Backup Documents 11/14/2017 Item #16D 1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
'I1R 0 1
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNA
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. Todd Henry Public Services Department TH 10/26/17
2. Jennifer A. Belpedio County Attorney Office VL.(3 10/2610
i
3. BCC Office Board of County
Commissioners 7j \\\VAVn
4. Minutes and Records Clerk of Court's Office
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees
above,may need to contact staff for additional or missing information.
Name of Primary Staff Phone Number
Contact/ Department Alan Portis,DOH Finance&Accounting 252-8206
�� �� �A�
252-8206 Please call for pick up
Agenda Date Item was 11/14/2017 'Y'l�c� J Agenda Item Number
Approved by the BCC IA 16- 16D k L
Type of Document FY17-18 Collier County Health Department Number of Original
Attached Annual Core Contract Documents Attached
(Between Collier County and DOH) 3
PO number or account
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 signa a?STAMPS IGNATURE IS ok —ft �.Act)
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 AP
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 AP
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 AP
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 11/14/17 and all changes made AP N/A is not
during the meeting have been incorporated in the attached document. The County an option for
Attorney's Office has reviewed the changes,if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the /\ N/A is not
BCC,all changes directed by the BCC have been made,and the document is ready for th an option for
Chairman's signature. this line.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
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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 2017-2018
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, 2017.
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 ofcoordinated 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 foregoing 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,
2017, through September 30, 2018, 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.
Environmental health services shall be supported by available federal, state and local funds
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and shall include those services mandated on a state or federal level. Examples of
environmental health services include, but are not limited to, food hygiene, safe drinking water
supply, sewage and solid waste disposal, swimming pools, group care facilities, migrant labor
camps, toxic material control, radiological health, and occupational health.
b. "Communicable disease control services" are those services which protect the health of
the general public through the detection, control, and eradication of diseases which are
transmitted primarily by human beings. Communicable disease services shall be supported by
available federal, state, and local funds and shall include those services mandated on a state
or federal level. Such services include, but are not limited to, epidemiology, sexually
transmissible disease detection and control, HIV/AIDS, immunization, tuberculosis control and
maintenance of vital statistics.
c. "Primary care services" are acute care and preventive services that are made available
to well and sick persons who are unable to obtain such services due to lack of income or other
barriers beyond their control. These services are provided to benefit individuals, improve the
collective health of the public, and prevent and control the spread of disease. Primary health
care services are provided at home, in group settings, or in clinics. These services shall be
supported by available federal, state, and local funds and shall include services mandated on
a state or federal level. Examples of primary health care services include, but are not limited
to: first contact acute care services; chronic disease detection and treatment; maternal and
child health services; family planning; nutrition; school health; supplemental food assistance
for women, infants, and children; home health; and dental services.
4. FUNDING. The parties further agree that funding for the CHD will be handled as follows:
a. The funding to be provided by the parties and any other sources is set forth in Part II of
Attachment II hereof. This funding will be used as shown in Part I of Attachment II.
i. The State's appropriated responsibility (direct contribution excluding any state fees,
Medicaid contributions or any other funds not listed on the Schedule C) as provided in
Attachment II, Part II is an amount not to exceed $ 6,617,807 (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 $ 1,455,000 (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 Department
Trust Fund that is attributed to the CHD shall be carried forward to the next contract period.
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c. Either party may establish service fees as allowed by law to fund activities of the CHD.
Where applicable, such fees shall be automatically adjusted to at least the Medicaid fee
schedule.
d. Either party may increase or decrease funding of this contract during the term hereof by
notifying the other party in writing of the amount and purpose for the change in funding. If the
State initiates the increase/decrease, the CHD will revise the Attachment II and send a copy of
the revised pages to the County and the Department of Health, Office of Budget and Revenue
Management. If the County initiates the increase/decrease, the County shall notify the CHD.
The CHD will then revise the Attachment II and send a copy of the revised pages to the
Department of Health, Office of Budget and Revenue Management.
e. The name and address of the official payee to whom payments shall be made is:
County Health Department Trust Fund
Collier County
3339 E. Tamiami Trail, Suite 145
Naples, FL 34112
5. CHD DIRECTOR/ADMINISTRATOR. Both parties agree the director/administrator of
the CHD shall be a State employee or under contract with the State and will be under the day-
to-day direction of the Deputy Secretary for County Health Systems. The director/administrator
shall be selected by the State with the concurrence of the County. The director/administrator
of the CHD shall ensure that non-categorical sources of funding are used to fulfill public health
priorities in the community and the Long Range Program Plan.
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 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
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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 paragraphs 6.i. and 6.k., below. Books,
records and documents must be adequate to allow the CHD to comply with the following
reporting requirements:
i. The revenue and expenditure requirements in the Florida Accounting
Information Resource (FLAIR) System;
ii. The client registration and services reporting requirements of the minimum
data set as specified in the most current version of the Client Information
System/Health Management Component Pamphlet;
iii. Financial procedures specified in the Department of Health's Accounting
Procedures Manuals, Accounting memoranda, and Comptroller's
memoranda;
iv. The CHD is responsible for assuring that all contracts with service providers
include provisions that all subcontracted services be reported to the CHD in
a manner consistent with the client registration and service reporting
requirements of the minimum data set as specified in the Client Information
System/Health Management Component Pamphlet.
d. All funds for the CHD shall be deposited in the County Health Department Trust Fund
maintained by the state treasurer. These funds shall be accounted for separately from funds
deposited for other CHDs and shall be used only for public health purposes in Collier County.
e. That any surplus/deficit funds, including fees or accrued interest, remaining in the
County Health Department Trust Fund account at the end of the contract year shall be
credited/debited to the State or County, as appropriate, based on the funds contributed by each
and the expenditures incurred by each. Expenditures will be charged to the program accounts
by State and County based on the ratio of planned expenditures in this contract and funding
from all sources is credited to the program accounts by State and County. The equity share of
any surplus/deficit funds accruing to the State and County is determined each month and at
contract year-end. Surplus funds may be applied toward the funding requirements of each
participating governmental entity in the following year. However, in each such case, all surplus
funds, including fees and accrued interest, shall remain in the trust fund until accounted for in
a manner which clearly illustrates the amount which has been credited to each participating
governmental entity. The planned use of surplus funds shall be 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.
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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.
m. The CHD shall establish a system through which applicants for services and current
clients may present grievances over denial, modification or termination of services. The CHD
will advise applicants of the right to appeal a denial or exclusion from services, of failure to take
account of a client's choice of service, and of his/her right to a fair hearing to the final governing
authority of the agency. Specific references to existing laws, rules or program manuals are
included in Attachment I of this contract.
n. The CHD shall comply with the provisions contained in the Civil Rights Certificate,
hereby incorporated into this contract as Attachment III.
o. The CHD shall submit quarterly reports to the County that shall include at least the
following:
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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, 2018 for the report period October 1, 2017 through
December 31, 2017;
ii. June 1, 2018 for the report period October 1, 2017 through
March 31, 2018;
iii. September 1, 2018 for the report period October 1, 2017
through June 30, 2018; and
iv. December 1, 2018 for the report period October 1, 2017
through September 30, 2018.
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.
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.
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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, 2018, 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 Public Service Division Administrator
Health in Collier County
Title Title
3339 E. Tamiami Trail, Suite 145 3339 E. Tamiami Trail, Suite 217
Naples, Florida 34112 Naples, Florida 34112
Address Address
(239) 252-5332 (239) 252-8468
Telephone Telephone
If different contract managers are designated after execution of this contract, the name,
address and telephone number of the new representative shall be furnished in writing to the
other parties and attached to originals of this contract.
c. Captions. The captions and headings contained in this contract are for the convenience
of the parties only and do not in any way modify, amplify, or give additional notice of the
provisions hereof.
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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, 2017.
BOARD OF COUNTY COMMISSIONERS STATE OF FLORIDA
FOR COLLIER COUN Y DEPARTMENT OF HEALTH
SIGNED BY: '. IGNED BY:
NAME: 'F n?LJ V 'TA-1 L.0(Z_ NAME: Celeste Philip, MD, MPH
TITLE: C-4-1A ) 12.vti- .t n) TITLE: Surgeon General and Secretary
DATE: / t1 a! DATE:
ATTESTED TO: ,,,.
SIGNED BY O'1-' CC(,( , I SIGNED BY: Ivi, .
AA& er 4 ;
NAME: t .e. 4 NAME: Stephanie Vick, M.S., B.S.N., R.N.
TITLE: u„ ( kr/L.- TITLE: CHD Director/Administrator
DATE: 1 -- 'V b`i DATE: 41/7
Attest as to Chairman's
signature only.
Approved as to form and legality
Assistunt County iCttu.TITy cx--‘1
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ATTACHMENT I
COLLIER COUNTY HEALTH DEPARTMENT
PROGRAM SPECIFIC REPORTING REQUIREMENTS AND PROGRAMS REQUIRING
COMPLIANCE WITH THE PROVISIONS OF SPECIFIC MANUALS
Some health services must comply with specific program and reporting requirements in addition to the Personal Health
Coding Pamphlet(DHP 50-20), Environmental Health Coding Pamphlet(DHP 50-21)and FLAIR requirements because of
federal or state law, regulation or rule. If a county health department is funded to provide one of these services, it must
comply with the special reporting requirements for that service. The services and the reporting requirements are listed
below:
Service Requirement
1. Sexually Transmitted Disease Requirements as specified in F.A.C. 64D-3, F.S. 381 and F.S. 384.
Program
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 in
Program for Women, Infants and DHM 150-24"and all federal, state and county requirements
Children(including the WIC detailed in program manuals and published procedures.
Breastfeeding Peer Counseling
Program)
4. Healthy Start/Improved Pregnancy Requirements as specified in the 2007 Healthy Start Standards and
Outcome Guidelines and as specified by the Healthy Start Coalitions in
contract with each county health department.
5. Family Planning Requirements as specified in Public Law 91-572, 42 U.S.C. 300, et
seq.,42 CFR part 59, subpart A, 45 CFR parts 74&92, 2 CFR 215
(OMB Circular A-110) OMB Circular A-102, F.S. 381.0051, F.A.C.
64F-7, F.A.C. 64F-16, and F.A.C. 64F-19. Requirements and
Guidance as specified in the Program Requirements for Title X
Funded Family Planning Projects(Title X Requirements)(2014)and
the Providing Quality Family Planning Services(QFP):
Recommendations of CDC and the U.S. Office of Population Affairs
published on the Office of Population Affairs website.
Programmatic annual reports as specified by the program office as
specified in the annual programmatic Scope of Work for Family
Planning and Maternal Child Health Services, including the Family
Planning Annual Report(FPAR), and other minimum guidelines as
specified by the Policy Web Technical Assistance Guidelines.
6. Immunization Periodic reports as specified by the department pertaining to
immunization levels in kindergarten and/or seventh grade pursuant
to instructions contained in the Immunization Guidelines-Florida
Schools, Childcare Facilities and Family Daycare Homes(DH Form
150-615)and Rule 64D-3.046, F.A.C. In addition, periodic reports
as specified by the department pertaining to the
surveillance/investigation of reportable vaccine-preventable
diseases, adverse events, vaccine accountability, and assessment
of immunization
ATTACHMENT I(Continued)
1 6 01
levels as documented in Florida SHOTS and supported by CHD
Guidebook policies and technical assistance guidance.
7. Environmental Health Requirements as specified in Environmental Health Programs
Manual 150-4"and DHP 50-21*
8. HIV/AIDS Program Requirements as specified in F.S. 384.25 and F.A.C. 64D-3.030
and 64D-3.031. Case reporting should be on Adult HIV/AIDS
Confidential Case Report CDC Form DH2139 and Pediatric
HIV/AIDS Confidential Case Report CDC Form DH2140.
Requirements as specified in F.A.C. 64D-2 and 64D-3, F.S. 381 and
F.S. 384. Socio-demographic and risk data on persons tested for
HIV in CHD clinics should be reported on Lab Request DH Form
1628 in accordance with the Forms Instruction Guide.
Requirements for the HIV/AIDS Patient Care programs are found in
the Patient Care Contract Administrative Guidelines.
9. School Health Services Requirements as specified in the Florida School Health
Administrative Guidelines (May 2012). Requirements as specified
in F.S. 381.0056, F.S. 381.0057, F.S. 402.3026 and F.A.C. 64F-6.
10. Tuberculosis Tuberculosis Program Requirements as specified in F.A.C. 64D-3
and F.S. 392.
11. General Communicable Disease Carry out surveillance for reportable communicable and other acute
Control diseases, detect outbreaks, respond to individual cases of
reportable diseases, investigate outbreaks, and carry out
communication and quality assurance functions, as specified in
F.A.C. 64D-3, F.S. 381, F.S. 384 and the CHD Epidemiology Guide
to Surveillance and Investigations.
12. Refugee Health Program Programmatic and financial requirements as specified by the
program office.
"or the subsequent replacement if adopted during the contract period.
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ATTACHMENT II
COLLIER COUNTY HEALTH DEPARTMENT
1 1
Part II,Sources of Contributions to County Health Department
October 1,2017 to September 30,2018
State CHD County Total CHD
Trust Fund CHD Trust Fund Other
(cash) Trust Fund (cash) Contribution Total
1.GENERAL REVENUE•STATE
015040 AIDS PATIENT CARE 140,000 0 140,000 0 140,000
015040 AIDS PREVENTION&SURVEILLANCE•GENERAL REVENUE 69,571 0 69,571 0 69,571
015040 CHD•'PB COMMUNITY PROGRAM 149,661 0 149,661 0 149,661
015040 DENTAL SPECIAL INITIATIVE PROJECTS 6,200 0 6,200 0 6,200
015040 FAMILY PLANNING GENERAL REVENUE 70,681 0 70,681 0 70,681
015040 HEPATITIS AND LIVER FAILURE PREVENTION&CONTROL 89,286 0 89,286 0 89,286
015040 MIGRANT LABOR CAMP SANITATION 74,533 0 74,533 0 74,533
015040 PRIMARY CARE PROGRAM 313,432 0 313,432 0 313,432
015040 SCHOOL HEALTH SERVICES•GENERAL REVENUE 218,073 0 218,073 0 218,073
015050 CHD GENERAL REVENUE NON-CATEGORICAL 1,892,126 0 1,892,126 0 1,892,126
GENERAL REVENUE TOTAL 3,023,563 0 3,023,563 0 3,023,563
2.NON GENERAL REVENUE-STATE
015010 STATE UNDERGROUND PETROLEUM RESPONSE ACT 3,565 0 3,565 0 3,565
015010 ENVIRONMENTAL BIOMEDICAL WASTE PROGRAM 13,086 0 13,086 0 13,086
015010 TOBACCO STATE AND COMMUNITY INTERVENTIONS 183,885 0 183,885 0 183,885
015010 HURRICAN MATTHEW EXECUTIVE ORDER 16-230 5,434 0 5,434 0 5,434
NON GENERAL REVENUE TOTAL 205,970 0 205,970 0 205,970
3.FEDERAL FUNDS•STATE
007000 AIDS DRUG ASSISTANCE PROGRAM ADMIN HQ 103,096 0 103,096 0 103,096
007000 WIC BREASTFEEDING PEER COUNSELING PROG 61,296 0 61,296 0 61,296
007000 COASTAL BEACH WATER QUALITY MONITORING 16,308 0 16,308 0 16,308
007000 COMPREHENSIVE COMMUNITY CARDIO•PHBG 36,000 0 36,000 0 36,000
007000 CMS-MCH PURCHASED CLIENT SERVICES 33,000 0 33,000 0 33,000
007000 FAMILY PLANNING TITLE X•GRANT 124,4.25 0 124,425 0 12.1,425
007000 IMMUNIZATION ACTION PLAN 87,564 0 87,564 0 87,564
007000 MCH SPECIAL PRJCT UNPLANNED PREGNANCY 39,976 0 39,976 0 39,976
007000 BASE COMMUNITY PREPAREDNESS CAPABILITY 131,814 0 131,814 0 131,814
007000 BASE PUB HLTH SURVEILLANCE&EPI INVESTIGATION 67,822 0 67,822 0 67,822
007000 AIDS PREVENTION 285,448 0 285,448 0 285.4.18
007000 RYAN WHITE TITLE II GRANT/CHD CONSORTIUM 287,051 0 287,051 0 287.051
007000 IMPROVING STD PROGRAMS 5,624 0 5,624 0 5.624
007000 WIC PROGRAM ADMINISTRATION 1,384,924 0 1,384,924 0 1,384,92-1
015075 INSPECTIONS OF SUMMER FEEDING PROGRAM•DOE 1,725 0 1,725 0 1.725
015075 SUPPLEMENTAL SCHOOL HEALTH 33,690 0 33,690 0 33,690
015075 REFUGEE HEALTH SCREENING REIMBURSEMENT ADMIN 78.281 0 78,281 0 78,281
015075 REFUGEE HEALTH SCREENING REIMBURSEMENT SERVICES 652,336 0 652,336 0 652.:136
FEDERAL FUNDS TOTAL 3,-1:30,380 0 3,430.380 0 3,130.380
4.FEES ASSESSED BY STATE OR FEDERAL RULES-STATE
001020 CHD STATEWIDE ENVIRONMENTAL FEES 172,554 0 472.554 0 472.554
001092 CHD STATEWIDE ENVIRONMENTAL FEES 199,532 0 199,53.2 0 199,532
001206 ON SITE SEWAGE DISI'uSAL PERMIT FEES 16,G:;8 0 16.6.3 u 16.6:35
,,d,,..rd.: _il_:.all_li ,'al yc I ut.3
ATTACHMENT II
1 6 0 1
COLLIER COUNTY HEALTH DEPARTMENT
Part II,Sources of Contributions to County Health Department
October 1,2017 to September 30,2018
State CHD County Total CHD
Trust Fund CHD Trust Fund Other
(cash) Trust Fund (cash) Contribution Total
001206 SANITATION CERTIFICATES(FOOD INSPECTION) 4,749 0 4,749 0 4,749
001206 SEPTIC TANK RESEARCH SURCHARGE 2,705 0 2,705 0 2,705
001206 SEPTIC TANK VARIANCE FEES 50% 350 0 350 0 350
001206 PUBLIC SWIMMING POOL PERMIT FEES-10%HQ TRANSFER 33,380 0 33,380 0 33,380
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 338 0 338 0 338
001206 ONSITE SEWAGE TRAINING CENTER 1,110 0 1,110 0 1,110
001206 TATTO PROGRAM ENVIRONMENTAL HEALTH 2,094 0 2,094 0 2,094
001206 MOBILE HOME&RV PARK FEES 2,157 0 2,157 0 2,157
FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 736,942 0 736,942 0 736,942
5.OTHER CASH CONTRIBUTIONS-STATE:
0 0 0 0 0
090001 DRAW DOWN FROM PUBLIC HEALTH UNIT 0 0 0 0 0
OTHER CASH CONTRIBUTION TOTAL 0 0 0 0 0
6.MEDICAID•STATE/COUNTY:
001057 CHD CLINIC FEES 0 49,600 49,600 0 49,600
001148 CHD CLINIC FEES 0 983,000 983,000 0 983,000
MEDICAID TOTAL 0 1,032,600 1,032,600 0 1,032,600
7.ALLOCABLE REVENUE•STATE:
018000 CHD CLINIC FEES 1,000 0 1,000 0 1,000
ALLOCABLE REVENUE TOTAL 1,000 0 1,000 0 1,000
8.OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND•STATE
ADAP 0 0 0 1,456,610 1,456,610
PHARMACY DRUG PROGRAM 0 0 0 37,691 37,691
WIC PROGRAM 0 0 0 5,632,203 5,632,203
BUREAU OF PUBLIC HEALTH LABORATORIES 0 0 0 52,103 52,103
IMMUNIZATIONS 0 0 0 1,222,538 1,222,538
OTHER STATE CONTRIBUTIONS TOTAL 0 0 0 8,401,145 8,401,145
9.DIRECT LOCAL CONTRIBUTIONS•BCC/TAX DISTRICT
008005 CHD LOCAL REVENUE&EXPENDITURES 0 1,455,000 1,-155,000 0 1,455,000
DIRECT COUNTY CONTRIBUTIONS TOTAL 0 1,455,000 1,455,000 0 1,455,000
10.FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION•COUNTY
001077 CHD CLINIC FEES 0 252.150 252,150 0 252,150
001077 GENERAL CLINIC RABIES SERVICES&DRUG PURCHASES 0 8,500 8,500 0 8,500
001094 CHD LOCAL ENVIRONMENTAL FEES 0 706,650 706,650 0 706,650
001110 VITAL STATISTICS CERTIFIED RECORDS 0 390,000 390,000 0 :190,000
FEES AUTHORIZED BY COUNTY TOTAL 0 1,357,300 1,:357.300 0 1,357,300
11.OTHER CASH AND T,OCAT.CONTRIBUTIONS•COUNTY
,_li_r'ai I_I,-F ay'ayu 4 of„
ATTACHMENT II 1 1
COLLIER COUNTY HEALTH DEPARTMENT
Part II,Sources of Contributions to County Health Department
October 1,2017 to September 30,2018
State CHD County Total CHD
Trust Fund CHD Trust Fund Other
(cash) Trust Fund (cash) Contribution Total
001029 CHD CLINIC FEES 0 82,500 82,500 0 82,500
001090 CHD CLINIC FEES 0 17,750 17,750 0 17,750
010500 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 0 3,000 3,000 0 3,000
011000 RYAN WHITE 0 27,000 27,000 0 27,000
011000 CHD CASH DONATION/NON-SPECIFIC 0 12,100 12,100 0 12,100
011000 EARLY LEARNING COALITION OF SOUTHWEST FLORIDA 0 60,900 60,900 0 60,900
011000 CHD LOCAL REVENUE&EXPENDITURES 0 10,000 10,000 0 10,000
011001 CHD HEALTHY START COALITION CONTRACT 0 475,265 475,265 0 475,265
012020 CHD LOCAL ENVIRONMENTAL FEES 0 1,000 1,000 0 1,000
090002 DRAW DOWN FROM PUBLIC HEALTH UNIT 0 322,817 322,817 0 322,817
OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 0 1,012,332 1,012,332 0 1,012,332
12.ALLOCABLE REVENUE-COUNTY
018000 CHD CLINIC FEES 0 1,000 1,000 0 1,000
COUNTY ALLOCABLE REVENUE TOTAL 0 1,000 1,000 0 1,000
13.BUILDINGS-COUNTY
ANNUAL RENTAL EQUIVALENT VALUE 0 0 0 525,048 525,048
IT ALLOCATION&GOLDEN GATE RENTAL 0 0 0 91,000 91,000
UTILITIES 0 0 0 164,500 164,500
BUILDING MAINTENANCE 0 0 0 0 0
GROUNDS MAINTENANCE 0 0 0 195,149 195,149
INSURAiNCE 0 0 0 0 0
OTHER(Specify) 0 0 0 0 0
OTHER(Specify) 0 0 0 0 0
BUILDINGS TOTAL 0 0 0 975,697 975,697
14.OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND-COUNTY
EQUIPMENT/VEHICLE PURCHASES 0 0 0 86,400 86,400
VEHICLE INSURANCE 0 0 0 18,700 18,700
VEHICLE MAINTENANCE 0 0 0 0 0
OTHER COUNTY CONTRIBUTION(SPECIFY) 0 0 0 0 0
OTHER COUNTY CONTRIBUTION(SPECIFY) 0 0 0 0 0
OTHER COUNTY CONTRIBUTIONS TOTAL 0 0 0 105,100 105,100
GRAND TOTAL CHD PROGRAM 7,397,855 4,858,232 12,256,087 9,481,942 21,738,029
-- ;,;;;_ii_i J _. -Pdye 3 ut 3
ATTACHMENT II 1 6 0
s
COLLIER COUNTY HEALTH DEPARTMENT
Part III,Planned Staffing.Clients,Services and Expenditures By Program Service Area Within Each Level of Service
October 1,2017 to September 30,2018
Quarterly Expenditure Plan
FTE's Clients,Services/ 1st 2nd 3rd 4th Grand
(0.00) Units Visits (Whole dollars only) State County Total
A. COMMUNICABLE DISEASE CONTROL:
IMMUNIZATION (101) 8.39 6,196 8,496 123,838 144,442 123,838 144,442 187,034 349,526 536,560
SEXUALLY TRANS.DIS. (102) 5.38 1,267 1,905 69,279 80,805 69,279 80,804 5,624 294,543 300,167
HIV/AIDS PREVENTION (03A1) 5.39 0 8,042 77,303 90,165 77,303 90,164 324,935 10,000 334,935
HIV/AIDS SURVEILLANCE (03A2) 1.33 0 11 18,485 21,560 18,485 21,561 80,091 0 80,091
HIV/AIDS PATIENT CARE (03A3) 7.62 526 3,648 141,993 165,618 141,993 165,618 492,022 123,200 615,222
ADAP (03A4) 2.90 49 345 39,965 46,614 39,965 46,615 173,159 0 173,159
TUBERCULOSIS (104) 5.36 487 2,934 92,494 107,883 92,494 107,883 302,004 98,750 400,754
COMM.DIS.SURV. (106) 9.14 0 7,509 131,837 153,772 131,837 153,772 67,822 503,396 571,218
HEPATITIS (109) 1.61 1,509 1,899 27,134 31,649 27,134 31,649 117,566 0 117,566
PREPAREDNESS AND RESPONSE (116) 3.40 0 45 67,558 78,798 67,558 78,798 257,512 35,200 292,712
REFUGEE HEALTH (118) 10.60 2,255 6,145 210,655 245,703 210,655 245,704 912,717 0 912,717
VITAL RECORDS (180) 3.45 12,325 45,952 43,486 50,722 43,486 50,722 0 188,416 188,416
COMMUNICABLE DISEASE SUBTOTAL 64.57 24,614 86,931 1,044,027 1,217,731 1,044,027 1,217,732 2,920,486 1,603,031 4,523,517
B. PRIMARY CARE:
CHRONIC DISEASE PREVENTION PRO (210) 1.38 101 101 23,182 27,040 23,182 27,040 36,000 64,444 100,444
WIC (21W1) 28.56 16,347 97,961 373,501 435,643 373,501 435,642 1,618,287 0 1,618,287
TOBACCO USE INTERVENTION (212) 2.93 0 232 47,382 55,265 47,382 55,266 205,295 0 205,295
WIC BREASTFEEDING PEER COUNSELING (21W2) 2.43 0 3,447 23,795 27,754 23,795 27,755 103,099 0 103,099
FAMILY PLANNING (223) 5.56 2,664 4,844 90,274 105,294 90,274 105,293 312,635 78,500 391,135
IMPROVED PREGNANCY OUTCOME (225) 0.00 0 0 73,856 86,144 73,856 86,144 0 320,000 320,000
HEALTHY START PRENATAL (227) 10.92 955 5,210 168,221 196,209 168,221 196,209 156,716 572,144 728,860
COMPREHENSIVE CHILD HEALTH (229) 1.99 307 506 30,796 35,920 30,796 35,921 0 133,433 133,433
HEALTHY START CHILD (231) 5.97 1,356 6,255 84,628 98,708 84,628 98,707 285,939 80,732 366,671
SCHOOL HEALTH (234) 8.45 0 413,108 106,646 124,390 106,646 124,390 386,572 75,500 462,072
COMPREHENSIVE ADULT HEALTH (237) 4.94 2,394 3,363 108,781 126,880 108,781 126,881 131,796 339,527 471,323
COMMUNITY HEALTH DEVELOPMENT (238) 4.30 0 266 64,212 74,895 64,212 74,896 278,215 0 278,215
DENTAL HEALTH (240) 14.08 4,745 9,785 252,024 293,955 252,024 293,956 6,200 1,085,759 1,091,959
PRIMARY CARE SUBTOTAL 91.51 28,869 545,078 1,447,298 1,688,097 1,447,298 1,688,100 3,520,754 2,750,039 6,270,793
C. ENVIRONMENTAL HEALTH:
Water and Onsite Sewage Programs
COSTAL BEACH MONITORING (347) 0.37 1,101 1,104 8,159 9,866 8,459 9,867 30,651 0 36,651
LIMITED USE PUBLIC WATER SYSTEMS (357) 0.57 145 1,336 10,592 12,354 10,592 12,353 21,896 23,995 45,891
PUBLIC WATER SYSTEM (358) 0.00 0 0 0 0 0 0 0 0 0
PRIVATE WATER SYSTEM (359) 0.07 2 98 1,540 1,796 1,540 1,797 0 6,673 6,673
ONSITE SEWAGE TREATMENT&DISPOSAL (361) 6.77 1,780 5,124 109,164 127,326 109,164 127,327 278,796 191,185 472,981
Group Total 7.78 3,028 7,602 129,755 151,342 129,755 151,344 337343 224,853 502,196
Facility Programa
TATTOO FACII.ITY SERVICES (344) 0.26 0 148 1,097 5,479 4,697 5,479 20,352 0 20,352
FOOD HYGIENE (348) 1.66 329 1.004 27,168 32,038 27,468 32,039 118,893 120 119,013
,uacnnicm_ii_,JIL,, :..,,1 w
ATTACHMENT II1 6 0 1
COLLIER COUNTY HEALTH DEPARTMENT
Part III,Planned Staffing,Clients,Services and Expenditures By Program Service Area Within Each Level of Service
October 1,2017 to September 30,2018
Quarterly Expenditure Plan
FTE's Clients Services/ 1st 2nd 3rd 4th Grand
(0.00) Units Visits (Whole dollars only) State County Total
BODY PIERCING FACILITIES SERVICES (349) 0.10 2 7 1,361 1,587 1,361 1,586 5,895 0 5,895
GROUP CARE FACILITY (351) 0.55 138 237 9,020 10,521 9,020 10,520 0 39,081 39,081
MIGRANT LABOR CAMP (352) 2.71 100 1,073 37,629 43,889 37,629 43,889 115,986 47,050 163,036
HOUSING&PUB.BLDG. (353) 0.00 0 0 0 0 0 0 0 0 0
MOBILE HOME AND PARK (354) 0.49 77 242 9,844 11,481 9,844 11,481 .12,250 400 42,650
POOIS/BATHING PLACES (360) 4.28 1,755 18,169 76,122 88,787 76,122 88,787 136,160 193,658 329,818
BIOMEDICAL WASTE SERVICES (364) 1.28 667 918 23,268 27,140 23,268 27,140 100,816 0 100,816
TANNING FACILITY SERVICES (369) 0.08 21 29 1,347 1,571 1,347 1,572 5,837 0 5,837
Group Total 11.41 3,089 21,827 190,756 222,493 190,756 222,493 546,189 280,309 820,498
Groundwater Contamination
STORAGE TANK COMPLIANCE SERVICES (355) 0.00 0 0 0 0 0 0 0 0 0
SUPER ACT SERVICES (356) 0.06 108 228 1,093 1,275 1,093 1,274 4,735 0 4,735
Group Total 0.06 108 228 1,093 1,275 1,093 1,274 4,735 0 4,735
Community Hygiene
COMMUNITY ENVIR.HEALTH (345) 0.00 0 0 0 0 0 0 0 0 0
INJURY PREVENTION (346) 0.00 0 0 0 0 0 0 0 0 0
LEAD MONITORING SERVICES (350) 0.00 0 0 0 0 0 0 0 0 0
PUBLIC SEWAGE (362) 0.00 0 0 0 0 0 0 0 0 0
SOLID WASTE DISPOSAL SERVICE (363) 0.00 0 0 0 0 0 0 0 0 0
SANITARY NUISANCE (365) 0.02 272 4 338 395 338 395 1,466 0 1,466
RABIES SURVEILLANCE (366) 0.00 0 0 0 0 0 0 0 0 0
ARBORVIRUS SURVEIL. (367) 0.00 0 0 0 0 0 0 0 0 0
RODENT/ARTHROPOD CONTROL (368) 0.00 0 0 0 0 0 0 0 0 0
WATER POLLUTION (370) 0.00 0 0 0 0 0 0 0 0 0
INDOOR AIR (371) 0.00 0 0 0 0 0 0 0 0 0
RADIOLOGICAL HEALTH (372) 0.00 0 0 0 0 0 0 0 0 0
TOXIC SUBSTANCES (373) 0.00 0 0 0 0 0 0 0 0 0
Group Total 0.02 272 4 338 395 338 395 1,466 0 1,166
ENVIRONMENTAL HEALTH SUBTOTAL 19.27 6,497 29,721 321,942 375,505 321,942 375,506 889,733 505,162 1,394,895
D. NONOPERATIONAL COSTS:
NONOPERATIONAL COSTS (599) 0.00 0 0 0 0 0 0 0 0 0
ENVIRONMENTAL HEALTH SURCIIARGE (399) 0.00 0 0 14,969 17,459 14,969 17,159 64,856 0 64,856
MEDICAID BUYBACK (611) 0.00 0 0 468 545 468 545 2,026 0 2,026
NONOPERATIONAL COSTS SUBTOTAL 0.00 0 0 15,437 18,004 15,437 18,004 66.882 0 G6,882
TOTAL CONTRACT 175.35 59,980 661,730 2,828,704 3,299,337 2,828,704 3,299,3.12 7 397,855 4,858,232 12,256,087
1 6 01
ATTACHMENT III
COLLIER COUNTY HEALTH DEPARTMENT
CIVIL RIGHTS CERTIFICATE
The applicant provides this assurance in consideration of and for the purpose of obtaining federal grants, loans,
contracts (except contracts of insurance or guaranty), property, discounts, or other federal financial assistance to
programs or activities receiving or benefiting from federal financial assistance. The provider agrees to complete
the Civil Rights Compliance Questionnaire, DH Forms 946 A and B (or the subsequent replacement if adopted
during the contract period), if so requested by the department.
The applicant assures that it will comply with:
1. Title VI of the Civil Rights Act of 1964, as amended,42 U.S.C., 2000 Et seq.,which prohibits
discrimination on the basis of race, color or national origin in programs and activities receiving or
benefiting from federal financial assistance.
2. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794,which prohibits discrimination
on the basis of handicap in programs and activities receiving or benefiting from federal financial
assistance.
3. Title IX of the Education Amendments of 1972, as amended, 20 U.S.C. 1681 et seq.,which prohibits
discrimination on the basis of sex in education programs and activities receiving or benefiting from
federal financial assistance.
4. The Age Discrimination Act of 1975, as amended,42 U.S.C.6101 et seq.,which prohibits discrimination
on the basis of age in programs or activities receiving or benefiting from federal financial assistance.
5. The Omnibus Budget Reconciliation Act of 1981, P.L. 97-35,which prohibits discrimination on the basis
of sex and religion in programs and activities receiving or benefiting from federal financial assistance.
6. All regulations, guidelines and standards lawfully adopted under the above statutes.The applicant agrees
that compliance with this assurance constitutes a condition of continued receipt of or benefit from federal
financial assistance, and that it is binding upon the applicant, its successors, transferees, and assignees
for the period during which such assistance is provided. The applicant further assures that all contracts,
subcontractors, subgrantees or others with whom it arranges to provide services or benefits to
participants or employees in connection with any of its programs and activities are not discriminating
against those participants or employees in violation of the above statutes, regulations, guidelines, and
standards. In the event of failure to comply,the applicant understands that the grantor may, at its
discretion, seek a court order requiring compliance with the terms of this assurance or seek other
appropriate judicial or administrative relief, to include assistance being terminated and further assistance
being denied.
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ATTACHMENT V 1 1
COLLIER COUNTY HEALTH DEPARTMENT
SPECIAL PROJECTS SAVINGS PLAN
CASH RESERVED OR ANTICIPATED TO BE RESERVED FOR PROJECTS
CONTRACT YEAR STATE COUNTY TOTAL
2016-2017' $ 0 $ 0 $ 0
2017-2018" $ 0 $ 0 $ 0
2018-2019"' $ 0 $ 0 $ 0
2019-2020"' $ 0 $ 0 $ 0
PROJECT TOTAL $ 0 $ 0 $ 0
SPECIAL PROJECTS CONSTRUCTION/RENOVATION PLAN
PROJECT NUMBER:
PROJECT NAME:
LOCATION/ADDRESS:
PROJECT TYPE: NEW BUILDING ROOFING
RENOVATION PLANNING STUDY
NEW ADDITION OTHER
SQUARE FOOTAGE: 0
PROJECT SUMMARY: Describe scope of work in reasonable detail.
START DATE (Initial expenditure of funds) :
COMPLETION DATE:
DESIGN FEES: $ 0
CONSTRUCTION COSTS: $ 0
FURNITURE/EQUIPMENT: $ 0
TOTAL PROJECT COST: $ 0
COST PER SQ FOOT: 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 9/30/17
Cash to be transferred to FCO account.
—Cash anticipated for future contract years.
Mission: is 61n
To protect,promote&improve the health _ G oroall people in Florida through integrated /
state,county&community efforts. HEALTH -rfgrbaita Philip, MD, MPH
Collier County Surgeon General and Secretary
2,1 t7
Vision:To be the Healthiest State in the Nation ���,f? � " 3.
50
Dc'errrber 8, 2017
Board Minutes & Records Department
Enclosed is an original signed copy of the core contract (Item 16D) approved by the Collier County
Board of County Commissioners Tuesday, November 14, 2017.
If you have any questions, please feel free to contact me at (239) 252-8206.
Sincerely,
Alan L. Portis
Finance and Accounting Director
Florida Department of Health-Collier County
Enclosure(s)
Cc: Steve Carnell, Public Services Division
Community and Human Services
Florida Department of Health in Collier County
Office of the Administrator,Stephanie Vick,M.S.,B.S.N.,RN
3339 Tamiami Trail,Suite 145•Naples,Florida 34112-4961 Accredited Health Department
PHONE:239/252-5332•FAX 239/774-5653 P H A B Public Health Accreditation Board
www.FloridaHealth.gov
1601 0 1
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 2017-2018
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, 2017.
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 foregoing 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,
2017, through September 30, 2018, 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,
Environmental health services shall be supported by available federal, state and local funds
1
1601
and shall include those services mandated on a state or federal level. Examples of
environmental health services include, but are not limited to, food hygiene, safe drinking water
supply, sewage and solid waste disposal, swimming pools, group care facilities, migrant labor
camps, toxic material control, radiological health, and occupational health.
b. "Communicable disease control services" are those services which protect the health of
the general public through the detection, control, and eradication of diseases which are
transmitted primarily by human beings. Communicable disease services shall be supported by
available federal, state, and local funds and shall include those services mandated on a state
or federal level. Such services include, but are not limited to, epidemiology, sexually
transmissible disease detection and control, HIV/AIDS, immunization, tuberculosis control and
maintenance of vital statistics.
c. "Primary care services" are acute care and preventive services that are made available
to well and sick persons who are unable to obtain such services due to lack of income or other
barriers beyond their control. These services are provided to benefit individuals, improve the
collective health of the public, and prevent and control the spread of disease. Primary health
care services are provided at home, in group settings, or in clinics. These services shall be
supported by available federal, state, and local funds and shall include services mandated on
a state or federal level. Examples of primary health care services include, but are not limited
to: first contact acute care services; chronic disease detection and treatment; maternal and
child health services; family planning; nutrition; school health; supplemental food assistance
for women, infants, and children; home health; and dental services.
4. FUNDING. The parties further agree that funding for the CHD will be handled as follows:
a. The funding to be provided by the parties and any other sources is set forth in Part II of
Attachment II hereof. This funding will be used as shown in Part I of Attachment II.
i. The State's appropriated responsibility (direct contribution excluding any state fees,
Medicaid contributions or any other funds not listed on the Schedule C) as provided in
Attachment II, Part II is an amount not to exceed $ 6,617,807 (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 $ 1,455,000 (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 Department
Trust Fund that is attributed to the CHD shall be carried forward to the next contract period.
2
16131
c. Either party may establish service fees as allowed by law to fund activities of the CHD.
Where applicable, such fees shall be automatically adjusted to at least the Medicaid fee
schedule.
d. Either party may increase or decrease funding of this contract during the term hereof by
notifying the other party in writing of the amount and purpose for the change in funding. If the
State initiates the increase/decrease, the CHD will revise the Attachment II and send a copy of
the revised pages to the County and the Department of Health, Office of Budget and Revenue
Management. If the County initiates the increase/decrease, the County shall notify the CHD.
The CHD will then revise the Attachment II and send a copy of the revised pages to the
Department of Health, Office of Budget and Revenue Management.
e. The name and address of the official payee to whom payments shall be made is:
County Health Department Trust Fund
Collier County
3339 E. Tamiami Trail, Suite 145
Naples, FL 34112
5. CHD DIRECTOR/ADMINISTRATOR. Both parties agree the director/administrator of
the CHD shall be a State employee or under contract with the State and will be under the day-
to-day direction of the Deputy Secretary for County Health Systems. The director/administrator
shall be selected by the State with the concurrence of the County. The director/administrator
of the CHD shall ensure that non-categorical sources of funding are used to fulfill public health
priorities in the community and the Long Range Program Plan.
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 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
1601.
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 paragraphs 6.i. and 6.k., below. Books,
records and documents must be adequate to allow the CHD to comply with the following
reporting requirements:
i. The revenue and expenditure requirements in the Florida Accounting
Information Resource (FLAIR) System;
ii. The client registration and services reporting requirements of the minimum
data set as specified in the most current version of the Client Information
System/Health Management Component Pamphlet;
iii. Financial procedures specified in the Department of Health's Accounting
Procedures Manuals, Accounting memoranda, and Comptroller's
memoranda;
iv. The CHD is responsible for assuring that all contracts with service providers
include provisions that all subcontracted services be reported to the CHD in
a manner consistent with the client registration and service reporting
requirements of the minimum data set as specified in the Client Information
System/Health Management Component Pamphlet.
d. All funds for the CHD shall be deposited in the County Health Department Trust Fund
maintained by the state treasurer. These funds shall be accounted for separately from funds
deposited for other CHDs and shall be used only for public health purposes in Collier County.
e. That any surplus/deficit funds, including fees or accrued interest, remaining in the
County Health Department Trust Fund account at the end of the contract year shall be
credited/debited to the State or County, as appropriate, based on the funds contributed by each
and the expenditures incurred by each. Expenditures will be charged to the program accounts
by State and County based on the ratio of planned expenditures in this contract and funding
from all sources is credited to the program accounts by State and County. The equity share of
any surplus/deficit funds accruing to the State and County is determined each month and at
contract year-end. Surplus funds may be applied toward the funding requirements of each
participating governmental entity in the following year. However, in each such case, all surplus
funds, including fees and accrued interest, shall remain in the trust fund until accounted for in
a manner which clearly illustrates the amount which has been credited to each participating
governmental entity. The planned use of surplus funds shall be 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.
4
160 .1
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.
m. The CHD shall establish a system through which applicants for services and current
clients may present grievances over denial, modification or termination of services. The CHD
will advise applicants of the right to appeal a denial or exclusion from services, of failure to take
account of a client's choice of service, and of his/her right to a fair hearing to the final governing
authority of the agency. Specific references to existing laws, rules or program manuals are
included in Attachment I of this contract.
n. The CHD shall comply with the provisions contained in the Civil Rights Certificate,
hereby incorporated into this contract as Attachment III.
o. The CHD shall submit quarterly reports to the County that shall include at least the
following:
5
6
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, 2018 for the report period October 1, 2017 through
December 31, 2017;
ii. June 1, 2018 for the report period October 1, 2017 through
March 31, 2018;
iii. September 1, 2018 for the report period October 1, 2017
through June 30, 2018; and
iv. December 1, 2018 for the report period October 1, 2017
through September 30, 2018.
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.
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.
6
16 01 ro
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, 2018, 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 Public Service Division Administrator
Health in Collier County
Title Title
3339 E. Tamiami Trail, Suite 145 3339 E. Tamiami Trail, Suite 217
Naples, Florida 34112 Naples, Florida 34112
Address Address
(239) 252-5332 (239) 252-8468
Telephone Telephone
If different contract managers are designated after execution of this contract, the name,
address and telephonenumber 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.
I
1 6 01
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, 2017.
BOARD OF COUNTY COMMISSIONERS STATE OF FLORIDA
FOR COLLIER COUNTY DEPARTMENT OF HEALTH
-----‘---)/r---
SIGNED B1•177. IGNED B _
NAME: p tv,-1 -MN Y:(z, NAME: Celeste Philip, MD, MPH
TITLE: C-"-0* N r2 w. TITLE: Surgeon General and Secretary
DATE: e t if`/ 11 DATE: /417 M7
ATTESTED TO:' . -
. /1.4k.
SIGNED BY: � Q SIGNED BY: SA"- 1Vi,Y1te
NAME: him V NAME: Stephanie Vick, M.S., B.S.N., R.N.
TITLE: eelL,CAll C.42r_ TITLE: CHD Director/Administrator
DATE: 1.\--\f ,� DATE: c7/5-X2
s to Chairman S
signature only. S
Approved as to form and legality
NCAA
Atlsigtant Cnnnty Attu0
�c— �
`,\
8
1601
ATTACHMENT I
COLLIER COUNTY HEALTH DEPARTMENT
PROGRAM SPECIFIC REPORTING REQUIREMENTS AND PROGRAMS REQUIRING
COMPLIANCE WITH THE PROVISIONS OF SPECIFIC MANUALS
Some health services must comply with specific program and reporting requirements in addition to the Personal Health
Coding Pamphlet(DHP 50-20), Environmental Health Coding Pamphlet(DHP 50-21)and FLAIR requirements because of
federal or state law, regulation or rule. If a county health department is funded to provide one of these services, it must
comply with the special reporting requirements for that service. The services and the reporting requirements are listed
below:
Service Requirement
1. Sexually Transmitted Disease • Requirements as specified in F.A.C.64D-3, F.S.381 and F.S.384.
Program
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 in
Program for Women, Infants and DHM 150-24"and all federal, state and county requirements
Children(including the WIC detailed in program manuals and published procedures.
Breastfeeding Peer Counseling
Program)
4. Healthy Start/Improved Pregnancy Requirements as specified in the 2007 Healthy Start Standards and
Outcome Guidelines and as specified by the Healthy Start Coalitions in
contract with each county health department.
5. Family.Planning Requirements as specified in Public Law 91-572,42 U.S.C. 300, et
seq.,42 CFR part 59, subpart A,45 CFR parts 74&92,2 CFR 215
(OMB CircularA-110)OMB CircularA-102, F.S. 381.0051, F.A.C.
64F-7, F.A.C.64F-16, and F.A.C. 64F-19. Requirements and
Guidance as specified in the Program Requirements for Title X
Funded Family Planning Projects(Title X Requirements)(2014)and
the Providing Quality Family Planning Services(QFP):
Recommendations of CDC and the U.S. Office of Population Affairs
published on the Office of Population Affairs website.
Programmatic annual reports as specified by the program office as
specified in the annual programmatic Scope of Work for Family
Planning and Maternal Child Health Services, including the Family
Planning Annual Report(FPAR), and other minimum guidelines as
specified by the Policy Web Technical Assistance Guidelines.
6. Immunization Periodic reports as specified by the department pertaining to
immunization levels in kindergarten and/or seventh grade pursuant
to instructions contained in the Immunization Guidelines-Florida
Schools, Childcare Facilities and Family Daycare Homes(DH Form
150-615)and Rule 64D-3.046, F.A.C. In addition, periodic reports
as specified by the department pertaining to the
surveillance/investigation of reportable vaccine-preventable
diseases, adverse events,vaccine accountability, and assessment
of immunization
ATTACHMENT I(Continued)
Attuchrnan[_i-PaSe 1 of 2
1601
levels as documented in Florida SHOTS and supported by CHD
Guidebook policies and technical assistance guidance.
7. Environmental Health Requirements as specified in Environmental Health Programs
Manual 150-4"and DHP 50-21"
8. HIV/AIDS Program Requirements as specified in F.S. 384.25 and F.A.C. 64D-3.030
and 64D-3.031. Case reporting should be on Adult HIV/AIDS
Confidential Case Report CDC Form DH2139 and Pediatric
HIV/AIDS Confidential Case Report CDC Form DH2140.
Requirements as specified in F.A.C. 64D-2 and 64D-3, F.S.381 and
F.S. 384. Socio-demographic and risk data on persons tested for
HIV in CHD clinics should be reported on Lab Request DH Form
1628 in accordance with the Forms Instruction Guide.
Requirements for the HIV/AIDS Patient Care programs are found in
the Patient Care Contract Administrative Guidelines.
9. School Health Services Requirements as specified in the Florida School Health
Administrative Guidelines(May 2012). Requirements as specified
in F.S. 381.0056, F.S. 381.0057, F.S.402.3026 and F.A.C.64F-6.
10. Tuberculosis Tuberculosis Program Requirements as specified in F.A.C.64D-3
and F.S. 392.
11. General Communicable Disease Carry out surveillance for reportable communicable and other acute
Control diseases, detect outbreaks, respond to individual cases of
reportable diseases, investigate outbreaks, and carry out
communication and quality assurance functions, as specified in
F.A.C.64D-3, F.S. 381, F.S. 384 and the CHD Epidemiology Guide
to Surveillance and Investigations.
12. Refugee Health Program Programmatic and financial requirements as specified by the
program office.
"or the subsequent replacement if adopted during the contract period.
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'" F COLLIER COUNTY HEALTH DEPARTMENT
' rr
Part II,Sources of Contributions to County health Department
October 1,2017 to September 30,2018
'''ff State CHD County Total CHD
;.,,,Zts.::';‘,
as Trust Fund,(06,z % �gHD Trust Fund Other
r �� � ' (cash), Trus and , (Cash) Contribui% Tota1
1.GENERAL REVENUE-STATE
015040 AIDS PATIENT CARE 140,000 0 140,000 0 140,000
015040 AIDS PREVENTION&SURVEILLANCE-GENERAL REVENUE 69,571 0 69,571 0 69,571
015040 CHD-TB COMMUNITY PROGRAM 149,661 0 149,661 0 149,661
015040 DENTAL SPECIAL INITIATIVE PROJECTS 6,200 0 6,200 0 6,200
015040 FAMILY PLANNING GENERAL REVENUE 70,681 0 70,681 0 70,681
015040 HEPATITIS AND LIVER FAILURE PREVENTION&CONTROL 89,286 0 89,286 0 89,286
015040 MIGRANT LABOR CAMP SANITATION 74,533 0 74,533 0 74,533
015040 PRIMARY CARE PROGRAM 313,432 0 313,432 0 313,432
015040 SCHOOL HEALTH SERVICES-GENERAL REVENUE 218,073 0 218,073 0 218,073
015050 CHD GENERAL REVENUE NON-CATEGORICAL 1,892,126 0 1,892,126 0 1,892,126
GENERAL REVENUE TOTAL 3,023,563 0 3,023,563 0 3,023,563
2.NON GENERAL REVENUE•STATE
015010 STATE UNDERGROUND PETROLEUM RESPONSE ACT 3,565 0 3,565 0 3,565
015010 ENVIRONMENTAL BIOMEDICAL WASTE PROGRAM 13,086 0 13,086 0 13,086
015010 TOBACCO STATE AND COMMUNITY INTERVENTIONS 183,885 0 183,885 0 183,885
015010 HURRICAN MATTHEW EXECUTIVE ORDER 16-230 5,434 0 5,434 0 5,434
NON GENERAL REVENUE TOTAL 205,970 0 205,970 0 205,970
3.FEDERAL FUNDS-STATE
007000 AIDS DRUG ASSISTANCE PROGRAM ADMIN HQ 103,096 0 103,096 0 103,096
007000 WIC BREASTFEEDING PEER COUNSELING PROG 61,296 0 61,296 0 61,296
007000 COASTAL BEACH WATER QUALITY MONITORING 16,308 0 16,308 0 16,308
007000 COMPREHENSIVE COMMUNITY CARDIO-PHBG 36,000 0 36,000 0 36,000
007000 CMS-MCH PURCHASED CLIENT SERVICES 33,000 0 33,000 0 33,000
007000 FAMILY PLANNING TITLE X-GRANT 124,425 0 124,425 0 124,425
007000 IMMUNIZATION ACTION PLAN 87,564 0 87,564 0 87,564
007000 MCH SPECIAL PRJCT UNPLANNED PREGNANCY 39,976 0 39,976 0 39,976
007000 BASE COMMUNITY PREPAREDNESS CAPABILITY 131,814 0 131,814 0 131,814
007000 BASE PUB HLTH SURVEILLANCE&EPI INVESTIGATION 67,822 0 67,822 0 67,822
007000 AIDS PREVENTION 285,448 0 285,448 0 285,448
007000 RYAN WHITE TITLE II GRANT/CHD CONSORTIUM 287,051 0 287,051 0 287,051
007000 IMPROVING STD PROGRAMS 5,624 0 5,624 0 5,624
007000 WIC PROGRAM ADMINISTRATION 1,384,924 0 1,384,924 0 1,384,924
015075 INSPECTIONS OF SUMMER FEEDING PROGRAM-DOE 1,725 0 1,725 0 1,725
015075 SUPPLEMENTAL SCHOOL HEALTH 33,690 0 33,690 0 33,690
015075 REFUGEE HEALTH SCREENING REIMBURSEMENT ADMIN 78,281 0 78,281 0 78,281
015075 REFUGEE HEALTH SCREENING REIMBURSEMENT SERVICES 652,336 0 652,336 0 652,336
FEDERAL FUNDS TOTAL 3,430,380 0 3,430,380 0 3,430,380
4.FEES ASSESSED BY STATE OR FEDERAL RULES-STATE
001020 CHD STATEWIDE ENVIRONMENTAL FEES 472,554 0 472,554 0 472,554
001092 CHD STATEWIDE ENVIRONMENTAL FEES 199,532 0 199,532 0 199,532
001206 ON SITE SEWAGE DISPOSAL PERMIT FEES 16,638 0 16,638 0 16,638
,..0_ ,,_.I_P.it_ii Page 1 of 3
-..„,-;,--:---.-i:, ':..-,..'5'
' \ FA'
ATTACHMENT II 601
COI, IER COUNTY HEAI4TH•DEPARTMENT
Part II,Sources of Contributions to County Healt a ;
_ »,ent
October 1,2017 to September`30,'2018
State CiD County Total CHD
Trust Fund CHD: °Trust Fund Other
,,. ,,, „ (cash), Trust Fund (cas,,)1C ntribution Total
001206 SANITATION CERTIFICATES(FOOD INSPECTION) 4,749 0 4,749 0 4,749
001206 SEPTIC TANK RESEARCH SURCHARGE 2,705 0 2,705 0 2,705
001206 SEPTIC TANK VARIANCE FEES 50% 350 0 350 0 350
001206 PUBLIC SWIMMING POOL PERMIT FEES-10%HQ TRANSFER 33,380 0 33,380 0 33,380
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 338 0 338 0 338
001206 ONSITE SEWAGE TRAINING CENTER 1,110 0 1,110 0 1,110
001206 TATTO PROGRAM ENVIRONMENTAL HEALTH 2,094 0 2,094 0 2,094
001206 MOBILE HOME&RV PARK FEES 2,157 0 2,157 0 2,157
FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 736,942 0 736,942 0 736,942
5.OTHER CASH CONTRIBUTIONS-STATE:
0 0 0 0 0
090001 DRAW DOWN FROM PUBLIC HEALTH UNIT 0 0 0 0 0
OTHER CASH CONTRIBUTION TOTAL 0 0 0 0 0
6.MEDICAID-STATE/COUNTY:
001057 CHD CLINIC FEES 0 49,600 49,600 0 49,600
001148 CHD CLINIC FEES 0 983,000 983,000 0 983,000
MEDICAID TOTAL. 0 1,032,600 1,032,600 0 1,032,600
7.ALLOCABLE REVENUE-STATE:
018000 CHD CLINIC FEES 1,000 0 1,000 0 1,000
ALLOCABLE REVENUE TOTAL 1,000 0 1,000 0 1,000
8.OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND-STATE
ADAP 0 0 0 1,456,610 1,456,610
PHARMACY DRUG PROGRAM 0 0 0 37,691 37,691
WIC PROGRAM 0 0 0 5,632,203 5,632,203
BUREAU OF PUBLIC HEALTH LABORATORIES 0 0 0 52,103 52,103
IMMUNIZATIONS 0 0 0 1,222,538 1,222,538
OTHER STATE CONTRIBUTIONS TOTAL 0 0 0 8,401,145 8,401,145
9.DIRECT LOCAL CONTRIBUTIONS-BCC/TAX DISTRICT
008005 CHD LOCAL REVENUE&EXPENDITURES 0 1,455,000 1,455,000 0 1,455,000
DIRECT COUNTY CONTRIBUTIONS TOTAL 0 1,455,000 1,455,000 0 1,455,000
10.FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION-COUNTY
001077 CHD CLINIC FEES 0 252,150 252,150 0 252,150
001077 GENERAL CLINIC RABIES SERVICES&DRUG PURCHASES 0 8,500 8,500 0 8,500
001094 CHD LOCAL ENVIRONMENTAL FEES 0 706,650 706,650 0 706,650
001110 VITAL STATISTICS CERTIFIED RECORDS 0 390,000 390,000 0 390,000
FEES AUTHORIZED BY COUNTY TOTAL 0 1,357,300 1,357,300 0 1,357,300
11.OTHER CASH AND LOCAL CONTRIBUTIONS-COUNTY
Page 2 of 3
AATTACHMEl 'I,TT
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COJJ,JER'COUNTY HEALTH DEPAR ENT
Cr'�/
1 i Fces of Contributions to County Health Department y
•.,,`October 1,2017 to September 30,2018
State CII) County Total CHD . '�
Trust Fund CHD Trust Fund Other
,. 4 tea..
.>. f, :• (co)i? ....... Trust Fund (cash) y,Cpntribntion Total
001029 CHD CLINIC FEES 0 82,500 82,500 0 82,500
001090 CHD CLINIC FEES 0 17,750 17,750 0 17,750
010500 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 0 3,000 3,000 0 3,000
011000 RYAN WHITE 0 27,000 27,000 0 27,000
011000 CHD CASH DONATION/NON-SPECIFIC 0 12,100 12,100 0 12,100
011000 EARLY LEARNING COALITION OF SOUTHWEST FLORIDA 0 60,900 60,900 0 60,900
011000 CHD LOCAL REVENUE&EXPENDITURES 0 10,000 10,000 0 10,000
011001 CHD HEALTHY START COALITION CONTRACT 0 475,265 475,265 0 475,265
012020 CHD LOCAL ENVIRONMENTAL FEES 0 1,000 1,000 0 1,000
090002 DRAW DOWN FROM PUBLIC HEALTH UNIT 0 322,817 322,817 0 322,817
OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 0 1,012,332 1,012,332 0 1,012,332
12.ALLOCABLE REVENUE-COUNTY
018000 CHD CLINIC FEES 0 1,000 1,000 0 1,000
COUNTY ALLOCABLE REVENUE TOTAL 0 1,000 1,000 0 1,000
13.BUILDINGS-COUNTY
ANNUAL RENTAL EQUIVALENT VALUE 0 0 0 525,048 525,048
IT ALLOCATION&GOLDEN GATE RENTAL 0 0 0 91,000 91,000
UTILITIES 0 0 0 164,500 164,500
BUILDING MAINTENANCE 0 0 0 0 0
GROUNDS MAINTENANCE 0 0 0 195,149 195,149
INSURANCE 0 0 0 0 0
OTHER(Specify) 0 0 0 0 0
OTHER(Specify) 0 0 0 0 0
BUILDINGS TOTAL 0 0 0 975,697 975,697
14.OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND-COUNTY
EQUIPMENT/VEHICLE PURCHASES 0 0 0 86,400 86,400
VEHICLE INSURANCE 0 0 0 18,700 18,700
VEHICLE MAINTENANCE 0 0 0 0 0
OTHER COUNTY CONTRIBUTION(SPECIFY) 0 0 0 0 0
OTHER COUNTY CONTRIBUTION(SPECIFY) 0 0 0 0 0
OTHER COUNTY CONTRIBUTIONS TOTAL 0 0 0 105,100 105,100
GRAND TOTAL CHD PROGRAM 7,397,855 4,858,232 12,256,087 9,481,942 21,738,029
li(td(.I'.iLEr:1_I'1_rz,LII-r'at'e 3 ut.5
` 1TPACHMENT II
:1414,44611
COIIIECOCTN1YJlEALmDEI'Az1' ENI
='; t8 Services and Expenditures By Program Service Area Within Each Level of S!Troy 4.0
�,,i�, O 1 21' ,Saptembe,r20,18:1
`+ y � �. 30 �rly`"� �' ✓a��L:✓��`�
✓ �°;
arteExpenditure Plan
> s Clients Services/ 1st 2nd Bid 4thg Grand
`<
. tta11.44,1f Visits %✓A.
1
A. COMMUNICABLE DISEASE CONTROL:
IMMUNIZATION (101) 8.39 6,196 8,496 123,838 144,442 123,838 144,442 187,034 349,526 536,560
SEXUALLY TRANS.DIS. (102) 5.38 1,267 1,905 69,279 80,805 69,279 80,804 5,624 294,543 300,167
HIV/AIDS PREVENTION (03A1) 5.39 0 8,042 77,303 90,165 77,303 90,164 324,935 10,000 334,935
HIV/AIDS SURVEILLANCE (03A2) 1.33 0 11 18,485 21,560 18,485 21,561 80,091 0 80,091
HIV/AIDS PATIENT CARE (03A3) 7.62 526 3,648 141,993 165,618 141,993 165,618 492,022 123,200 615,222
ADAP (03A4) 2.90 49 345 39,965 46,614 39,965 46,615 173,159 0 173,159
TUBERCULOSIS (104) 5.36 487 2,934 92,494 107,883 92,494 107,883 302,004 98,750 400,754
COMM.DIS.SURV. (106) 9.14 0 7,509 131,837 153,772 131,837 153,772 67,822 503,396 571,218
HEPATITIS (109) 1.61 1,509 1,899 27,134 31,649 27,134 31,649 117,566 0 117,566
PREPAREDNESS AND RESPONSE (116) 3.40 0 45 67,558 78,798 67,558 78,798 257,512 35,200 292,712
REFUGEE HEALTH (118) 10.60 2,255 6,145 210,655 245,703 210,655 245,704 912,717 0 912,717
VITAL RECORDS (180) 3.45 12,325 45,952 43,486 50,722 43,486 50,722 0 188,416 188,416
COMMUNICABLE DISEASE SUBTOTAL 64.57 24,614 86,931 1,044,027 1,217,731 1,044,027 1,217,732 2,920,486 1,603,031 4,523,517
B. PRIMARY CARE:
CHRONIC DISEASE PREVENTION PRO (210) 1.38 101 101 23,182 27,040 23,182 27,040 36,000 64,444 100,444
WIC (21W1) 28.56 16,347 97,961 373,501 435,643 373,501 435,642 1,618,287 0 1,618,287
TOBACCO USE INTERVENTION (212) 2.93 0 232 47,382 55,265 47,382 55,266 205,295 0 205,295
WIC BREASTFEEDING PEER COUNSELING (21W2) 2.43 0 3,447 23,795 27,754 23,795 27,755 103,099 0 103,099
FAMILY PLANNING (223) 5.56 2,664 4,844 90,274 105,294 90,274 105,293 312,635 78,500 391,135
IMPROVED PREGNANCY OUTCOME (225) 0.00 0 0 73,856 86,144 73,856• 86,144 0 320,000 320,000
HEALTHY START PRENATAL (227) 10.92 955 5,210 168,221 196,209 168,221 196,209 156,716 572,144 728,860
COMPREHENSIVE CHILD HEALTH (229) 1.99 307 506 30,796 35,920 30,796 35,921 0 133,433 133,433
HEALTHY START CHILD (231) 5.97 1,356 6,255 84,628 98,708 84,628 98,707 .285,939 80,732 366,671
SCHOOL HEALTH (234) &45 0 413,108 106,646 124,390 106,646 124,390 386,572 75,500 462,072
COMPREHENSIVE ADULT HEALTH (237) 4.94 2,394 3,363 108,781 126,880 108,781 126,881 131,796 339,527 471,323
COMMUNITY HEALTH DEVELOPMENT (238) 4.30 0 266 64,212 74,895 64,212 74,896 278,215 0 278,215
DENTAL HEALTH (240) 14.08 4,745 9,785 252,024 293,955 252,024 293,956 6,200 1,085,759 1,091,959
PRIMARY CARE SUBTOTAL 91.51 28,869 545,078 1,447,298 1,688,097 1,447,298 1,688,100 3,520,754 2,750,039 6,270,793
C. ENVIRONMENTAL HEALTH:
Water and Onsite Sewage Programs
COSTAL BEACH MONITORING (347) 0.37 1,101 1,104 8,459 9,866 8,459 9,867 36,651 0 36,651
LIMITED USE PUBLIC WATER SYSTEMS (357) 0.57 145 1,336 10,592 12,354 10,592 12,353 21,896 23,995 45,891
PUBLIC WATER SYSTEM (358) 0.00 0 0 0 0 0 0 0 0 0
PRIVATE WATER SYSTEM (359) 0.07 2 98 1,540 1,796 1,540 1,797 0 6,673 6,673
ONSITE SEWAGE TREATMENT&DISPOSAL (361) 6.77 1,780 5,124 109,164 127,326 109,164 127,327 278,796 194,185 472,981
Group Total 7.78 3,028 7,662 129,755 151,342 129,755 151,344 337,343 224,853 562,196
Facility Programs
TATTOO FACILITY SERVICES (344) 0.26 0 148 4,697 5,479 4,697 5,479 20,352 0 20,352
FOOD HYGIENE (348) 1.66 329 1,004 27,468 32,038 27,468 32,039 118,893 120 119,013
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ATTACIiMENT If
COLLI�-C UI�It Y HEALTH DEPAETMENT
Part III Planned Staffing.Clients,Services and Expenditures By Program Service Area Within Each Level,of.Service
October 1,2017 to September 30,2018
Quarterly Expenditure Plan '"
ETE's Clients Services/ 1st + 2nd 3rd 4th Grand ",
AA* ,, , (0.00) Uttar Visits (Whole dollars only) .', to C u Tot
BODY PIERCING FACILITIES SERVICES (349) 0.10 2 7 1,361 1,587 1,361 1,586 5,895 0 5,895
GROUP CARE FACILITY (351) 0.55 138 237 9,020 10,521 9,020 10,520 0 39,081 39,081
MIGRANT LABOR CAMP (352) 2.71 100 1,073 37,629 43,889 37,629 43,889 115,986 47,050 163,036
HOUSING&PUB.BLDG. (353) 0.00 0 0 0 0 0 0 0 0 0
MOBILE HOME AND PARK (354) 0.49 77 242 9,844 11,481 9,844 11,481 42,250 400 42,650
POOLS/BATHING PLACES (360) 4.28 1,755 18,169 76,122 88,787 76,122 88,787 136,160 193,658 329,818
BIOMEDICAL WASTE SERVICES (364) 1.28 667 918 23,268 27,140 23,268 27,140 100,816 0 100,816
TANNINGFACILITYSERVICES (369) 0.08 21 29 1,347 1,571 1,347 1,572 5,837 0 5,837
Group Total 11.41 3,089 21,827 190,756 222,493 190,756 222,493 546,189 280,309 826,498
Groundwater Contamination
STORAGE TANK COMPLIANCE SERVICES (355) 0.00 0 0 0 0 0 0 0 0 0
SUPER ACT SERVICES (356) 0.06 108 228 1,093 1,275 1,093 1,274 4,735 0 4,735
Group Total 0.06 108 228 1,093 1,275 1,093 1,274 4,735 0 4,735
Community Hygiene
COMMUNITY ENVIR.HEALTH (345) 0.00 0 0 0 0 0 0 0 0 0
INJURY PREVENTION (346) 0.00 0 0 0 0 0 0 0 0 0
LEAD MONITORING SERVICES (350) 0.00 0 0 0 0 0 0 0 0 0
PUBLIC SEWAGE (362) 0.00 0 0 0 0 0 0 0 0 0
SOLID WASTE DISPOSAL SERVICE (363) 0.00 0 0 0 0 0 0 0 0 0
SANITARY NUISANCE (365) 0.02 272 4 338 395 338 395 1,466 0 1,466
RABIES SURVEILLANCE (366) 0.00 0 0 0 0 0 0 0 0 0
ARBORVIRUS SURVEIL. (367) 0.00 0 0 0 0 0 0 0 0 0
RODENT/ARTHROPOD CONTROL (368) 0.00 0 0 0 0 0 0 0 0 0
WATER POLLUTION (370) 0.00 0 0 0 0 0 0 0 0 0
INDOOR AIR (371) 0.00 0 0 0 0 0 0 0 0 0
RADIOLOGICAL HEALTH (372) 0.00 0 0 0 0 0 0 0 0 0
TOXIC SUBSTANCES (373) 0.00 0 0 0 0 0 0 0 0 0
Group Total 0.02 272 4 338 395 338 395 1,466 0 1,466
ENVIRONMENTAL HEALTH SUBTOTAL 19.27 6,497 29,721 321,942 375,505 321,942 375,506 889,733 505,162 1,394,895
D. NONOPERATIONAL COSTS:
NONOPERATIONAL COSTS (599) 0.00 0 0 0 0 0 0 0 0 0
ENVIRONMENTAL HEALTH SURCHARGE (399) 0.00 0 0 14,969 17,459 14,969 17,459 64,856 0 64,856
MEDICAID BUYBACK (611) 0.00 0 0 468 545 468 545 2,026 0 2,026
NONOPERATIONAL COSTS SUBTOTAL 0.00 0 0 15,437 18,004 15,437 18,004 66,882 0 66,882
TOTAL CONTRACT 175.35 59,980 661,730 2,828,704 3,299,337 2,828,704 3,299,342 7,397,855 4,858,232 12,256,087
1681
ATTACHMENT III
COLLIER COUNTY HEALTH DEPARTMENT
CIVIL RIGHTS CERTIFICATE
The applicant provides this assurance in consideration of and for the purpose of obtaining federal grants, loans,
contracts(except contracts of insurance or guaranty), property, discounts, or other federal financial assistance to
programs or activities receiving or benefiting from federal financial assistance. The provider agrees to complete
the Civil Rights Compliance Questionnaire, DH Forms 946 A and B(or the subsequent replacement if adopted
during the contract period), if so requested by the department.
The applicant assures that it will comply with:
1. Title VI of the Civil Rights Act of 1964, as amended,42 U.S.C.,2000 Et seq.,which prohibits
discrimination on the basis of race, color or national origin in programs and activities receiving or
benefiting from federal financial assistance.
2. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794,which prohibits discrimination
on the basis of handicap in programs and activities receiving or benefiting from federal financial
assistance.
3. Title IX of the Education Amendments of 1972,as amended,20 U.S.C. 1681 et seq.,which prohibits
discrimination on the basis of sex in education programs and activities receiving or benefiting from
federal financial assistance.
4. The Age Discrimination Act of 1975, as amended,42 U.S.C. 6101 et seq.,which prohibits discrimination
on the basis of age in programs or activities receiving or benefiting from federal financial assistance.
5. The Omnibus Budget Reconciliation Act of 1981, P.L. 97-35,which prohibits discrimination on the basis
of sex and religion in programs and activities receiving or benefiting from federal financial assistance.
6. All regulations,guidelines and standards lawfully adopted under the above statutes.The applicant agrees
that compliance with this assurance constitutes a condition of continued receipt of or benefit from federal
financial assistance,and that it is binding upon the applicant, its successors,transferees, and assignees
for the period during which such assistance is provided. The applicant further assures that all contracts,
subcontractors, subgrantees or others with whom it arranges to provide services or benefits to
participants or employees in connection with any of its programs and activities are not discriminating
against those participants or employees in violation of the above statutes, regulations, guidelines, and
standards. In the event of failure to comply, the applicant understands that the grantor may, at its
discretion, seek a court order requiring compliance with the terms of this assurance or seek other
appropriate judicial or administrative relief,to include assistance being terminated and further assistance
being denied.
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ATTACHMENT V 1 61
COLLIER COUNTY HEALTH DEPARTMENT
SPECIAL PROJECTS SAVINGS PLAN
CASH RESERVED OR ANTICIPATED TO BE RESERVED FOR PROJECTS
CONTRACT YEAR STATE COUNTY TOTAL
2016-2017* $ 0 $ 0 $ 0
2017-2018** $ 0 $ 0 $ 0
2018-2019*** $ 0 $ 0 $ 0
2019-2020*** $ 0 $ 0 $ 0
PROJECT TOTAL $ 0 $ 0 $ 0
SPECIAL PROJECTS CONSTRUCTION/RENOVATION PLAN
PROJECT NUMBER:
PROJECT NAME:
LOCATION/ADDRESS:
PROJECT TYPE: NEW BUILDING ROOFING
RENOVATION PLANNING STUDY
NEW ADDITION OTHER
SQUARE FOOTAGE: 0
PROJECT SUMMARY: Describe scope of work in reasonable detail.
START DATE (Initial expenditure of funds) :
COMPLETION DATE:
DESIGN FEES: $ 0
CONSTRUCTION COSTS: $ 0
FURNITURE/EQUIPMENT: $ 0
TOTAL PROJECT COST: $ 0
COST PER SQ FOOT: $ 0
Special Capital Projects are new construction or renovation projects and new furniture or equipment associated with these projects and
mobile health vans.
*Cash balance as of 9/30/17
**Cash to be transferred to FCO account.
***Cash anticipated for future contract years.
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