Backup Documents 03/11/2011 Item #16D3"JX1%j1111-1L 1JVl.V1V1L'1\ 10 QL lNVU 111 14l.7 cJLlr 16
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. Original documents should be hand delivered to the Board Office. The completed routing slip and original
documents are to be forwarded to the Board Office only after the Board has taken action on the item.)
ROUTING SLIP
Complete routing lines #1 through #4 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 throng routing lines #I throw #4, complete the checklist, and forward to Ian Mitchell (line #5).
Route to Addressee(s)
(List in routing order)
Office
Initials
Date
1.
Housing, Human and Veteran Services
(Initial)
Applicable)
2.
__.....__ ___.__. -_.__
Agenda Item Number
16 D3
3,
__ _ __.._. _ __. __.._
..
Type of Document
Change order to Contract 10 -5428
Number of Original
1
5. Ian Mitchell, Executive Manager
Board of County Commissioners
I Documents Attached
3ll0�,,
6. Minutes and Records
Clerk of Court's Office
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending BCC approval. 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, including Sue Filson, need to contact staff for additional or missing
information. All original documents needing the BCC Chairman's signature are to be delivered to the BCC office only after the BCC has acted to approve the
item.)
Name of Primary Staff
Marcy Krumbine, Director
Phone Number
774 -8442
Contact
Housing, Human and Veteran Services
(Initial)
Applicable)
Agenda Date Item was
3/8/11
Agenda Item Number
16 D3
Approved by the BCC
signed by the Chairman, with the exception of most letters, must be reviewed and signed
Type of Document
Change order to Contract 10 -5428
Number of Original
1
Attached
I
I Documents Attached
INSTRUCTIONS & CHECKLIST
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is
Yes
N/A (Not
appropriat e.
(Initial)
Applicable)
1.
Original document has been signed/initialed for legal sufficiency. (All documents to be
MK
signed by the Chairman, with the exception of most letters, must be reviewed and signed
by the Office of the County Attorney. This includes signature pages from ordinances,
resolutions, etc. signed by the County Attorney's Office and signature pages from
contracts, agreements, etc. that have been fully executed by all parties except the BCC
Chairman and Clerk to the Board and possibly State Officials.)
2.
All handwritten strike - through and revisions have been initialed by the County Attorney's
n/a
Office and all other parties except the BCC Chairman and the Clerk to the Board
3.
The Chairman's signature line date has been entered as the date of BCC approval of the
'M
document or the final negotiated contract date whichever is applicable.
4.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
mk
signature and initials are required.
5.
In most cases (some contracts are an exception), the original document and this routing slip
mk
should be provided to Ian Mitchell in the BCC office within 24 hours of BCC approval.
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!
6.
The document was approved by the BCC on 3/8/11 and all changes made during the
No
meeting have been incorporated in the attached document. The County Attorney's
changes
Office has reviewed the changes, if applicable.
I made
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
16U
MEMORANDUM
Date: March 10, 2011
To: Marcy Krumbine, Director
Housing, Human and Veteran Services
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Contract #10 -5428 Change Order with Physician Led
Access Network, Inc. (PLAN) for a Health Information
Technology Grant with Department of Health & Human
Services, Health Resources and Services Administration
Attached for your records is a copy of the document referenced above
(Item #16D3) approved by the Board of County Commissioners March 8, 2011.
If you have any questions, please feel free to call me at 252 -8406.
Thank you.
Attachment
CHANGE ORDER
CHANGE ORDER NO. 1
TO: Deb Cecere, Executive Director
Physician Led Access Network — PLAN
1012 Goodlette R, Suite 201
Naples, FL
DATE: February 10, 2011
PROJECT NAME: PLAN HIT grant
PROJECT NO.: N/A
Under our AGREEMENT dated January 13, 2009.
16a�
CONTRACT NO 10 -5428
BCC Date: January 13, 2009
Agenda Item: 16 D2
You hereby are authorized and directed to make the following change(s) in accordance with terms and
conditions of the Agreement: increase the level of funding to complete the HIT project.
FOR THE Additive Sum of: Forty five thousand dollars ($45,000).
Original Agreement Amount $105,211
Sum of Previous Changes $0
This Change Order add $45,00 0
Present Agreement Amount $150,211
The time for completion shall be the same number of calendar days due to this Change Order. Accordingly,
the Contract Time is now _n/a_ ( ) calendar days. The substantial completion date is
December 31, 2011 and the final completion date is the same date. Your acceptance of this Change Order shall
constitute a modification to our Agreement and will be performed subject to all the same terms and conditions as
contained in our Agreement indicated above, as fully as if the same were repeated in this acceptance. The
adjustment, if any, to the Agreement shall constitute a full and final settlement of any and all claims of the
Contractor arising out of or related to the change set forth herein, including claims for impact and delay costs.
Accepted: 7J c r_t a, / [/, , 20 I1 .
Organization
Physicir Led Access Network
By:
Deborah Cecere
OWNER:
BOARD OF COUNTY COMMISSIONERS
OF COLLIER COUNTY, FLORIDA
DEPAR �YIENT DIRECT R
By: `--
Marcy Krumbine
Date: '✓ V'
ATTEST
kA
Dwight Ej#rolerkr4` °`
BY:
��
App l'0
and Legal Sufficiency:
Print Name: Jersru4er ipvki
Deputy County Attorney
LIN
DIVISION
1bU3
CONTRACT SPECIALIST
By: l
Lyn wood
BOARD OF COUNTY COMMISSIONERS OF
COLLIER COUNTY FLORIDA
BY: LIJ •
Fred W. Coyle, Chairman kJ
Item #
Agenda
Date -�
Date /j tj)—j1