Backup Documents 11/13/2012 Item #16E 6ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1,6E6
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County .Attorney Office at
the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later than
Monday preceding the Board meeting.
* *NEW ** ROUTING SLIP
Complete routing lines #I 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 thronph routine 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.
appropriate.
(Initial)
2.
November 13, 2012
Agenda Item Number
16.E.6
3. Emily R. Pepin, County Attorney Office
County Attorney Office
I'3
4. BCC Office
Board of County Commiss�s
c>�i�c�
2
5. Minutes and Records
Clerk of Court's Office
Documents Attached
`b
Lk I(3
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 ma need to contact staff for additional or missiniz information.
Name of Primary Staff
Diana Deleon, Purchasing ept.
Phone Number
252 -8375
Contact / Department
appropriate.
(Initial)
Agenda Date Item was
November 13, 2012
Agenda Item Number
16.E.6
Approved by the BCC
2.
Does the document need to be sent to another agency for additional signatures? If yes,
Type of Document
Contract /Agreement
Number of Original
2
Attached
EMS Billing #12 -5874
Documents Attached
PO number or account
signed by the Chairman, with the exception of most letters, must be reviewed and signed
cep
number if document is
by the Office of the County Attorney.
/
to be recorded
4.
All handwritten strike - through and revisions have been initialed by the County Attorney's
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is
Yes
N/A (Not
appropriate.
(Initial)
Applicable
1.
Does the document require the chairman's original signature?
2.
Does the document need to be sent to another agency for additional signatures? If yes,
hJ /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
signed by the Chairman, with the exception of most letters, must be reviewed and signed
cep
by the Office of the County Attorney.
/
4.
All handwritten strike - through and revisions have been initialed by the County Attorney's
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
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
signature and initials are required.
7.
In most cases (some contracts are an exception), the original document and this routing slip
N
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 onll (enter date) and all changes made
1'10 &h
during the meeting have been incorporated in th attached document. The County
0-
Attorney's Office has reviewed the changes, if applicable.
9.
Initials of attorney verifying that the attached document is the version approved by the
BCC, all changes directed by the BCC have been made, and the document is ready for the
(25 10
Chairman's signature. �' 40ho t-e 1t
orn v as) on it
ct to vt v,Qor a�ee find
vJotc�„S �dQ,ress � �csfi, �i� � m a� I -tram de hdor.
See G 1fi(�C h r �$
16E6
MEMORANDUM
Date: January 15, 2013
To: Diana De Leon, Contract Technician
Purchasing Department
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Contract #12 -5874 "EMS Billing"
Contractor: Data Processing, Inc.
Attached, is an original copy of the contract referenced above (Item #16E6),
approved by the Board of County Commissioners on Tuesday, November 13,
2012.
The second original will be held on file with the Minutes and Record's
Department in the Board's Official Records.
If you have any questions, please contact me at 252 -8411.
Thank you.
Attachment
16E6
DeLeonDiana
From: Agostinelli, Teresa [ Teresa .Agostinelli @intermedix.com]
Sent: Friday, December 21, 2012 11:43 AM
To: DeLeonDiana
Cc: BayArtie; Passaro, Don
Subject: RE: Intermedix - Collier County Agreement 12 -5874 for EMS Billing
Diana,
I was informed by our insurance agent that the Professional Liability insurance coverage includes Cyber Liability. Let me
know if this information is acceptable?
Teresa
tlii„Uli
www.intermedix.com
Teresa Agostinelli, Contracts Manager
T: 954 -308 -8700 ext. 3831
T: 954- 308 -8737 (direct)
F:954- 308 -8725
Teresa .agostinelli(a,intermedix.com
The information contained in this message is confidential and may be privileged and/or protected under law. If you received this
message in error, please notify us immediately by forwarding a copy to compliance(ci)intermedix.com and then deleting the original
message and any attachments.
From: DeLeonDiana [ mailto : Diana DeLeonCd)colliergov.net]
Sent: Tuesday, December 18, 2012 11:06 AM
To: Agostinelli, Teresa
Cc: BayArtie
Subject: RE: Intermedix - Collier County Agreement 12 -5874 for EMS Billing
Teresa,
Our Risk Management Department returned the agreement to Purchasing because they couldn't find proof of Cyber
Liability coverage as required by the contract.
Please provide COI showing proof of coverage.
Thanks,
ND
From: DeLeonDiana
Sent: Thursday, December 13, 2012 9:51 AM
To: 'Agostinelli, Teresa'
Subject: RE: Intermedix - Collier County Agreement 12 -5874 for EMS Billing
Teresa,
16E6
Attached is the complete contract with the requested changes. Please have Mr. Williams sign two (2) copies of the
agreement and mail both copies to my attention at the address below along with current copies of the certificate of
insurance(s) meeting contract requirements.
Please let me know if you have any questions.
Thanks,
Diana Diaz DeLeon, CPPB
Collier County BCC
Purchasing Dept.
3327 E. Tamiami Trail
Naples, FL 34112
(239)252-8375i Fax
From: Agostinelli, Teresa [mailto: Teresa .Agostinelli @intermedix.com]
Sent: Thursday, December 13, 2012 9:35 AM
To: DeLeonDiana
Subject: FW: Intermedix - Collier County Agreement 12 -5874 for EMS Billing
From: Agostinelli, Teresa
Sent: Wednesday, December 12, 2012 4:22 PM
To: 'dianedeleon @colliergov.net'
Subject: Intermedix - Collier County Agreement 12 -5874 for EMS Billing
Diane,
Per our discussion, we kindly ask that the following be changed in the Agreement in order to accurately convey our
company name and address. Can you please send me revised slip sheets so I can insert it in my contract?
Page 1- I" paragraph:
The accurate way to state our company name is:
"Advanced Data Processing, Inc., d /b /a Intermedix, a Delaware Corporation"
Our correct business address is:
"6451 North Federal Hwy., Suite 1000, Fort Lauderdale, FL 33308"
Page 2, Section 5 Notices:
Delete and replace with:
"Intermedix, Attn: Brad Williams, VP & CAO, 6451 North Federal Hwy., Suite 1000, Fort Lauderdale, FL 33308. Tel: 954-
308 -8700, Fax: 954- 308 - 8702"
Page 8 Signatory:
Delete "Advanced Data Processing, Inc. D.B.A. Intermedix Corporation ", and replace with:
"Advanced Data Processing, Inc., d /b /a Intermedix, a Delaware Corporation"
Please confirm the changes and I will have an officer of our company sign the Agreement. We have the required
Certificate of Insurance to include with the Agreement.
Thank you for your assistance.
Teresa Agostinelli 16E6
intermedix
www.intermedix.com
Teresa Agostinelli, Contracts Manager
T: 954 -308 -8700 ext. 3831
T: 954 - 308 -8737 (direct)
F: 954- 308 -8725
Teresa. agostinelliL&intermedix.com
The information contained in this message is confidential and may be privileged and /or protected under law. If you received this
message in error, please notify us immediately by forwarding a copy to complianceneintermedix.com and then deleting the original
message and any attachments.
Under Florida Law. e -mail addresses are public records. If you do not want your e -maii address released in response to a public records request. do not send
electronic mail to this entity. instead. contact this office by telephone or in writing.
'-4' a ? ^;— 1 -) 16E6
' ' Purchasing Department
3327 Tamiami Trail East
Naples, Florida 34112
Administafi Services Diivision Telephone: (239) 252 -8375
Purchasingfi i `� i y! �, :�; iv1 �I � FAX: (239) 252 -6597
Email: dianadeleon@.colliergov.net
www.colliergov.neUpurchasinq
Memorandum
Subject: 12 -5874 "EMS Billing"
i IL- _- mIV�:- j
Date: December 17, 2012
From: Diana DeLeon, Purchasing Dept. for Scott Johnson
HIvK Au r . o-11 r,,aEN
To: Ray Carter, Manager Risk Finance
These contracts were approved by the BCC on November 13, 2012 agenda item 16.E.6.
The County is in the process of executing this contract with Advanced Data Processing d /b /a
Intermedix. The insurance requirements are on page 3 of the agreement.
Please review the Insurance Certificate(s).
• If the insurance is not in order please contact the vendor /insurance company to obtain a proper
certificate. Once you receive the proper certificate(s), please acknowledge your approval and send
to the County Attorney's office via the attached Request for Legal Services.
• If the insurance is in order please acknowledge your approval and send to the County Attorney's
office via the attached Request for Legal Services.
If you have any questions, please contact me at the above referenced information.
Insurance Appro y:
g r Risk Finance bate
(Please route to County Attorney via attached Request for Legal Services)
G /Acq uisitions /AgentFormsand Letters /RiskMgmtReviewoflnsurance4 /15/2010/16/09
16 E 6
OF-C ! �f+Stii)
RISK Nl ii,� a , �, -,,- - .1,EN E
A G R E E M E N T 12-5874
for
EMS Billing
THIS AGREEMENT, made and entered into on this 134' day of 1Jc- ,e,,,•,6Q,, 2011 by and
between Advanced Data Processing, Inc, d /b /a Intermedix, a Delaware Corporation,
authorized to do business in the State of Florida, whose business address is 6451 North
Federal Highway, Suite 1000, Fort Lauderdale, Florida 33308 (the "Contractor ") and Collier
County, a political subdivision of the State of Florida, (the "County "):
WITNESSETH:
1. COMMENCEMENT. The contract shall be for a two (2) year period, commencing on
Board approval date, and terminating two years from that date.
The County may, at its discretion and with the consent of the Contractor, renew the
Agreement under all of the terms and conditions contained in this Agreement for three
(3) additional one (1) year periods. The County shall give the Contractor written notice
of the County's intention to extend the Agreement term not less than ten (10) days prior
to the end of the Agreement term then in effect.
2. STATEMENT OF WORK. The Contractor shall provide billing services in accordance
with the terms and conditions of RFP #12 -5874 and the Contractor's proposal referred
to herein and made an integral part of this agreement. This Agreement contains the
entire understanding between the parties and any modifications to this Agreement shall
be mutually agreed upon in writing by the Contractor and the County Project or
Contract Manager or his designee, in compliance with the County Purchasing Policy
and Administrative Procedures in effect at the time such services are authorized.
3. COMPENSATION: The County shall pay the Contractor for the performance of this
Agreement in accordance with Schedule A, attached herein and incorporated by
reference. Payment will be made upon receipt of a proper invoice and in compliance
with Chapter 218 Fla. Stats., otherwise known as the "Local Government Prompt
Payment Act ".
3.1 Payments will be made for services furnished, delivered, and accepted, upon
receipt and approval of invoices submitted on the date of services or within six (6)
months after completion of contract. Any untimely submission of invoices beyond the
Page 1 of 9
16E6
specified deadline period is subject to non - payment under the legal doctrine of
"laches" as untimely submitted. Time shall be deemed of the essence with respect to
the timely submission of invoices under this agreement.
4. SALES TAX. Contractor shall pay all sales, consumer, use and other similar taxes
associated with the Work or portions thereof, which are applicable during the
performance of the Work.
5. NOTICES. All notices from the County to the Contractor shall be deemed duly served
if mailed or faxed to the Contractor at the following Address:
Intermedix
Attn: Brad Williams, VP & CAO
6451 North Federal Hwy., Suite 1000
Fort Lauderdale, FL 33308
Tel: 954 - 308 -8700; Fax: 954 - 308 -8702
All Notices from the Contractor to the County shall be deemed duly served if mailed or
faxed to the County to:
Collier County Government Center
Purchasing Department
3327 Tamiami Trail, East
Naples, Florida 34112
Attention: Purchasing & General Services Director
Telephone: 239 - 252 -8407
Facsimile: 239 - 252 -6480
The Contractor and the County may change the above mailing address at any time upon
giving the other party written notification. All notices under this Agreement must be in
writing.
6. NO PARTNERSHIP. Nothing herein contained shall create or be construed as creating
a partnership between the County and the Contractor or to constitute the Contractor as
an agent of the County.
7. PERMITS: LICENSES: TAXES. In compliance with Section 218.80, F.S., all permits
necessary for the prosecution of the Work shall be obtained by the Contractor. Payment
for all such permits issued by the County shall be processed internally by the County.
All non - County permits necessary for the prosecution of the Work shall be procured
and paid for by the Contractor. The Contractor shall also be solely responsible for
payment of any and all taxes levied on the Contractor. In addition, the Contractor shall
comply with all rules, regulations and laws of Collier County, the State of Florida, or the
Page 2 of 9
16E6
U. S. Government now in force or hereafter adopted. The Contractor agrees to comply
with all laws governing the responsibility of an employer with respect to persons
employed by the Contractor.
8. NO IMPROPER USE. The Contractor will not use, nor suffer or permit any person to
use in any manner whatsoever, County facilities for any improper, immoral or offensive
purpose, or for any purpose in violation of any federal, state, county or municipal
ordinance, rule, order or regulation, or of any governmental rule or regulation now in
effect or hereafter enacted or adopted. In the event of such violation by the Contractor
or if the County or its authorized representative shall deem any conduct on the part of
the Contractor to be objectionable or improper, the County shall have the right to
suspend the contract of the Contractor. Should the Contractor fail to correct any such
violation, conduct, or practice to the satisfaction of the County within twenty -four (24)
hours after receiving notice of such violation, conduct, or practice, such suspension to
continue until the violation is cured. The Contractor further agrees not to commence
operation during the suspension period until the violation has been corrected to the
satisfaction of the County.
9. TERMINATION. Should the Contractor be found to have failed to perform his services
in a manner satisfactory to the County as per this Agreement, the County may terminate
said agreement for cause; further the County may terminate this Agreement for
convenience with a thirty (30) day written notice. The County shall be sole judge of
non - performance.
In the event that the County terminates this Agreement, Contractor's recovery against
the County shall be limited to that portion of the Contract Amount earned through the
date of termination. The Contractor shall not be entitled to any other or further recovery
against the County, including, but not limited to, any damages or any anticipated profit
on portions of the services not performed.
10. NO DISCRIMINATION. The Contractor agrees that there shall be no discrimination as
to race, sex, color, creed or national origin.
11. INSURANCE. The Contractor shall provide insurance as follows:
A. Commercial General Liability: Coverage shall have minimum limits of $1,000,000
Per Occurrence, $2,000,000 aggregate for Bodily Injury Liability and Property Damage
Liability. This shall include Premises and Operations; Independent Contractors;
Products and Completed Operations and Contractual Liability.
B. Business Auto Liability: Coverage shall have minimum limits of $1,000,000 Per
Occurrence, Combined Single Limit for Bodily Injury Liability and Property Damage
Liability. This shall include: Owned Vehicles, Hired and Non -Owned Vehicles and
Employee Non - Ownership.
Page 3 of 9
16E6
C. Workers' Compensation: Insurance covering all employees meeting Statutory
Limits in compliance with the applicable state and federal laws.
The coverage must include Employers' Liability with a minimum limit of $1,000,000 for
each accident.
D. Employee Dishonesty/ Crime Coverage $1,000,000 Per Occurrence
Cyber Liability/ Privacy Liability $1,000,000 Per Occurrence
Special Requirements: Collier County Government shall be listed as the Certificate
Holder and included as an Additional Insured on the Comprehensive General Liability
Policy.
Current, valid insurance policies meeting the requirement herein identified shall be
maintained by Contractor during the duration of this Agreement. The Contractor shall
provide County with certificates of insurance meeting the required insurance
provisions. Renewal certificates shall be sent to the County ten (10) days prior to any
expiration date. Coverage afforded under the policies will not be canceled or allowed to
expire until the greater of: ten (10) days prior written notice, or in accordance with
policy provisions. Contractor shall also notify County, in a like manner, within twenty -
four (24) hours after receipt, of any notices of expiration, cancellation, non - renewal or
material change in coverage or limits received by Contractor from its insurer, and
nothing contained herein shall relieve Contractor of this requirement to provide notice.
Contractor shall ensure that all subcontractors comply with the same insurance
requirements that he is required to meet.
12. INDEMNIFICATION. To the maximum extent permitted by Florida law, the
Contractor shall indemnify and hold harmless Collier County, its officers and
employees from any and all liabilities, damages, losses and costs, including, but not
limited to, reasonable attorneys' fees and paralegals' fees, whether resulting from any
claimed breach of this Agreement by Contractor, any statutory or regulatory violations,
or from personal injury, property damage, direct or consequential damages, or
economic loss, to the extent caused by the negligence, recklessness, or intentionally
wrongful conduct of the Contractor or anyone employed or utilized by the Contractor in
the performance of this Agreement. This indemnification obligation shall not be
construed to negate, abridge or reduce any other rights or remedies which otherwise
may be available to an indemnified party or person described in this paragraph.
This section does not pertain to any incident arising from the sole negligence of Collier
County.
12.1 The duty to defend under this Article 12 is independent and separate from the
duty to indemnify, and the duty to defend exists regardless of any ultimate liability of
the Contractor, County and any indemnified party. The duty to defend arises
Page 4 of 9
16E6
immediately upon presentation of a claim by any party and written notice of such
claim being provided to Contractor. Contractor's obligation to indemnify and defend
under this Article 12 will survive the expiration or earlier termination of this
Agreement until it is determined by final judgment that an action against the County or
an indemnified party for the matter indemnified hereunder is fully and finally barred
by the applicable statute of limitations.
13. CONTRACT ADMINISTRATION. This Agreement shall be administered on behalf of
the County by the Emergency Medical Services Department.
14. CONFLICT OF INTEREST: Contractor represents that it presently has no interest and
shall acquire no interest, either direct or indirect, which would conflict in any manner
with the performance of services required hereunder. Contractor further represents that
no persons having any such interest shall be employed to perform those services.
15. COMPONENT PARTS OF THIS CONTRACT. This Contract consists of the following
component parts, all of which are as fully a part of the contract as if herein set out
verbatim: Contractor's Proposal, Insurance Certificate, RFP #12- 5874 -EMS Billing
Services Scope of Services and Addenda, Schedule A.
16. SUBJECT TO APPROPRIATION. It is further understood and agreed by and between
the parties herein that this agreement is subject to appropriation by the Board of County
Commissioners.
17. PROHIBITION OF GIFTS TO COUNTY EMPLOYEES. No organization or
individual shall offer or give, either directly or indirectly, any favor, gift, loan, fee,
service or other item of value to any County employee, as set forth in Chapter 112, Part
III, Florida Statutes, Collier County Ethics Ordinance No. 2004 -05, and County
Administrative Procedure 5311. Violation of this provision may result in one or more of
the following consequences: a. Prohibition by the individual, firm, and /or any
employee of the firm from contact with County staff for a specified period of time; b.
Prohibition by the individual and/or firm from doing business with the County for a
specified period of time, including but not limited to: submitting bids, RFP, and/or
quotes; and, c. immediate termination of any contract held by the individual and /or
firm for cause.
18. IMMIGRATION LAW COMPLIANCE. By executing and entering into this agreement,
the Contractor is formally acknowledging without exception or stipulation that it is fully
responsible for complying with the provisions of the Immigration Reform and Control
Act of 1986 as located at 8 U.S.C. 1324, et seq. and regulations relating thereto, as either
may be amended. Failure by the Contractor to comply with the laws referenced herein
shall constitute a breach of this agreement and the County shall have the discretion to
unilaterally terminate this agreement immediately.
19. OFFER EXTENDED TO OTHER GOVERNMENTAL ENTITIES. Collier County
encourages and agrees to the successful proposer extending the pricing, terms and
Page 5 of 9
16E6
conditions of this solicitation or resultant contract to other governmental entities at the
discretion of the successful proposer.
20. AGREEMENT TERMS. If any portion of this Agreement is held to be void, invalid, or
otherwise unenforceable, in whole or in part, the remaining portion of this Agreement
shall remain in effect.
21. ADDITIONAL ITEMS /SERVICES. Additional items and /or services may be added to
this contract in compliance with the Purchasing Policy.
22. DISPUTE RESOLUTION. Prior to the initiation of any action or proceeding permitted
by this Agreement to resolve disputes between the parties, the parties shall make a good
faith effort to resolve any such disputes by negotiation. The negotiation shall be
attended by representatives of Contractor with full decision - making authority and by
County's staff person who would make the presentation of any settlement reached
during negotiations to County for approval. Failing resolution, and prior to the
commencement of depositions in any litigation between the parties arising out of this
Agreement, the parties shall attempt to resolve the dispute through Mediation before an
agreed -upon Circuit Court Mediator certified by the State of Florida. The mediation
shall be attended by representatives of Contractor with full decision - making authority
and by County's staff person who would make the presentation of any settlement
reached at mediation to County's board for approval. Should either party fail to submit
to mediation as required hereunder, the other party may obtain a court order requiring
mediation under section 44.102, Fla. Stat.
23. VENUE. Any suit or action brought by either party to this Agreement against the other
party relating to or arising out of this Agreement must be brought in the appropriate
federal or state courts in Collier County, Florida, which courts have sole and exclusive
jurisdiction on all such matters.
24. CONTRACT STAFFING: The Contractor's personnel and management to be utilized
for this project shall be knowledgeable in their areas of expertise. The County reserves
the right to perform investigations as may be deemed necessary to ensure that
competent persons will be utilized in the performance of the contract. The Contractor
shall assign as many people as necessary to complete the required contract services and
each person assigned shall be available for an amount of time adequate to meet the
requirements of the Agreement.
25. ORDER OF PRECEDENCE: In the event of any conflict between or among the terms of
any of the Contract Documents, the terms of the Request for Proposal and /or the
Contractor's Proposal, the Contract Documents shall take precedence. In the event of any
conflict between the terms of the RFP 12 -5874 EMS Billing and the Contractor's Proposal,
the language in the RFP would take precedence.
26. ASSIGNMENT: Contractor shall not assign this Agreement or any part thereof, without
the prior consent in writing of the County. Any attempt to assign or otherwise transfer
Page 6 of 9
16E6
this Agreement, or any part herein, without the County's consent, shall be void. If
Contractor does, with approval, assign this Agreement or any part thereof, it shall require
that its assignee be bound to it and to assume toward Contractor all of the obligations and
responsibilities that Contractor has assumed toward the County.
27. Reports: The Contractor shall provide the County with status reports at the request of the
EMS Department, and other reports as mutually agreed. The Contractor shall also
provide changes to such reports and ad hoc report requests on a reasonable basis and as
mutually agreed. The Contractor shall provide reports within five (5) business days. The
reports must be pre- reviewed by the Contractor prior to submitting to Collier County to
verify the accuracy and consistency of any report(s). No data shall be provided to any
individual or entity. Such requests for information shall be submitted directly to the
County through the established Public Records Request process.
28. Quarterly Meetings: The County and the Contractor shall hold quarterly meetings to
discuss issues and react to changing conditions. Meetings shall be arranged by the County
and confirmed in writing with the Contractor.
Page 7 of 9
16E6
IN WITNESS WHEREOF, the Contractor and the County, have each, respectively, by an
authorized person or agent, hereunder set their hands and seals on the date and year first
above written.
ATTEST:
Dw4ght E. ,`Br-oc%, • rk of Courts
Da
A ,te5EAL) , .e ,P
as to Ch'a f raw 0�
t
Firs Witness
TType print witness nameT
Secon Witness
TType/ print witness nameT
Approved as to form and
legal sufficiency:
Assistant C unty Attorney
Print Name
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
By: � LJ-111"�
Fred W. Coyle, Chairman
Advanced Data Processing Inc.
d /b /a Intermedix, a Delaware Corporation
Contractor
By:
Signature
Page 8 of 9
P�D�Ni
Typed signature and title
Item #
f
Agenda
Date
Gate
5 I3
Rec'
Dquty Clerk
16E6
Schedule A
Rate Schedule
The prices shown herein shall include all expenses of billing and collection including, but not
limited to, stationary, forms, envelopes, postage, and phone facilities.
Medicaid Claim $7.50 per each transport account processed
Standard Claim for non - Medicaid transport accounts, 4.45% of net collections less refunds
HIPPA Notice - No Charge
Page 9 of 9
A CERTIFICATE OF LIABILITY INSURANCE
I A 1: 6
rW DATE (MM/DDIYYYY)
12/05/2012
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
Marsh USA Inc.
1560 Sawgrass Corporate Pkwy, Suite 300
Sunrise, FL 33323
Attn: FtLauderdale .CertRequest @marsh.com F:212 -948 -0512
CONTACT
NAME:
PHONE FAX
'C No):
E -MAIL
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A : St. Paul Mercury Insurance Company
24791
101309 -GAWU- PROF -12 -13
INSURED
Intermedix Corporation
6451 North Federal Highway, Suite 1000
INSURER B : Phoenix Insurance Company
25623
INSURER C : Columbia Casualty Company
31127
INSURER D: Travelers Property Casualty Company Of America
25674
Fort Lauderdale, FL 33308
INSURER E:
GENERAL AGGREGATE
INSURER F:
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY PRO- LOC
PRODUCTS - COMP /OP AGG
COVERAGES CERTIFICATE NUMBER: ATL- 003131918 -01 REVISION NUMBER: 14
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
INSR
WVD
POLICY NUMBER
MM DDY/YYYY
MML
DDIYYYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE M OCCUR
of Marsh USA Inc.
ZLP-1 OT961 1A-1 2-13
06/30/2012
06130/2013
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES Ea occurrence
$ 250,000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY PRO- LOC
PRODUCTS - COMP /OP AGG
$ 2,000,000
$
D
AUTOMOBILE LIABILITY
X ANY AUTO
ALL OWNED SCHEDULED
AUTOS NON -OWNED
HIREDAUTOS AUTOS
BA 1AB17433
Owned Comp /Coll Ded. $1,000
Hired Comp /Coll Ded. $100/$1,000
06/30/2012
06/30/2013
COMBINED SINGLE LIMIT
Ea accident)
1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
EACH OCCURRENCE
$
HCLAIMS-MADE
AGGREGATE
$
DED I I RETENTION $
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE �
OFFICER /MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
UB- lA83727 -2 -12
06/30/2012
06/30/2013
X WC STATU- OTH-
E.L. EACH ACCIDENT
500,000
$
E.L. DISEASE - EA EMPLOYE
$ 500,000
E.L. DISEASE - POLICY LIMIT
$ 500,000
C
Professional Liability
Retro Date: 10/1/2002
425573593
SIR: $75,000
06/30/2012
0613012013
Each Claim or Proceeding 1,000,000
Aggregate 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Collier County Board of Commissioners are included as additional insured where required by written contract.
CERTIFICATE HOLDER CANCELLATION
Collier County, a political subdivision
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
of the State of Florida
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
3327 Tamiami Trail East
ACCORDANCE WITH THE POLICY PROVISIONS.
Naples, FL 34112
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Carmen Gordon
ACORD 25 (2010/05)
@ 1988 -2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
16E6
� , ®
A� CERTIFICATE OF LIABILITY INSURANCE
DATE I M
12/01 MI
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
Marsh USA Inc.
1560 Sawgrass Corporate Pkwy, Suite 300
Sunrise, FL 33323
Attn: FtLauderdale .CertRequest @marsh.com F:212 -948 -0512
CONTACT
NAME:
PHONE Fa X
ac No
E -MAIL
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A : Zurich American Insurance Company
16535
101309 - Crime- -12 -15
INSURED
Intermedix Holdings, Inc.
INSURER B:
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
6451 North Federal Highway, Suite 1000
INSURER C :
INSURER D:
$
Fort Lauderdale, FL 33308
INSURER E:
$
INSURER F:
AUTOMOBILE LIABILITY
A
ANY AUTO
ALL OWNED L SCHEDULED
AUTOS NON -OWNED
HIREDAUTOS AUTOS
rnVPPArl =c CFRTIFICATF NIIMIRFR- ATL- 003131924 -01 REVISION NUMBER:5
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
INSR
WVD
POLICY NUMBER
MM /DDY/YYYY
EXP
/YYYY
MMIDD
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE F—I OCCUR
of Marsh USA Inc.
Carmen Gordon -�
EACH OCCURRENCE
$
DAMAGE TO RENTED
PREMISES Ea occurrence
$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO LOC
JECT F-1
PRODUCTS - COMP /OP AGG
$
$
AUTOMOBILE LIABILITY
A
ANY AUTO
ALL OWNED L SCHEDULED
AUTOS NON -OWNED
HIREDAUTOS AUTOS
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PPReO�PERdT ntDAMAGE
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
EACH OCCURRENCE
$
HCLAIMS-MADE
AGGREGATE
$
DED I I RETENTION$
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N PROPRIETOR ANY OFFICER /MEM ER/EXCLUDED? ECUTIVE �
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
WC STATUS OTH-
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYE
$
E.L. DISEASE - POLICY LIMIT
$
A
Crime
MPL 9132944 -03
10/05/2012
06/30/2015
Limit: 1,000,000
Deductible: 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
CFRTIFICATF HAI nFR CANCELLATION
Collier County, a political subdivision
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
of the State of Florida
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
3327 Tamiami Trail East
ACCORDANCE WITH THE POLICY PROVISIONS.
Naples, FL 34112
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Carmen Gordon -�
@ 1988 -2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD