Backup Documents 09/26/2017 Item #16E 9 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLI
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO .11. 6E9
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney
Office at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney
Office no later than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with
the exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
_Route to Addressee(s) (List in routing order) Office Initials Date
1. County Attorney Office County Attorney Office w
Az)11,
2. BCC Office Board of County
Commissioners l / cAZ-71,\--A
3. Minutes and Records Clerk of Court's Office
4. Procurement Services Procurement Services
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event
one of the addressees above,may need to contact staff for additional or mi sing information.
Name of Primary Staff Barbara Lance for Sandra He era Contact Information 239-252-8998
Contact/ Department
Agenda Date Item was 97''Y2/17 q,a,(1, 1— Agenda Item Number 16.E,M.
Approved by the BCC
Type of Document Amendment Number of Original Y�
Attached Documents Atta hed
PO number or account N/A 12-5874 EMS idling InterMedix
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature STAMP OK tel-
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 BL
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's 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 BL
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip N/A
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 09 2017 and all changes made during
the meeting have been incorporated in the attac current. 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.
16E9
MEMORANDUM
Date: September 28, 2017
To: Barbara Lance, Purchasing Tech
Procurement Services
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Second Amendment to Agreement #12-5874 with
Advanced Data Processing
Attached, please find an original copy of the contract referenced above, (Item #16E9)
approved by the Board of County Commissioners on Tuesday, September 26, 2017.
The second original contract will be held in the Minutes and Records Department for
the Official Record.
If you have any questions, please contact me at 252-8406.
Thank you.
Attachment
16E9
SECOND AMENDMENT TO AGREEMENT#12-5874
BETWEEN COLLIER COUNTY
AND
ADVANCED DATA PROCESSING,INC,D/B/A INTERMEDIX
FOR
EMS BILLING
THIS AGREEMENT, made and entered into on this(21.04\ day of &. rnbr 2017, by and
between Advanced Data Processing, Inc, d/b/a Intermedix, a corporation, authorized to do business
in the State of Florida, whose business address is 6451 North Federal Highway, Suite 1000. Fort
Lauderdale, Florida 33308 (the "Contractor")and Collier County,a political subdivision of the State of
Florida, (the "County"):
WHEREAS, on November 13, 2012, Item 16.E.6, the County entered an Agreement with
Contractor to provide billing services for Collier County Emergency Medical Services;
WHEREAS, on November 15, 2016, Item 16.E.6, the County approved an Amendment to
the Agreement to include consulting services to County to enroll in the Florida EMS PEMT (Public
Emergency Medical Transports)Medicaid program,and to provide ongoing consulting/costing services
for both the Florida CPE(Certified Public Expenditures)PEMT which includes Medicaid managed care
transports revenue programs.
WHEREAS,the parties desire to amend the Amendment No. 2 to correct a Scrivener's error
to now say Amendment No. 1 as no prior amendment was executed prior to this second amendment;
WHEREAS,the parties desire to further amend the Agreement to add one additional one year
period extension to allow the Contractor time to invoice for accounts filed through September 30, 2017
along with any payment due for processing Certified Public Expenditure data through Public Consulting
Group;
NOW, THEREFORE, in consideration of the mutual promises and covenants herein
contained, it is agreed by the parties as follows:
Words Struck T rough are deleted; Words Underlined are added
Page 1 of 3
16E9
* * * * .
1. COMMENCEMENT.The contract shall be for a two(2)year period,commencing on Board
approval date, and terminating two years from that date.
The County may, at its discretion and with the consent of the Contractor, renew the
Agreement under all the terms and conditions contained in this Agreement for three (3)
additional one (1) year periods. The County shall give the Contractor written notice of the
County's intention to extend the Agreement term not less than ten(10)days prior to the end
of the Agreement term then in effect.
The Parties agree to renew the Agreement for a period of one-year from November 13, 2017
through November 13,2018, for the limited purpose of processing accounts received prior to
October 1, 2017.
2. STATEMENT OF WORK. The Contractor shall provide billing services in accordance
with the terms and conditions of RFP #12-5874 and the Contractor's proposal referred to
herein and made an integral part of this agreement. This Agreement contains the entire
understanding between the parties and any modifications to this Agreement shall be mutually
agreed upon in writing by the Contractor and the County Project or Contract Manager or his
designee, in compliance with the County Purchasing Policy and Administrative Procedures
in effect at the time such services are authorized.
The Contractor shall not accept from the County any additional accounts for processing after
October 1, 2017.
* * * * *
SIGNATURE PAGE TO FOLLOW
**Remainder of this page left blank intentionally**
Page 2 of 3
16E9
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.
ATTEST:
Dwight E. Brock, Clerk of Courts BOARD OF COUNTY COMMISSIONERS
F COLLI.; 1 Y, FLORIDA
By:
a 1 o-( • By: // '. , A
4 envy ay� .-rman/
Dated: '`,JW s
(SEAT;) Ate,S o Chairman's,
signature only.
;_G((41 Vel� Advanced Data Processing, Inc, d/b/a
Fi t fitness Intermedin
Linda Smith Contractor
TType/print witness namet
By: NC/
Signature
JMelissa Leigh, SVP and General Counsel
,4d_____
Se d Witness TType/print signature and titleT
Adam Holman
TType/print witness nameT
A ro ed to F d e ality:
Depu County Attorney
4 1 (1 L 4-_
Print Name
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item* Hae-
Agendll
Date
Date /1:16:\
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Page 3 of 3
Detail by Entity Name Page 1 of 3
16E9
Florida Department of State DIVISION OF CORPORATIONS
,f4:414.org
Department of State / Division of Corporations / Search Records / Detail By Document Number/
Detail by Entity Name
Foreign Profit Corporation
ADVANCED DATA PROCESSING, INC.
Filing Information
Document Number F02000005151
FEI/EIN Number 22-3875190
Date Filed 10/11/2002
State DE
Status ACTIVE
Principal Address
6451 N. FEDERAL HIGHWAY
SUITE 1000
FORT LAUDERDALE, FL 33308
Changed: 01/14/2011
Mailing Address
6451 N. FEDERAL HIGHWAY
SUITE 1000
FORT LAUDERDALE, FL 33308
Changed: 01/14/2011
Registered Agent Name&Address
REGISTERED AGENT SOLUTIONS, INC.
155 OFFICE PLAZA DR
STE.A
TALLAHASSEE, FL 32301
Name Changed: 09/26/2011
Address Changed: 09/26/2011
Officer/Director Detail
Name&Address
Title Director
SHAMON, DOUG
6451 N. FEDERAL HIGHWAY, SUITE 1000
FORT LAUDERDALE, FL 33308
http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 8/18/2017
Detail by Entity Name Page 2 of 3
16E9
Title President, Director
COOKE, KEN
6451 N. FEDERAL HIGHWAY
SUITE 1000
FORT LAUDERDALE, FL 33308
Title VP
WILLIAMS, BRAD
6451 N. FEDERAL HIGHWAY, SUITE 1000
FORT LAUDERDALE, FL 33308
Title D
ABBRECHT,TODD
100 FEDERAL STREET 35TH FLOOR
BOSTON, MA 02110
Title D
nelson,Josh
100 FEDERAL STREET 35TH FLOOR
BOSTON, MA 02110
Title D
PRENIER, MEGAN
100 FEDERAL STREET 35TH FLOOR
BOSTON, MA 02110
Title D
BOROM, MICHAEL
100 FEDERAL STREET 35TH FLOOR
BOSTON, MA 02110
Title CEO
portice,Joel
6451 N. FEDERAL HIGHWAY
SUITE 1000
FORT LAUDERDALE, FL 33308
Title Secretary
Leigh, Melissa
6451 N. FEDERAL HIGHWAY
SUITE 1000
FORT LAUDERDALE, FL 33308
Annual Reports
http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 8/1 8/20 1 7
Detail by Entity Name Page 3 of 3
Report Year Filed Date 16E9
2015 05/01/2015
2016 04/14/2016
2017 05/18/2017
Document Images
05/18/2017--ANNUAL REPORT View image in PDF format
04/14/2016--ANNUAL REPORT View image in PDF format
05/01/2015--ANNUAL REPORT View image in PDF format
04/27/2014—ANNUAL REPORT View image in PDF format
04/18/2013--ANNUAL REPORT View image in PDF format
03/27/2012--ANNUAL REPORT View image in PDF format
09/26/2011--Req.Agent Change View image in PDF format
01/14/2011--ANNUAL REPORT View image in PDF format
01/28/2010—ANNUAL REPORT View image in PDF format
01/21/2009--ANNUAL REPORT View image in PDF format
04/28/2008--ANNUAL REPORT View image in PDF format
04/23/2007--ANNUAL REPORT View image in PDF format
03/03/2006--ANNUAL REPORT View image in PDF format
04/18/2005—ANNUAL REPORT View image in PDF format
03/19/2004--ANNUAL REPORT View image in PDF format
04/04/2003--ANNUAL REPORT View image in PDF format
10/11/2002--Foreign Profit View image in PDF format
Florida Department of State,Division of Corporations
http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 8/1 8/20 1 7