Agenda 10/25/2011 Item #16D 810252011 Item 16.D.8.
CYlY \I
Aea ®mndnbo m approve and aelhotintlm CWGmao mnxute oche FY ii- ]Snommt bMwm
Caldtr County and ma skate of Floras Deparmant of Fiplth fw ain ndoo of &a CdDar Conant
R DePmrman[ m me amount a$1,324,dad.
O Fl�CTTW To provide local funding m m tuna dun Ievel 017public Iee1W smvices provided
m the residents of Colfie County.
CONSmERAMONS: Each year, the Comdy enmm into an agreement wiM de Stale ofFimida
Department ofHeeDh to provide fords and facilities for the Provision of public h services.
The atmched represena the FYI 1 -12 cuumot efacti' ve October 1, 2011 through September 30,
2012.
The agreement identifies the services dent will be provided with the cast share between the Sate
and the County. The mat armurt affacW is $1,324,400.
EINCAF. OZACT. The comnct includes a cash wambution of $1,324,400 for Public heildt
Programs. These fiords are budgeted in the FY12 General Fond (001) budget in tle Public Heath
cost center. Adminiswtion cobs of $327,300 me in sdditiun to the contact pmgrem coats of
$1, 324,400 and use included in the FY12 Gmmal Fund (001) budget.
GROWTH MANAGEMENT IMPACT: Them is no Gmwth himadmams: Plan impact
associated with this hat.
LEGAD MMDERATIONS: This item has been reviewed by the County Atomey's Office,
ryu'ma majority man, and is Iep[ly sufieient for Bound nation. CMG
BT& 2MENDATION: That the 130=1 of County CammlSamrea approve and udborim the
Chairman m enamte the annual contract with the Sam of Florida Depow nt of HesIW for de
operations of the Collie Can* Health Depamned.
Prepared by: Ann Portia, Collier County Heath Department.
Packet Pap -2Wl-
10/25/2011 Item 16.D.6.
^ COLLIER COUNTY
Board of County Commissioners
Item Number: 16.0.8.
Rem Summary: Recommendation to approve and autharlxe the Chairman to execute the
FY 11 -12 contract between Collier County and the State of Florida Department of Health for
operation of the Collier County Health Department in the amount of $1,324,400.
Meeting Date: 10/25/2011
Prepared By
Name Nelsoni
Title: Administrative Assistant. Senior,Parks & Recreation
1013/2011 11 11:43 AM
Submitted by
Title: Administrative Assistant, San or,Parks & Recreation
Name: NelevTore
10/32011 11:11'.44 AM
Approved Ry
Name: NelsunTOna
Titie: Administrative Assistant, Sentor,Patks & Recreation
Date: l0/32f111223'.03 PM
Name: NelsonTom
Title. Administrative Assistan , SeniogParks & Recreation
Date 10/10201142629 AM
Name: RamseyMZrla
Tide: Adminiaramr, Public Services
Date: 10/11,20112603) PM
Name: GreeneColleen
Title: Assistant County ARomey,County Atowni
Date'. 10/12/20119'.13:1] AM
Packet Page -2092-
Name: KlamkoxleR
Title; County AmmMey,
Date: 10/14 /2011 11:43:24 AM
Name: Prym(Tep-0
Title: Managememl Budget Analyst Senicr,O fiw ofManagament @Budget
Date: 10/17/2011 4:5899 PM
Name: Ocigsleo
Tate,, Coumy Manager
Cale: 10/17/2011 531:39PM
Packet Page -2093-
10/25/2011 Item 16.D.8.
n
10/25/2011 Item 16.D.B.
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 2011 -2012
This agreement ('Agreement') is made and entered into between the State of Florida,
Department of Health ("Stale ") and the Collier County Board of County Commissioners
( "County'), through their undersigned authorities, effective October 1, 2011.
RECITALS
A. Pursuant to Chapter 154, F.S., 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. It is necessary for the parties hereto to enter into
this Agreement in order to assure 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
conect and incorporated herein by reference.
2. TERM, The parties mutually agree that this Agreement shall be effective from
October —1,2011, through September 30, 2712, 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 B,
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
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10/25/2011 Item 16.D.8.
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 central, radiological health, and occupational health.
If. "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 avallable federal, state, and local funds and shall include these services
mandated on a state or federal level. Such services include, but are not HIV /AIDS,
�munlmatwn, transmissible
and maintenance of vital statistics, control,
G. "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
dimes. These services shall be supported by available federel, 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; r,
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
If of Attachment II hereof. This funding will be used as shown in Pad I of Attachment II.
i. The State's appropriated responsibility (dlred mnhmutbn exdWmg arrears leas,
haedxam coddhuxons w any oasar hoes nd ailed on the Sidi c) as provided in
Attachment II, Part 11 is an amount not to exceed $ 5,882,163 (stare General
Pheenue, stale Funds, other Slate Funds and Federal Funds &on on the Sche nis C). The
State's obligation to pay under this contract Is contingent upon an annual
appropriation by the Legislature.
ff. The County's appropriated responsibility (axed convkulbn exdudasg any fees,
ease, cash vwxx cummwtions) as provided in Attachment II, Part II Is an amount not
to exceed $1,324,400 (amount bled under the 'Bi of (bully Commlasioners Annual
Appmpdeficns ssctkn of the revenue eHechnrent).
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 ofhetwise, any surplus at the and of the term of this Agreement 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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10/2512011 Item 16.D.8.
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 increaseordecrease 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 inflates the increase /decrease, the CHD will revise the Attachment It
and send a copy of the revised pages to the County and the Department of Health.
Bureau of Budget Management. If the County inicates the increase/decrease, the County
shall notify the CHID. The CHO will then revise the Attachment II and send a copy of the
revised pages to the Department of Health, Bureau of Budget 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, Bldg. H
Naples, FL 34112
5. CHD DIRECTOR/ADMINISTRATOR. Both parties agree the directodadminlstrator
of the CHD shall be a State employee or under consent with the State and will be under
the day -t day direction of the Deputy State Health Officer. The director /administrator
shall be selected by the State with the concurrence of the County. The
directadadministrator of the CHD shall insure 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 Bractor/administrator to the parties no later than
October 1 of each year (This Is Ins standard pualiry assuranre °Cckxrty Hasa; Pre te•repon Incatea w
as Office ofPlanarg, E asatmn 6 Date Malysk lnicanal sta)
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 Stale or State-contract personnel
subject to State personnel colas and procedures. Employees will report time in the Health
Management System compatible formal 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 commented, Such justification and compliance documentation shall
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10/25/2011 Item 16.D.8.
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 slate 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 Nose records that are not otherwise subject to disclosure
as provided by law which are subject to the confidentially provisions of paragraph 61,
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
System Information Resource (FLAIR).
H. 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;
W. Financial procedures specifed in the Department of Health's Accounting
Pmcedums Manuals, Accounting memoranda, and Comptrollers
memoranda; ^
Al. 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 CHID 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 CHD 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
credHed /debfed to the state or county, as appropriate, based on the funtls conMbuted 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 fine 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 Wst 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
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10/25/2011 Item 16.D.6.
^
surplus funds shall be reflected in Attachment II, Pad I of this contmd, 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 me pu dc's health and the Deputy State
Health Officer has approved the transfer. The Deputy State Health Officer 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 party, an audit may be conducted by an independent CPA
on the financial records of the CHD and the results made available to the pardes within
180 days after the close of the CHD fiscal year. This audit will follow requirements
contained in OMB Circular A 433 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.
y. The CHD shall retain all client records, financial records, supporting documents,
statistical records, and any other documents (including electronic storage media) pedinent
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 and 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 protedion and
confidentiality of all such records and shall comply with sections 384.29, 387 004, 392.65
and 456.057, Florida Statutes, and all other state and federal have regarding
confidentiality. All confidentiality procedures Implemented by the CHID shall be consistent
with the Department of Health Information Security Policies, Protocols, and Procedures,
dated AprII 2005, as amended, the terms of which are incorporated herein by reference.
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 rasped 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 6.1s. hereof.
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
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10/25/2011 Item 16.D.8.
CHID will advlaa applicants of the night 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, Mies or
program manuals are Included in Attachment I of this Agreement.
n. The CHID shall comply with the provisions contained in the Civil Rights Certificate,
hereby incorporated into this contract as Attachment 111.
o. The CHID 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
DE385L1 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, Bureau of Budget
Management.
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10125/2011 Item 16.D.8.
P. The dates for the submission of quarterly reports to the county
circumstances shall nc as follows
unless the ontri generation and distribution of reports is delayed due to circumstances beyond
the CHD's control:
i. March 1, 2012 for the report period October 1, 2011 through
December 31, 2011;
fi. June 1, 2012 for the report period October 1, 2011 through
March 31, 2012; -
Al.. September 1, 2012 for the report period October 1, 2011
through June 30, 2012; and
or December 1, 2012 for the report period October 1, 2011
through September 30, 2012,
T. FACILITIES AND EQUIPMENT. The parties mutually agree that:
a. CHD facilNes 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 assure 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 transomed to the ownership of the County and registered as
county vehicles. The county shall assure 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 HeaIN Department Treat 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
Treat 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 counted 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 certiFled mail. return
receipt requested, or in person to the other party's contract manager with proof of delivery.
i-. c. Termination for Breach. This Agreement may be terminated by one party, upon no
less than thirty (30) days notice, because of the other padys failure to perform an
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10125/2011 Item 16.D.8.
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 shell not be construed to be a modification of the terms of this
Agreement.
9. MISCELLANEOUS. The parliesfuRheragree:
a. Ava'lab'fty of Funds. If this Agreement, any renewal hereof, or any term,
performance or payment hereunder, extends beyond the fiscal year beginning July 1,
2012, 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 faces:
For the State: For the County:
Joan M Colter M D M P.H.
Made Olsv'a Ramosv
Name
Name
Director, Collier County Health Deol
Public Services Administrator ^
TRIe
Title
3339E Tam am Tre'I Bldg, H
3339E Tam am' Trial Bldg. H
Naples. Florida 34112
Naples. Florida 34112
Address
Address
(2391252 -8201 -
(239) 252 -8383
Telephone
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. Cam. 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.
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10/25/2011 Item 16.D.8.
In WITNESS THEREOF, the parties hereto have caused this 24 page agreement to be
executed by their undersigned officials as duly authorized effective the Id day of October, 2011,
BOARD OF COUNTY COMMISSIONERS STATE OF FLORIDA
FOR COLLIER COUNTY DEPARTMENT OF HEALTH
SIGNED BY:
NAME: H. Frank Farmer, Jr.. MD, PhD, FACP
TITLE: State Sumeon General
ATTESTED TO:
SIGNED BV: NA E
NAME: NAME: J en II. Colter M.D. M.P.H.
TITLE: TITLE: CCHO Director /Administrator
1G
DATE: DATE: > f4x ... Is D(I i,a 0 /I
Appromectlas to corm and
legs en y:
Seffr %latzkow
Count torney
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9
10/25/2011 Item 16.D.B.
ATTACHMENT I ^
COLLIER COUNTY HEALTH DEPARTMENT
PROGRAM SPECIFIC REPORTING REQUIREMENTS AND PROGRAMS REQUIRING
COMPLIANCE WITH THE PROWSIONS OF SPECIFIC MANUALS
Some health seMCes must comply with species program and re ending requlra'nants to addition to the Personal Health
Coding Pamphlet (CHIP 50 -20), Environmental HeaIN Coding Pommel (DHP W -21) and FLAIR requirements bemuse
of federal or state law, regulet'mn ofrule. If a county health department is fundetl to provide one of those saMces, it
moth c0mptywilh fhe special repotling aquVemenk im Net service. The services and the mpoNing requirements are
Ilstet below:
Sw m Reouagmnt in FAC 1. Specially Tansmlhad Disease Requirements g and We OHD'GUdldabook 64D -3, F.S. 301 and
Program
2. Dental Health MonPly repod'mg on DH Form 1000'. Additional capering
'Ill hired The
requirements, under d0valopment xs e , requ
additional reporting requirements all be communication! upon
Onalhafion.
3. Spacbl Supplemental Nulrimn
Service documentation and monthly financial copper as
specified in DHM 150-24- and all f all slats and county
Program her Women, bubble
d baled in program manuals and punished
and Children (including the WIC
requirements
BreesReeding Peer Counseling
Procedures.
Program)
4. HeauhyslarV
Regmameok as spemned in the 2007 Healthy Stan
Improved Pregnancy Outcome
Stan Coalitions In moVacl verb spur munryhelel�hHeellhy
department.
Periodic financial and progammalls reports as shoutetl
S. Family Planning
by the program office and In the CHO Guidebook. internal
OpereYng Pdiby Pear N 14'
Passaic reports as assured by the assembled re9aking
8. Immunkmain
Me suruelllanceilwar ligallon of reportable vaccine
prevenabbe diseases. va¢Ine usage accountabibily as
documenletl In Funds SHOTS, the assessment of venous
uniagm levels As documabted In Florida SHOTS and
terms doming adverse events Meaning Immuniati
7. Chronic Disease Program
Requirements as spstlfled in the Heal My Communities,
Healthy Feople Guidebook.
8. Environmental Health
Requirements es specified! In Envbonmenkl Heats Prcgams
Manual 107.4' and DHP or
9. HIV/AIDS Program
Requirements as specified in FS. 3134.25 and
64D -3.016 and 3.017 F A.G. and vie CHD Guidebook. Case
reposing should be on Adult HMAIDS Confidential Casa
Report CDC Form OH2139 and Pediall HIV/AIDS
Confidential Use Repot CDC Fear DI-2140. fork
10
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10/25/2011 Item 16.D.8.
ATTACHMEobT I(Contoned)
tlemogrephe date on persons rested for HIV In CND conics
shouod be reported on Lab Request DH Form 1620 or Part-
Task CdNseling DH For 1626G These repair; are to be
sent 0 Me Headquarters HIV /AIDS office eithin 5 days of the
Was post -test counseling appoin"ent or Within 90 road d
the missed post -test counseling appointment.
ia. 3chod Hill Servlcos Requirements as speafred In Me Florida School Heigh
Administrative Gunshots (Agri 2007).
11, Tuberculosis Tuberculous Program Requirements as specified In FAC
64D 3. 1 Specific Autlnrpy 361.0011(13), 381003(2),
38f. 0031(6). 364.33, 392.53(2), 39266 FS Lew implemented
381.001 1(4), 381.003(1), 381.0031(1), (2f, (6), 38306,
384.23, 384.25, 385.202, 39253 FS.381 and CHD
Guidebook.
12. General Communicable Disease Control Carry out suraWance for reportable communicable and other
acute diseases, detect outbreaks, respond to Individual cases
of reportable diseases, Mweagate oulWaaks, and carry out
wmmunuallon and quality assurance locators, as specified
In the CHD Guide to Suwelliance and Investigations.
-or Me subsequent replacement if Wopted doing Me contract period.
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10/25/2011 Item 16.D.8.
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74,533
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255M5
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3,554.546
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13,949
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131.218
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30.08
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45.158
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0 19351
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129.181
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10/2512011 Item 16.D.8.
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3. FEOERALFONDF -Stale
015025 BBHOPLTffxu NWo
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33.690
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0
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3,V5jx
0
3,02530
0
3,05.800
4. FEES ASSESSED BY STATE OR 111MRAL ROLES STATE
CILS U
0
3,180
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o01oz0 RANixnllsmOFESMIT
56,9w
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19,300
0
19j00
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28,0o
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0
0
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0
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0
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0
0
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0
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0
0
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0
0
0
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0
0
0
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0
0
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0
0
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623$50
0
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0
0
0
0
0
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66,02
0
65,m2
0
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O TIES CASH CONTRIBUTIONS TOTAL
66.032
0
0,02
0
6. MEDICAID- sTATFICOVNTT
I.RDIGIDPBARMACY
248.498
319.80
564,00
0
561.000
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WE
32.908
32.908
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19,0D
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38.00
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20.00
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4.0
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0
269.626
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2108
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Item 16.D.8.
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6. MBOIGN- STATP/(.UUNrY
3.9W
4469
0
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3 ;655
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3,769
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675,593
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3,160
;160
180
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0
0
0 101.]65
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0
0 INP30
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0
°
0
0
0
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0
0
0 865.91
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0
0
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0
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0
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0
0
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133
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1,334,400
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10. MMAUTROMBE
Packet Page
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10/25/2011
Item
16.D.8.
IO, pMA=OMEDHVCOUAI
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001060
CHD 6IPPORt 0.'68rINV
0
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VALC9i0
0
0
0
0
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139.778
154.771
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0
0
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0
0
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0
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1.058,128
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1.068!28
11. OTNGRCASHANDLOCALCONMlSUTIDNB- COUNTY
RENPNEDCHECKTTEM
0
0
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Packet Page -2110.
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10/25/2011 Item 16.D.8.
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0 °
011000 GPANi�NRELI ° ° 0
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011000 GRANLDIRHT 0
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OTHER CASH AND LOCAL CONTRBUTIONS TOTAL ° 1956.W1 1,954011 0 %956Wi
12. ALLOCABLE REVENUB- COUNTY
OIWW PPPDNDS 2.180 2,no 0 2,180
olift'l PRIDRYPI.RwARRnNr ° u 0 0 °
032" Ixmaxreanw,wRN+T R ° ° °
COONTYALLOCARLEREVENUETOTAL 0 TIRO y16o 0 21"
13. BUILDINGS - COUNTY
ANN[IPLnEMALEOmvPLENrvALUE 0 0 0 ss5,0N llSOW
CROUNORMAMTHINAMLY 0 0 195,149 195,149
01RER lRPBLRY) 0 0
MSUTORE 0 0 0
UOLITIR�TFl8PH01E,RLEC1RlC, WATERR5EWE0. 0 0
0 0 0 0 0 0 xO.R 2A31
OMRRISPEGIPYI 0
Hvu.D1ND MnmrexANCa ° o ° 65,10 6saRR
maIDING5 TOTAL 0 0 o Lm9s91 Lm9s91
14, OTHER COUNTY CONTRIBUTIONS NOT IN CHO=On RIINB- COOKY
EONPM6Ni1VEMQ6PVRCHARES 0 0 0 °
VEHICLBINRIIXANCR 11.900 1 7'9W
VEIIICLB MAINOWAN¢ 0 ° 0
OTHC3LOUMYLOR40.0)V110NIRPECIPYI ° 0 �^
OTIB2COUNTYNNTRIBUTIW1lRPEGPIJ 0 0 0 0 0
O THEIR COUNTY CONTRIBUTIONS TOTAL 0 0 0 11900 11.9W
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10/252011 Item 16.D.8. 1
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A. Magee NICAB 0patAB2LYINTROL:
M16NMZATI(DT001) 1412 1 ;510 26.40 240.612 206y9 MG612 Bang 80.636 M376 ULM
STDDO) 69 96 1,00 186.122 9 ;147 19012 93.147 7,072 193.610 400610
SIIWI PREVBNPON(NAI) 330 63,50 54,1".7 218)50 LIAM 235.46
RIVIMILS )
pRyh4ANC N ) Lso 169 393 21,oN AM 271000 00000 SO,MO 9.000 IDIOM
®VIANBPATIINPOMP @3.V) 1 @0 1,151 26D 29,116 72.062 2$116 225261 443.701 5 5 969,]56
Ap(0M) 230 603 IIAN T7 0 MP50 81. @0
TE COMRN.SERVI�(101) 256 87 M '1151 414 331 81,156 420,70 314,318 MPH
OOBW[ABDUESORV Ow 6.30 0 17 39,615 119670 139,615 IV,6M RS 518.545 51 &57
pl®yPMION(109) 374 2567 3,568 45545 32019 45,545 39.039 10..161 7 169.168
A CF@U.3H 7777,540 7227 ([16) 552 0 4 98.149 84.110 98.149 84.128 153.356 211,198 3641551
WMSTAMUCIGHM 4.30 5 1,685 51,040 005 N.80 47,905 2 71,688 WGOO
COMMUNICABL608 MBVXTOTAL 7122 4.061 DD .50 I,6,,5 1,091,0111,]69,05 1,091,41 ;011,789 3,47,101 4.021,]53
B. PRIMARVGRE:
FIRCMC ORPASEaBIV10ENAM 0 MR 13.210 11,92 1I,w 11,9]] 15.617 35.417 I,OII
TOBACCGPRGV0i31 RIN LB 0 2542 NcNI 48546 56,539 49,546 15],5]4 S ;M 21OGM _
MCRIWI) 7825 10,50 121,551 QGJV 2;16x` 3".9201,58 &218 0 1,5Y.218
006 RRPA6TPFPDMG PEPR WONS61sXG 71003) 2 4556 31900 25151 39,981 436.151 AM 101.20 0 IW r
11ANNMO(M) 25k 4415 06 61 99,461 410.998 0 430,99
MPM1OVCO PPPGNANCT OVINL0225) 1,516 9519 395.01 167,]18 195,671 161.71D 493,09 233.75 726,378
1®ALTXY clARTPMNATALaGO1 1909 226.94 INGO 26.924 194,549 500.000 MN6 0506
COMPACNNL3IYE CX11llXP.LLTX(339J 136] 1333 IQ67 54,260 46,509 YSW 46,50 RO526 111,163 I,AE
TXY SSART3NE Ml) 341 882 4122 14,902 38 }0 ME 3840 16]]8 0 65]18
SCGOp1, N61aSX Q34J 719 0 NG.MO WIN MAI$ 178.001 103,858 341,052 IN aN NS.i le
rye 78117,21@.77,)X6329
1,511 3.150 116.30 1]5420 146,In 125,450 25.624 M.MD IAaLt4
p163111MTY1@pLTX GGYGLOPMENlQ38) 0.0 0 0 0 0 0 0
7278.77, 1@.77,)4(20) 154] 4.90 IOj05 31,50 0 111563 ] 391,61 BW.06 1231,90
pR]MABYCA SUBTOTAL IM41 990 410,485 1)61,510 1,510475 1P61,510 ;,510,413 4.515,258 205.12 6.54370
C. ENVRIONAMNfALHLV,TR:
W N
1 ad OMM SGMB+ PMOMMP
q7, SBAGI MOiiIORMO(J4'O 02 851 851 8.916 ].43 &916 7M2 33.116 0 31.116
LIMf18G VBB PUBLIC 00.7282 SYSIeNSPS'O 0.18 3 %V9 ;65 3,145 ].l0 10.50
RRWC \VARBR SYSTEMQ58) 000 0 0
MVATBWATa03yIM%D M aOD 0 0 58 50 58 W 0 216 216
P DDtDUAL SBWAGE OISF. P61) 655 3,113 8,521 155257 135699 158.257 135.49 Mae 24,921 585.012
Group TOlel" 7.17 4.03 W.Me 17.04 145,766 IMMO 145.766 379,152 2525M 631,652
aClMy PlIgnma
PpOORYUMME(YB) 101 In IM M..50 31513 78.50 11,343 135.BID u 135530
MTP4q 00 5 13 288 M7 278 247 554 516 1,00
CARE PACIPTY(]51) 104 191 Te 13616 11.685 13,616 Men 4,504 46.14 50.646
pANi1ABd6C6Mp(39) 194 PD 1,288 3109 27,110 31,699 27.170 77.60 40. %a 117.98
NCUSMO.PV012C BLOC SAFETYgLMTA9Wjl53p 00 0 0 0 0 0 0 0 0 0
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MOOIt6HOM6PND PARK33E0.VIC61354) 057 113 435 9.912 Q790 794 4]90 Nuw 9.924
WIIgA14GpOOLSBATNnOn6% 3.G 1.110 O.IN 82,861 C.OG U857 71,O9 233.771 N,NI 303,792
WW[aaU WAOEORVIE 06) 64900 66 oe SO M ANNMO PACIITTY 39 WOODOt 516 IS,IW 15'153 63.6%
Group Total 1030 2.126 16,351 193,771 164.638 19 ;078 168.631 Oc.Q5 170,997 93,432
• Ta OOnbnlnaNOn
AM(COAP1lAN<e(355) U1 0 0 0 0
SOFPR road VICEnS% 0 96
Group nIt 0.01 II 16 198 170 198 170 736 0 96
OammuNry HYRlana
OIXUPAi1pINNQN) ON 0 0 0 0 0
RIHR RE
COLAIVMTY 1Hp45) u 0 0 0 0
MIII0.Y PREVENIIONn461 P 0 0 19362 8.589 19.362 93.91a 992
OTaUcsNRmE(36O RVICfi3n5% 007 0 50 6 3 1336
06 (3663 00 0 14 0
aGAD n ) 000 0
�NrtaRY
001 1 a 116 99 116 BMILGNW (365) 0A
n66).()W OU 0 0
99 xi2 x
�Rt198VRVaI1lANCEn6l) SS 000 0 0 0 0 a D 0 0
WATERPOLL OD7M ROLQ68I 0
ONp7% 000 0 0 0 0 0 0 0 0 0
AIRn7U ano 0 o 0 0 0 0 0 0
ww1DLDHICnLH6N.T9o7H aoo o 0
TOwc swar,wcFS p») 0 0 0
Group Total 12B 1 53Z 3 ;719 19.469 33.719 19.969 4G&67 40,&9 84386
&NVp10N17@N[AL VFALTO 9OBTOTAL I866 ke21 ,an 3laW3 18 5'050 310.081 965.990 960,196 1,430,386
D NON- OP%RATIONAL COSTS:
NanLpnulwul Cm ORO 000 0 0 0 0 0 0 0 0
m4vmDnmercra.xEa.Tx suRCx ixcaps9) aoo p Star 0 Sam
NON -OPERATIONAL C0WS S(IBTOTAL 0w 0 0 13462 IL538 50.000 0 _
TOTAL COMPACT 19335 KOG 500974 I,4uO7 ;943,09X,429,857 c "3.0937.545,517 5200091 12,745,98
Version: 2 1 Page 2 of 2
Packet Page -2111
10/25/2011 Item 16.D.8.
ATTACHMENT III
COLLIER COUNTY HEALTH DEPARTMENT
CIVIL RIGHTS CERTIFICATE
The applicant povMss this assurance in consideration of and for the purpose of obtaining federal grants, loans,
contracts (except Orchards of ireurval w guaranty), Property discounts, m order federal financial l ater�al m
prrgrama or activities receding m benefiting farm federal finanuel assist rrvu The provider agrees ro complete
the Civil Rights Compliance Due dionneha, DH Forms 946 A and B (o me subsequent replacement If adopted
during vie contract periM). If so requested by the department.
no applicant measures that It will comply wM:
1. Tito VI of 0e Civil Rights Act of 1964, as appeal 42 U.&C., 2000 Et seq., which prohibits
dacrlminatbn on the basis Of race, odor or national mgln in programs and adMlles receding cr
bene6fng farm federal financial restaurant.
C Section 504 of the Rehabilitation Act Of 1973, as amended, 29 LL5.0. 794, which prohibits tliWminalbn
on Me basis of handicap In programs and aGNltes recaiving Or banishing from federal financier
asslsompt..
3. Tits IX of the Educe lon Amendments of 19l as amended. 20 US.C. Men at seq., which prowl
discrimination on the basis of am In education programs and Activities receiving Or deneNing from
federal financial assistance.
4. The Age Discrimination Act of 1975, set amended. 42 USA. 6101 at seq., which proMbXS discrimination
on the baste Of age in programs Cr aCtvtles receiving o beneftng from board! Cnencied assistance.
5. The Carl Budget Rewnclital Act of 1991, P.L. 97 -36, wMCb pmhil lls dlacdminatnn on Me basis ^
of Sax and religion In programs and activities receiving or lending from fa Naval financial assistance .
6. MI regulations, guidelines and standards lawfully adopted under the above sds line applicant agrees
that compliance wltlt this assurance constitutors a condition of continued receipt of or beneM tom fa l
financial assistance, and that It Is binding upon the apprlcent, its specessora, hensferess, and assignees
for the period during which such assistance Is provided. The regi bent further usual Net etl conhads,
subcontrands, subtropical Or Others with Whom It arranges to pnwNe services w baneMS to
padtdpents Or employees in connection with any d Its programs and aCfrvities are not discriminating
against grow participants or employees In violation of me above statutes, regulation, gukellnas, and
standards. In the event of failure to comply, the sppllcant understands Nat Me grantor may, at its
discretion, seek a mud order requhing canalanca with the terms of 1M1b assurance or seek other
appropriate Judicial or admbishative rated, M Include assistance being temirmted and further asshleroe
being dented
Packet Page -2115-
10125/2011 Item 16.D.8.
ATTACHMENT IV
COLLIER COUNTY HEALTH DEPARTMENT
FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT
Facility
Description
Collier County Health
Department 5 Public
Services Building H
Immokalee Satellite
n
Golden Gate WIC Office
Location Owned
3339 E. Tamiami Trail Collier County
Building H, Naples
419 North First Street Collier County
Immokalee
4945 Golden Gate Parkway Henderson
Unit 102, Naples Development
Packet Page 2116-
10125/2011 Item 16.D.8.
ATTACHMENTV
COLLIER COUNTY HEALTH DEPARTMENT
SPECIAL PROJECTS SAVINGS PLAN
IOENTEYTHE AMOUNT OF CASHTHAT IS ANTICIPATEOTO BESET ABIDE ANNUALLY FOR THE PROJECT
CONTRACT YEAR
STATE
mum
TOTAL
20M -2010.
$
$
$
20102011
$
$
$
20113012
$ 0
$ 0
S 0
2012-2013
$
$
S
2013-2014
$
$
8
PROJECTTOTAL
$ O
$ 0
$�
SPECIAL PROJECT CONSTRUCTIONIRENOVATION PLAN
PROJECT NAME:
LOCATIOWAOORESS:
PROJECTTYPE:
NEW BUILDING_
ROOFING
RENOVATION
PLANNING STUDY_
NEW ADDITION_
OTHER _
SQUARE FOOTAGE'.
PROJECTSUMMARY: Oesvvibe scope Wwwk inreesmeWe dehX.
No savingsfor Spedal Pmlecla are scheEUled mr20II-2012.
ESTIMATED PROJECT INFORMATION:
START DATE T✓+awe;wmnure ✓rN,V:
COMPLETION DATE:
DESIGN FEES:
$
CONSTRUCTION COSTS:
S
FURNITUREIEOUIPMENT
$
TOTALPROJECTCOST:
$
COST PER SO FOOT:
$ #DlVAh
Spacial Capital Projects ere new cormVUtllon or renovation project$ and new Nmlture or equipment
associated with these projects and mobile health vane.
24
Packet Page 2117-