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Backup Documents 11/13/2018 Item #16D 8 (Secondary: Golden Care Home Health, Inc)
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 6 D 8 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#1 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 through routing 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. Risk Risk Management c G j�I 1314 2. County Attorney Office County Attorney Office 4. BCC Office Board of County ( Commissioners , aki-k.\ 4. Minutes and Records Clerk of Court's Office It/108 11:31/ 5. Procurement Services Procurement Services 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,may need to contact staff for additional or missin information. Name of Primary Staff Ana Reynoso/PURCHASIN Contact Information 239-252-8950 Contact/ Depailntent Agenda Date Item was November 13, 2018 Agenda Item Number 16.D.8. Approved by the BCC Type of Document CONTRACT Number of Original 6 Attached Documents Attached PO number or account N/A 18-7300 Primary: Eleven Ash, number if document is Primary: Eleven Ash, . ••. . • _ to be recorded Inc.dba Health Force Sec• : •ary: Golden Secondary: Golden Care Home Health • Care Home Health,Inc. Tertiary:Always Tertiary:Always There Home Health There Home Health Care,Inc. Care,Inc. 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 STAMP OK N/A 2. Does the document need to be sent to another agency for additional signatures? If yes, N/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 AR signed by the Chairman,with the exception of most letters,must be reviewed and signed by the Office of the County Attorney. 4. 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 5. The Chairman's signature line date has been entered as the date of BCC approval of the AR 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 AR signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip N/A 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 awaryour deadlines! 8. The document was approved by the BCC m3,08t217i018 and all changes made during the meeting have been incorporated in the attached document. The County Attorney's Office has reviewed the changes,if applicable. ((—t3 '/ 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 t q } Chairman's signature. 1608 MEMORANDUM Date: November 14, 2018 To: Ana Reynoso, Procurement Services From: Teresa Cannon, Sr. Deputy Clerk Minutes & Records Department Re: Contract #18-7300 "Services for Seniors Program" Contractor: Secondary: Golden Care Home Health, Inc. Attached for your records is an original of each referenced document above, (Item #16D8) adopted by the Board of County Commissioners on Tuesday, November 13, 2018. The Board's Minutes & Records Department has kept an original as part of the Board's Official Records. If you have any questions, please feel free to contact me at 252-8411. Thank you. Attachment 16pg FIXED FEE PROFESSIONAL SERVICE AGREEMENT # 18-7300 for Services for Seniors Program THIS AGREEMENT, made and entered into on this J. VI day of tNVQ.Arlbt1 20 ( e, by and between Golden Care Home Health Inc. authorized to do business in the State of Florida, whose business address is 1876 Trade Center Way, Naples, Florida 34109 , (the "Contractor") and Collier County, a political subdivision of the State of Florida, (the "County"): WITNESSETH: 1. The Agreement shall be for a three (3 ) year period, commencing n upon the date of Board approval I I on and terminating on three (3 ) year(s) from that date or until all outstanding Purchase Order(s) issued prior to the expiration of the Agreement period have been completed or terminated. 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(s) periods. The County shall give the Contractor written notice of the County's intention to renew the Agreement term prior to the end of the Agreement term then in effect. The County Manager, or his designee, may, at his discretion, extend the Agreement under all of the terms and conditions contained in this Agreement for up to one hundred and eighty (180) days. The County Manager, or his designee, shall give the Contractor written notice of the County's intention to extend the Agreement term prior to the end of the Agreement term then in effect. 2. COMMENCEMENT OF SERVICES. The Contractor shall commence the work upon issuance of a Purchase Order ❑ n Werk-Orde-r. 3. STATEMENT OF WORK. The Contractor shall provide services in accordance with the terms and conditions of I.I Request for Proposal (RFP) n d (-ITB Other ( ) # 18-7300 , including all Attachment(s), Exhibit(s) and Addenda and the Contractor's proposal referred to herein and made an integral part of this Agreement. n The Contractor shall also provide services in accordance with Exhibit A — Scope of Services attached hereto. Page 1 of 15 Fixed Price Professional Service Agreement#2017-001 (Ver.2) 16D8 3.1 This Agreement contains the entire understanding between the parties and any modifications to this Agreement shall be mutually agreed upon in writing by the Parties, in compliance with the County's Procurement Ordinance, as amended, and Procurement Procedures in effect at the time such services are authorized. 3.2 The execution of this Agreement shall not be a commitment to the Contractor to order any minimum or maximum amount. The County shall order items/services as required but makes no guarantee as to the quantity, number, type or distribution of items/services that will be ordered or required by this Agreement. 4. THE AGREEMENT SUM. The County shall pay the Contractor for the performance of this Agreement based on Exhibit B- Fee Schedule, attached hereto and the price methodology as defined in Section 4.1. Payment will be made upon receipt of a proper invoice and upon approval by the County's Contract Administrative Agent/Project Manager, and in compliance with Chapter 218, Fla. Stats., otherwise known as the "Local Government Prompt Payment Act". 4.1 Price Methodology (as selected below): n _.•• a _... -e..• . • ..•• '..:e a _. a e •: '••_. e _ • •'.- _ •: _ •_... :.e e•• •: _ 2 _ • e • : e • e • •• e • e - - -- •: .. • _ me •e_.. e ••_ •...e _ e :..-..:.• :e, •: •: _e• _ _....e •• !- • e •• e •-. .._..- - - _.. .e • e • : e _.•... a .': _ ••_. • _ •:_. _e-..• : • ••: • e •.-. • :e 110 Time and Materials: The County agrees to pay the contractor for the amount of labor time spent by the contractor's employees and subcontractors to perform the work (number of hours times hourly rate), and for materials and equipment used in the project (cost of materials plus the contractor's markup). This methodology is generally used in projects in which it is not possible to accurately estimate the size of the project, or when it is expected that the project requirements would most likely change. As a general business practice, these contracts include back-up documentation of costs; invoices would include number of hours worked and billing rate by position (and not company (or subcontractor) timekeeping or payroll records), material or equipment invoices, and other reimbursable documentation for the project. • • • _ - _• : _e_. • _ _ e _ •• •• -. :e 'a•••.•. e - •: _.• :.. e :e: • • e e ee _ - •.. _:. }: : .:. •_. .9a •. .... •. a• I : . a. a _- !: S.. . -e e • carton e 0 •: '.•....R• _ '.•:• •:. _.• .. e :.._ 0e •.- • ••e: e •. _-. �.--� =d. as _9•. __ • :a e e _s_ : •e • Page 2 of 15 Fixed Price Professional Service Agreement#2017-001 (Ver.2) 16138 4.2 Any County agency may obtain services under this Agreement, provided sufficient funds are included in their budget(s). 4.3 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 the Agreement. Any untimely submission of invoices beyond the 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. 4.4 n - e: ._ _ _ _ e t _ e e • -.• • e _ •.. - .• • ••• e • .. e. ... - - -.• - .? ••, _ .. •- - 'e• �.. -'•••. -tom: *_.. •.,_ et a w.....,. ••..e. Mileage $0.44.5 per mile Breakfast $6:00 Lunch $ 0 Dinner Airfare - _e_ •.• _, e e _ _ , Rental car Y_._ _ _, MM e .__,•.._ ___, Virg Actual cost of lodging at single •.. •_ . - . ' . e e •.e u. than $150.00 per night Parking Actual-cost--of-parking Taxi-Or-Airport-Limousine Actual cost of either taxi or airport limousine u_. S 4..• t ••_ ...• t • _ • ®..._e •_'_ _• _ .. . •••• -..ee •e. e e . '•.e: - re• • • e•e • • : • et • e- e •.e e _ee ••e..._... e- .e ee_ _ et. • �..-.�.•e e _ .._. ! __. u___... a_... ._.. e• ,,. - e• __.e __a.. e e e :e _ a _ti•e _.e . _ _...e _.. et _._e e •_•e ..e a_.. _e- •_ . e : !: - - `-.. t e • • • • _ •., _.... •e•_ •,= a_.....: ...a_"_-_.• e •.- e • ::••: • 5. 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. Collier County, Florida as a political subdivision of the State of Florida, is exempt from the payment of Florida sales tax to its vendors under Chapter 212, Florida Statutes, Certificate of Exemption # 85-8015966531C. Page 3 of 15 Fixed Price Professional Service Agreement#2017-001 (Ver.2) 16D8 6. NOTICES. All notices from the County to the Contractor shall be deemed duly served if mailed or emailed to the Contractor at the following: Company Name: Golden Care Home Health Inc. Address: 1876 Trade Center Way Naples, Florida 34109 Authorized Agent: Adam Corcoran Attention Name & Title: Adam Corcoran, Director of Business Development Telephone: 239-440-2900 E-Mail(s): acorcoran@goldencarefl.com & swebley@goldencarefl.com All Notices from the Contractor to the County shall be deemed duly served if mailed or emailed to the County to: Board of County Commissioners for Collier County, Florida Division Director: Kimberley Grant Division Name: Community and Human Services Division Address: 3339 East Tamiami Trail Building H, Room 211 Naples, Florida 34112 Administrative Agent/PM: Wendy Klopf, Grants Coordinator Telephone: 239-252-2901 E-Mail(s): wendy.klopf@colliercountyfl.gov 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. 7. 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. 8. 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. The County will not be obligated to pay for any permits obtained by Subcontractors. 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 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. Page 4 of 15 Fixed Price Professional Service Agreement#2017-001 (Ver.2) 16D8 9. 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 Agreement 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. 10. 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 the 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 Agreement 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. 11 . NO DISCRIMINATION. The Contractor agrees that there shall be no discrimination as to race, sex, color, creed or national origin. 12. INSURANCE. The Contractor shall provide insurance as follows: A. ■1 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. ISI 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. C. • Workers' Compensation: Insurance covering all employees meeting Statutory Limits in compliance with the applicable state and federal laws. Page 5 of 15 Fixed Price Professional Service Agreement#2017-001 (Ver.2) 16pg The coverage must include Employers' Liability with a minimum limit of $1,000,000 for each accident. D. U■ Professional Liability: Shall be maintained by the Contractor to ensure its legal liability for claims arising out of the performance of professional services under this Agreement. Contractor waives its right of recovery against County as to any claims under this insurance. Such insurance shall have limits of not less than $ 1,000,000 each claim and aggregate. E. E Cyber-Liability: Coverage-shalf . i _ per occurrence: T: ❑ . - • - e _ _ e : • . ..•.•.. _ ea e $ - - per occurrence: !: ❑ United States Longshoreman-'s-and Harborworker's Act Coverage shall bee.maintained where applicable to-the-completion of the work$ occurrence. I. Marit' erage.shall -limits__of L. U Crime/Employee Dishonesty (other): Coverage shall have minimum limits of$50,000 per occurrence. Special Requirements: Collier County Board of County Commissioners, OR, Board of County Commissioners in Collier County, OR, Collier County Government shall be listed as the Certificate Holder and included as an "Additional Insured" on the Insurance Certificate for Commercial General Liability where required. This insurance shall be primary and non-contributory with respect to any other insurance maintained by, or available for the benefit of, the Additional Insured and the Contractor's policy shall be endorsed accordingly. 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 thirty (30) days prior to any expiration date. Coverage afforded under the policies will not be canceled or allowed to expire until the greater of: thirty (30) 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. Page 6 of 15 Fixed Price Professional Service Agreement#2017-001(Ver.2) 16D8 Contractor shall ensure that all subcontractors comply with the same insurance requirements that the Contractor is required to meet. 13. INDEMNIFICATION. To the maximum extent permitted by Florida law, the Contractor shall defend, 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. 13.1 The duty to defend under this Article 13 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 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 13 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. 14. AGREEMENT ADMINISTRATION. This Agreement shall be administered on behalf of the County by the Community and Human Services Division 15. 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. 16. COMPONENT PARTS OF THIS AGREEMENT. This Agreement consists of the following component parts, all of which are as fully a part of the Agreement as if herein set out verbatim: Contractor's Proposal, Insurance Certificate(s), U■I Exhibit A Scope of Services, Exhibit B Fee Schedule, n RFP/ I I -I-TBIf Other #18-7300 , including Exhibits, Attachments and Addenda/Addendum, n subsequent quotes, and 01 Other Exhibit/Attachment: Grant Documents Page 7 of 15 Fixed Price Professional Service Agreement#2017-001(Ver.2) 16D8 17. APPLICABILITY. Sections corresponding to any checked box (E) will expressly apply to the terms of this Agreement. 18. 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. 19. 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, as amended, 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 Agreement held by the individual and/or firm for cause. 20. COMPLIANCE WITH LAWS. By executing and entering into this Agreement, the Contractor is formally acknowledging without exception or stipulation that it agrees to comply, at its own expense, with all federal, state and local laws, codes, statutes, ordinances, rules, regulations and requirements applicable to this Agreement, including but not limited to those dealing with 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; taxation, workers' compensation, equal employment and safety including, but not limited to, the Trench Safety Act, Chapter 553, Florida Statutes, and the Florida Public Records Law Chapter 119, including specifically those contractual requirements at F.S. § 119.0701(2)(a)-(b) as stated as follows: IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT: Communication and Customer Relations Division 3299 Tamiami Trail East, Suite 102 Naples, FL 34112-5746 Telephone: (239) 252-8383 The Contractor must specifically comply with the Florida Public Records Law to: 1. Keep and maintain public records required by the public agency to perform the service. Page 8 of 15 Fixed Price Professional Service Agreement#2017-001 (Ver.2) 16D8 2. Upon request from the public agency's custodian of public records, provide the public agency with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law. 3. Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law for the duration of the contract term and following completion of the contract if the Contractor does not transfer the records to the public agency. 4. Upon completion of the contract, transfer, at no cost, to the public agency all public records in possession of the Contractor or keep and maintain public records required by the public agency to perform the service. If the Contractor transfers all public records to the public agency upon completion of the contract, the Contractor shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the Contractor keeps and maintains public records upon completion of the contract, the Contractor shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to the public agency, upon request from the public agency's custodian of public records, in a format that is compatible with the information technology systems of the public agency. If Contractor observes that the Contract Documents are at variance therewith, it shall promptly notify the County in writing. 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. 21. OFFER EXTENDED TO OTHER GOVERNMENTAL ENTITIES. Collier County encourages and agrees to the successful Contractor extending the pricing, terms and conditions of this solicitation or resultant Agreement to other governmental entities at the discretion of the successful Contractor. 22. 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. 23. ADDITIONAL ITEMS/SERVICES. Additional items and/or services may be added to this Agreement in compliance with the Procurement Ordinance, as amended, and Procurement Procedures. 24. 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 Page 9 of 15 Fixed Price Professional Service Agreement#2017-OOl (Ver 2) 1 6 D 8 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. 25. 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. 26. I I . • _ 111A •: _ ea_ _ _ e _ -e •. : e_e: :e e • e e•=_ • - •_ ..■ 9 .. . • •.:_ e - • •:• - e -.. a-, a a e - •.. - -r • a.._. . •.... • •- ■ • a•. .. •e_ e •_ ••_ e: --.a.-.• •..- r _ _ • _ - • • •a a-.._ • e: _e• •- -e. • •-.. ,-.a a u._• e •- e -..aa-.• . •- _ e• - _• _ u._..• a=ee_- • : _:__- • e _ease -,.-. •: --..'. _:_ e • _ •u: _.e. .. - _.�i :,v_• e: -e• e: t- a _.a . 1•9 - a ue:9. - = e •a=: • - :e._• :w _..-.r -.. a -._. •- e• _... a • •.e.. • _•.•- -. - • a.- a - e_..e_... •e -eae•_..e• - _ ••_ eee--e _ --.••.-.• _. •- -. _ - C.._..._ • • : __ ••: • • • • • _ _..•.. -_ e• •• • - •- -. • • __a - e__.a •._..• a -_w • •.e. • - e _ • --._ _- e e _•• - • - •• _ _ • • as- .. _e••••: -• :- .. ,.. - -. a e r _ _.e •.a •.. e - • a..... ,. ••■ - - • a_ _ e a..-. a _..•.•:. •- • • - • a ee e e e eee-:e =e - -_••_• e= .ea .: . ■ AGREEMENT STAFFING. The Contractor's personnel and management to be utilized for this Agreement 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 Agreement. The Contractor shall assign as many people as necessary to complete required services on a timely basis, and each person assigned shall be available for an amount of time adequate to meet required services. 27. E • . \_. • . .._. • a : __.• e _.• _e•. •. . a . _-.• a u a •e •_. aa_ a _.•. e a- _ e• n e __ u-.• -.. •2 2 _ e -• •_• *e • •- _ e•. e.. _ i • • eee_. .u-.ae..e •: _ e., • '.r De.c a _ ee. a =e =-.- 2• _._ •••a_. r •_ _ e• _ - , •• • _ _•_ - e - :•- a If ORDER OF PRECEDENCE (Grant Funded). In the event of any conflict between or among the terms of any of the Contract Documents and/or the County's Board approved Executive Summary, the terms of the Agreement shall take precedence over the terms of all other Contract Documents, except the terms of any Supplemental Conditions shall take precedence over the Agreement. To the extent any conflict in the terms of the Contract Documents cannot be resolved by application of the Supplemental Conditions, if any, or the Agreement, the conflict shall be resolved by Page 10 of 15 Fixed Price Professional Service Agreement#2017-001 (Ver.2) 1608 imposing the more strict or costly obligation under the Contract Documents upon the Contractor at County's discretion. 28. 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 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. 29. SECURITY. The Contractor is required to comply with County Ordinance 2004-52, as amended. Background checks are valid for five (5) years and the Contractor shall be responsible for all associated costs. If required, Contractor shall be responsible for the costs of providing background checks by the Collier County Facilities Management Division for all employees that shall provide services to the County under this Agreement. This may include, but not be limited to, checking federal, state and local law enforcement records, including a state and FBI fingerprint check, credit reports, education, residence and employment verifications and other related records. Contractor shall be required to maintain records on each employee and make them available to the County for at least four (4) years. All of Contractor's employees and subcontractors must wear Collier County Government Identification badges at all times while performing services on County facilities and properties. Contractor ID badges are valid for one (1) year from the date of issuance and can be renewed each year at no cost to the Contractor during the time period in which their background check is valid, as discussed below. All technicians shall have on their shirts the name of the contractor's business. The Contractor shall immediately notify the Collier County Facilities Management Division via e-mail (DL-FMOPS@colliergov.net) whenever an employee assigned to Collier County separates from their employment. This notification is critical to ensure the continued security of Collier County facilities and systems. Failure to notify within four (4) hours of separation may result in a deduction of$500 per incident. (Intentionally left blank-signature page to follow) Page 11 of 15 Fixed Price Professional Service Agreement#2017-001 (Ver 2) 1608 IN WITNESS WHEREOF, the parties hereto, have each, respectively, by an authorized person or agent, have executed this Agreement on the date and year first written above. ATTEST: BOARD OF C•40 TY COMMIS •HERS COLLIER NT ; FLORID;. Cryst Kinzel, Cl rk & Comptrol B By: £'di Solis, Esq. , Chairman Dated: 11- (SEAL) Attest as to Chairman's signature only. Contractor's Witnesses: Golden Care Home Health Inc. Contractor L VA By: - - Contr-ct.is Fi st Witness Si•,at,r CLAS CEO )c)\ 1 1_-cit n '1-Type/print signature and title TType/print witness name Contractors Sec Witness 'itZbe4.41-(,)TType/prig witness nameT =ppro -d a: t•y. and Legality: 4111,All o tyAt�pr-ey n � I b not game " Item# t)S6 Agenda Date Aityli Date Rec'd -11-11.4%% Deputy Clerk Page l2of15 Fixed Price Professional Service Agreement 42017-001(Ver.2) - 16D8 Exhibit A Scope of Services Cl following this page (pages 1 through 5 ) ❑ this exhibit is not applicable Page 13 of 15 Fixed Price Professional Service Agreement#2017-001(Ver.2) 1b08 EXHIBIT A SCOPE OF SERVICES The purpose of the solicitation was to secure Contractors for the provision of home and community-based services,to be delivered to persons sixty years and older under CCE and HCE, and to qualified persons eighteen years or older under ADI, within the geographic area of Collier County. Unless otherwise stated, minimum hours of availability are 7:00 am to 5:00 p.m. Monday through Saturday,except for federal and state holidays. Respite services and emergency services must be available 24 hours/day, 365 days/year if needed. Work Schedule: The Contractors shall be placed on a rotation list for the services, as follows: a. A selection committee meeting was held on June 29, 2018 establishing a ranking of the following firms: #1 Eleven Ash, Inc., d/b/a Health Force; #2 Golden Care Home Health Inc.; #3 Always There Home Health Care, Inc. Work assignments are awarded on a rotational basis by the County's Administrative Agent starting with Eleven Ash, Inc., d/b/a Health Force (ranked#1); Golden Care Home Health Inc. (ranked #2); Arden Courts-Lely Palms of Naples FL, LLC d/b/a Arden Courts of Lely Palms (ranked#3); and Always There Home Health Care, Inc. (ranked#4). b. As each work assignment is identified the next Contractor in the rotation will be offered the opportunity to negotiate that work assignment with the County's Contract Administrative Agent. A Purchase Order will be issued prior to commencing the services. c. The County's Contract Administrative Agent will ensure an equitable distribution of work among selected Contractors. If a Contractor is unable to provide the services, the County's Contract Administrative Agent will select the next Contractor in the rotation. d. Direct Selection: For work assignments requiring unique experience, knowledge or preference by the Client, as noted below in the Scope of Services, the County's Contract Administrative Agent may select a specific Contractor. When direct select is deemed necessary, a letter must be attached to the Purchase Order with sufficient detail to justify the need for a direct select. Such justification should identify the individual making the request, description of requirement, address why the requirement can only be fulfilled by the identified Contractor. Scope of Services: Definitions, standards, and requirements of these services are included in the 2012 Department of Elder Affairs' Home and Community-Based Services Handbook (DOEA Handbook). Page 1 of 5 0 1608 The Contractor must adhere to all requirements in the RFP, in addition to maintaining adherence with the guidelines set for the by the then current DOEA Handbook. Lack of knowledge of all requirements of a service listed in the proposal SHALL NOT relieve the provider of liability and obligations under this agreement. Collier County shall serve as the Lead Agency for service authorization and coordination. In an effort to comply with the requirements of the ADI, CCE and HCE Programs, clients entering the service system will be assessed and prioritized by the Lead Agency. Upon determination of the service level to be provided, the Lead Agency will offer the client a listing of service vendors ("Contractors") for the specific service(s) outlined within their care plan. The client will be encouraged to pick a service provider ("Contractors") of their choice, and have the option of interviewing potential service providers. Should the client not have a preference, the Lead Agency will select a service provider from the centralized provider list, using a rotation basis (rotating to the next vendor on the list). In this manner, all service providers will be equally treated unless the client has a preference. The Lead Agency shall not endorse one service provider over another. Upon the determination of the service, the service levels, and the selected vendor, the Lead Agency will contact the vendor agency, and authorize the service, number of hours, and frequency. In keeping with the state policy of client (client) choice of service providers, Collier County does not guarantee a minimum or maximum number of clients that will be referred, nor a minimum or maximum number of service hours that will be requested during the contract period. Should a client later indicate dissatisfaction with the chosen service provider, they will again be offered their choice of the vendor. The Lead Agency shall send the agreed-upon Service Authorization to the chosen provider. These "service authorizations" or "service orders" must contain necessary client information, such as street address, telephone number, and services or items needed, as well as the name and telephone number of the Lead Agency case manager authorizing the service. In order to meet client needs, some services may be required outside of normal office hours (8:00 AM to 5:00 PM, Monday - Friday). The Lead Agency reserves the right to request adding additional service providers throughout the resultant agreement period. The County may do so through a competitive and publicly announced selection process, which shall be coordinated through the County's Procurement Services Division. Services shall be provided in the manner described in the then current DOEA manual and outlined herein. Services covered by this agreement include, but are not limited to (should funding for additional Senior Services be identified, the County reserves the right to add to the resultant agreements the services, descriptions, rates, etc. by way of a contract addendum): 1. Adult Day Care: A program of therapeutic social and health activities and services provided to adults who have functional impairments, in a protective environment that provides as non- institutional an environment as possible. 2. Chore: Performance of routine house or yard tasks including such jobs as seasonal cleaning, yard work, lifting and moving furniture, appliances, or heavy objects, household repairs which do not require a permit or specialist, and household maintenance. Pest control may be included when not performed as a distinct activity. Page2of5 16D8 3. Enhanced Chore: This service is beyond the scope of chore due to the level of service needed. The service includes a more intensified, thorough cleaning to address more demanding circumstances. 4. Companion: Visiting a client who is socially and/or geographically isolated, for the purpose of relieving loneliness and providing continuing social contact with the community by casual conversation, providing assistance with reading, writing letters, entertaining games, escorting a client to a doctor's appointment, and other diversional activities, such as going to the movies, the mall, the library, or grocery shopping; these activities are not permitted to solely provide transportation to another service, but to accompany the client during such activities, and provide assistance and/or supervision as necessary. This service is non-medical care. May assist the client with tasks such as meal preparation, laundry and shopping; however these tasks shall be assistive and companionship in nature. 5. Homemaking: Specific home management duties including housekeeping, laundry, cleaning refrigerators, clothing repair, minor home repairs, assistance with budgeting and paying bills, client transportation, meal planning and preparation, shopping assistance, and routine house- hold activities by a trained homemaker. 6. Shopping Assistance: Assisting a client in getting to and from stores or shopping on behalf of a client; and includes proper selection of items to purchase. The service also includes storing purchased items upon return to the client's home. And individual Shopping Aide may assist mor than one client during a shopping trip. 7. Personal Care: Assistance with eating, dressing, personal hygiene and other activities of daily living. This service may include assistance with meal preparation, housekeeping chores such as bed making, dusting, and vacuuming incidental to the care furnished or essential to the health and welfare of the individual. Personal care can include accompanying the client to clinics, physician office visits, or trips for the purpose of health care provided that the client does not require special medical transportation. Personal care can also include shopping assistance to purchase food, clothing, and other items needed for the client's personal care needs. 8. In Home Respite (funded by CCE, HCE, ADI) — Relief or rest for a primary caregiver from the constant/continued supervision, companionship, therapeutic and/or personal care, of a functionally impaired older person for a specified period of time. 9. Escort: Personal accompaniment and assistance to a person who has difficulties (physical or cognitive) using regular vehicular transportation. The accompaniment and assistance is provided to individuals to or from serviced providers, medical appointments, or other destinations needed by the client. 10. Skilled Nursing (funded by CCE, HCE) - part-time or intermittent nursing care administered to an individual by a licensed practical nurse, registered nurse, or advanced registered nurse practitioner, in the client's place of residence, pursuant to a care plan approved by a licensed physician. 11. Emergency Alert Response Services (EARS) (funded by CCE) - Emergency alert/response service is defined as a community based electronic surveillance service which monitors the frail homebound elder by means of an electronic communication link with a response center. Page 3 of 5 1 6D8 � 12. Specialized Medical Equipment, Services, and Supplies (funded by CCE, HCE, ADI)Adaptive devices, controls, appliances, or services, which enable individuals to increase their ability to perform activities of daily living and repair of such services which may include: dentures, walkers, reaching devices, bedside commodes, telephone amplifiers, touch lamps, adaptive eating equipment, glasses, hearing aids, and other mechanical or non-mechanical, electronic, and non- electronic adaptive devices. Supplies may include such things as adult briefs, bed pads, oxygen or nutritional supplements. 13. Facility Respite (funded by CCE) —24-hour care in a State of Florida Licensed Nursing. 14. Establish protocols for contacting Lead Agency Case Managers in emergency or unusual circumstances and include the documentation requirements (oral and written) in the Service Provider Application. 15. Provide disaster response protocols, plans and services: In the event of a natural disaster (hurricane, tropical storm, tornado, flood, heat wave, etc.), the provider will have staff available to serve those clients in critical need of services, as designated by the Lead Agency Case Managers. 16. Establish a client grievance process: Each service provider agency must have a policy addressing client grievances and/or complaints. 17. Establish and provide staff training: All services provided with funding from DOEA require service delivery personnel to have general pre-service orientation and training specific to the service being provided. Lead Agencies are responsible for provision of the pre-service training (on program and billing requirements, in particular) for all paid staff, volunteer staff and assigned staff of service providers. Pre-service orientation also must include: • An overview of the aging process • An overview of the aging network • Communication techniques with the elderly • Observation of abuse, neglect, exploitation and incident reporting • Local agency service procedures and protocol • Client confidentiality. NOTE: All "hands-on" service personnel must receive training emphasizing the necessity of Universal Precautions. Home Health Aides must have documentation of successful completion of 40 hours required training, and CNAs must have on file a copy of their State of Florida certification. In-service training hours and topics are to be provided at the discretion of the service provider agency and shall meet state requirements. 18. Compile and report program service delivery statistics and other data as identified by the Lead Agency. These are reported to the Area Agency on Aging and Department of Elder Affairs in accordance with the reporting requirements developed by the Department. Lead agencies are responsible for entry of data in the Client Information and Registration Tracking System (CIRTS), which generates payment to the service provider agency. Therefore, service provider agencies are required to provide Lead Agencies with correct and timely service data to comply with these requirements. Timely submission is considered to be no later than noon on Wednesday of the week following the week services are performed (service week defined as Monday through Sunday). Page 4 of 5 1bD8 19. Maintain complete and accurate records: Service delivery logs, at a minimum, must be legible and contain the name of client, type/s of services and date/s and hour/s of delivery. The client/caregiver must sign the log at the time of each service visit. The service worker must sign and date the log upon completion and submit it to the service provider agency. 20. Provide complete, clear and accurate invoices: Weekly invoices must be submitted by noon on the Wednesday following the week that the service was provided and shall include service provided. The service week is defined as Monday through Sunday. Monthly reporting requirements for CIRTS dictate that all client and service data for the previous month to be entered into CIRTS by the 9th day of the month. Collier County "Services for Seniors" will coordinate with vendors to determine due dates for invoices. This will insure compliance with DOEA reporting requirements. Failure to record or report units of service will result in nonpayment (or delayed payment) for such services. Data required on weekly invoices and weekly timesheets include: • Vendor name • Vendor address • Vendor telephone number • Client name • Service Provider employee who delivered the service(s) • Services ordered and services delivered date • Number of service hours, cost per hour and total cost • Person preparing the report and the date it was prepared • Weekly timesheets signed and dated by the client and Service Provider employee 21. Prepare for annual on-site compliance audits by the Lead Agency or members of the Collier County staff as directed by the Lead Agency or grant requirements. Page 5 of 5 16D8 Exhibit B Fee Schedule following this page (pages 1 through 1 ) Page 14 of 15 Fixed Price Professional Service Agreement#2017-001(Ver.2) 16138 Golden Care Cost Per Service Reimbursement Rate Per Service Description Service Unit Unit In-kind Match Unit Homemaking Per Hour $ 23.33 $ 2.33 $ 21.00 Personal Care Per Hour $ 24.11 $ 2.41 $ 21.70 Respite(In-Home) Per Hour $ 24.11 $ 2.41 $ 21.70 1608 Other Exhibit/Attachment Description: Grant Documents ❑■ following this page ❑ this exhibit is not applicable Page 15 of 15 Fixed Price Professional Service Agreement#2017-001(Ver.2) II 1608 EXHIBIT I.A FEDERAL CONTRACT PROVISIONS FEDERAL UNITED STATE DEPARTMENT OF AGING AND FLORIDA DEPARTMENT OF ELDER AFFAIRS The supplemental conditions contained in this section are intended to cooperate with, to supplement, and to modify the general conditions and other specifications. In cases of disagreement with any other section of this contract,the Supplemental Conditions shall govern. Contractor means an entity that receives a contract. The services performed by the awarded Contractor shall be in compliance with the provisions of 45 Code of Federal Regulations(CFR) 75 and/or 45 CFR Part 92, 2 CFR Part 200 and other applicable regulations. It shall be the awarded Contractor's responsibility to acquire and utilize the necessary manuals and guidelines that apply to the work required to complete this project. In general, 1)The contractor(including all subcontractors)must insert these contract provisions in each lower tier contracts (e.g. subcontract or sub-agreement); 2)The contractor(or subcontractor)must incorporate the applicable requirements of these contract provisions by reference for work done under any purchase orders, rental agreements and other agreements for supplies or services; 3) The prime contractor is responsible for compliance with these contract provisions by any subcontractor, lower-tier subcontractor or service provider. FCP-1 16D8 EXHIBIT I.A FEDERAL CONTRACT PROVISIONS FEDERAL CONTRACT PROVISIONS Administrative, contractual, or legal remedies (Ref. 41 U.S.C. 1908, 2 CFR§ 200 Appendix 11 (A) Unless otherwise provided in this contract, all claims, counter-claims, disputes and other matters in question between the local government and the contractor, arising out of or relating to this contract, or the breach of it, will be decided by arbitration, if the parties mutually agree, or in a Florida court of competent jurisdiction. Access to Records and Reports (Reference: 2 CFR §200.333, 2 CFR§ 200.336) The contractor/vendor agrees to maintain all books, records, accounts and reports required under this contract for a period of not less than three years after the date of termination or expiration of this contract, except in the event of litigation or settlement of claims arising from the performance of this contract, in which case the Contractor agrees to maintain same until the Purchaser,the Grantor Administrator,the Comptroller General, or any of their duly authorized representatives, have disposed of all such litigation, appeals, claims or exceptions related thereto. Furthermore,the County shall maintain written policies and procedures for computer system backup and recovery and shall have the same requirement of its Contractors. No Government Obligation to Third Parties-The Federal Government is not a party to this contract and is not subject to any obligations or liabilities to the non-Federal entity, contractor, or any other party pertaining to any matter resulting from the contract." Program Fraud and False or Fraudulent Statements of Related Acts The contractor acknowledges that 31 U.S.C. Chap. 38 (Administrative Remedies for False Claims and Statements) applies to the contractor's actions pertaining to this contract." Clean Air and Federal Water Pollution Control Acts (Reference: 2 CFR § 200 Appendix 11 (G)) Contracts and subgrants of amounts in excess of $150,000 shall contain a provision that requires the Contractor or recipient to comply with all applicable standards, orders, or requirements issued pursuant to the Clean Air Act (42 U.S.C. 7401-7671q) and the Federal Water Pollution Control Act as amended (33 U.S.C. 1251-1387). Violations must be reported to the Federal awarding agency and the Regional Office of the Environmental Protection Agency (EPA). Energy Policy and Conservation Act - (Reference 2 CFR § 200 Appendix !! (H) The contractor shall comply with any mandatory standards and policies relating to energy efficiency which are contained in the Florida state energy conservation plan issued in compliance with the Energy Policy and Conservation Act (Pub. L. 94-163, 89 Stat. 871, 42 U.S.0 Section 6201) Debarment and Suspension (Reference 2 CFR § 200 Appendix II (I) Contract awards that exceed the small purchase threshold and certain other contract awards shall not be made to parties listed on the government wide Excluded Parties List System in the System for Award Management(SAM), in accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR Part 1986 Comp., p. 189) and 12689 (3 CFR Part 1989 Comp., p. 235), "Debarment and Suspension." The Excluded Parties List System in SAM contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549. The successful bidder, by administering each lower tier subcontract that exceeds $25,000 as a "covered transaction", must verify each lower tier participant of a "covered transaction" under the project is not presently debarred or otherwise disqualified from participation in this federally assisted project. Byrd Anti-Lobbying Amendment(31 U.S.C. 1352) (Reference 2 CFR§200 Appendix II (J) Vendors must certify it will not and has not used Federal appropriated funds have been paid or will be paid, by or to any person or organization for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the FCP-2 16D8 EXHIBIT LA FEDERAL CONTRACT PROVISIONS making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. The certification includes any lobbying with non-Federal funds that takes place in connection with obtaining any Federal award. Procurement of Recovered Materials (Reference 2 CFR§ 200.322) Contractor and subcontractor agree to comply with Section 6002 of the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act, and the regulatory provisions of 40 CFR Part 247. (1) In the performance of this contract,the Contractor shall make maximum use of products containing recovered materials that are EPA designated items unless the product cannot be acquired (i)Competitively within a timeframe providing for compliance with the contract performance schedule; (ii) Meeting contract performance requirements;or (iii)At a reasonable price. (2) Information about this requirement is available at EPA's Comprehensive Procurement Guidelines web site, http://www.epa.gov/cpg/. The list of EPA- designate items is available at https://www.epa.gov/smm/comprehensive-procurement-guideline-cpq- program Diversity (Reference 2 CFR§ 200.321) The County is dedicated to fostering the continued development and economic growth of small, minority-, women-, and service-disabled veteran business enterprises. All contracting and subcontracting opportunities afforded by this solicitation/contract are strongly encouraged to contribute as both Contractors and Sub-Contractors. Firms may be required to submit documentation addressing diversity and describing the efforts being made to encourage the participation of small, minority-, women-, and service-disabled veteran business enterprises. Information on Certified Minority Business Enterprises (CMBE) and Certified Service-Disabled Veteran Business Enterprises(CSDVBE) is available from the Office of Supplier Diversity at: http://dms.myflorida.com/other programs/office of supplier diversity osd/ Termination for Cause and Convenience See County's Standard Terms and Conditions. Nondiscrimination-Civil Rights Compliance The Contractor will 1. not discriminate against any person in the provision of services or benefits under this contract or in employment because of age, race, religion, color, disability, national origin, marital status or sex in compliance with state and federal law and regulations. 2. Assumes others with whom it arranges to provide services or benefits in connection with any of its programs and activities are not discriminating against clients or employees because of age, race, religion, color, disability, national origin, marital status or sex. And 3. Assures 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. Computer Use and Social Media Policy The Florida Department of Elder Affairs has implemented a Social Media Policy, in addition to its Computer Use Policy, which applies to all employees, contracted employees, consultants, OPS and volunteers, including all personnel affiliated with third parties, such as, but not limited to, contractors and subcontractors. Any entity that uses the Department's computer resource systems must comply with the Department's policy regarding social media. Social Media includes, but is not limited to blogs, podcasts, discussion forums, Wikis, RSS feeds, video sharing, social networks like MySpace, Facebook and Twitter, as well as content sharing networks such as flickr and YouTube.This policy is available on the Department's website at: http://elderaffairs.state.fl.us/doea/financial.php STATE CONTRACT PROVISIONS Discriminatory Vendors List In accordance with Section 287.134, Florida Statutes, an entity or affiliate who has been placed on the discriminatory vendor list may not submit a bid on a contract to provide any goods or services to a public FCP-3 16D8 EXHIBIT I.A FEDERAL CONTRACT PROVISIONS entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to a public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity, and may not transact business with any public entity. Inspector General Cooperation The Parties agree to comply with Section 20.055(5), Florida Statutes, for the inspector general to have access to any records, data and other information deemed necessary to carry out his or her duties and incorporate into all subcontracts the obligation to comply with Section 20.055(5), Florida Statutes. Equal Employment Opportunity The Contractor shall not discriminate against any employee or applicant for employment because of race, age, creed, color, sex or national origin. The Agency will take affirmative action to ensure that applicants are employed, and that employees are treated during employment,without regard to their race, age,creed, color, sex, or national origin. Such action shall include, but not be limited to, the following: Employment upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation;and selection for training, including apprenticeship. Contractors must insert a similar provision in all subcontracts, except subcontracts for standard commercial supplies or raw materials. Interest of Members of Congress No member of or delegate to the Congress of the United States shall be admitted to any share or part of this contract or to any benefit arising therefrom. Interest of Public Officials No member, officer, or employee of the public body or of a local public body during his tenure or for two years thereafter shall have any interest, direct or indirect, in this contract or the proceeds thereof. For purposes of this provision, public body shall include municipalities and other political subdivisions of States; and public corporations, boards, and commissions established under the laws of any State. Interest of Public Officials No member, officer, or employee of the MPO or of a local public body during his tenure or for two years thereafter shall have any interest, direct or indirect, in this contract or the proceeds thereof. Lobbying No funds received pursuant to this Agreement may be expended for lobbying the Legislature, the judicial branch or a state agency. EVerify Vendors/Contractors/Subcontractors: 1. shall utilize the U.S. Department of Homeland Security's E-Verify system to verity the employment eligibility of all new employees hired by the Vendor/Contractor during the term of the contract;and 2.shall expressly require any subcontractors performing work or providing services pursuant to the state contract to likewise utilize the U.S. Department of Homeland Security's E-Verify system to verify the employment eligibility of all new employees hired by the subcontractor during the contract term. FCP-4 16D8 EXHIBIT I.B GRANT CERTIFICATIONS AND ASSURANCES GRANT CERTIFICATIONS AND ASSURANCES THE FOLLOWING DOCUMENTS NEED TO BE RETURNED WITH SOLICIATION DOCUMENTS BY DEADLINE TO BE CONSIDERED RESPONSIVE 1. Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions 2. Certification regarding Lobbying 3. Conflict of Interest 4. Anticipated DBE, M/WBE or VETERAN Participation Statement 5. Opportunity List for Commodities and Contractual Services and Professional Consultant Services 6. Acknowledgement of Grant Terms and Conditions 7. Scrutinized Companies Certification GCA - 1 1608 Collier County Solicitation 18-7300 EXHIBIT 1.B GRANT CERTIFICATIONS AND ASSURANCES CQLLIER COUNTY Certification Regarding Debarment,Suspension,and Qther Responsibility Matters Primary Covered Transactions (1) The prospective primary participant certifies to the best of its knowledge and belief,that it and its principals: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; (b) Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction;violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph (I)(b) of this certification; and (d) Have not within a three-year period preceding this application/proposal had one or more public transactions(Federal,State or local)terminated for cause or default. (2) Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. /1,A. s.itte/ J Cvn.-0 Name Project Name the Project Number� (11.10t4.1 Q/[..as,.. km. 440,6 - r"l b - J , c!S l7,0 Firm Tax ID Number DUNS Number Street Address,City, State;Zip °01/(1-A1-.- Signature GCA-2 • 2/26/2018 2:25 PM p.22 1608 Collier County Solicitation 18-7300 EXHIBIT 1.B GRANT CERTIFICATIONS AND ASSURANCES COLLIERCOUNTY Certification Regarding Lobbying 60°4" The undersigned A, . q,tf (Vendor/Contractor)certifies,to the best of his or her knowledge and belief, that: (1)No State appropriated funds have been paid or will be paid,by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a member of the Legislature, an officer or employee of the judicial branch, or an employee of a State agency in connection with the awarding of any State contract, the making of any State grant, the making of any State loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any State contract,grant, loan, or cooperative agreement. (2) No grantee, nor its persons or affiliates, may employ any person or organization with funds received pursuant to any State agreement for the purpose of lobbying the Legislature, the judicial branch, or a State agency. The purpose of lobbying includes, but is not limited to, salaries, travel expenses and per diem, the cost for advertising, including production costs;postage; entertainment; and telephone and telegraph; and association dues. The provisions of this paragraph supplement the provisions of section 11.062, Florida Statutes, which is incorporated by reference into this solicitation,purchase order or contract. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. The Vendor/Contractor, ala c04(.4.0 CAit. , certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition,the Contractor understands and agrees that the provisions of 11.062, Florida Statutes., apply to this certification and disclosure, if any. Atty. 64.674.4x0 Name of Authorized Official 0`(- ✓s Ady) DuA Title Signature of Vendor/Contractor's Authorized Official 3/2,5/1$ Date GCA-3 2/26/2018 2:25 PM p.23 16D8 Collier County Solicitation 18-7300 EXHIBIT I.B GRANT CERTIFICATIONS AND ASSURANCES COLLIER COUNTY Conflict of Interest Certification Collier County Solicitation No. A © , hereby certify that to the best of my knowledge, neither I nor my spouse, dependent child, general partner, or any organization for which I am serving as an officer, director,trustee,general partner or employee, or any person or organization with whom I am negotiating or have an arrangement concerning prospective employment has a financial interest in this matter. I further certify to the best of my knowledge that this matter will not affect the financial interests of any member of my household. Also, to the best of my knowledge, no member of my household; no relative with whom I have a close relationship; no one with whom my spouse, parent or dependent child has or seeks employment; and no organization with which I am seeking a business relationship nor which I now serve actively or have served within the last year are parties or represent a party to the matter. I also acknowledge my responsibility to disclose the acquisition of any financial or personal interest as described above that would he affected by the matter, and to disclose any interest I, or anyone noted above, has in any person or organization that does become involved in,or is affected at a later date by,the conduct of this matter. ADAM. CC0L161Cue-- NameSignature Y,k�sll`R d� �i3Sr�� I�;u. 3)zs Datete Position Privacy Act Statement Title I of the Ethics in Government Act of 1978 (5 U.S.C. App.), Executive Order 12674 and 5 CFR Part 2634, Subpart I require the reporting of this information.The primary use of the information on this form is for review by officials of The Justice Department to determine compliance with applicable federal conflict of interest laws and regulations. Additional disclosures of the information on this report may he made: (1) to a federal, state or local law enforcement agency if the Justice Department becomes aware of a violation or potential violation of law or regulations; (2) to a court or party in a court or federal administrative proceeding if the government is a party or in order to comply with a judge-issued subpoena; (3)to a source when necessary to obtain information relevant to a conflict of interest investigation or decision; (4) to the National Archives and Records Administration or the General Services Administration in records management inspections; (5) to the Office of Management and Budget during legislative coordination on private relief legislation; and (6) in response to a request for discovery or for the appearance of a witness in a judicial or administrative proceeding, if the information is relevant to the subject matter. This confidential certification will not be disclosed to any requesting person unless authorized by law. See also the OGE/GOVT-2 executive branch-wide Privacy Act system of records. GCA-4 2/26/2018 2:25 PM p.24.: .; 16D8 EXHIBIT 1.13GRANT CERTIFICATIONS AND ASSURANCES COWER COUNTY RAN PART SATED OiSADVANTAGED,MINORI3Y,WOMEN OR VETEICIPATION STATEMENT Atoms Oe ani We t a a lewd. so sce that a 7 .. : :'.,. - - - s Rudd ( Pit)t+W.lad6EA CONT1AC'f DOtLAA A& UWY tdip 6fiLOEIJ tett nom A Y t avaa� Y4 ACTTi t Y GF nes txa arn_ tateibri a` ? Y a ? Y ^r �OR��A ears�►cm tA Mill!"t r� Twnt.? Y A tS14AT#d!Y' A �YRT!*AI' tMPSt? y OTtftA' Y N SISb u) Y s nes su&e6S D A y YES,RtV1S4Ot�WAWA, �. Y. , roman CW t ffi :gig , N' a. u{: 4 r 1 Y • hew a o}a a + "$ > a a',"?'''''''"''.1:,i!...-ii:, s€ s ..'. � ber MANS } N I f$ 1 m= NAME...... GATE TIME 5tt Ar m ` 2„ t VI4.c�. fAX �L cam. A CO MCA tlto�E�oi pupa D8Wr(h.G.� ,1r� ,1 ttcw.. aa(N_ S mem410 The,..... a?1 N Infinnnadon et g and r not become pert oe the be x of to a d and a carded a can�ar xt the he aetad to the ,. A sokaaleigtSidi H i 1%k fTUs -� — --.. ete • "a �� sa ' a 6AANTeA�CfltTRACf: 1608 EXHIBIT I.B GRANT CERTIFICATI©NS AND ASSURANCES Couitt Mill",r'Ge xMT cc.el'uszsC1 roam pyo OPPORTUNITY LIST FOR COMMODITIES ANo cUNrucru .SERVICES AND PROEESS1ONAL CONSULTANT SERVICES a a are parry a/Wear aunty Mot dnolvvetayed hsrrsses and snooty renders as in the OW*4 Refuiotions PCM4 e' tlmrdm Moony(PT]rata bort dw op)aRakf ty set P an cono-6[ts wKhldrral ad/or we Aron►est Prone ceraaator/►nms ne ooftaat /1 CI0LpeN CR(l +,'rayl Ito L r4 Address and ranee Number Int `rti %ck WVBEtt k$43., MOLES ,FL gkldi Proomenient humborierivenmemord tanner: 1$- 3O SEto 50-0 104 The est beim,s wewlad to be s bang of Anis that are,or attempting to,panaceas on the prefect numbered above.The 6a mint n yule the inn bidding or atoning as pnmR as wall as subs and sappers quoins for partiapatioa Prone cmntrstnn and mnsultan is must provide mimosa=ter Mrwibt+'s 1,2,3,and 4,and,should provide oaf wilomwbon they have for Numbers 5,6,7,and B.lei farm must be submitted with the bei package. L Fedral tan in Somber 4 b - 3((IS V.) 4..E] 0131 ® DBE IL bremmi Grose 1 rime Kam* 'tcj,>Lul CA kr- 4401." Non—Dist Less than$1 pram 3 Phone Nunb.c 730 LW 0-2440 t(44"'"' sawn 513 main & mesas i g 34, co fat ert.444.illnonan S 5-10 nelhan NA f1 act. VI t a 1 7.0 L4tccattactar between 51415 maim Subooroaltant More titan$13 million 5. Year Free estabietntl: t�7 1 Wand Tax FD Number 6.1 I Die I. Anneal G4 lS*Its 2. Pm FName IIF—�itl Non-OSE Ltsi than 51 mike 3 Prean rannber. Between S 13 ninon ♦ Address Between$S-ID Milian 7.0Suboomra mor ea.reon$1415 indica Subconseltant More than 515 inion S. Yam Lina Established 3. Federal Tax ID*sober6. DBEAnnual Gross Receipts I 2.. PY'raName ® N -0 - KS mn6E I, Lthan$1 mime 3.Penne number. .Saracen$13=lien IS Address .Between$5-10 milion 7. Silac rias 1111Between$1.0.15'alai El Subtonstltsnt 1.1 than 513 nano 5.Year Pete Established; L Federal Tax Ila Number: 6. DK l annual Groan Waists 2. Pam Name; &a Non-DISE Less than$1 maim L Phone Number Between$1-5 inion 4.Address El eetsasen S 5-10 Phnom 7. Subcontractor between S 1415 name Subcon tent More than 515 minim 5.Tem Firmtstai shed: GCA-6 1608 Collier County Solicitation 18-7300 EXHIBIT I.B GRANT CERTIFICATIONS AND ASSURANCES COLLIER COUNTY Acknowledgement of Terms,Conditions and Grant Clauses Flow Down of Terms and Conditions from the Grant Agreement Subcontracts: If the vendor subcontracts any of the work required under this Agreement, a copy of the signed subcontract must be available to the Department for review and approval. The vendor agrees to include in the subcontract that (1) the subcontractor is bound by the terms of this Agreement, (ii) the subcontractor is bound by all applicable state and federal laws and regulations, and (iii) the subcontractor shall hold the Department and Recipient harmless against all claims of whatever nature arising out of the subcontractor's performance of work under this Agreement, to the extent allowed and required by law. The recipient shall document in the quarterly report the subcontractor's progress in performing its work under this agreement. For each subcontract, the Recipient shall provide a written statement to the Department as to whether the subcontractor is a minority vendor as defined in Section 288.703,Fla. Stat. Certification On behalf of my firm, I acknowledge, and agree to perform all of the specifications,and grant requirements identified in this solicitation document(s). Vendor/Contractor Name 6(V(uiif 6144, 14*M. (ALT,. Date 3173/ th Authorized Signature (r..«... Address I t3-6 Ttuct a Ceva vel , N A(U.i v - f'L yk a I Solicitation/Contract# k's' GCA -7 2/26/2018 2:25 PM p.27 16D8 Collier County Solicitation 18-7300 EXHIBIT LB GRANT CERTIFICATIONS AND ASSURANCES ......... ... ... COLLIER cauNTY Scrutinized Companies Certification The undersigned _ • endor/ Contractor) certifies, to the best of his or her knowledge and belief,that it is not listed on the • Scrutinized Companies with Activities in Sudan List, • Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List,and/or • Scrutinized Companies with Activities in Israel List (eff. 10.1.2016), pursuant to Section 215.473, F.S. 'The subcontractor further agrees the County may immediately terminate this contract for cause if the vendor/contractor is found to have submitted a false certification or is placed on the Scrutinized Companies list during the term of the contract. !"ick- C Name of Authorized Official l7 pet.. e4 rejlaASO Title Ql-tlzCm-- Signature of Vendor/Contractor's Authorized Official 3/ZS. lit Date GCA - 8 2/26/2018 2:25 PM p.28 1608 COLLIER COUNTY Certification Regarding Lobbying The undersigned certifies,to the best of his or her knowledge,that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form- LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements)and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31, U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The Contractor,c U Ccs +bre) iklA certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. § 3801 et seq.,apply to this certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 11.062, Florida Statutes., apply to this certific.fon and disclosure, if any. Signature of Contractor's Authorized Official `.11�:G�� ►1.=1:_ C) Name of Authorized Official and Title Date 07/18 R6 1608 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 08/28/2018 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 have ADDITIONAL INSURED provisions or 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 CONTACT Marlena Randall NAME: Brown&Brown of Florida,Inc. PHONE (386)252-9601 FAX (386)239-5729 (A/C,No,Ext): (A/C,No): P.O.Box 2412 E-MAIL marandall@bbdaytona,com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC C Daytona Beach FL 32115-2415 INSURER A: GuideOne National Insurance Company INSUREDINSURER e: GuideOne Mutual Insurance Company 15032 Golden Care Home Health Inc. INSURER c: Associated Industries Insurance Company,Inc. 23140 1876 Trade Center WayINSURER D: Travelers Casualty and Surety Company 19038 INSURER E: Naples FL 34109 INSURER F: COVERAGES CERTIFICATE NUMBER: CL1882818979 REVISION NUMBER: 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 ADDLSUBR POLICY EFFPOUCY EXP LIMITSLTR TYPE OF INSURANCE INSD WVD POLICY NUMBER JMMIDD/YYYY) (MMIDO/YYYY) X COMMERCIAL GENERAL LIABILITY ! EACH OCCURRENCE S 1,000.000 DAMAGE TO RENTED 50,000 CLAIMS-MADE XI OCCUR PREMISES(Ea occurrence) S MED EXP(Any one person) $ 5,000 A Professional 1M/3M Y PGO511018013 111231201; 11/23/2018 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 3'000'000 PRO- JECT LOC I PRODUCTS AGG S 1'000'000 POLICY _ OTHER: EEL 5 1,000,000 AUTOMOBILE LIABILITY f `---1- COMBINED SINGLE LIMIT S 1,000,000 (Ea accdenb _ ANY AUTO ( BODILY INJURY(Per person) $ — B X OWNED SCHEDULED Y 1786027 11/23/2017 11/23/2018 BODILY INJURY(Per accdent) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S X AUTOS ONLY X AUTOS ONLY (Per accdentl Underinsured motorist 5 UMBRELLA UAB - OCCUR EAhOCCUZI4 E, . 5 EXCESS LINE CLAIMS-MADE AGGREGATE S DEO RETENTION S $ WORKERS COMPENSATION ..(1 PER OTH- AND EMPLOYERS'LIABILITY Y/N "'NI STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y NIA AWC1104872 04/05/2018 04/05/2019 E.L.EACH ACCIDENT S 1,000.000 C OFFICER/MEMBER EXCLUDED? (Mandatory in NH) El.DISEASE-EA EMPLOYEE $ 1,000,000 If yes.descnbe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S Crime D 106823398 10/23/2017 11/23/2018 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space is required) Collier County Board of County Commissioners is included as an additional insured under the General Liability and Automobile policies for contract #18-7300. Both policies included a 30 day cancellation clause. CERTIFICATE HOLDER CANCELLATION ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Collier County Board of County Commissioners ACCORDANCE WITH THE POUCY PROVISIONS. 3295 Tamiami Trail E. AUTHORIZED REPRESENTATIVE Naples FL 34112 / -y 1�{.-f I ��r ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1 6 D 8 ADDITIONAL COVERAGES Ref# Description I PROF LIABILITY Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 1,000,000 3,000,000 Ref# Description Coverage Code Form No. Edition Date THEFT OF CLIENT PROP Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 25,000 25,000 1,000 Ref# Description I SEX/PHYS ABUSE Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 1,000,000 3,000,000 Ref# Description Coverage Code Form No. Edition Date Employee Benefits EBL IA Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 13 1,000 Ref# Description Coverage Code Form No. Edition Date PIP-Basic PIP Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 10,000 Ref# Description I Coverage Code Form No. Edition Date Medical payments MEDPM Limit 1 Limit 2 Limit 3 Deductible Amount I Deductible Type Premium 5,000 Ref# Description Coverage Code Form No. Edition Date Uninsured motorist combined single limit UMCSL Limit 1 Limit 2 Limit 3 Deductible Amount i Deductible Type Premium 1,000,000 Ref# Description Coverage Code Form No. Edition Date WCOT3 WCOT3 Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $1,865.00 Ref# Description Coverage Code Form No. Edition Date WCOT2 WCOT2 Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $11,897.00 Ref# Description Coverage Code Form No. Edition Date Expense constant EXCNT Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $200.00 Ref# Description Coverage Code Form No. Edition Date WCOT1 WCOT1 Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $2,381.00 OFADTLCV Copyright 2001,AMS Services,Inc. 1608 ADDITIONAL COVERAGES Ref# Description Coverage Code Form No. Edition Date Premium discount PDIS Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium -$11,945.00 Ref# Description Coverage Code Form No. Edition Date Experience Mod Factor 1 EXPO1 Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium -$19,263.00 Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description ______Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount _ Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium OFADTLCV Copyright 2001,AMS Services,Inc.