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FY17 Contract w/FL DOH 16t37 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 2016-2017 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, 2016. 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, 2016, through September 30, 2017, 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. CO�9 1 607 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 ll 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 $ 6,159,689 (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 $1,419,500 (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 1 6 0 7 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 lI 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 1 6 0 7 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 4 ® 1 6 0 7 credited to each participating governmental entity. The planned use of surplus funds shall be 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 'o 1 6 0 7 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 Ill. 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 year end DE385L1 report if the variance exceeds or falls below 25 percent of the planned expenditure amount for the contract year. 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, 2017 for the report period October 1, 2016 through December 31, 2016; ii. June 1, 2017 for the report period October 1, 2016 through March 31, 2017; iii. September 1, 2017 for the report period October 1, 2016 through June 30, 2017; and iv. December 1, 2017 for the report period October 1, 2016 through September 30, 2017. 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 1 607 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 contract, any renewal hereof, or any term, performance or payment hereunder, extends beyond the fiscal year beginning July 1, 2017, it is agreed that the performance and payment under this contract 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 Health in Collier County Public Services Division Administrator Title Title 7 9r. 1 607 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 pages), Attachment IV (one pages), and Attachment V (one pages), to be executed by their undersigned officials as duly authorized effective the 1st day of October, 2016. BOARD OF COUNTY COMMISSIONERS STATE OF FLORIDA FOR COLLIER COUNTY DEPARTMENT OF HEALTH SIGNED BY: SIGNED BY: NAME: Donna Fiala NAME: Celeste Philip, MD, MPH Chairman TITLE: TITLE: Surgeon General and Secretary DATE: 1012.S \' DATE: ATTESTED TO: SIGNED BY: /i�(�� SWC • SIGNED BY: k. : slo_ NAME: Av A p NAME: Stephanie Vick, M.S., B.S.N., R.N. TITLE: 3r. 1t° TITLE: CHD Director/Administrator DATE: q I I9 1(e ' DATE: Approved as to form and legality 8 Jennifer A.Belpe ` Assistant County Attorney Gt..`fa- 1607 ATTACHMENT I COLLIER COUNT(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.640-3,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 150-24and 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 8.92,2 •• 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 Duality 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 640-3.046,F.A.C. • • In addition,periodic reports as specified by the department pertaining to the surveillancennvestigation of reportable vaccine- preventable diseases,adverse events,vaccine accountability, • and assessment of immunization attachment) Page 1 al 2 16137 ATTACHMENT I(Continued) 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 OHP 50-21* 8. HIV/AIDS Program Requirements as specified in F.S.384.25 and F.A.C.64D-3.030 and 640-3,031.Case reporting should be on Adult HIV/AIDS Confidential Case Report CDC Form OH2139 and Pediatric HIV/AIDS Confidential Case Report CDC Form DH2140. Requirements as specified in FAC.640-2 and 640-3,ES.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 ES.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.640-3,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 -Page 2 of 2 1607 S .- to W '-- a 4 0. ...1 I 1 0 in 0 0 • co .1! •.••• 0 c4 7 CO 1 0 o i- to 0 a• 0 1:50 e s , 1 0 ?- 4 0 54 IS ‘4, (•, cc csi 0 r- is 0 1 4- ti 1.-• g II) 5 0 1 'Ws 0 r a a t- to 0 0 0 ts cc % c.‘ - s 1...11 r- o 10;:i 0 S• 0 0 0 1- a; 0 s r* 'in ksi 0) o '4 1 1. n .... a. ' % o ••• 1.- 0 c. s ..., s s 2 e ts U +AO- ifc 0 1 -6 '6. 0 y ,,,0-6 co :,..• ct. 0 S, 76 S us 0 ,.0 •a 'z a .-1 o 0 tn c. 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Ca''''' •-- 13- C •c; () 1 0 %.To - c, a 2, tvt 48 0 ri 1607 ATTACHMENT U COLLIER COUNTY HEALTH DEPARTMENT Part II,Sources of Contra:manna to County Health Department October I,2016 to September 30,2017 State CHD County Total CUD Treat Fund CUD Treat Fund Other (cash) Treat Fund (cash) Contribution Total I.GENERAL REVENUE•STATE 015040 AIDS PATIENT CARE 140,000 0 140,000 0 140,000 015040 AIDS PREVENTION&SURVEILLANCE•GENERAL REVENUE 60,671 0 09,571 0 69,571 015040 CHD-TB COMMUNITY PROGRAM 171,090 0 171,096 0 171,095 015010 DENTAL SPECIAL INITIATIVE PROJECTS 5,806 0 5,806 1) 5,800 0160•10 FAMILY PLANNING GENERAL REVENUE 04,257 0 04.257 0 61 257 015040 HEPATITIS AND LIVER FAILURE PREVENTION&CONTROL 89,280 0 89,286 0 89,286 015040 MIGRANT LABOR CAMP SANITATION 74,533 0 71,533 0 74 533 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 015050 CHI)GENERAL REVENUE NON-CATEGORICAL 1,816,023 0 1,816,023 0 1,810,023 GENERAL REVENUE TOTAL 2,962.077 0 2,962,077 0 2,962,079 2,NON GENERAL REVENUE'STATE 015010 STATE UNDERGROUND PETROLEUM RESPONSE ACT 3.565 0 3,565 0 3,565 015010 ENVIRONMENTAL BIOMEDICAL WASTE PROGRAM 13,898 0 13,898 0 13,898 015010 TOBACCO STATE AND COMMUNITY INTERVENTIONS 183,885 0 183,885 0 183,885 NON GENERAL REVENUE TOTAL 201,348 0 201,318 0 201,348 3,FEDERAL FUNDS'STATE 007000 AIDS DRUG ASSISTANCE PROGRAM ADMIN HQ 77,940 0 77.045 0 7/.945 007000 BIOTERRORISM HOSPITAL PREPAREDNESS 540 0 640 0 640 007000 WIC BREASTFEEDING PEER COUNSELING PIIOG 62.587 0 52,687 0 52,587 007000 COASTAL BEACH WATER QUALITY MONITORING 16,478 0 16,178 0 16,478 007000 COMPREHENSIVE COMMUNITY CARDIO•P1i110 36,000 0 35,000 0 35,000 007000 CMS-MCH PURCHASED CLIENT SERVICES 20109015 13,500 0 13,500 0 13.500 007000 FAMILY PLANNING TITLE X'GRANT 167,442 0 167,412 0 167,442 007000 HPF VOLUNTEER MANAGEMENT 19,322 0 19,322 0 19,322 007000 IMMUNIZATION ACTION PLAN 72,552 0 72,552 0 72.552 007000 MCH SPECIAL PRJCT UNPLANNED PREGNANCY 32,991 0 32,094 0 32.904 007000 BASE COMMUNITY PREPAREDNESS CAPABILITY 68,602 0 68,602 0 68,602 007000 BASE PUB FILTH SURVEILLANCE&EPI INVESTIGATION 07,822 0 67,822 0 67 822 007000 AIDS PREVENTION 238,086 0 238,086 0 238.086 007000 RYAN WHITE TITLE II GRANT/CHD CONSORTIUM 287,051 0 987,051 0 237 051 007000 IMPROVING STD PROGRAMS 5,62.1 0 5,621 0 5,624 007000 WIC PROGRAM ADMINISTRATION 1,205,577 0 1.205,677 0 1,205,577 016075 INSPECTIONS OF SUMMER FEEDING PROGRAM•DOE 1,500 0 1,500 0 1,500 015075 SUPPLEMENTAL SCHOOL HEALTH 33,690 0 33,690 0 33,590 015075 REFUGEE HEALTH SCREENING REIMBURSEMENT 699,651 0 690,651 0 611)651 FEDERAL FUNDS TOTAL 3,090,063 0 3,090,063 0 3,096,003 4.FEES ASSESSED BY STATE OR FEDERAL RULES•STATE 001020 CHD STATEWIDE ENVIRONMENTAL FEES 475,581 0 475,581 0 415,5141 001092 CHD STATEWIDE ENVIRONMENTAL FEES 156,740 0 155,740 0 155,740 Antathment_a_Pati JI-Page I at 3 1 1 6 0 7 ATTACHMENT U COLLIER COUNTY HEALTH DEPARTMENT Part II,Sources of Corstributions to County Health Department October I,2018 to September 30,2017 State CHD County Total CIID Trust Fund CHD Trust Fund Other (cask) Trust Fund , (cash) Contribution Total 001206 ON SITE SEWAGE DISPOSAL PERMIT FEES 10,139 0 10,139 0 10.139 001206 SANITATION CERTIFICATES(FOOD INSPECTION) 4,062 0 4,062 0 4,062 001206 SEPTIC TANK RESEARCH SURCHARGE 1,740 0 1,740 0 1,740 001206 SEPTIC TANK VARIANCE FEES 50% 360 0 350 0 350 001206 PUBLIC SWIMMING POOL.PERMIT FEES•10%HQ TRANSFER 26,314 0 26,314 0 20.313 001206 DRINKING WATER PROGRAM OPERATIONS 1,305 0 1,305 0 1,305 001206 REGULATION OF BODY PIERCING SALONS 30 0 30 0 30 001206 TANNING FACILITIES 353 0 353 0 363 001206 ONSITE SEWAGE TRAINING CssrER 1,136 0 1,135 0 1,135 001206 Tam PROGRAM ENVIRONMENTAL HEALTH 1,380 0 1,380 0 1 380 001206 MOBILE HOME th RV PARK FEES 2,110 0 2.110 0 2,110 FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL, 680.239 0 680,239 0 080,239 5.OTHER CASH CONTRIBUTIONS.-STATE: 0 0 0 0 0 090001 DRAW DOWN FROM PUBLIC HEALTH UNIT 0 0 0 0 o OTHER CASH CONTRIBUTION TOTAL 0 0 0 0 0 6.MEDICAID-STATE/COUNTY: 001057 CHD CLINIC FEES 0 94,600 94,600 0 9.4600 001148 CHD CLINIC FEES 0 906,827 906,827 0 906,827 MEDICAID TOTAL 0 1,001,427 1,001,427 0 1,001,127 7.ALLOCABLE REVENUE•STATE: 018000 CHD CLINIC FEES 6,338 0 6,338 0 6,338 ALLOCABLE REVENUE TOTAL 6,338 0 0,338 0 6,338 B.OTHER STATS CONTRIBUTIONS NOT IN CND TRUST FUND•STATE ADAP 0 0 0 1.168,490 1,468,490 PHARMACY DRUG PROGRAM 0 0 0 37 563 37,663 WIC PROGRAM 0 0 0 5,893,900 5 893,930 BUREAU OF PUBLIC HEALTH LABORATORIES 0 0 0 61,661 61,661 IMMUNIZATIONS 0 0 0 417,783 417,783 OTHER STATE CONTRIBUTIONS TOTAL 0 0 0 7,869,397 7,869,397 9.DIRECT LOCAL CONTRIBUTIONS•13CCJTAX DISTRICT 008005 CHD LOCAL REVENUE&EXPENDFrURES 0 1,419,500 1,119,500 0 1,419,500 DIRECT COUNTY CONTRIBUTIONS TOTAL 0 1,419,600 1419,500 0 1.419,500 10.FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION-COUNTY 001077 CHD CLINIC FEES 0 275 100 275,100 0 275,100 001077 GENERAL CLINIC RABIES SERVICES&DRUG PURCHASES 0 7.000 7,000 (I 7,000 001094 CH I/LOCAL ENVIRONMENTAL FEES 0 872,585 672.685 0 072,685 001110 VITAL STATISTICS CERTIFIED RECORDS 0 335,000 338.000 0 335,000 FEES AUTHORIZED BY COUNTY TOTAL 0 1,289,685 1,280 685 0 1 289,685 Aftathmentoart ji.Pogo 2(143 1 1607 ATTACHMENT II COWER COUNTY HEALTH DEPARTMENT Part 11,Sources of Contributions to County Health Departmont October 1,2018 to September 30,2017 State CND County Total CHI3 Trust Fund CHD Trust Fund Other (cash) Trtiat Fund (eaah) Contribution Total 11.OTHER CASH AND LOCAL CONTRIBUTIONS•COUNTY 001020 CHD CLINIC EEES 0 63030 03,030 0 63,030 001029 GENERAL CLINIC RABIES SERVICES&DRUG PURCHASES 0 3000 3,000 0 3.000 001090 CHD CLINIC FEL*3 0 98,280 38,280 0 98,280 010303 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 0 600 600 0 600 010600 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 0 3000 3,000 0 3,000 011000 RYAN WHITE 0 21,000 21,000 0 21,000 011000 CHD CLINIC FEES 0 10,000 10,000 0 10 000 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 0 249,220 249,220 0 249,220 011001 CHD HEALTHY START COALITION CONTRACT 0 529,458 520,458 0 529,458 012020 CHD LOCAL ENVIRONMENTAL FEES 0 20,000 20,000 0 26O00 090002 DRAW DOWN FROM PUBLIC HEALTH UNIT 0 541,343 541,343 0 511,343 OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 0 1,607,931 1,607,931 0 1,607,931 12,ALLOCABLE REVENUE'COUNTY 012000 CUD CLINIC FEES 0 6,338 6,338 0 6,338 COUNTY ALLOCABLE REVENUE TOTAL 0 0,338 6,338 0 6,338 13.BUILDINGS-COUNTY ANNUAL RENTAL EQUIVALENT VALUE 0 0 0 626,048 525,048 IT ALLOCATION&GOLDEN GATE RENTAL 0 0 0 85,200 86,200 UTILITIES 0 0 0 188,200 188,200 BUILDING MAINTENANCE 0 0 n 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 0 993,697 993,597 14.OTHER COUNTY CONTRIBUTIONS NOT IN CII)TRUST FUND•COUNTY EQUIPMENT/VEHICLE PURCHASES 0 0 0 63,600 63,000 VEHICLE INSURANCE 0 0 0 15,600 15,500 VEHICLE MAINTENANCE 0 0 0 0 0 OTHER COUNTY CONTRIBUTION(SPECIFY) 0 0 0 0 0 OTHER COUNTY CONTRIBUTION(SPECIFY) 0 0 0 0 D OTHER COUNTY CONTRIBUTIONS TOTAL 0 0 0 76,100 79,109 GRAND TOTAL CHB PROGRAM 6 946,065 6,321,881 12,270,940 8,942,091 21,213,040 Attachmorit_il_Pasi /1,,,Page)of 3 1 6 0 7 ATTACHMENT.II COLLIER COUNTY HEALTH DEPARTMENT Part III,Planned Steller,CHanta,Services and Expenditures By Program Service Area Within Each Level of Service" October 1,2016 to September 60,2017 Quarterly Expenditure Plan FTE's Clients Services) let2nd 3rd 4th Grand (0.00) Unita Visits` (Whole dollars oely) State County Total A. COMMUNICABLE DISEASE CONTROL IMMUNIZATION(101) 11.75 11,600 11573 171.798 200,381 171.798 200382 21.4,765 600,594 741 359 SEXUALLY TRANS.018. (102) 5.9 1,161 1,829 72,586 84.779 72,080 84,780 31,006 280,025 314 931 111V6A11)S111EVEN11t1N(03A1) 6.01 1:641 1,951 79660 02.414 79,600 92,913 337,147 8,000 345,117 HIV4AIDSSURVEIILANCE (03A2) 218 0 7 10,138 19,172 16,438 19,172 71,220 0 71220 III VMIDSPATIENT CARE(03A3) 6.40 102 2,856 118.155 137,81 118,165 137,811 168,333 13.005 511,938 ADAP(01A4) 2.I6 15 252 30,648 35,631 30,548 35,032 132,350 0 132,3.59 TUBERCULOSIS (101) 0.82 722 3,557 113,088 132,952 113,988 1322,952 3113,610 100,370 19.3,880 COMM.HIS SUNNI. (106) 7.27 9 5,700 120,608 1)358 120,508 110,550 251,032 271,101 522,133 HEPATITIS (104) 1,00 1.515 1,813 24,298 28,204 24,108 95,221 101,84 0 101.814 PREPAREDNESS AND RESPONSE (1 I61 4.25 0 68 78,069 91,058 78,000 41,058 201,254 37,000 338,254 REFUGEE HEALTH(118) 8.94 2.219 6,440 213.450 338,963 213.450 218,463 924,820 0 924.826 VITAL RECORDS(180) 3.36 19,871 60,710 11,727 48.670 •11;727 48,671 0 180,795 180,795 COMMUNICABLE DISEASE SUBTOTAL 6-1,89 29,182 86.817 1 081,2225 1,361,110 1,081,225 1,251,190 3,233.`76 1,451,300 1,684,68(1 B. PRIMARY CARE: CHRONIC DISEASE PREVENTION PRO(210) 1.13 41 395 23,188 37,017 23,188 27,017 60,370 34.100 100,170 WIC (2111) 98.77 12,877 97,893 300,801 420,035 360,801 420,836 1.56.1.652 0 1,593,052 TOBACCO USE INTERVENTION (212) 3.51 0 366 45,190 60,108 48,190 50,207 183,885 24,910 208,795 WIC BREASTFEEDING PEER COUNSELING (2)W2) 2.38 0 2,907 17,993 20,087 17.903 20987 77,900 0 77960 FAMILY PLANNING (253) 130 6,744 8,002 80,2.39 100,688 86,239 100,688 323,054 60,000 373,654 IMPROVED PREGNANCY OUTCOME(225) 0.23 230 234 76,912 89.708 76,912 89,700 0 33.9,241 333.241 22EALT)4Y START PRENATAL.(227) 10.93 1,022 5,703 105,730 193,304 165,730 193.203 188.606 529,458 718,067 COMPREHENSIVE CHILI)HEALTH (229) 2.09 283 483 33,203 38,751 33,222 38,752 0 143,949 143,9ID HEALTIII'START CHILD(2.231) 4.81 921 5,178 13,417 83,032 73.417 85632 192,689 125,400 318,0118 SCHOOL HEALTH 1231) 8.49 0 478373 103.137 120,297 10,7,)37 120:'296 361,072 85,795 440,807 COMPREHENSIVE ADULT HEALTH (237) 0.20 2,041 3,701 191.110 183.,02.1 131,113 152,023 121.238 440,820 568,067 COMMUNITY HEALTH DEVELOPMENT(238) 2<86 0 343 44.99( 52.480 (4,991 52.481 0 (94,949 143,549 DENTAL HEALTH (210) 15.30 1,001 9,070 W1,459 301900 201,459 301 960 5,806 1,127,022 1,132,838 PRIMARY CARE SUBTOTAL 91,•12 28,795 611298 1,420183 2,063,821 1,420,483 1,663,820 3 090,935 3,089,672 0180.007 C. ENVIRONMENTAL I(EALTH: ((( Water mod Docile Sewage Programa COSTAL BEACH MONITORING(347) 020 607 508 0,082 7,004 6,082 1,093 10478 9.873 20.351 LIMITED USE PUBLIC WATER SYSTEMS (351) 0.71 238 2.169 12,156 14,178 12,156 11,179 31 737 20.932 52,009 PUBLIC IVATER SYSTEM(358) 0.00 0 0 3 1 3 4 0 1 14 PRIVATE WATERSYSTEM (350) 0.06 2 88 1.390 1,6211 1,296 1,020 0 6,050 6,050 ONSITE SE(VAOE TREATMENT&DISPOSAL(301) 6.25 1,641 4,024 98,001 11.1 306 08,001 114,305 148.915 275,608 424,013 Croup Total 731 2,378 0780 117,638 137:'211 117.698 137,210 197 130 312,567 509,697 Facility Programa TA'I'Pex)FACILITY SERVICES(3401 0 a 0 100 4,221) 4 303 )1=10 4,9).13 21,103 (11)31 18,124 Attou,m+t„8 3>ati w.Pogo 142 16137 ATTACHMENT II Ct7LLiE8 COUN'T'Y HEALTH DEPARTMENT Part III,Planned StalEna.Clients,Services and Expenditures By Program Service Area Within Each Level of Service October 1,2016 to September 30,2017 Quarterly Expenditure Plan in's Clients Services/ let 2nd 3rd 4th Grand. (0,00) Units Visits (Whole doltsra only) State Counts Total FOOD I4YGIENE 1348) 1.80 277 831 27,341 31.890 27,341 31,889 45.104 73,207 118,161 BODY PIERCING FACILITIES SERVICES(3491 1101 2 2 174 203 174 2.03 270 484 764 GROUP CARE FACILITY(151) 0.54 1.77 173 8,420 9.828 8,426 9,829 0 36,509 39.50.) MICRANTLABOR CAh1P(362) 2.17 110 773 31,690 36,262 31,690 36,961 88,708 18,545 I37,303 HOUSING R.PUB.BLDG, (353) 0,00 0 0 2 2 2 I 0 7 7 MOBILE1IOMEAND PARK (354) 9,36 77 '+30 0,120 3,133 6,120 7,137 19.403 7,052 26,515 POOLS/BATHING PLACES (3601 4.53 2.051 10,771 81,170 94.685 81,179 04,984 14(1917 234,810 351,727 I)IORIEBICALWASTE SERVICES(331) 1,19 502 732 19,813 '1.3,109 19,813 23,108 59,208 20,545 85,843 TANNING FACILITY SERVICES(360) 0.08 19 20 1.141 1,338 1,147 1,337 3,385 1,584 4,909 Group Total 10.05 3,270 19,038 130.121 210,088 180,121 210,082 374,688 405,724 780,412 Groundwater Contamination STORAGE TANK CON1PUANCE SERVICES(355) 0.00 0 0 0 0 0 0 0 0 0 SOPER ACT SERVICES(350) 0.01 4 20 253 390 2253 46 1,093 0 I.098 Group Total 4.01 4 00 263 206 253 746 1.098 9 1,098 Community Hygiene COMMUNITY ENV/R.((SALT)! (345) 0.00 0 0 0 0 0 0 0 0 0 INJURY PREVENTION(340) 0.94 0 0 14,668 17,108 14,608 17,108 0 83.552 6.3,552 LEAD MONITORING SERVICES(35() 0,00 0 0 20 24 20 24 0 88 88 PUBLIC SEWAGE 1302) 0.00 0 0 0 0 0 0 0 0 0 SOLID WASTE DISPOSAI.SERVICE 1363) 0,02 0 0 242 282 242 282 0 1,048 1,048 SANITARY NUISANCE(365) 0.00 0 0 84 08 84 99 0 365 365 RABIES SURVEILLANCE(3061 0.00 0 0 9 0 0 0 0 0 0 ARBORVIRUS SURVEIL (367) 0.00 0 0 0 0 0 0 0 0 0 RODENT/ARTHROPOD CONTROL 13081 0.00 0 0 0 0 0 0 0 0 4 , WATER I'OU,UTION(370) 0.00 0 0 31 36 31 37 0 135 135 iNDOORAIR(371) 0.00 0 0 0 0 0 0 0 0 0 RADIOLOGICAL HEALTH (3721 0.01 0 0 78 92 78 32 0 :110 340 TOXIC SUBSTANCES(373) 000 0 0 0 0 0 0 0 0 0 Group Total 0.97 0 1) 15,133 17,640 16,123 17612 0 05,528 05,628 ENVIRONMENTAL HEALTH SUBTOTAL 19 24 0,967 26.447 31.1,135 305,235 313,135 365,230 572,919 783.810 1.306,735 D. NONOPERATIONAL COSTS: NONOPERATIONAL COSTS(899) 0.00 0 0 0 0 0 0 0 0 0 ENVIRONMENTAL HEALTIISURCHARGE(3119) 000 0 0 11,40 13,169 11,290 13,109 48,918 0 48,018 MEDICAID BUYBACK(011) 0.09 0 0 0 0 0 0 0 0 0 NONOPERATIONAL COSTS SUBTOTAL 0.00 0 0 11, 0 13,109 11,290 13.169 18,018 0 48,018 TOTAL CONTRACT 115.05 93.504 727,822 2,83,,too 3,303.341 5,832,133 3,303,339 0,016,00.5 5,12.1,881 (2,270,016 Anaoo nt_u_Part(a.Page 2 at 2 160 7 ATTACHMENT HI 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,OH 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. Ali 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 partidpants 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. iutedm*mju-easmtori 16C V CI9 a. C! so E N W •Ii. O a i ti! N h D 1C1 6 U p m so n 0 co © © 'In c c 'O I co N 07 N 3 3 A I . • 1 i � � i y ca, . m c c w a 0 2 0 c c m ., _ m y o d u. E a, � 0 0 0 o c ^ O ,„ h la Um ' v d � E c oac c > y . 0 r vi E U � E ►mU � 0 ,-. S a0U V Z U su V (.) tt $ ZLI Ceye vs p - C § U ) U O . E oi r CU m.41 ,z..,r E CO CO w yr © ``fo C. ag d b d O O 4 sE a - cn > h $ 0 U A 0 * hy r- 3 c c .a.' XC © rem w 7 © O a 0U0Ns U U CI U ` � o c I ,e .0 .0 C) o _EIi3 g i g 'v m 0 4 ppy 5i c �. = U C �, so so N r N- > 73 V to ® K� Ci ° G C7 O r d e 3 y, c rs R ani E so so = ?I o► o a a ci c Q U a '1 Q c o © oos c so t U. •41 N § H N 44 CW W v s � LL G RI CD w0 Z ta Z-4 d td y 44 0 m a 01 it n �+ _ �'r L C aj m y o o u 0 air .2 Lh U and , (Y x y E 0.to O c' vc1 OSi "--- .. a z p !� E o U 8 3 A c' U N . � c. 0 cm pp CD � � N c 4 Q c a M ti '4 N E y �/ V A'. CV 16 m 40 to N J ?o •= co 00 ,- 'a - EY N a .8 C .�. A 'C1 O 9 u- C 0 VU Q t N C yy {j, • d CU. [D L. 0 U. z fa }' m Z dam in n, 45 t LLl d'. m �� m N CDQ y p i U Ot z 0Z � C41 2 tn Cf as 1607 ATTACHMENT V COLLIER COUNT(HEALTH DEPARTMENT SPECIAL PROJECTS SAVINGS PLAN CASH RESERVED OR ANTICIPATED TO RE RESERVED FOR PROJECTS CONTRACT YEAR STATE COUNTY TOTAL 2015-2016* 0 S 0 $ 0 2010-2017** S 0 S 0 S 0 2017-2018"* 0 S 0 S 0 2018-2019— 0 $ 0 $ 0 PROJECT TOTAL 5 0 5 0 $ SPECIAL PROJECTS CONSTRUCTIONMENOVATION PLAN PROJECT NUMBER: PROJECT NAME. LOCATION/ADDRESS. PROJECT TYPE: NEW BUILDING ROOFING RENOVATION PLANNING STUDY NEW AMMON OTHER SQUARE FOOTAGE: PROJECT SUMMARY: Describe scope of work In reasonable detail START DATE (initial expend cot!undo COMPLETION DATE: DESIGN FEES: 0 CONSTRUCTION COSTS: 0 FURNITUREJEOUIPMENT: 0 TOTAL PROJECT COST: S 0 COST PER SQ FOOT: S 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 mono **Cash to be transferred to FCC/account. **••Cash anticipated for future contract years, Attacluniont,V Page 1 0110 1 6 0 7 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 2016-2017® This Addendum is made this L. day of Q c erfi!/L , 2016, and is added to and amends the 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 2016-2017 ("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 IL Part II, in an amount not to exceed $249,220famount 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: Celeste Phillip, MD,MPH TITLE: Surgeon General/Secretary of Health DATE: 1 o f 2 1607 SIGNED BY: NAME: Stephanie Vick, M.S., B.S.N., R.N. TITLE: CHD Administrator DATE: AS TO THE COUNTY: Attest: BOARD OF COUNTY COMMISSIONERS FOR DWIGHT E. BROCK, Clerk COLLIER COUNTY By: P ��', Q C • By: ` ',ton.3"e rav, :fte clerk Donn Fiala, Chairman to`ZS 1�� , t as to r; an signature only. Approved as to form and legality: Jennifer A. Belpedio 2� Assistant County Attorney � 0\\* 2 of 2 0