Collected per DOT ea $ 35.00 Urine Specimen Collection Guidelines -49 CFR Part 40) Drug Screen w/MRO - HRS 5 Panel ea $ 26.00 Drug Screen w/MRO - HRS 10 Panel ea $ 47.00 Hepatitis Panel Test ea $ 80.00 Measles, Mumps,Rubella Vaccination (MMR) ea $ 85.00 -' MMR Titer _ ea $ 25.00 Mumps Vaccination ea $ 75.00 Mumps Titer ea a $ 45.00 Measles Vaccination ea $ 75.00 Measles Titer ea $ 45.00 Varicella Vaccination (Price per injection) ea $ 155.00 Varicella Titer ea $ 18.00 , Hepatitis A Vaccination Series (Price per injection) ea $ 75.00 Hepatitis B Vaccination Series (Price per injection) ea $ 45.00 Hepatitis Titer (if previously immunized) ea $ 16.00 HIV 1 &2 Antibody Test ea $ 32.00 Pre-exposure Rabies Vaccination Series (Price per injection) ea $ 290.00 Rabies Titer (if previously immunized) ea $ 35.00 Tetanus/diphtheria Vaccination ea $ 28,00 Tdap Vaccination ea $ 55.00 EKG -12 Lead (with interpretation and physician ea $ 40.00 confirmation) Cardiac Stress Test (with interpretation and physician ea $ 135.00 confirmation) Echocardiogram (with interpretation and physician ea $ 110.00 confirmation) Prostate Exam ea $ 1.00 PAP Test ea $ 35.00 18 0 16E1 EXHIBIT C Business Associate Agreement (following this page) 19 16E1 HIPAA BUSINESS ASSOCIATE AGREEMENT THIS HIPAA BUSINESS ASSOCIATE AGREEMENT ("Agreement") is made by and between Collier County, Florida (hereinafter referred to as "Client") and Advance Medical of Naples, LLC (hereinafter referred to as "AMN"). This Agreement is effective as of the date signed by Client. RECITALS WHEREAS, Client is a "covered entity" within the meaning of 45 CFR § 160.103; WHEREAS, AMN provides accounting, consulting, or other services to Client and, in connection therewith, Client wishes to disclose "protected health information" within the meaning of 45 CFR § 160.103 to AMN and AMN wishes to receive protected health information and, on behalf of Client, create, maintain, or transmit protected health information (collectively, "Client's PHI"); WHEREAS, AMN is a "business associate" within the meaning of 45 CFR § 160.103; WHEREAS, Client and AMN intend to protect the privacy and provide for the security of Client's PHI in compliance with the Health Insurance Portability and Accountability Act of 1996, the Health Information Technology for Economic and Clinical Health Act of 2009, and the regulations and policy guidance thereunder ("HIPAA Rules"); WHEREAS, the HIPAA Rules require that Client receive adequate assurances that AMN will comply with certain obligations with respect to Client's PHI and, accordingly, the parties hereto desire to enter into this Agreement for the purpose of setting forth in writing the terms and conditions for the use, disclosure, and safeguarding of Client's PHI, including provisions required by the HIPAA Rules as the same may be amended from time to time; NOW, THEREFORE, in consideration of the foregoing recitals and mutual covenants herein contained and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties agree as follows: TERMS OF AGREEMENT 1. Obligations and Activities of AMN. a. Permitted and Required Uses and Disclosures. AMN shall not use or disclose Client's PHI except as permitted or required by this Agreement or as required by law. Specifically, AMN agrees as follows: i. AMN may only use or disclose Client's PHI as necessary to perform the services set forth in the service agreement, if any, between Client and AMN, to perform functions, activities, or services for, or on behalf of, Client as requested by Client from time to time, or as required by law. Page 1 of 8 EXHIBIT C-Contract#15-6474R "Medical Director for Collier County and Employment Physicals and Drug Testing" 16E1 ii. AMN shall use or disclose only the "Minimum Necessary" amount of information, as such term is defined in the HIPAA Rules, required to conduct the authorized activities herein, except that AMN will limit disclosures to a limited data set as set forth in 45 CFR § 164.514(e)(2) as required by the HIPAA Rules. iii. AMN may not use or disclose Client's PHI in a manner that would violate Subpart E of 45 CFR Part 164 if done by Client, except that AMN may use or disclose Client's PHI for the proper management and administration of AMN or to carry out the legal responsibilities of AMN, provided the use or disclosures are required by law or AMN obtains reasonable assurances from the person to whom the information is disclosed that Client's PHI will remain confidential and used or further disclosed only as required by law or for the purposes for which it was disclosed to the person, and the person notifies AMN of any instances of which it is aware in which the confidentiality of Client's PHI has been breached. iv. AMN may use Client's PHI to provide "data aggregation services" relating to the health care operations of Client within the meaning of 45 CFR § 164.501. v. AMN shall not disclose Client's PHI in a manner that would violate any restriction thereof which has been duly communicated to AMN. vi. Except as permitted by the HIPAA Rules, AMN shall not directly or indirectly receive remuneration in exchange for any of Client's PHI unless authorized in writing by Client. b. Safeguards. AMN shall use appropriate safeguards, and comply with Subpart C of 45 CFR Part 164 with respect to electronic protected health information, to prevent use or disclosure of Client's PHI other than as provided in this Agreement. i. Administrative Safeguards. AMN shall implement all required administrative safeguards pursuant to 45 CFR § 164.308 as such are made applicable to business associates pursuant to the HIPAA Rules. Additionally, AMN shall either implement or properly document the reasons for non- implementation of all administrative safeguards of 45 CFR § 164.308 that are designated as "addressable" as such are made applicable to business associates pursuant to the HIPAA Rules. ii. Physical Safeguards. AMN shall implement all required physical safeguards pursuant to 45 CFR § 164.310 as such are made applicable to business associates pursuant to the HIPAA Rules. Additionally, AMN shall either implement or properly document the reasons for non-implementation of all Page 2 of 8 EXHIBIT C-Contract#15-6474R "Medical Director for Collier County and Employment Physicals and Drug Testing" 0 16E1 physical safeguards of 45 CFR § 164.310 that are designated as "addressable" as such are made applicable to business associates pursuant to the HIPAA Rules. iii. Technical Safeguards. AMN shall implement all required technical safeguards pursuant to 45 CFR § 164.312 as such are made applicable to business associates pursuant to the HIPAA Rules. Additionally, AMN shall either implement or properly document the reasons for non-implementation of all technical safeguards of 45 CFR § 164.312 that are designated as "addressable" as such are made applicable to business associates pursuant to the HIPAA Rules. c. Reporting of Disclosures. AMN shall report to Client any use or disclosure of Client's PHI not provided for by this Agreement of which AMN becomes aware, including any acquisition, access, use or disclosure (i.e., "breach") of "unsecured protected health information," within the meaning of 45 CFR § 164.403, and any security incident of which AMN becomes aware. AMN shall make such report to Client without unreasonable delay and in no case later than sixty (60) calendar days following discovery of the breach. AMN's notice to Client shall include all information needed by Client to provide notice to affected individuals and otherwise satisfy the requirements of 45 CFR § 164.410. d. AMN's Subcontractors. AMN may disclose Client's PHI to one or more subcontractors and may allow its subcontractors to create, receive, maintain, or transmit Client's PHI on behalf of AMN. AMN shall obtain satisfactory assurances from any such subcontractor that it will appropriately safeguard Client's PHI in accordance with 45 CFR § 164.314(a) and shall ensure that the subcontractor agrees in writing to the same or more stringent restrictions, conditions, and requirements that apply to AMN with respect to Client's PHI. Upon AMN contracting with a subcontractor regarding Client's PHI, AMN shall provide Client written notice of such executed agreement. e. Satisfying Requests for Access. AMN shall make available to Client Client's PHI in a "designated record set," within the meaning of 45 CFR § 164.501, as Client may require to satisfy its obligations to respond to a request for access pursuant to 45 CFR § 164.524. If AMN receives a request for access directly from an individual or an individual's designee, AMN shall forward such request within five (5) calendar days to Client for Client to fulfill. f. Satisfying Requests for Amendment. AMN shall make any amendments to Client's PHI in a designated record set, as Client may require to satisfy its obligations to respond to a request for amendment pursuant to 45 CFR § 164.526. If AMN receives a request for amendment directly from an individual or an individual's designee, AMN shall forward such request within ten (10) calendar days to Client for Client to fulfill. g. Internal Practices. AMN shall make its internal practices, books and records relating to the use and disclosure of Client's PHI available to the Secretary of the Page 3 of 8 EXHIBIT C-Contract#15-6474R "Medical Director for Collier County and Employment Physicals and Drug Testing" 16E1 United States Department of Health and Human Services or his or her designee for purposes of determining compliance with the HIPAA Rules. h. Accounting. AMN shall document disclosures of Client's PHI and information related to such disclosures and otherwise maintain and make available the information required to provide an accounting of disclosures to the Client as necessary to permit the Client to respond to a request for an accounting pursuant to 45 CFR § 164.528. If AMN receives a request for an accounting directly from an individual or an individual's designee, AMN shall forward such request within ten (10) calendar days to Client for Client to fulfill. Policies and Procedures; Documentation. AMN shall develop appropriate policies and procedures relating to its compliance with the administrative, physical, and technical safeguards set forth in Section 1.b. and shall document, retain, and update such policies and procedures as required by 45 CFR § 164.316. j. Compliance as if Covered Entity. To the extent AMN is to carry out one or more of the obligations imposed on the Client as a "covered entity" under Subpart E of 45 CFR Part 164, AMN shall comply with the requirements of said Subpart E that apply to the Client in the performance of such obligations. 2. Client Obligations. Client shall provide notice to AMN of any of the following: a. Any limitations in the notice of privacy practices of Client under 45 CFR § 164.520, as well as any changes to such limitations, to the extent that such limitation may affect AMN's use or disclosure of Client's PHI. b. Any changes in, or revocation of, the permission by an individual to use or disclose his or her protected health information, to the extent that such changes may affect AMN's use or disclosure of Client's PHI. c. Any restriction on the use or disclosure of protected health information that Client has agreed to or is required to abide by under 45 CFR § 164.522, to the extent that such restriction may affect AMN's use or disclosure of Client's PHI. d. Client shall not request AMN to use or disclose Client's PHI in any manner that would not be permissible under the HIPAA Rules if done by Client, except that Client may request AMN to provide to Client "data aggregation services" relating to the health care operations of the Client within the meaning of 45 CFR § 164.501, as permitted by 45 CFR § 164.504(e)(2)(i)(B). 3. Termination of Agreement. Termination shall be in accordance with terms and conditions as set forth in Section 11, Agreement#15-6474R. Page 4 of 8 EXHIBIT C-Contract#15-6474R "Medical Director for Collier County and Employment Physicals and Drug Testing" 0 16E1 4. Treatment of Client's PHI after Termination. Upon termination of this Agreement for any reason, AMN, with respect to Client's PHI, shall: a. Retain only that portion of Client's PHI which is necessary for AMN to continue its proper management and administration or to carry out its legal responsibilities; b. Return to Client or, if agreed to by Client, destroy remaining Client's PHI that AMN still maintains in any form and retain no copies of such Client's PHI; c. Continue to use appropriate safeguards and comply with Subpart C of 45 CFR Part 164 with respect to electronic protected health information to prevent use or disclosure of Client's PHI, other than as provided for in this Section, for as long as AMN retains any Client's PHI; d. Not use or disclose Client's PHI retained by AMN other than for the purposes for which Client's PHI was retained and subject to the same conditions, as set forth in Section 2, which applied prior to termination; e. Return to Client or, if agreed to by Client, destroy remaining Client's PHI retained by AMN when it is no longer needed by AMN for its proper management and administration or to carry out its legal responsibilities and retain no copies of such Client's PHI; f. Obtain or ensure the destruction of any Client's PHI created, received, or maintained by any of AMN's subcontractors; and g. Within thirty (30) calendar days after termination or expiration of this Agreement, certify in a written statement signed by a senior officer of AMN, that all Client's PHI has been returned or disposed of as required above. If the parties mutually agree that return or destruction is not feasible, this Agreement shall continue to apply to Client's PHI and, without limitation to the foregoing, the obligations of AMN under this Agreement shall survive the termination of this Agreement with respect to any Client's PHI retained by AMN. AMN shall limit further use and disclosure of Client's PHI to those purposes that make the return or destruction of Client's PHI infeasible. 5. Amendment to Comply with Law. The parties acknowledge that state and federal laws relating to electronic data security and privacy are rapidly evolving and that amendment of this Agreement may be required to provide for procedures to ensure compliance with such developments. The parties agree to promptly enter into negotiations concerning the terms of an amendment to this Agreement embodying written assurances consistent with the HIPAA Rules or other applicable law upon the written request of either party. Page 5 of 8 EXHIBIT C-Contract#15-6474R "Medical Director for Collier County and Employment Physicals and Drug Testing" 16E1 6. No Third Party Beneficiaries. Nothing expressed or implied in this Agreement is intended to confer, nor shall anything herein confer, upon any person other than Client, AMN, and their respective successors or assigns, any rights, remedies, obligations, or liabilities whatsoever. 7. Indemnification. This section shall be in accordance with terms and conditions as set forth in Section 13,Agreement#15-6474R. 8. Interpretation. This Agreement shall be interpreted in a reasonable manner as necessary to implement and comply with the HIPAA Rules. The parties agree that any ambiguity in this Agreement shall be resolved in favor of a meaning that complies and is consistent with the HIPAA Rules. There shall be no presumption for or against either party, by reason of one of the parties causing this Agreement to be drafted, with respect to the interpretation or enforcement of this Agreement. 9. Notices. All notices and other communications required or permitted hereunder or necessary or convenient in connection herewith shall be in writing and shall be deemed to have been given when hand delivered or mailed by registered or certified mail, as follows (provided that notice of change of address shall be deemed given only when received): If to Client, to: Collier County Government Center 3311 Tamiami Trail E. Naples, Florida 34112 Attn:Jeff Walker, Risk Management Director Telephone no: 239-252-8461 Facsimile no: 239-252-8048 If to AMN,to: Advance Medical of Naples, LLC 720 Goodlette-Frank Road N, Suite 500 Naples, Florida 34102 Attention: Patricia Jackson Telephone no: 239-566-7676 . Facsimile no: 239-254-3105 or to such other names or addresses as Client or AMN, as the case may be, shall designate by notice to the other in the manner specified in this Section 9. 10. Survival. The obligations contained in this Agreement which by their nature or context survive or are expressly intended to survive the expiration or termination of this Agreement will so survive and continue in full force and effect. Without limiting the Page 6 of 8 EXHIBIT C-Contract#15-6474R "Medical Director for Collier County and Employment Physicals and Drug Testing" 0 I 1 16E1 generality of the foregoing, Sections 2, 4, and 7 shall survive the termination of this Agreement. 11. Severability. If any provision of this Agreement is determined by a court of competent jurisdiction to be invalid, illegal, or unenforceable, the remaining provisions of this Agreement shall remain in full force, if the essential terms and conditions of this Agreement for each party remain valid, binding, and enforceable. 12. Entire Agreement. This Agreement constitutes the entire agreement between the parties on the matters contained herein. 13. Non-Waiver. No failure or delay in exercising any right or remedy under this Agreement and no course of dealing between the parties operates as a waiver or estoppel of any right, remedy, or condition. A waiver made in writing on one occasion is effective only in that instance and only for the purpose that it is given and is not to be construed as a waiver on any future occasion. (signature page to follow) Page7of8 EXHIBIT C-Contract#15-6474R "Medical Director for Collier County and Employment Physicals and Drug Testing" 4150 16E1 IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be signed as of the date first set forth above. COVERED ENTITY: BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA 414,140 By: Donna Fiala Chairman BUSINESS ASSOCIATE: Advance Medical of Naples, LLC First Witness B G By: ri 14:✓l./! Par tLJ L. \----Pa e'i'cte.t_ G ..<Jc,.Gi<:._ k) Print Name Patricia Jackson Seco Witness f By: +< >)--ed6td-.44 Print Name App ove• as to Form an* Legality: ATTEST: /41/ D'v`VJGH ..BROCK,CLERK Assistant County Attorney Depu Attest as to .n's signature only. Page 8 of 8 EXHIBIT C-Contract#15-6474R "Medical Director for Collier County and Employment Physicals and Drug Testing" , c 16E1 CERTIFICATE OF LIABILITY INSURANCE DATE M/DDIYYYY) t""""�r 9/812015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PROOUCER CONTACT Lutgert Insurance-Naples NAME:. Nancy Rice PO Box 112500 PHONE A o.E„).239-262 7171 iAi'tc.NO):239-262-5360 Naples FL 34108 E-MAIL nrice tut ertnsurance.corn Acmes& INSURER S,IAFFORDING COVERAGE NAIL# INSURER A:FCCi Insurance Company 10178 INSURED ADVAN 1 1 INSURER B: Advance Medical of Naples,LLC INSURER C Lori-Ann Martel/ 720 Goodiette Rd N,#500 . INSURER D Naples FL 34102 , INSURER E:_ _.... .INSURER F COVERAGES CERTIFICATE NUMBER:732614400 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ._..._....._ . ........-__.__ ADDC;-SIIBR LTR TYPE OF INSURANCE POLICY EFF �POUCY EXP ,..�.._. L_ INSD+WYD POLICY —.._. .... ._._._.. '{MM/ODIYYYY} {MM1DDlYY'YYI LIMITS A x COMMERCIAL GENERAL UABILFTY Y GL0013746 6/1/2015 6/1/2016 EACH OCCURRENCE 31,000,000 — DAMAGE T O NTE6 CLAIMS-MADE X OCCUR PREMISES{Ea occurrence) $100,000 _........... ._._.....__... ._ __......... MED EXP(Any one person) $5,000 ._ PERSONAL&ACV INJURY ,$1,000,000 GENL AGGREGATE MOT APPLIES PER' E.__RL AGGREGATE,,........ ... GENERAL AGGREGATE 32000 000 X ' POLICY ._... JEC LOC PRODUCTS•-COMP,OPAGG SINCLUDED OTHER: _.. ._._....... $ A AUTOMOBILE UABILITY CA0021260 6/1,2015 6/1/2016 'Ea aS E?SINv1 E LIMIT 1{700,000 ANY AUTO BODILY INJURY(Per oe'son) $ ALL OWNED -SCHEDULED ..._.._--. ._.... --..__.._ _.. _ _AUTOS i AUTOS BODILY INJURY(Pe°amdant) n. .. '`PROPERTY DAMAGE ' .. :NUN-OWNED ... _... X HIRED AUTOS ` X '„AUTOS $ - 7Pe�ac-^Cavxf.._._ UMBRELLA UAB OCCUR '.... : EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- , AND EMPLOYERS'LIABILITY YIN ....!STATUTE_i _ER_., _. ,. ANY PROPRIETOR(PARTNER/EXECUTIVE OFFICERJMEMBER EXCLUDED? N I A E.L.EACH ACCIDENT ,S (Mandatory In NH) E L.DISEASE-EA EMPLOYEE 3 If yes,describe under .__........_ ..__.... DESCRIPTION OF OPERATIONS bolo E.L.DISEASE POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more.space Is required) Collier County Board of Commissioners 3327 E Tamiami Trail, Naples FL 34112 is Additional Insured with regards to General Liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY.OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Collier County Board of County Commissioners ACCORDANCE WITH THE POLICY PROVISIONS, 3327 E Tamiami Trail Naples FL 34112 AUTHORIZED REPRESENTATIVE .;Jc7 4 ; .b 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD � R � CERTIFICATE LIABILITY T EL, 03/01/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Dan Reale Dan Reale,Agent/Owner FL License#A216059 PHONE Aviso Insurance,LLC E-r' Ng-E t 407-B0R-6149 I(NC,No): 866-660,1415__ E-MAIL AD 527 Lake Como Circle DRESS: an>k§avisninSllrenr corn Orlando Ft. 32803 INSURER(S)AFFORDING COVERAGE NA1C S INSURER A: AmTrust/Comp Options 15954 INSURED __ INSURER B: Advance Medical of Naples INSURER C: 720 Goodlette Road,North INSURER D: Naples FL 34102 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTIMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TDLTSlR� {{ POUCY EFF POLICY EXP LTR TYPE OF INSURANCE INSR�I WVD POLICY NUMBER !(MINDDIYYYY) IMMIDDJYYYY) LIMITS •GENERAL LIABILITY I _ EACH OCCURRENCE L COMMERCIAL GENERAL LIABILITY AGE O-REN I ti.) PREMISES(Ea occurrence) 1$ CLAIMS-MADE OCCUR - MED EXP(Any one person) S I PERSONAL&ADV INJURY S GENERAL AGGREGATE $ ,GEN'L AGGREGATE LIMIT APPLIES PER: ) j� PRO ( PRODUCTS-COMP/OP AGG $ + 1 POLICY LOC $ 1 AUTOMOBILE LIABILITY f I i COMBINED SINGLE LIMIT _____i I�! f II I(Ea accidentl _-$ i ANY AUTO _ BODILY INJURY(Per person) S ALL OWNED —i SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S �� I HIRED AUTOS NON-O NED PROPERTY DAMAGE AUTOS (Per accident) $ UMBRELLA LIAB OCCUR (- j� S I I (EACH OCCURRENCE 1 5 ■EXCESS LIAR (CLAIMS-MADE 'AGGREGATE 1 g i DED RETENTION$ j I s 1 WORKERS COMPENSATION I WC STA7U- OTH- AND EMPLOYERS'LIABILITY YIN X TORY LIMITS ER A ,ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICE/MEMBER EXCLUDED? N N f A n CWC100001 D 04/01/2015 04/01/2016 £.L.EACH ACCIDENT $500.000 (Mandatory In NH) 1 E.L.DISEASE 5 500,000 I If yes,describe under f -EA EMPLOYEE_ DESCRIPTION OF OPERATIONS below !EL DISEASE-POLICY LIMIT S 500,000 71 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Romance Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Above named insured. ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED RESENTATiVE f L i eL - �' y � c S f LI ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD ,...vrrrr vcr J 11-11‘.../4 I c or LIAbILI I Y INSURANCE 1 6 EI1GATb0 2/ 01PRODUCER 01/12/20 16 THIS ROYLANCE&ASSOCIATES,INC: Serial# 106643 ' ONLY CANDIFCONFERSISNO RIGH S U ONR THENCERT F CATE ATI 7232 SAND LAKE RD,SUITE 302 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ORLANDO,FL 32819 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURED INSURERS AFFORDING COVERAGE NAIC# INSURER A: MAG Mutual Insurance Company 42617 ADVANCE MEDICAL OF NAPLES,LLC INSURER 8: 720 GOODLETTE ROAD N., 5TH FLOOR NAPLES, FLORIDA 34102 INSURER c: INSURER D: COVERAGES INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS: NSA AOD'L - - LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POUCY EXPIRATION GENERAL LIABILITY -. _ DATE(MM/DD/YY) DATE.(MM/00/YYI LIMITS EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 111111 MADE PREMISES(Eaoccurer>rrel $ OCCUR MED EXP (Arty one person L__ L_ `■ - PERSONAL.BADV INJURY I$ GENT AGGREGATE LIMIT APPLIES PER: (GENERAL AGGREGATE ;. POLICY n JE a T�1 LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO COMBINED.SINGLE LIMIT $ (Ea accident) ■ALL OWNED AUTOS III SCHEDULED AUTOS BODILY INJURY 111 HIRED AUTOS (Per person) $ ■''NON-DWNED AUTOS BODILY INJURY _ (Per acdtlent) (Per ac danI,DAMAGE _. GARAGE UABIUTY ■ ANY AUTO AUTO ONLY-EA ACCIDENT $ OTHER THAN EA ACC S AUTOONLY: AGO EXCESS/UMBRELLA UABIUTY EACH OCCURRENCE ; 1111 OCCUR ❑CLAIMS MADE AGGREGATE $ ■DEDUCTIBLE y RETENTION $ $ WORKER'S 'UASI SATIONj ND I TORY LIMITS I 1 ER EMPLOYERS'UASIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT -; OFFICER/MEMBER EXCLUDED' If yes.describe under EL DISEASE-EA EMPLOYEE S SPECIAL PROVISIONS below EL DISEASE-POLICY LIMIT $ A OTHER PSL-160265606 2/19/16 2119/17 PROFESSIONAL LIABILITY I $250,000 EACH CLAIM/ $750,000 MADE FORM 000 AGGREGATE DESCRIPTION OF OPERATIONS/LOCAT10NSNEMICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL.PROVISIONS :SPECIALTY: ORGANIZATION COVERAGE WITH SEPARATE LIMITS RETROACTIVE DATE: 2/19/10 EMPLOYEE COVERAGE: SHARES IN ORGANIZATION LIMITS- JILL ANDERSON, CINDY BROWN; DEENA KRISHNA, SHERI MANGUEIRA, STEVEN MITNICK. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES EE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE.ISSUING INSURER.WILL ENDEAVOR TO MAIL 1.0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL. IMPOSE NO OBLIGATION OR BlUTY OF ANY RIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHOR PRES E ROYLANCE;ASSOCIATES,INC, ACORD 25(200 1/08) p ACORD CORPORATION 1988 16E1 From: GonzalezGreily To: CrouchJason; HerreraSandra Cc: Walker]eff;AdamsRebecca Subject: FW: 15-6474R Advanced Medical Date: Wednesday,February 10,2016 10:15:39 AM Attachments: imaoe001.ioq Good Morning, In reference to the aforementioned agreement Risk Management would like to point out that Section 12 E on the contract is a duplicate of Section 12 D; for Medical Professional Liability and Medical Malpractice are the same coverage. During the BID process both items were checked by mistake; but the only coverage that is required is Medical Professional Liability with limits of $250,000 per occurrence and $750,000 aggregate.These limits are consistent with the limit carried under this agreement in the past. Therefore,the Certificate of Insurance providing proof of coverage for the Medical Professional Liability with a limit of$250,000 is in compliance. If you have any questions please contact our office. Respectfully, gre4y g Operations Coordinator Risk Management Division Ph: (239)252-8461 Fax: (239)252-8048 Under Florida Law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead,contact this office by telephone or in writing.