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Agenda 10/28/2014 Item #16D1110/28/2014 16. D.11. EXECUTIVE SUMMARY Recommendation to approve the FY 14-15 contract with the State of Florida Department of Health for the operation of the Collier County Health Department in the amount of $1,289,500. OBJECTIVE: To provide local funding to augment the level of public health services provided in Collier County. CONSIDERATIONS: Each year, the County enters into an agreement with the State of Florida Department of Health to provide funds and facilities for the provision of public health services. The attached represents the FY14 -15 contract effective October 1, 2014 through September 30, 2015. The agreement identifies the services that will be provided with the cost share between the State and the County. The total amount of funding to the Department of Health under the contract is $1,289,500. FISCAL IMPACT: The contract includes a cash contribution of $1,289,500 for public health programs. These funds are budgeted in the FY15 General Fund budget along with facility operating costs of $288,100 and $48,000 in funds for capital equipment replacement for a total of $1,625,600 in funds in support of the Health Department. GROWTH MANAGEMENT IMPACT: There is no Growth Management Plan impact associated with this item. LEGAL CONSIDERATIONS: This item is approved for form and legality and requires a majority vote for Board action. -- JAB RECOMMENDATION: That the Board of County Commissioners approves and authorizes the Chairman to execute the annual contract with the State of Florida Department of Health for the operations of the Collier County Health Department. Prepared by: Alan Portis, Collier County Health Department Packet Page -1717- 10/28/2014 16. D.11. COLLIER COUNTY Board of County Commissioners Item Number: 16.16.D.16.D.11. Item Summary: Recommendation to approve the FY 14 -15 contract with the State of Florida Department of Health for the operation of the Collier County Health Department in the amount of $1,289,500. Meeting Date: 10/28/2014 Prepared By Name: AlonsoHailey Title: Operations Analyst, Public Services Division 10/10/2014 4:37:02 PM Approved By Name: AlonsoHailey Title: Operations Analyst, Public Services Division Date: 10/10/2014 4:57:20 PM Name: TownsendAmanda Title: Director - Operations Support, Public Services Division Date: 10/13/2014 1:55:54 PM Name: BelpedioJennifer Title: Assistant County Attorney, CAO General Services Date: 10/13/2014 4:26:44 PM Name: CarnellSteve Title: Administrator - Public Services, Public Services Division Date: 10/13/2014 4:55:39 PM Name: BelpedioJennifer Title: Assistant County Attorney, CAO General Services Date: 10/14/2014 8:08:13 AM Name: KlatzkowJeff Title: County Attorney, Date: 10/15/2014 3:00:26 PM Packet Page -1718- 10/28/2014 16. D.11. Name: FinnEd Title: Management/Budget Analyst, Senior, Transportation Engineering & Construction Management Date: 10/20/2014 3:12:12 PM Name: OchsLeo Title: County Manager, County Managers Office Date: 10/21/2014 8:57:21 AM Packet Page -1719- 10/28/2014 16. D.11 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 2014-2015 This agreement ("Agreement") 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, 2014. RECITALS ti 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 County Health Departments created throughout Florida. D. It is necessary for the parties -hereto to enter into this Agreement in order to ensure coordination between the State and the County in the operation of the CHD. NOW THEREFORE, in consideration of the mutual promises set forth herein, the sufficiency of which are hereby acknowledged, the parties hereto agree as follows: 1. RECITALS. The parties mutually agree that the forgoing recitals are true and correct and incorporated herein by reference. 2. TERM. The parties mutually agree that this Agreement shall be effective from October 1, 2014, through September 30, 2015, or until a written agreement replacing this Agreement is entered into between the parties, whichever is later, unless this Agreement is otherwise terminated pursuant to the termination provisions set forth in paragraph 8, below. 3. SERVICES MAINTAINED BY THE CHID. The parties mutually agree that the CHD shall provide those services as set forth on Part III of Attachment 11 hereof, in order to maintain the following three levels of service pursuant to Section 154.01(2), Florida Statutes, as defined below: a. "Environmental health services" are those services which are organized and operated to protect the health of the general public by monitoring and regulating activities in the environment which may contribute to the occurrence or transmission of disease. Packet Page -1720- 10/28/2014 16 Environmental health services shall be supported by available federal, state and local funds and shall include those services mandated on a state or federal level. Examples of environmental health services include, but are not limited to, food hygiene, safe drinking water supply, sewage and solid waste disposal, swimming pools, group care facilities, migrant labor camps, toxic material control, radiological health, and occupational health. b. "Communicable disease control services" are those services which protect the health of the general public through the detection, control„ and eradication of diseases which are transmitted primarily by human beings. Communicable disease services shall be supported by available federal, state, and local funds and shall include those services mandated on a state or federal level. Such services include, but are not limited to, epidemiology, sexually transmissible disease detection and control, HIWAIDS, 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 are set forth in Part II of Attachment 11 hereof. This funding will be used as shown in Part I of Attachment 11. L 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 11, Part 11 is an amount not to exceed $ 5,491,305 (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 11, Part 11 is an amount not to exceed $ 1,2$9,500 (amount listed under the 'Board of County Commissioners Annual Appropriations section of the revenue attachment). b. Overall expenditures will not exceed available funding or budget authority, whichever is less, (either current year or from surplus trust funds) in any service category. Unless requested otherwise, any surplus at the end of the term of this Agreement in the Packet Page -1721- D.11. 10/28/2014 16. D.11. County Health Department Trust Fund that is attributed to the CHD shall be carried forward to the next contract period. c. Either party may establish service fees as allowed by law to fund activities of the CHD. Where applicable, such fees shall be automatically adjusted to at least the Medicaid fee schedule. d. Either parry may increase or decrease funding of this Agreement 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 Il 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 11 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 who 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 Statewide Services. The director /administrator shall be selected by the State with the concurrence of the County. The director /administrator of the CHD shall ensure that non - categorical sources of funding are used to fulfill public health priorities in the community and the Long Range Program Plan. A report detailing the status of public health as measured by outcome measures and similar indicators will be sent by the CHD director /administrator to the parties no later than October 1 of each year (This is the standard quality assurance "County Health Profile" report located on the Division of Public Health Statistics and Performance Management Intranet site). 6. ADMINISTRATIVE POLICIES AND PROCEDURES. The parties hereto agree that the following standards should apply in the operation of the CHD: a. The CHD and its personnel shall follow all State policies and procedures, except to the extent permitted for the use of county purchasing procedures as set forth in subparagraph b., below. All CHD employees shall be State or State - contract personnel subject to State personnel rules and procedures. Employees will report time in the Health Management System compatible format by program component as specified by the State. b. The CHD shall comply with all applicable provisions of federal and state laws and regulations relating to its operation with the exception that the use of county purchasing procedures shall be allowed when it will result in a better price or service and no statewide Department of Health purchasing contract has been implemented for those goods or services. In such cases, the CHD director /administrator must sign a justification therefore, Packet Page -1722- 10/28/2014 16. D.11. 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 Agreement. 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 those promulgated by the Generally Accepted Accounting Principles (GAAP) and Governmental Accounting Standards Board (GASB), and the requirements of federal or state law. These records shall be maintained as required by the Department of Health Policies and Procedures for Records Management and shall be open for inspection at any time by the parties and the public, except for those records that are not otherwise subject to disclosure as provided by law which are subject to the confidentiality provisions of paragraph 6.i., below. Books, records and documents must be adequate to allow the CHD to comply with the following reporting requirements: The revenue and expenditure requirements in the Florida Accounting System Information Resource (FLAIR). 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 CND 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 the core 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 `r Packet Page -1723- 10/28/2014 16. D.11. 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 Statewide Services has approved the transfer. The Deputy Secretary for Statewide Services shall forward written evidence of this approval to the CHD within 30 days after an emergency transfer. g. The CHD may execute subcontracts for services necessary to enable the CHD to carry out the programs specified in this Agreement. Any such subcontract shall include all aforementioned audit and record keeping requirements. h. At the request of either parry, an audit may be conducted by an independent CPA on the financial records of the CHID 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 CND 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 Agreement for a period of five (5) years after termination of this Agreement. 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. hereof. Packet Page -1724- 10/28/2014 16. D.11. 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 Agreement. n. The CHD shall comply with the provisions contained in the Civil Rights Certificate, hereby incorporated into this contract as Attachment Ill. o. The CHD shall submit quarterly reports to the county that shall include at least the following: i. The DE3851-1 Contract Management Variance Report and the DE58OL1 Analysis of Fund Equities Report; ii. A written explanation to the county of service variances reflected in the DE3851-1 report if the variance exceeds or falls below 25 percent of the planned expenditure amount. However, if the amount of the service specific variance between actual and planned expenditures does not exceed three percent of the total planned expenditures for the level of service in which the type of service is included, a variance explanation is not required. A copy of the written explanation shall be sent to the Department of Health, Office of Budget and Revenue Management. 6 Packet Page -1725- 10/28/2014 16. D.11. 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: March 1, 2015 for the report period October 1, 2014 through December 31, 2014; ii. June 1, 2015 for the report period October 1, 2014 through March 31, 2015; iii. September 1, 2015 for the report period October 1, 2014 through June 30, 2015; and iv. December 1, 2015 for the report period October 1, 2014 through September 30, 2015. 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. a. Termination at Will. This Agreement 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 Agreement become unavailable, either party may terminate this Agreement 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 parry's contract manager with proof of delivery. c. Termination for Breach. This Agreement may be terminated by one party, upon no less than thirty (30) days notice, because of the other party's failure to perform an Packet Page -1726- 10/28/2014 16.D 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 Agreement 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 Agreement. 9. MISCELLANEOUS. The parties further agree: a. Availability of Funds. If this Agreement, any renewal hereof, or any term, performance or payment hereunder, extends beyond the fiscal year beginning July 1, 2015, it is agreed that the performance and payment under this Agreement are contingent upon an annual appropriation by the Legislature, in accordance with section 287.0582, Florida Statutes. b. Contract Managers. The name and address of the contract managers for the parties under this Agreement are as follows: For the State: Stephanie Vick, M.S..B.S.N. , R.N. Name Administrator, Florida Department of Health in Collier County Title 3339 E. Tamiami Trai! , Suite 145 Naples, Florida 34112 Address (239) 252 -5332 Telephone For the County: Steve Carnell Name Public Services Division Administrator Title 3339 E. Tamiami Trail, Suite 217 Naples, Florida 34112 Address (239) 252 -8468 Telephone If different contract managers are designated after execution of this Agreement, 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 Agreement. C. Captions. The captions and headings contained in this Agreement are for the convenience of the parties only and do not in any way modify, amplify, or give additional notice of the provisions hereof. s Packet Page -1727- 11. 10/28/2014 16.D. 11. In WITNESS THEREOF, the parties hereto have caused this 20 page agreement to be executed by their undersigned officials as duly authorized effective the 1 sr-day of October, 2014. BOARD OF COUNTY COMMISSIONERS FOR COLLIER COUNTY SIGNED BY: NAME:--T(>r.-% TITLE: r— 1A A % a Y` *,A 1�3 DATE: ATTESTED TO: SIGNED BY: TITLE: DATE: -�,r 1!2 DWIGHT S. BROCK, Clerk STATE OF FLORIDA DEPARTMENT OF HEALTH SIGNED BY: NAME: John H. Armstrong, MD TITLE: Surgeon General/Secretary of Health DATE: SIGNED BY: NAME: Stephanie Vick, M.S., B.S.N., R.N. TITLE: CHD Administrator DATE: ,, i ':' F Packet Page -1728- Approved as to form and legality w Attorney Assistant County Att - WY 9 10/28/2014 16.D.11. 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 1. Sexually Transmitted Disease Program 2. Dental Health 3. Special Supplemental Nutrition Program for Women, Infants and Children (including the WIC Breastfeeding Peer Counseling Program) 4. Healthy Start/ Improved Pregnancy Outcome 5. Family Planning Requirement Requirements as specified in F.A.C. 64D -3, F.S. 381 and F.S. 384. Periodic financial and programmatic reports as specified by the program office. Service documentation and monthly financial reports as specified in DHM 150 -24' and all federal, state and county requirements detailed in program manuals and published procedures. Requirements as specified in the 2007 Healthy Start Standards and Guidelines and as specified by the Healthy Start Coalitions in contract with each county health department. 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, RA.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, 10 Packet Paae -1729- 10/28/2014 16. D.11. ATTACHMENT I (Continued) vaccine accountability, and assessment of immunization levels as documented in Florida. SHOTS and supported by CHID 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 Control Carry out surveillance for reportable communicable and other acute diseases, detect outbreaks, respond to individual cases of reportable diseases, investigate outbreaks, and carry out communication and quality assurance functions, as specified in F.A.C. 64D -3, F.S. 381, F.S. 384 and the CHD Epidemiology Guide to Surveillance and Investigations. 12. Refugee Health Program Programmatic and financial requirements as specified by the program office. .or the subsequent replacement if adopted during the contract period. Packet Page -1730- e 2 u � _ U ■ ■ e z u ■ w _ < I O _ -i « w _ � z � 0 Q q: W � 0 Q P K a 0 R =R /iE =o% &7k ■ o .E Cc / �R £cm �I@ 2/f a °I $%f /ff / � � Co k / § 2 § Cl) CL 5 � { /2 ) kƒ u \ o o U � ) / Cm ) 0 2 ) Ok a 00 k � \ ƒ \ CO \ s© 2U') \C\J LL\ /% (/ �E q 2 #? 0 ° Q £ E /I ƒƒ -\ // /G Em ©o to f w w \/ §2 CL (n/ /\ C6 ¥ Packet Page -1731- 10/28/2014 16.D.11. & .g 10/28/2014 16. D.11. 4. FEES ASSESSED BY STATE O12 FEDERAL RULES - STATE 001020 001092 )120(1 001206 ATTACHMENT II. 403.770 102.300 1,000 2,093 0 403.770 0 102.311 U 1,1100 I1 2.045 (1 403,770 0 102.3011 0 1,000 0 2,095 Version: COLLIER COUNTY HEALTH DEPARTMENT Page 1 of 3 Part 11. Sources of Contributions to County Health Department October 1, 2014 to September 30, 2015. . State C110 County Total 01D Trust Fund .. CHI) Trust Fund Other (cash) Trust Fund (cash) Contribution Total 1. GENERALREVENUE -STATE 015W0 AIDS P,ATIFNI' CARL: 140.000 0 140.001 U 140.000 015040 AIDS PRE:VI-..N'11ON & SItRVI.?Ii_Lt1NC'Ii• GI NVkAI_ KEATNUE 69,371 0 0,571 II 69.371 0150.11) CI ID • TR CON•IMIINI IN PROIIRAM 1.37.173 0 147.173 0 147,173 015040 DENTAI_ SPECIAL_ INl'I IA'I1VF 11kOJF(. FS 7,076 ti 7,070 0 7.071) Mi040 1x31 -1 kLSP0NSF'f0TrRkORISN'I 73.643 0 71.643 (i 73.,43 01 i040 FAMILY" PLANNING GENI:kAL RFVENUt, 57.217 I! 57.217 0 57.217 115040 11LPA'NriS AND LIVI -k FAIL1.1RF PICT' VEX] -1ON l CON 'I'll 01, 89.286 0 Sq.25i, 1 89.286 015040 N !GRAN l 1,A1.3[)I4 CANII' SANI 1'ATION 74.533 0 74.1 i3 0 74.333 113040 PRINIARYCARLPR(XiRAM 3[3,432 0 313,432 0 31.3,432 015040 SCI iOOI.1IrA1A]ISkl. \11CTS- GIiNERAl.RFVFN1.Jh' 218.073 0 21, ' 0 218.073 013030 Cl 11) GENERAL_ Rl'.VI_NUL NON- CAIT'GORICAI. 1.820,944 t) 1.820,944 0 1.820.944. GENERALREVENUETOTAL. 3.010948 0 3 3.010.945 2. NON GENERAL REVENl.11 - S 'I'A1 -E Mif11O C'IiDCAiNI RAI., IaiVENUI: NON -C'Al l :(iORIC'Al. 46.6011 0 46.606 fl 46,606 01;010 FNVIR0NN4I N'1'A[ B10M]7DIC'Al_ WAS IT 11RCXiRAM 13,75L) fl 13,739 0 13.759 013010 STATE UNDfiRCiROUND PFTROI_L•UNi RESPONSE ACT 3200 0 3.200 0 3.200 01-3 () 10 1'0BACC05TAI- F.ANDCO)'01% EUNITYINTE.RVLNTIONS 224.230 0 22:4,230 0 224.230 NON GENERAL REVENI.JE TOTAL 287.795 0 '87 795 0 287.795 . FEDERAL FUNDS -State 007000 AIDS DkUG ASSIS'I'AN'C' PROC.ERAM ADM1N 77,946 It 77,946 0 77,916 007000 AIDS Ilk FV1 N'IION 239.788 0 239.788 0 230.788 007000 BIOfBRRORISMIIDSPI "5A1.PRLPARLUNFSS 20.243 0 20.2.13 0 21.243 107000 C'OAST'AL BEACH WA'FF:R QIJAl.1'fl` NIONITORING 16.874 1 16,874 0 16,874 007000 C'ONiPREI IGNSIVE CONIN11.iN1 I'1' C'AKll10- PIIBG 22.586 0 22,386 (i 22.386 017000 FAMILYPI.ANNING 111.15X- (;RANI' 100.722 1 100,721 0 100.722 007000 INMIjN17.AIIONACFIONPLAN 76.761 0 007000 IMPROVING STD PR(XiR \N1S 2.812 0 76.761 n 76,71,1 2,812 0 2.812 007000 MCI I SPECIAL PRJ('T UNPI.ANNED PREGNANCY 0 007001 NIC"I I SPIY:'L11.. 1'R0JFC LS DI:NT'A1 .3'_,615 3-200 1) 32,615 1 32,018 0071M)0 NIt' KJ131 -IC IILAI.1 IA Ilk I-PARFDNF.SS 13ASE AI..LOC I :3.393 {) 3?00 133.593 [) 0 3?00 I - ;1.593 007000 RADON INDOOR Alk LPA F•(JNDNG ASSISI ANCE 6.10 0 0074)00 'FB C'ON'I'k0[_ PROJE'C'T' 7.1,0,2 0 031) 0 630 007000 'FOBACCO PRE•VEN'LION AND CONTROL, PItOGRANI 12,1100 0 74.062 0 74.06' 007000 WIC BRFASTFEFIXN(i 1'1.51511 COUNSI =:LING PRC)G 55A42 12,0011 0 12.000 I) 53,442 0 ;5.442 007000 WIC PRO(JI(AM ADMINISTRA IION 1,385,410 () 1355,416 0 1.383,416 015075 INSPECTIONS OF SUMNIFIt FEEDING I'I:OGRANt- DOF 1,500 0 015075 REFUGET I IE A1.:1'1I SC'REFNING EXIT -NSF RE•I1%1l131JRSFMF.NT 450,0(1[1 1) 1,300 0 1.5011 450.000 0 450.00() 115071 SUPPLEN•IENTAL. SC14001- IIEALTH 33.1590 1) :3,690 f) 33,690 FEDERAL FUNDS TOTAL 2,119,883 O '.739.S8 3 0 2- 739,8133 4. FEES ASSESSED BY STATE O12 FEDERAL RULES - STATE 001020 001092 )120(1 001206 (7I10SiATHWIDL f.NVIRONMENTAI•FFES CH S1 A I1iN'IDL' ENVIRONNMKI -AI. FFF.S DRINKING 1VATFk Pk0 1J CAM OPERATIONS MOBIU-.' I1OMF ti RV I'.ARK 1 GL:S 403.770 102.300 1,000 2,093 0 403.770 0 102.311 U 1,1100 I1 2.045 (1 403,770 0 102.3011 0 1,000 0 2,095 Version: Page 1 of 3 Packet Page -1732- 10/28/2014 16. D.11. ATTACHMENT II. COLLIER COUNTY HEALTH DEPARTMENT Part 11. Sources of Contributions to County:Heal.W.Department October 1. 2014 to September S0, 2015.' State,CtlD :: Count%, Total CHU Trust Fund .: CIJD Trust Fund Other (cash} Trust Fund (rash) Contribution 4. FEES ASSESSED BY STATE OR FEDERAL RULES - STATE 0 7.000 01) 1206 ON SiTF SI ;WA(JFD] SPOSAI. VF MIT FEES 7.000 001206 ONSI'lE SEWAGF'l RAINING (TNITFI1 1.000 001206 INIBIJC.' SW1,14Ni1NQ 1`001. PERMIT FEE510 %110 TRANSFI`R 27,000 001206 RR; t11.AT[ON OF BODY PIERCING SALONS 30 001206 SAN I TAI ION CER I IFICA "IES(F1:)OD INSPECT ION) 3500 001206 SLPTII' I'ANK RFSFARCIi SORC11ARGE 500 001206 I ANNING FACIIJ HFI,S 375 001206 TATTO VR1.X :RAM FNVIRONMI: ?N'I'AL I1LALAI1 1.000 FEES ASSESSED 131' STATE OR FEDERAL RULES TOTAL 549,570 �. OTHER CASH CONTRIBUTIONS - STATE 6500 OTHER CASH CONTRIBUTIONS TOTAL U 6. MEDICAID- STATE /COUNTY 20,1100 001061 HFALT11 START MP.DICAID WAI VFR DIREC -r - AHCA 20,1X)0 001069 CI ID CLINK' ITES 0 001076 CIID(LINICFFES 0 001078 Cl 11) (TIN IC FFF.S 0 001087 CI 11) CLINIC FEES 0 0111079 Cl ID CLINIC FF.I -S 0 001082 C'I ID CLINIC ITES 0 001039 C71 11) CLINIC FFFS 0 0o 1193 CI ID (L.INIC FI.FS 0 001192 CI 11) CLINIC FLLS 0 A9EDIC1ID TOTAL 0 7. ALLOCABLE REVENUE • STATE 1) ALLOCABLE REVENUE TOTAL U 8. OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST` FUND - STATE ADAP 0 PHARMACY DR(10 PROGRAM 0 WIC PR()GRANI 0 BUREAU OF PUBLIC HEALTH LABORATORIES 0 IMMUNIZATIONS 0 O'T'HER STATE. CONTRIBUTIONS TOTAL n 9. DIRECT LOCAL CONTRIBUTIONS- BCC /TAX DISTRICT 96336 009031 CFIll I.00AI. itFVFN1IF & FXI NDII URES 0 DIRECT COUNTY CONTRIBUTION TOTAL 0 10. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION - COUNTY 001077 C1113C,INIC FEES (1 001077 GI"NI-RAL CLINIC kABIFS SL:RVIC: FS .0 DRUG PURCI IASFS 0 001114 VLI AL, S'I A71STICS C FRIIFIED RECORDS 0 Version: 1289,5n0 Packet Page -1733- Total 0 7.000 0 7.000 0 1.000 U 1.000 0 27.000 0 27.000 1) 30 t) 30 0 3.500 0 3.500 0 500 0 500 Cl 375 U 375 0 1,000 fl 1.000 549,570 1) 549,570 L) 0 0 II 0 22.516 22 516 0 22.516 25,000 25.000 0 25.000 1.000 1,000 U LOW 6,500 6500 0 6-500 20,0110 20,1100 0 20,1X)0 22.000 77.000 0 22.000 30.000 30.000 0 30.000 1,300 1.500 0 1.500 6510 6,5(H) 0 6,500 135.016 135,01(, 0 135.016 0 1) 0 0 0 0 2,013.679 2.018,679 0 0 127,266 127,260 0 0 5,769.474 5,768,474 0 I) 96336 86 „356 (1 0 921.672 821.672 0 0 8,822.447 8.822.447 1,289.500 1.280.500 0 1289,5n0 1,299.500 1,299,50(1 0 1,289,5110 I W650 159,650 0 158,650 750 710 0 750 AWN*”, _ 50,00[1 )0.000 O 50,000 a_ Page 2 of 3 10/28/2014 16. D.11. ATTACHMENT II, COLLIER COUNTY, HEALTH:DEPARTMENT Part 11. Sources of Contributions to County, Health Department October 1, 2014 to September 30, 2015 OTHER CASH AND LOC:ALCONT'RIBUTIONS TOTAL 0 2.491534 _2;192.;34 0 3.492.53.1 12. ALLOCABLE REVENUE - COLINTI' ,70UNT'Y ALLOCABLE REVENUE TOTAL 0 State C lJD . County Total CHO 0 13. BUILDINGS - COUNTY Trust fund..'. CI.ID Trust Fund Other 0 0 0 (cash) `` Trust Fund (cash) Contribution Total 10. FEES AUTHORMED BY CO(1NTY ORDINANCE Ott RESOLUTION - COUNT), 711.200 UT1 1-1'11FS 0 0 01) 10)4 CI S'I'A'1'FWIOE IiNVIRONMENTA1. 1'FES 0 j72,700 572,7011 0 572.700 001 115 VITAL. STAl1ti'i)('S (TIO]FIFI) RECORDS 0 255,000 2;;_000 0 255.000 FEES ALIT11ORIZED BY COUNTY TOTAL. 0 1.037,100 I.t)_ 7.11X1 0 1,037,100 11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNT)' 1--(1tfl['MFN'I I V1 11CA F PURCHASES' 0 0 n 45,000 001029 C11D CLINIC FEES 0 942.775 9.12.775 0 942,775 (it) 1029 GENERAL CI, INK, RA 13 FS SFRVICES & DRL16 PURCIlASE-S 0 6,250 6?50 0 6.250 001029 RYAN k\'J111'E 0 213.000 243.000 0 243.000 0011190 CI1D CLINIC FIA -S 0 38.401) 38,400 p 35.400 010..03 (11I)SALE OF SERVICES IN OR OUTSIDE 01; S'(ATF GOVT 0 200 200 0 200 611000 CHI.) I- OC.AL. REV; N IE. & LXITNIA [URL'S 0 246,440 246.440 ti 246.440 011000 EARLY IA"-,ARNING COA1.11T)N OF SOU'1 HWEST FLORIDA 0 60.900 60,000 0 60,901) W 1001 CIID I TEAL I'M START C'OAL.I "IION CON1 RACT 0 465,096 405.096 0 465.096 010100 (:'111) SALES OF WAVIC'ES IN OR OUTSIDE OF SI'A'FE GOVT 0 2,000 2.000 0 2.000 011007 CI ID CLINIC FF S 0 500 500 0 500 090002 DRAW DOWN FKOM M113LIC IW..A1,111 UNIT 0 486.973 456.973 0 456,973 OTHER CASH AND LOC:ALCONT'RIBUTIONS TOTAL 0 2.491534 _2;192.;34 0 3.492.53.1 12. ALLOCABLE REVENUE - COLINTI' ,70UNT'Y ALLOCABLE REVENUE TOTAL 0 0 0 0 0 13. BUILDINGS - COUNTY ANNUAI. RENTAL FQUIVAI_LN'S' V:V,LO= 0 0 0 525.045 525.045 I'1 Al..LOCA I ION ,C (iOl .l)F:N GA 11: RFNI'Al. 0 0 0 76,200 711.200 UT1 1-1'11FS 0 0 0 196,000 196.000 GROUNDS MAIN]FNANC'E 0 0 0 195,149 195.149 BUII.,DINGS TOTAL t1 0 0 992.397 992..97 14. OTHER COUNTY CONTRIBUTIONS NOT IN Cl-II) TRUST FUND - COUNTY 1--(1tfl['MFN'I I V1 11CA F PURCHASES' 0 0 n 45,000 48.000 VF111CLE INMIRANCI' 0 0 0 15.9o0 15900 OTHER COUNTY CONTRIBUTIONS TOTA1, 0 0 0 0.900 6;900 GRAND TOTAL, CHO PROGRAM 6,558,19(; 4.954,15o 11,542,344 9,575,744 21,421,090 Version: Page 3 of,3 Packet Page -1734- 10/28/2014 16. D.11. ATTACHMENT fI, COLLIER COUNTY HEALTH DEPARTMENT Part 111. Planned Stang, Clients, Services, And Expenditures By PrograwService Area Within Each Level Of Service October 1, 2024 to September 30, 2015 }Quarterly ivxpendilurc.Plan 171"E's Clients: Services/ is[ 2411. 3rd 4th Grand (0,00) Units Visits (Whole dollars only) State County Total A. COMMUNICABLE NICABLE DISEASE CONTROL: I.NUMUNF!_ATION(101) 11114 9,i4t1 12,709 192,068 164,588 292,068 191,994 305,086 435,632 740.718 S'1'1) (102) 3.2o 1,211 1,924 75.520 b4,715 75,520 7i.490 107,040 184,205 291,245 IIIV /AIDS P11INENTIDN101AU 562 1.>i9 1,853 82.906 71.044 82,906 82,874 319.730 11 319,730 IIIV /AIDS SI)RVI?JLLAN(T,(03A2) 1.19 17 17 17,299 14,824 17,299 17,29.1 66.71(1 0 66,716 11117AIDS I'A'I't1:N "I' ('ARE(03A3) 7.50 388 2.2114 149.512 128.120 149,512 149,454 2 19,2 1 ± 357.385 576,598 ADAP(03A4) 1.99 31 68 31,221 215.754 31,221 11108 120.404 0 120.404 C13 CON1'R0L. SLRVICGS(104) 6.39 657 3.570 117.391 100,595 117 „391 117.345 321.202 131,520 452,722 CON1N•1. DISI:ASF.. SURV. (106) 6.19 0 4.443 120,125 102,937 120.125 120.078 197.656 265,609 463,2hi IIFPA'NrisPRFV1iN'1-10N(109) 1(i1 1,6-5 2 2,120 28.741 24,628 28.741 28,729 110.839 0 110,8319 Ill 113LIC I ILA 1. H I PRS:P AND RFSP(1 16) 4.95 0 8 96.356 82.570 96,356 96,320 327,916 43.686 371,602 Rl ".FIfGF1_ III:A11 -11(I19) 6.34 8.10 2336 166,073 142.3)2 166,073 166,010 6153.46 25,122 640,468 V11'AI.STATISI'IC:S(180) 271 IS, 23i 30.2 1() 35.137 30.452 ,15,537 35.522 0 137.048 1-17,0118 COMMUNICABLE DISEASE SUBTOTAL, h1 79 24,130 61,905 1,112,749 953•539 1,112.749 1.112,315 2,711,145 1,580,207 4.291,355 B. PRIMARY CARE: CHRONIC D1SF_ASE SkRVICGS(210) 1.47 tab 109 27.375 23.455 27.375 27.364 63.507 42,065 105,572 'I011AC:C'OPRIiVi'NTION(2121 4.88 0 4,1157 70.336 60.272 71336 70.309 271153 0 271.253 WICA21W1) 30.43 11,153 83.917 425,8(2(5 364.882 425.806 425.{511 1.6{)7.374 34,761 1,642.135 M, "'IC 13HEASl'FI:IiD1N(i ITER C`OI)NSFI 1NO(21W2) 3 17 0 5.538 34,05-5 29,183 34,055 34,043 89,840 41,496 131..;36 FANCILY I'LANNIN(i(223) 3 76 3.OS7 3.494 86,615 74,223 86.615 86 .5.4 2 229.274 11')4.761 334,035 IN•IPROVFD PREGNANCY OUR ONIL (_25) (I.IN 39 258 87,578 75.W7 87.578 57.544 0 337,747 337,7117 111:AL:11lYS'FAR "I 1'RFNAT'AL1227) 1089 1088 6.575 162,24; 139,031 162,245 162,152 155,SON 467,195 625,703 CON, t)' 12 1:II6NSIVFC141LD11FAI.TII(229) 1.23 217 491 20,721 17.756 20.721 20,712 0 79.9)0 79.910 I MAUI] fY S'1 "All I INI:AN1 (23 1) 4.91 778 4,955 78,332 67,124 78.332 78,302 53.578 248,512 302,090 SO1001, HFAL"I'l1(2 34) 7 6 O 171.926 106,391 91,169 106,391 1015.350 332.906 77.3 95 410.301 COM I'K HI I I.NS I V F, ADt11,1 11E:ALI "11(237) 797 IN" li1 13,861 146,457 125,525 146,487 146.430 236,837 328.095 564,932 COMS4 Nf'1'1' iIFAI, "FII DI-NI'TOPNII-NT1218) 1 15 0 431 19,(145 16.32(1 19.045 19.0,16 12,526 150920 73.446 DF.NTAI.HFALITI(240) 1643 4.297 8,265 310,862 266.383 310862 310.743 167.501 1,031,345 1,19S,952 PRIMARY CARE SURTOTAI, 94.11 28,9i6 506 -183 1,575,848 1.350,375 1,575.8.18 1,575?1N 3.223.110 2.554.202 6,077,312 C. ENVIRONMENTAL.IIEAI,T11: Water and Onsite Sewage Programs COASTAL BFA(:H MONf'1'ORING(347) 0.15 321 321 5.732 ;1,912 5,732 5.729 22.105 f) 22,105 2.17411'121) I1SI 11I..BIAC.' WATER SYSTEMS(3i7) 0.23 208 1,1(12 :1.766 3,227 3.766 3.766 5,154 9,371 14.525 N.IB1.1(' WA1'ER SYS'lFM(3581 0,00 0 0 20 17 N) 19 3i 41 76 PR1VATF WAITRSYS'H- Ai(359) 0.01 0 9 237 203 237 236 0 913 913 INDIVIDUAL SE=1VACiF DIM) (.361) 6.512 2,083 4,046 99,903 55,609 99,903 99,564 158,795 2215,484 385.279 Group Total 6.41 2.612 5,478 104,6`18 93'968 109,658 109,614 186,059 236,809 422,898 Facility Programs FOOD HYGIF.,NFi (3481 1.26 176 761 19,595 16,794 19,598 19,590 75.380 0 75,580 13)D1' PIERCING FACI!_I'rl1 S SI::RVIC'LS(349) 1).01 2 3 327 280 327 327 1,261 0 1.261 GROUP CARE FACIL11- 1'(331) 0.54 184 304 8,435 7,225 8,435 5,131 0 32,529 32,529 1 IGIZAN'T LABOR CANV(352) 2 91 184 1,09i 49,115 42;130 49'5 I i 49,4915 132,959 57.967 190,9555 Version: Page 1 of 2__ Packet Paaa -1715- 10/28/2014 16. D.11. ATTACHMENT.M...'... COLLIER COUNTY HEALTH DEPARTMENT Part 111. Planned Staffing, Clients, Services, And Expenditures By Pro gram` Service Area Within Each Level Of Service �Oqober 1. 2014 to.Septernber.304015.!...., Quarterly Expenditure 1112n FFE's :Clients Services/ -:1st 6 2.0. 3rd. 4th Grand (0.00) Units "sits dollars only) State County Total C. ENVIRONMENTAL HEALTH: Facility Programs I IOUSINQPUBLIC 131.136 SAI:17TY.SANI'FA-1-ION(353y).00 1) 0 0 U 0 0 O 0 0 MORILF HOW AND PA R K S SF R V I C I-- S (3 54) 0.40 80 243 6.121 5.245 6,121 6.119 23.606 f5, 23,606 S W1110 N1 I N(; 1100INR Afl It NG (3 60) 364 1,663 18.0i0 70,804 60.673 70.804 70.776 112.975 160,182 273.057 BIOMEDICAL WASTE.SERVICE,S(304) 1.07 631 660 22.349 19.151 22.3119 22.339 56,182 30,006 86,198 TANNING FACI L I I Y SERVICES(369) 0.09 15 46 1,312 1,124 1.312 1.311 4,559 500 1,059 Group Total 9 -92 '_x)35 21.162 178.461 152.925 178,461 178.389 407.052 281.184 688.236 Groundwater Contamination STORAUFTANK COMPLIANCE(.355) 000 0 0 0 0 0 0 S1.111ER ACI SERVICE (156) 0.06 40 64 1.001 858 1,001 1.000 3.860 1) 3.860 Group Total 006 40 64 1,001 858 1,001 1.()()() 3,860 0 3.860 Community Hygiene TA FI 00 FACIL,I HFIS SI:RVI(*[:S 18 0 43 3,162 2.710 3,162 3, t 61 12.195 1) 12.195 COMMUNITY ENVIP, 111.7A1.T1 1 (34-.)) 0,00 0 0 15 13 Ii 14 28 19 57 INJURY PREVENTION(346) 0.02 0 0 .;i(j 476 556 3511 1,000 1.144 2.144 LEAD MONITORING SERVICES(350) 0.00 0 0 9 N 9 9 17 18 35 K fl)L,[C* -SI.-WA(;[: (362) 0,(4) 0 1) 29 25 29 29 5,0 62 112 SOHD WASTF DlSfl(.*.)SAI.(303) 0.00 0 0 9 8 9 9 35 kNl 1AIZY NIJISANCHJ3651 0.00 0 0 52 45 i2 ;2 100 WI 201 RABIES SURVEILLANCT-WON IROL (366)0.00 11 0 ARBOVIRUS SURVI-T-LANCf.'(367) 0.00 0 0 89 76 89 813 0 342 342 RODENVAR] 11P,01101) CONTROI. (368) 0.00 0 0 0 WATI-A P0[A.UI*K.)N(370) 0,00 0 INDOOR AIR(371) 0,00 0 0 0 0 0 RADIOLOGICAL 1-11-ALT1 1(372) 0A)0 8 7 8 9 16 16 32 I'OXIC SUHSTAWTS 1373) 0,00 1) 8 7 8 9 16 1 b 32 Group Total 0.20 O 45 3.937 3.375 3,937 3.936 13.•37 1.749 15.185 ENVIRONMENI'Al, HEALTH SIJBTOT,kl. 1&39 5,587 26,749 293,057 231.120 293,057 292939 610,438 519,741 1,130.179 D. NON-OPLRATIONALCOSTS: NC)N•OPt?.12A'1'IONA[. COSTS(299) 0.01.) 0 U 0 0 0 I-NVIRONNII-XI'Al, 1-fl-'Al. I'll SO(MAK(3I-'(3399) (1 00 0 0 11,280 9.666 1 LM 11,274 43.5041 0 43,500 M 1: 1) 1 CA 11) 13 Ll Y13 A C K (611 ) 0.00 0 0 0 0 0 NON-OPERi%TIONAL COSTS S1,113TOTA L 0.00 0 a 11.280 9,666 11,280 11,2711 43-500 TOTA L CONT RA CT 172-49 i8.673 5,144.937 2,992.934 2.564.709 2,992.934 2.991.769 6.588.19b 4,954,150 11 .542-146 Version Packet Page -1736- Page 2 of 2 10/28/2014 16.D. 11. 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. IS Packet Paee -1737- 10/28/2014 16.D. 11. ATTACHMENT IV COLLIER COUNTY HEALTH DEPARTMENT FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT Facility Description Collier County Health Department & Public Services Building H Immokalee Satellite Golden Gate WIC Office CCHD Annex Location Owned By 3339 E. Tamiami Trail Collier County Building H, Naples 419 North First Street Collier County Immokalee 4945 Golden Gate Parkway Benderson Unit 142, Naples Development 3205 Beck Blvd Naples Packet Page -1738- Florida Department of Environmental Protection 10/28/2014 16. D.11. ATTACHMENT V COLLIER COUNTY HEALTH DEPARTMENT SPECIAL PROJECTS SAVINGS PLAN CASH RESERVED OR ANTICIPATED TO BE RESERVED FOR PROJECTS CONTRACT YEAR STATE COUNTY TOTAL 2013 - 2014' $ $ $ 2014- 2015" $ 0 $ 0 S 0 2015- 2016— $ $ S 2016- 2017— $ $ S PROJECTTOTAL $ 0 $ 0 S 0 SPECIAL PROJECT CONSTRUCTION/RENOVATION PLAN PROJECT NUMBER: PROJECT NAME: LOCATION/ ADDRESS: PROJECT TYPE: NEW BUILDING ROOFING _ RENOVATION e PLANNING STUDY _ NEW ADDITION OTHER SQUARE FOOTAGE: PROJECT SUMMARY: Describe scope of work in reasonable detail START DATE (initial expenditure of funds) COMPLETION DATE: DESIGN FEES: $ CONSTRUCTION COSTS: $ FURNITURE/EQUIPMENT $ TOTAL PROJECT COST: $ COST PER SO FOOT: $ f#DIV /Ol 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 9130/14. "'Cash to be transferred to FCO account. '**Cash anticipated for future contract years. 20 Packet Page -1739-