Backup Documents 10/25/2011 Item #16D 8ORIGIN AL DOCUMENTS CHECKLIST & ROUTING STIP6o8
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 toe Baud Office, The completed routing slip and original
documents are to be fanrarded to the Board Office only lily the Board bas taken action on the item.)
ROUTING SLIP
Complete routing lines #1 through #4 as appropriate for additional signatures. dates, and/or fidamatim needed. N the document is already compleee with tiro
o- Ah —wist anA finrwwd to Sue Ellison. (line #5).
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Date
1.
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livable
2.
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Agenda Item Number
3.
Approved by the BCC
4.
by the Office of the County Attorney. This includes signature pages from ordinances,
Type of Document
5,
Ian Mitchell, Executive Manager
Board of County Commissioners
Attached
to�,��,
6. Minutes and Records
Clerk of Court's Office
PRIMARY CONTACT INFORMATION
(The primary contact is the bolder of the original document pending BCC approval. NotmaBy the pry five
summary. primary contact information is needed in the event one of the addressees above, including
information. All original documents needing the BCC Chairman a signature are to be delivered to the BCC of M Only after tiro BCC has acted to approve the
item
Name of Primary Staff
Initial the Yes column or mark'N /A" in the Not Applicable column. whichever is
Phone Number
N/A (Not
Contact
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livable
Agenda Date Item was
Ito_
Agenda Item Number
Approved by the BCC
by the Office of the County Attorney. This includes signature pages from ordinances,
Type of Document
Number of Original
Documents Attached
resolutions, etc. signed by the County Attorney's Office and signature pages from
Attached
(:�J/�Gt�
contracts, agreements, etc. that have been fully executed by all parties except-the BCC
nveTDTTCurrn1VC & rHECKLIST
L Foams/ County Forms/ BCC Parmat Original Documents Routing slip W WS 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
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livable
1.
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
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
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
document or the final negotiated contract date whichever is linable.
4.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
sianatum and initials are required.-
5.
In most cases (some contracts are an exception), the ori ginal document and this routing slip
should be provided to Sue Filson in the BCC office within 24 hours of BCC approval.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
aware
time frame or the BCC's actions are nullified. Be of our deadlines!
6 . _
-The documentmm- approaedby -- EentaFdata)- aed-all-ehanges .
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trade during the meeting have been incorporated In attached document The
County Attorney's Office has reviewed the changes, if livable.
L Foams/ County Forms/ BCC Parmat Original Documents Routing slip W WS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
FLORIDA DEPARTMENT OF
HEALT
October 25, 2011
The Honorable Fred W. Coyle, Chairman
Board of County Commissioners
Collier County Government Center
3299 East Tamiami Trail
Naples, FL 34112
16R,ps 8o tt
0
Governor
H. Frank Fanner, Jr., MD, PhD, FACP
State Surgeon General
RE: FY 2010 -11 Contract between the Board of Collier County Commissioners and the
Department of Health for Operation of the County Health Department
Dear Chairman Coyle:
Enclosed are four originals for signature of the Core Contract between the Department of
Health and Collier County as approved at the October 25t�', 2011 meeting of the BCC, Consent
Item 16d(8). After signature, please contact me at (239) 252 -8206 or 5334 for courier pickup.
If you have any further questions, please feel free to contact me at (239) 252 -8206.
Sincerely,
Alan L. Portis
Director, Finance and Accounting
Enclosures (4)
Joan M. Colter, M.D., M.P.H., Director
3339 East Tamiami Trail, Suite 145- Bldg.H Mailing Address:
Naples, Florida • 34112 -4961 Collier Post Office Box 429
Telephone (239) 252 -8200 County Naples, Florida • 34106 -0429
Health
Department
Caring... Committed... Helping... Dedicated
To the Wellness of Our Community
•1:
MEMORANDUM
Date: October 28, 2011
To: Alan Portis, Business Manager
Collier County Health Department
From: Ann Jennejohn, Sr. Deputy Clerk
Minutes & Records Department
Re: FY11 /12 Contract between Collier County and the
State of Florida's Department of Health
Attached for further processing are four (4) original copies of the contract
referenced above, (Item #16D8), approved by the Board of County Commissioners
October 25, 2011.
Please forward to the State Surgeon General for signature and return a fully
executed original to the Minutes and Record's Department for the Board's
Official Record.
If you should have any questions, please call me at 252 -8406.
Thank you.
Attachments (4)
FLORIDA DEPARTMENT OF
HEALT
INTEROFFICE MEMORANDUM
DATE: November 28, 2011
TO: Ann Jennejohn, Sr. Deputy Clerk
Minutes and Records Department
3299 East Tamiami Trail
Naples, FL 34112
FROM: Alan Portis, Business Manager
Collier County Health Department
3339 East Tamiami Trail, Room 145
P.O. Box 429
Naples, FL 34106 -0429
6 D &ck Scott
overnor
H. Frank Farmer, Jr., NM, PhD, FACP
State Surgeon General
SUBJECT: FYI 1/12 Contract between Collier County and State of Florida's
Department of Health
As referenced, (Item #16138), was approved by the Board of County Commissioners on
October 25, 2011. A fully executed original is attached for the Board's Official Record.
If you have any additional questions, please contact me at (239) 252 -8206.
ALAN L. PORTIS
Finance & Accounting Director
Collier County Health Department
Attachments (1)
Joan M. Colfer, M.D., M.P.H., Director
3339 East Tamiami Trail, Suite 145- BIdg.H Mailing Address:
Naples, Florida • 34112 -4961 Collier Post Office Box 429
Telephone (239) 252 -8200 County Naples, Florida • 34106 -0429
Health
Department
Caring... Committed ...Heiping...Dedicated
To the Wellness of Our Community
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 ( "State ") 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
correct and incorporated herein by reference.
2. TERM. The parties mutually agree that this Agreement shall be effective from
October 1, 2011, through September 30, 2012, 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 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
16DKI
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, HIV /AIDS,
immunization, tuberculosis control and maintenance of vital statistics.
c. "Primary care services" are acute care and preventive services that are made
available to well and sick persons who are unable to obtain such services due to lack of
income or other barriers beyond their control. These services are provided to benefit
individuals, improve the -collective health of the public, and prevent and control the spread
of disease. Primary health care services are provided at home, in group settings, or in
clinics. These services shall be supported by available federal, state, and local funds and
shall include services mandated on a state or federal level. Examples of primary health
care services include, but are not Limited to: first contact acute care services; chronic
disease detection and treatment; maternal and child health services; family planning;
nutrition; school health; supplemental food assistance for women, infants, and children;
home health; and dental services.
4. FUNDING. The parties further agree that funding for the CHD will be handled as
follows:
a. The funding to be provided by the parties and any other sources are set forth in Part
II of Attachment II hereof. This funding will be used as shown in Part I of Attachment II.
i. The State's appropriated responsibility (direct contribution excluding any state fees,
Medicaid contributions or any other funds not listed on the Schedule C) as provided in
Attachment II, Part II is an amount not to exceed $ 5,882,163 (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 orlocal contributions) as provided in Attachment II, Part II is an amount not
to exceed $1,324,400 (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
County Health Department Trust Fund that is attributed to the CHD shall be carried
forward to the next contract period.
2
c. Either party may establish service fees as allowed by law to fund activities of the
CHD. Where applicable, such fees shall be automatically adjusted to at least the
Medicaid fee schedule.
d. Either party may increase or decrease funding of this 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 II
and send a copy of the revised pages to the County and the Department of Health,
Bureau of Budget Management. If the County initiates the increase /decrease, the County
shall notify the CHD. The CHD will then revise the Attachment II and send a copy of the
revised pages to the Department of Health, 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 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 State Health Officer. The director /administrator
shall be selected by the State with the concurrence of the County. The
director /administrator 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 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 Office of Planning, Evaluation & Data Analysis 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,
and all county - purchasing procedures must be followed in their entirety, and such
compliance shall be documented. Such justification and compliance documentation shall
• ' I
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:
i. The revenue and expenditure requirements in the Florida Accounting
System Information Resource (FLAIR).
fl. The client registration and services reporting requirements of the
minimum data set as specified in the most current version of the Client
Information System /Health Management Component Pamphlet;
iii. Financial procedures specified in the Department of Health's Accounting
Procedures Manuals, Accounting memoranda, and Comptroller's
memoranda;
iv. The CHD is responsible for assuring that all contracts with service
providers include provisions that all subcontracted services be reported
to the CHD in a manner consistent with the client registration and
service reporting requirements of the minimum data set as specified in
the Client Information System /Health Management Component
Pamphlet.
d. All funds for the CHD shall be deposited in the County Health Department Trust
Fund maintained by the state treasurer. These funds shall be accounted for separately
from funds deposited for other CHDs and shall be used only for public health purposes in
Collier County.
e. That any surplus /deficit funds, including fees or accrued interest, remaining in the
County Health Department Trust Fund account at the end of the contract year shall be
credited /debited to the state or county, as appropriate, based on the funds contributed by
each and the expenditures incurred by each. Expenditures will be charged to the program
accounts by state and county based on the ratio of planned expenditures in 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
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
4
Inc
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 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 parties within
180 days after the close of the CHD fiscal year. This audit will follow requirements
contained in OMB Circular A -133 and may be in conjunction with audits performed by
county government. If audit exceptions are found, then the director /administrator of the
CHD will prepare a corrective action plan and a copy of that plan and monthly status
reports will be furnished to the contract managers for the parties.
i. The CHD shall not use or disclose any information concerning a recipient of
services except as allowed by federal or state law or policy.
j. The CHD shall retain all client records, financial records, supporting documents,
statistical records, and any other documents (including electronic storage media) pertinent
to this 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,
dated April 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 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.
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
r • 1;
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 III.
o. The CHD shall submit quarterly reports to the county that shall include at least the
following:
L The DE3851-1 Contract Management Variance Report and the DE580L1
Analysis of Fund Equities Report;
ii. A written explanation to the county of service variances reflected in the
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, Bureau of Budget
Management.
4 Mel 1 0
p. The dates for the submission of quarterly reports to the county shall be as follows
unless the generation and distribution of reports is delayed due to circumstances beyond
the CHD's control:
i. March 1, 2012 for the report period October 1, 2011 through
December 31, 2011;
ii. June 1, 2012 for the report period October 1, 2011 through
March 31, 2012;
iii. September 1, 2012 for the report period October 1, 2011
through June 30, 2012; and
iv. December 1, 2012 for the report period October 1, 2011
through September 30, 2012.
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 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 transferred 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 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 party'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
me 9046�
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,
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 follows:
For the State:
Joan M. Colfer, M.D.,M.P.H
Name
Director, Collier County Health Dept
Title
3339 E. Tamiami Trail, Bldg. H
Naples, Florida 34112
Address
(239) 252 -8201
Telephone
For the County:
Marla Olsvig Ramsey
Name
Public Services Administrator
Title
3339 E. Tamiami Trail, Bldg. H
Naples, Florida 34112
Address
(239) 252 -8383
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.
[tie
'11 Hum I
In WITNESS THEREOF, the parties hereto have caused this 24 page agreement to be
executed by their undersigned officials as duly authorized effective the 1'day of October, 2011.
BOARD OF COUNTY COMMISSIONERS
FOR COLLIER COUNTY
SIGNED B
NAME: JRz Co'q LG
TITLE: CH A i P Vlei A r-,(
DATE: I b/ 2 5 1 20 l(
ATTESTED TO:
SIGNED BY
NAME: '
t k
TITL
DATE:i s .
r0.
as to form and
Jeff y A, Klat
G ttorney
STATE OF FLORIDA
DEPARTMENT OF HEALTH
SIGNED 244 4zCD
NAME: H. Frank Farmer, Jr., MD, PhD, FACP
TITLE: State Surgeon General
DATE: / lP It
• •. •
TITLE: CHD Director /Administrator
DATE: a
I
ATTACHMENT I
COLLIER COUNTY HEALTH DEPARTMENT
PROGRAM SPECIFIC REPORTING REQUIREMENTS AND PROGRAMS REQUIRING
COMPLIANCE WITH THE PROVISIONS OF SPECIFIC MANUALS
Some health services must comply with specific program and reporting requirements in addition to the Personal Health
Coding Pamphlet (DHP 50 -20), Environmental Health Coding Pamphlet (DHP 50 -21) and FLAIR requirements because
of federal or state law, regulation or rule. If a county health department is funded to provide one of these services, it
must comply with the special reporting requirements for that service. The services and the reporting requirements are
listed below:
Service
Requirement
1. Sexually Transmitted Disease
Requirements as specified in FAC 64D -3, F.S. 381 and
Program
F.S. 384 and the CHD Guidebook.
2. Dental Health
Monthly reporting on DH Form 1008*. Additional reporting
requirements, under development, will be required. The
additional reporting requirements will be communicated upon
finalization.
3. Special Supplemental Nutrition
Service documentation and monthly financial reports as
Program for Women, Infants
specified in DHM 150 -24* and all federal, state and county
requirements detailed in program manuals and published
and Children (including the WIC
Breastfeeding Peer Counseling
procedures.
Program)
4. Healthy Start/
Requirements as specified . in the 2007 Healthy Start
Improved Pregnancy Outcome
Standards and Guidelines and as specified by the Healthy
Start Coalitions in contract with each county health
department.
5. Family Planning
Periodic financial and programmatic reports as specified
by the program office and in the CHD Guidebook, Internal
Operating Policy FAMPLAN 14*
6. Immunization
Periodic reports as specified by the department regarding
the surveillance /investigation of reportable vaccine
preventable diseases, vaccine usage accountability as
documented in Florida SHOTS, the assessment of various
immunization levels as documented in Florida SHOTS and
forms reporting adverse events following immunization.
7. Chronic Disease Program
Requirements as specified in the Healthy Communities,
Healthy People Guidebook.
8. Environmental Health
Requirements as specified in Environmental Health Programs
Manual 150 -4* and DHP 50 -21*
9. HIV /AIDS Program
Requirements as specified in F.S. 384.25 and
64D -3.016 and 3.017 F.A.C. and the CHD Guidebook. Case
reporting should be on Adult HIV /AIDS Confidential Case
Report CDC Form DH2139 and Pediatric HIV /AIDS
Confidential Case Report CDC Form DH2140. Socio-
t0
j
ATTACHMENT I (Continued)
demographic data on persons tested for HIV in CHD clinics
should be reported on Lab Request DH Form 1628 or Post -
Test Counseling DH Form 1628C. These reports are to be
sent to the Headquarters HIV /AIDS office within 5 days of the
initial post -test counseling appointment or within 90 days of
the missed post -test counseling appointment.
10. School Health Services Requirements as specified in the Florida School Health
Administrative Guidelines (April 2007).
11. Tuberculosis Tuberculosis Program Requirements as specified in FAC
64D -3, F.S. Specific Authority 381.0011(13), 381.003(2),
381.0031(6), 384.33, 392.53(2), 392.66 FS Law Implemented
381.0011(4), 381.003(1), 381.0031(1), (2), (6), 383.06,
384.23, 384.25, 385.202, 392.53 FS.381 and CHD
Guidebook.
12. 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 the CHD Guide to Surveillance and Investigations.
*or the subsequent replacement if adopted during the contract period.
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1. GENERAL REVENUE - STATE
19,261
0
19,261
0
19,261
015040
AIDS PREVENTION
50,310
0
50,310
0
50,310
015040
AIDS SURVEILLANCE
0
0
015040
ALG /CESSPOOL IDENTIFICATION AND ELIMINATION
0
0
0
100,000
015040
ALG /CONTR TO CHDS -AIDS PATIENT CARE
100,000
0
100,000
0
0
015040
ALG /CONTR TO CHDS -AIDS PATIENT CARE NETWORK
0
0
0
0
0
015040
ALG /CONTR. TO CHDS - SOVEREIGN IMMUNITY
0
0
0
0
0
015040
ALG/IPO HEALTHY STARVIPO
0
0
0
0
0
156,716
015040
ALG/PRIMARY CARE
156,716
0
156,716
0
015040
ALPHA ONE PROGRAM - MIAMI -DARE
0
0
0
0
0
015040
CHILD HEALTH MEDICAL SERVICES
0
0
0
0
0
015040
CLOSING THE GAP PROGRAM
0
0
0
0
0
015040
COMMUNITY SMILES - MIAMI -DADE
0
0
0
0
56,977
015040
COMMUNITY TB PROGRAM
56,977
0
56,977
0
0
015040
COUNTY SPECIFIC DENTAL PROJECTS- ESCAMBIA
0
0
0
0
6,542
015040
DENTAL SPECIAL INITIATIVES
6,542
0
6,542
0
0
015040
DUVAL TEEN PREGNANCY PREVENTION
0
0
0
0
36,794
015040
FAMILY PLANNING GENERAL REVENUE
36,794
0
36,794
0
0
015040
FL CLPPP SCREENING & CASE MANAGEMENT
0
0
0
0
89,286
015040
FL HEPATITIS & LIVER FAILURE PREVENTIONCONTROL
89,286
0
89,286
0
015040
HEALTHY START MED WAIVER- SOBRA
0
0
0
0
0
0
015040
HEALTHY START MED - WAIVER- CLIENT SERVICES
0
0
0
0
0
015040
JESSIE TRICE CANCER CTR/HEALTH CHOICE - MIAMI -DADE
0
0
0
0
015040
LA LIGA LEAGUE AGAINST CANCER- MIAMI-DADE
0
0
0
0
0
0
015040
MANATEE COUNTY RURAL HEALTH SERVICES
0
0
0
0
0
015040
METRO ORLANDO URBAN LEAGUE TEENAGE PREG PREV
0
0
0
0
015040
MIGRANT LABOR CAMP SANITATION
74,533
0
74,533
0
74,533
0
015040
MINORITY OUTREACH- PENALVER CLINIC- MIAMI -DADE
0
0
0
0
015040
SCHOOL HEALTH GENERAL REVENUE
80,855
0
80,855
0
80,855
015040
SPECIAL NEEDS SHELTER PROGRAM
0
0
0
0
0
0
015040
STATEWIDE DENTISTRY NETWORK- ESCAMBIA
0
0
0
0
0
015040
STD GENERAL REVENUE
0
0
0
0
0
1,883,272
015050
NON - CATEGORICAL GENERAL REVENUE
1,883,272
0
1,883,272
GENERAL
REVENUE TOTAL
2,554,546
0
2,554,546
0
2,554,546
2. NON GENERAL REVENUE - STATE
015010
ALG /CONTR. TO CHDS - BIOMEDICAL WASTE
13,849
0
13,849
0
13,849
015010
ALG /CONTR. TO CHDS -SAFE DRINKING WATER PRG
0
0
0
0
0
156,716
0
156,716
0
156,716
015010
ALG/PRIMARY CARE
0
015010
CHD PROGRAM SUPPORT
0
0
0
0
0
015010
FOOD AND WATERBORNE DISEASE PROGRAM ADM TRDACS
0
0
0
0
015010
PUBLIC SWIMMING POOL PROGRAM
0
0
0
0
0
137,218
015010
SCHOOL HEALTH TOBACCO TF
137,218
0
137,218
0
015010
SUPER ACT SERVICES
6,200
0
6,200
0
6,200
30,000
015010
TOBACCO ADMINISTRATIVE SUPPORT
30,000
0
30,000
0
117,000
015010
TOBACCO COMMUNITY INTERVENTION
117,000
0
117,000
0
015020
TRANSFER FROM ANOTHER STATE AGENCY
0
0
0
0
0
5,000
015020
TRANSFER FROM ANOTHER STATE AGENCY- INDIRECT
5,000
0
5,000
0
015020
TRANSFER FROM ANOTHER STATE AGENCY
0
0
0
0
0
Page 1 of 7
Version:
2
2. NON GENERAL REVENUE - STATE
015060
NON - CATEGORICAL TOBACCO REBASING
32,134
0
32,134
0
32,134
NON GENERAL REVENUE TOTAL
498,117
0
498,117
0
498,117
3. FEDERAL FUNDS - State
217,508
0
217,508
0
217,508
007000
AIDS PREVENTION
0
0
0
0
007000
AIDS SURVEILLANCE
0
0
0
007000
BIOTERRORISM HOSPITAL PREPAREDNESS
0
0
0
19,287
007000
COASTAL BEACH MONITORING PROGRAM
19,287
0
19,287
0
0
007000
COLORECTAL CANCER SCREENING2009 -10
0
0
0
0
p
007000
ENHANCE COMPREHENSIVE PREVENTION PLANNING AND IMP L
0
0
0
0
0
007000
EXPANDED TESTING INITIATIVE(ETI)
0
0
0
0
0
0
0
0
0
007000
FGTF /AIDS MORBIDITY
0
0
007000
FGTF/BREAST & CERVICAL CANCER ADMIN/CASE MAN
0
0
0
0
007000
FGTF/FAMILY PLANNING TITLE X SPECIAL INITIATIVES
0
0
0
0
87,306
007000
FGTF/FAMILY PLANNING-TITLE X
87, 306
0
87, 306
0
p
007000
HEALTH PROGRAM FOR REFUGEES
0
0
0
0
0
23,944
007000
HEALTHY PEOPLE HEALTHY COMMUNITIES
23,944
0
23,944
0
007000
HIV HOUSING FOR PEOPLE LIVING WITH AIDS
0
0
0
0
0
007000
HIV INCIDENCE SURVEILLANCE
0
0
0
0
0
80,614
007000
IMMUNIZATION FEDERAL GRANT ACTIVITY SUPPORT
80,614
0
80,614
0
007000
IMMUNIZATION FIELD STAFF EXPENSE
0
0
0
0
p
007000
IMMUNIZATION WIG LINKAGES
0
0
0
0
0
p
007000
IMMUNIZATION -WIC LINKAGES
0
0
0
0
78,746
007000
MCH BGTF- SPECIAL PROJECTS
78,746
0
78,746
0
007000
MCH BGTF - HEALTHY START COALITIONS
0
0
0
0
0
007000
ORAL HEALTH WORKFORCE ACTIVITIES
0
0
0
0
0
007000
PHP - CITIES READINESS INITIATIVE
0
0
0
0
0
129,181
007000
PUBLIC HEALTH PREPAREDNESS BASE
129,181
0
129,181
0
007000
RAPE PREVENTION & EDUCATION GRANT
0
0
0
0
0
0
0
0
0
007000
RYAN WHITE
0
0
0
0
007000
RYAN WHITE - EMERGING COMMUNITIES
0
77,945
007000
RYAN WHITE -AIDS DRUG ASSIST PROG•ADMIN
77,945
0
77,945
0
0
007000
RYAN WHITE- CONSORTIA
0
0
0
0
p
17,050
HEALTH INFRASTRUCTURE FOR IMPROV1ObIEALTH
OUTCOMES
17,050
007000
STRENGTHENING PUBLIC
0
0
007000
STD FEDERAL GRANT - CSPS
0
0
0
0
5,624
007000
STD PROGRAM INFERTILITY PREVENTION PROJECT(IPP)
5,624
0
5,624
0
007000
SYPHILIS ELIMINATION
0
0
0
0
0
0
007000
TEENAGE PREGNANCY PREVENTION REPLICATION2010 -11
0
0
0
0
007000
TEENAGE PREGNANCY PREVENTION REPLICATION2011 -12
0
0
0
0
145,158
007000
TITLE X HIV/AIDS PROJECT
145,158
0
145,158
0
0
75,086
007000
TITLE X MALE PROJECT
75,086
0
75,086
0
007000
TOBACCO FAITH BASED PROJECT
0
0
0
0
0
124,324
007000
TUBERCULOSIS CONTROL- FEDERAL GRANT
124,324
0
124,324
1,582,818
007000
WIC ADMINISTRATION
1,582,818
0
1,582,818
0
104,264
007000
WIC BREASTFEEDING PEER COUNSELING
104,264
0
104,264
0
0
015009
MEDIPASS WAIVER HLTHY STRT CLIENT SERVICES
0
0
0
0
0
015009
MEDIPASS WAIVERSOBRA
0
0
0
0
0
26,955
007055
ARRA Federal Grant- Schedule C
26,955
0
26,955
Page 2 of 7
Version:
2
3. FEDERAL FUNDS - State
015075
REFUGEE HEALTH SCREENING
015075
SCHOOL HEALTH TITLE XXI
015075
Inspections of Summer Feeding Programs
015075
TRANSFER OF FEDERAL GRANT FROM OTHER AGENCY
FEDERAL FUNDS TOTAL
4. FEES ASSESSED BY STATE OR FEDERAL RULES - STATE
001020
TANNING FACILITIES
001020
BODY PIERCING
001020
MIGRANT HOUSING PERMIT
001020
MOBILE HOME AND PARKS
001020
FOOD HYGIENE PERMIT
001020
BIOHAZARD WASTE PERMIT
001020
PRIVATE WATER CONSTR PERMIT
001020
PUBLIC WATER ANNUAL OPER PERMIT
001020
PUBLIC WATER CONSTR PERMIT
001020
NON -SDWA SYSTEM PERMIT
001020
SAFE DRINKING WATER
001020
SWIMMING POOLS
001092
OSDS PERMIT FEE
001092
I & M ZONED OPERATING PERMIT
001092
AEROBIC OPERATING PERMIT
001092
SEPTIC TANK SITE EVALUATION
001092
NON SDWA LAB SAMPLE
001092
OSDS VARIANCE FEE
001092
ENVIRONMENTAL HEALTH FEES
001092
OSDS REPAIR PERMIT
001170
LAB FEE CHEMICAL ANALYSIS
001170
WATER ANALYSIS- POTABLE
001170
NONPOTABLE WATER ANALYSIS
010304
MQA INSPECTION FEE
001206
Central Office Surcharge
FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL
5. OTHER CASH CONTRIBUTIONS - STATE
010304
STATIONARY POLLUTANT STORAGE TANKS
090001
DRAW DOWN FROM PUBLIC HEALTH UNIT
OTHER CASH CONTRIBUTIONS TOTAL
6. MEDICAID - STATE /COUNTY
001056
MEDICAID PHARMACY
001076
MEDICAID TB
001078
MEDICAID ADMINISTRATION OF VACCINE
001079
MEDICAID CASE MANAGEMENT
001081
MEDICAID CHILD HEALTH CHECK UP
001082
MEDICAID DENTAL
001083
MEDICAID FAMILY PLANNING
Version: 2
246,000
0
246,000
0
246,000
33,690
0
33,690
0
33,690
0
0
0
0
0
0
0
0
0
0
3,075,500
0
3,075,500
0
3,075,500
3,150
0
3,150
0
3,150
0
0
0
0
0
56,900
0
56,900
0
56,900
19,500
0
19,500
0
19,500
28,000
0
28,000
0
28,000
35,000
0
35,000
0
35,000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
315,000
0
315,000
0
315,000
140,000
0
140,000
0
140,000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
26,000
0
26,000
0
26,000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
50,000
0
50,000
0
50,000
673,550
0
673,550
0
673,550
0
0
0
0
0
66,032
0
66,032
0
66,032
66,032
0
66,032
0
66,032
248,498
315,502
564,000
0
564,000
16,702
21,206
37,908
0
37,908
19,000
19,000
38,000
0
38,000
12,000
12,000
24,000
0
24,000
0
0
0
0
0
339,097
430,529
769,626
0
769,626
0
0
0
0
0
Page 3 of 7
6. MEDICAID - STATE /COUNTY
MEDICAID TOTAL
7. ALLOCABLE REVENUE - STATE
018000 REFUNDS
037000 PRIOR YEAR WARRANT
038000 12 MONTH OLD WARRANT
ALLOCABLE REVENUE TOTAL
8. OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND - STAT
PHARMACY SERVICES
LABORATORY SERVICES
TB SERVICES
IMMUNIZATION SERVICES
STD SERVICES
CONSTRUCTION/RENOVATION
WIC FOOD
ADAP
DENTAL SERVICES
OTHER (SPECIFY)
OTHER (SPECIFY)
OTHER STATE CONTRIBUTIONS TOTAL
9. DIRECT LOCAL CONTRIBUTIONS - COUNTY
3,769
6,738
2,969
001087
MEDICAID STD
74,115
0
74,115
32,655
001089
MEDICAID AIDS
0
0
0
0
001147
Medicaid HMO Capitation
3,369
001191
MEDICAID MATERNITY
0
001192
MEDICAID COMPREHENSIVE CHILD
1,484
001193
MEDICAID COMPREHENSIVE ADULT
2,969
001194
MEDICAID LABORATORY
0
001208
MEDIPASS $3.00 ADM. FEE
217
001059
Medicaid Low Income Pool
0
001051
Emergency Medicaid
0
001058
Medicaid - Behavioral Health
0
001071
Medicaid - Orthopedic
0
0
0
0
001072
Medicaid - Dermatology
0
001075
Medicaid - School Health Certified Match
0
001069
Medicaid - Refugee Health
0
001055
Medicaid - Hospital
0
001148
Medicaid HMO Non - Capitation
0
001074
Medicaid - Newborn Screening
0
0
0
675,592
MEDICAID TOTAL
7. ALLOCABLE REVENUE - STATE
018000 REFUNDS
037000 PRIOR YEAR WARRANT
038000 12 MONTH OLD WARRANT
ALLOCABLE REVENUE TOTAL
8. OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND - STAT
PHARMACY SERVICES
LABORATORY SERVICES
TB SERVICES
IMMUNIZATION SERVICES
STD SERVICES
CONSTRUCTION/RENOVATION
WIC FOOD
ADAP
DENTAL SERVICES
OTHER (SPECIFY)
OTHER (SPECIFY)
OTHER STATE CONTRIBUTIONS TOTAL
9. DIRECT LOCAL CONTRIBUTIONS - COUNTY
3,769
6,738
0
6,738
41,460
74,115
0
74,115
0
0
0
0
0
0
0
0
1,885
3,369
0
3,369
3,769
6,738
0
6,738
0
0
0
0
217
434
0
434
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
849,336
1,524,928
0
1,524,928
2,180 0
0 2
2,180 0
0 2
2,180
0 0
0 0
0 0
0 0
0
0 0
0 0
0 0
0 0
0
2,180 0
0 2
2,180 0
0 2
2,180
0 0 0 0 0
008030 Contribution from Health Care Tax 0 1,324,400
008034 BCC Contribution from General Fund 0 1,324,400 1,324,400
DIRECT COUNTY CONTRIBUTION TOTAL
0 1,324,400 1,324,400 0 1,324,400
10. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION - COUNTY
Page 4 of 7
Ve rsion: 2
10. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION - COUNT
11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY
001009 RETURNED CHECK ITEM
001029 THIRD PARTY REIMBURSEMENT
001029 HEALTH MAINTENANCE ORGAN (HMO)
001054 MEDICARE PART D
001077 RYAN WHITE TITLE II
001090 MEDICARE PART B
001190 Health Maintenance Organization
005040 INTEREST EARNED
005041 INTEREST EARNED -STATE INVESTMENT ACCOUNT
007010 U.S. GRANTS DIRECT
008010 Contribution from City Government
008020 Contribution from Health Care Tax not thru BCC
008050 School Board Contribution
008060 Special Project Contribution
010300 SALE OF GOODS AND SERVICES TO STATE AGENCIES
010301 EX? WITNESS FEE CONSULTNT CHARGES
010405 SALE OF PHARMACEUTICALS
010409 SALE OF GOODS OUTSIDE STATE GOVERNMENT
011001 HEALTHY START COALITION CONTRIBUTIONS
011007 CASH DONATIONS PRIVATE
012020 FINES AND FORFEITURES
012021 RETURN CHECK CHARGE
028020 INSURANCE RECOVERIES -OTHER
090002 DRAW DOWN FROM PUBLIC HEALTH UNIT
011000 GRANT DIRECT -NOVA UNIVERSITY CHD TRAINING
011000 GRANT - DIRECT
011000 GRANT DIRECT - COUNTY HEALTH DEPARTMENT DIRECT SERVICES
011000 COUNTY COMMISSION - LIP FUND
011000 GRANT- DIRECT
011000 GRANT - DIRECT
011000 GRANT DIRECT - QUANTUM DENTAL
011000 GRANT DIRECT - HEALTH CARE DISTRICT PAHOKEE
Version: 2
200
0
0
154,778
0
0
609,450
62,000
238,000
4,000
0
0
0
1,068,428
0
0
0
200
200 0
001060
CHD SUPPORT POSITION
0
0
0 0
001077
RABIES VACCINE
p
0
0 0
001077
CHILD CAR SEAT PROG
0
154,778
154,778 0
001077
PERSONAL HEALTH FEES
0
0
0 0
001077
AIDS CO -PAYS
p
p
0
0 0
001094
ADULT ENTER PERMIT FEES
0
609,450
609,450 0
001094
LOCAL ORDINANCE FEES
0
62,000
62,000 0
001114
NEW BIRTH CERTIFICATES
0
238,000
238,000 0
001115
Vital Statistics - Death Certificate
0
4,000
4,000 0
001117
VITAL STATS -ADM. FEE 50 CENTS
0
0
0
0
0
p
0
0
001073
Co -Pay for the AIDS Care Program
0
0
0 0
001025
Client Revenue from GRC
p
0
0 0
001040
Cell Phone Administrative Fee
p
0
0
FEES AUTHORIZED BY COUNTY TOTAL
0
1,068,428
1,068,428 0
11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY
001009 RETURNED CHECK ITEM
001029 THIRD PARTY REIMBURSEMENT
001029 HEALTH MAINTENANCE ORGAN (HMO)
001054 MEDICARE PART D
001077 RYAN WHITE TITLE II
001090 MEDICARE PART B
001190 Health Maintenance Organization
005040 INTEREST EARNED
005041 INTEREST EARNED -STATE INVESTMENT ACCOUNT
007010 U.S. GRANTS DIRECT
008010 Contribution from City Government
008020 Contribution from Health Care Tax not thru BCC
008050 School Board Contribution
008060 Special Project Contribution
010300 SALE OF GOODS AND SERVICES TO STATE AGENCIES
010301 EX? WITNESS FEE CONSULTNT CHARGES
010405 SALE OF PHARMACEUTICALS
010409 SALE OF GOODS OUTSIDE STATE GOVERNMENT
011001 HEALTHY START COALITION CONTRIBUTIONS
011007 CASH DONATIONS PRIVATE
012020 FINES AND FORFEITURES
012021 RETURN CHECK CHARGE
028020 INSURANCE RECOVERIES -OTHER
090002 DRAW DOWN FROM PUBLIC HEALTH UNIT
011000 GRANT DIRECT -NOVA UNIVERSITY CHD TRAINING
011000 GRANT - DIRECT
011000 GRANT DIRECT - COUNTY HEALTH DEPARTMENT DIRECT SERVICES
011000 COUNTY COMMISSION - LIP FUND
011000 GRANT- DIRECT
011000 GRANT - DIRECT
011000 GRANT DIRECT - QUANTUM DENTAL
011000 GRANT DIRECT - HEALTH CARE DISTRICT PAHOKEE
Version: 2
200
0
0
154,778
0
0
609,450
62,000
238,000
4,000
0
0
0
1,068,428
0
0
0
0
0
0
830,113
830,113
0
830,113
0
0
0
0
0
0
8,400
8,400
0
8,400
0
0
0
0
0
0
80,343
80,343
0
80,343
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
39,340
39,340
0
39,340
0
0
0
0
0
0
451,381
451,381
0
451,381
0
3,300
3,300
0
3,300
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
85,280
85,280
0
85,280
0
0
0
0
0
0
367,386
367,386
0
367,386
0
0
0
0
0
0
90,504
90,504
0
90,504
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Page 5 of 7
......__._.....
11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNT
0
0
0
0
0
011000 GRANT- DIRECT
0
0
0
0
011000 GRANT - DIRECT
0
0
0
0
0
011000 GRANT- DIRECT
0
0
0
0
0
011000 GRANT- DIRECT
0
0
0
0
0
0
011000 GRANT- DIRECT
0
0
0
0
011000 GRANT DIRECT -ARROW
0
0
0
010402 Recycled Material Sales
0
0
0
0
0
0
0
0
010303 FDLE Fingerprinting
0
0
0
0
007050 ARRA Federal Grant
0
0
0
001010 Recovery of Bad Checks
0
0
0
0
0
0
0
0
008065 FCO Contribution
0
0
0
0
011006 Restricted Cash Donation
0
0
0
0
0
0
028000 Insurance Recoveries
0
0
0
0
0
001033 CMS Management Fee - PMPMPC
0
0
010400 Sale of Goods Outside State Government
0
0
0
0
0
0
0
0
010500 Refugee Health
0
0
0
0
005045 Interest Famed -Third Parry Provider
0
0
0
005043 Interest Earned- Contract/Grant
0
0
0
0
0
010306 DOH/DOC Interagency Agreement
0
0
0
0
0
0
0
0
008040 BCC Grant/Contract
0
0
0
0
011002 ARRA Federal Grant- Sub - Recipient
0
OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL
0
1,956,047
1,956,047
0
1,956,047
12. ALLOCABLE REVENUE - COUNTY
0
2,180
2,180
0
2,180
018000 REFUNDS
0
0
0
0
0
037000 PRIOR YEAR WARRANT
0
0
038000 12 MONTH OLD WARRANT
0
0
0
COUNTY ALLOCABLE REVENUE TOTAL
0
2,180
2,180
0
2,180
13. BUILDINGS - COUNTY
0
0
0
525, 048
525,048
ANNUAL RENTAL EQUIVALENT VALUE
195,149
0
0
0
195,144
GROUNDS MAINTENANCE
0
0
0
0
0
OTHER (SPECIFY)
0
0
INSURANCE
0
0
0
0
0
0
243,700
243,700
UTILITIES- TELEPHONE, ELECTRIC, WATER & SEWER
0
0
0
0
0
OTHER (SPECIFY)
0
0
0
65,700
65,700
BUILDING MAINTENANCE
0
0
0
1,029,597
1,029,597
BUILDINGS TOTAL
NOT IN CHD TRUST FUND
- COUNTY
14. OTHER COUNTY CONTRIBUTIONS
EQUIPMENTNEHICLE PURCHASES
0
0
0
0
0
17,900
0
0
0
17,900
VEHICLE INSURANCE
0
0
VEHICLE MAINTENANCE
0
0
0
0
OTHER COUNTY CONTRIBUTION (SPECIFY)
0
0
0
0
0
OTHER COUNTY CONTRIBUTION (SPECIFY)
0
0
0
0
0
0
p
17,900
17,900
OTHER COUNTY CONTRIBUTIONS TOTAL
Page 6 of 7
Version: 2
GRAND TOTAL CHD PROGRAM
Page 7 of 7
Ve rsion: 2
A. COMMUNICABLE DISEASE CONTROL:
IMMUNIZATION (101)
14.12
22,510
26,400
240,612
206,239
240,612
206,239
420,826
472,876
893,702
STD (102)
8.28
946
1,638
108,172
92,147
108,172
92,147
7,028
393,610
400,638
HIV /AIDS PREVENTION (03A1)
3.30
372
865
63,595
54,173
63,595
54,173
218,350
17,186
235,536
HIV /AIDS SURVEILANCE(03A2)
1.50
169
393
27,000
23,000
27,000
23,000
50,000
50,000
100,000
HIV /AIDS PATIENT CARE (03A3)
10.20
1,151
2,673
259,116
225,762
259,116
225,762
443,701
526,055
969,756
ADAP (03A4)
2.30
260
603
21,840
18,720
21,840
18,720
81,120
0
81,120
TB CONTROL SERVICES (104)
12.58
1,187
8,021
211,351
181,158
211,351
181,158
470,700
314,318
785,018
COMM. DISEASE SURV. (106)
6.38
0
7,717
139,615
119,670
139,615
119,670
25
518,545
518,570
HEPATITIS PREVENTION (109)
3.74
2,567
3,568
45,545
39,039
45,545
39,039
169,161
7
169,168
PUBLIC HEALTH PREP AND RESP(116)
5.57
0
4
98,149
84,128
98,149
84,128
153,356
211,198
364,554
VITAL STATISTICS(180)
4.30
15,025
51,685
54,840
47,005
54,840
47,005
2
203,688
203,690
7227
44,187
103,567
1,269,835
1,091,041
1,269,835
1,091,041
2,014,269
2,707,483
4,721,752
COMMUNICABLE DISEASE SUBTOTAL
B. PRIMARY CARE:
CHRONIC DISEASE SERVICES (210)
0.90
0
1,238
13,740
11,777
13,740
11,777
15,617
35,417
51,034
TOBACCO PREVENTION (212)
3.88
0
2,342
56,639
48,548
56,639
48,548
157,574
52,800
210,374
WIC (21WI)
36.25
10,585
121,557
427,189
366,920
427,189
366,920
1,588,218
0
1,588,218
WIC BREASTFEEDING PEER COUNSELING(21W2)
2.00
4,356
908
28,151
23,981
28,151
23,981
104,264
0
104,264
FAMILY PLANNING(223)
2.58
4,415
7,131
116,038
99,461
116,038
99,461
430,998
0
430,998
IMPROVED PREGNANCY OUTCOME (225)
6.91
1,516
9,719
195,671
167,718
195,671
167,718
493,073
233,705
726,778
HEALTHY START PRENATAL(227)
14.39
1,403
7,808
226,974
194,549
226,974
194,549
500,000
343,046
843,046
COMPREHENSIVE CHILD HEALTH (229)
2.67
332
1,067
54,260
46,509
54,260
46,509
80,376
121,162
201,538
HEALTHY START INFANT(231)
3.41
887
4,372
44,902
38,487
44,902
38,487
166,778
0
166,778
SCHOOL HEALTH (234)
7.19
0
240,080
120,001
102,858
120,001
102,858
341,052
104,666
445,718
COMPREHENSIVE ADULT HEALTH (237)
5.77
101
3,758
146,382
125,470
146,382
125,470
245,824
297,880
543,704
COMMUNITY HEALTH DEVELOPMENT(238)
0.00
0
0
0
0
0
0
0
0
0
DENTAL HEALTH (240)
16.47
4,962
10,505
331,563
284,197
331,563
284,197
391,484
840,036
1,231,520
102.42
29,967
410,485
1,761,510
1,510,475
1,761,510
1,510,475
4,515,258
2,028,712
6,543,970
PRIMARY CARE SUBTOTAL
C. ENVIRONMENTAL HEALTH:
Water and Onsite Sewage Programs
COASTAL BEACH MONITORING(347)
0.24
851
851
8,916
7,642
8,916
7,642
33,116
0
33,116
LIMITED USE PUBLIC WATER SYSTEMS(357)
0.18
119
651
2,829
2,425
2,829
2,425
3,145
7,363
10,508
PUBLIC WATER SYSTEM (358)
0.00
0
0
0
0
0
0
0
0
0
PRIVATE WATER SYSTEM (3 59)
0.00
0
0
58
50
58
50
0
216
216
INDIVIDUAL SEWAGE DISP. (361)
6.75
3,113
8,521
158,257
135,649
158,257
135,649
342,891
244,921
587,812
7.17
4,083
10,023
170,060
145,766
170,060
145,766
379,152
252,500
631,652
Group Total
Facility Programs
FOOD HYGIENE (348)
2.01
388
1,960
36,567
31,343
36,567
31,343
135,820
0
135,820
BODY ART (349)
0.03
5
13
288
247
288
247
554
516
1,070
GROUP CARE FACILITY (351)
1.04
391
791
13,636
11,688
13,636
11,688
4,504
46,144
50,648
MIGRANT LABOR CAMP(352)
1.94
193
1,288
31,699
27,170
31,699
27,170
77,690
40,048
117,738
HOUSING,PUBLIC BLDG SAFETY,SANITATION(353)0.00
0
0
0
0
0
0
0
0
0
Page
1 of 2
Version: 2
C. ENVIRONMENTAL HEALTH:
Facility Programs
MOBILE HOME AND PARKS SERVICES (354)
0.57
SWIMMING POOLSBATHING (360)
3.64
BIOMEDICAL WASTE SERVICES (364)
0.90
TANNING FACILITY SERVICES(369)
0.07
Group Total
10.20
Groundwater Contamination
STORAGE TANK COMPLIANCE (355)
0.00
SUPER ACT SERVICE (356)
0.01
Group Total
0.01
Community Hygiene
OCCUPATIONAL HEALTH(344)
0.00
COMMUNITY ENVIR HEALTH (345)
0.00
INJURY PREVENTION (346)
1.27
LEAD MONITORING SERVICES(350)
0.00
PUBLIC SEWAGE (362)
0.00
SOLID WASTE DISPOSAL(363)
0.00
SANITARY NUISANCE (365)
0.01
RABIES SURVEILLANCF/CONTROL SERVICES (366)0.00
ARBOVIRUS SURVEILLANCE (367)
0.00
RODENT /ARTHROPOD CONTROL (368)
0.00
WATER POLLUTION(370)
0.00
INDOOR AIR (371)
0.00
RADIOLOGICAL HEALTH(372)
0.00
TOXIC SUBSTANCES (373)
0.00
Group Total
128
ENVIRONMENTAL HEALTH SUBTOTAL
18.66
D. NON - OPERATIONAL COSTS:
Non - Operational Costs (599)
0.00
ENVIRONMENTAL HEALTH SURCHARGE(399)
0.00
NON - OPERATIONAL COSTS SUBTOTAL
0.00
TOTAL CONTRACT
193.35
Version: 2
113 425 7,922 6,790 7,922 6,790 19,500 9,924 29,424
1,110 11,144 82,867 71,029 82,867 71,029 233,771 74,021 307,792
500 664 18,104 15,518 18,104 15,518 66,900 344 67,244
26 66 995 853 995 853 3,696 0 3,696
2,726 16,351 192,078 164,638 192,078 164,638 542,435 170,997 713,432
0 0 0 0 0 0 0 0 0
11 16 198 170 198 170 736 0 736
11 16 198 170 198 170 736 0 736
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 529 22,589 19,362 22,589 19,362 43,428 40,474 83,902
0 0 7 6 7 6 13 13 26
0 0 2 2 2 2 4 4 8
0 0 0 0 0 0 0 0 0
1 3 116 99 116 99 222 208 430
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
1 532 22,714 19,469 22,714 19,469 43,667 40,699 84,366
6,821 26,922 385,050 330,043 385,050 330,043 965,990 464,196 1,430,186
0 0 0 0 0 0 0 0 0
0 0 13,462 11,538 13,462 11,538 50,000 0 50,000
0 0 13,462 11,538 13,462 11,538 50,000 0 50,000
80,975 540,974 3,429,857 2,943,097 3,429,857 2,943,097 7,545,517 5,200,391 12,745,908
Page 2 of 2
R.
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.
22
ATTACHMENT IV
COLLIER COUNTY HEALTH DEPARTMENT
! 41
FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT
Facility
Description
Collier County Health
Department & Public
Services Building H
Immokalee Satellite
Golden Gate WIC Office
Location
3339 E. Tamiami Trail
Building H, Naples
419 North First Street
Immokalee
Owned By
Collier County
Collier County
4945 Golden Gate Parkway Benderson
Unit 102, Naples Development
23
me 9001-9
ATTACHMENT V
COLLIER COUNTY HEALTH DEPARTMENT
SPECIAL PROJECTS SAVINGS PLAN
IDENTIFY THE AMOUNT OF CASH THAT IS ANTICIPATED TO BE SET ASIDE ANNUALLY FOR THE PROJECT.
CONTRACT YEAR
2009 -2010
2010 -2011
2011 -2012
2012 -2013
2013 -2014
PROJECT TOTAL
STATE
$ 0
$ 0
COUNTY
$ 0
$ 0
SPECIAL PROJECT CONSTRUCTION /RENOVATION PLAN
PROJECT NAME:
LOCATION/ ADDRESS:
PROJECT TYPE:
NEW BUILDING
RENOVATION
NEW ADDITION
ROOFING
PLANNING STUDY
OTHER
SQUARE FOOTAGE:
PROJECT SUMMARY: Describe scope of work in reasonable detail.
No savings for Special Projects are scheduled for 2011 -2012.
ESTIMATED PROJECT INFORMATION:
START DATE (initial expenditure of funds) :
COMPLETION DATE:
DESIGN FEES:
$
CONSTRUCTION COSTS:
$
FURNITURE /EQUIPMENT
$
TOTAL PROJECT COST:
$ -
COST PER SQ FOOT:
$ #DIV /0!
TOTAL
$ 0
$ 0
Special Capital Projects are new construction or renovation projects and new furniture or equipment
associated with these projects and mobile health vans.
24