Backup Documents 01/13/2009 Item #16D 2
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SUI 6 0 2
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 th-: Board Office. The completed routing slip and original
documents are to be forwarded to the Board Oftice only after the Board has taken action on the item.)
ROUTING SLIP
Complete routing lines #1 through #4 as appropriate for additional signatures, dates. and/or information needed. If the document is already complete with the
excention of the Chairman's sillnature. draw a line throulZh routing lines #1 throulZ.h #4, comnlctc the checklist. and forward to Sue Filson line #5).
Route to Addressee(s) Office Initials Date
(List in routing order)
1. Terri Daniels Housing and Human Services 01/14/09
2.
~_/-~ //-'-, .., ~ /~
/' ----
3. ~ ..--- ." 1-----------------
--"'-"-' --- ---- --------------.----... .-.' -._~..,-_.-,---------
.------ ~- ,--.
4, Sue Filson, Executive Manager Board of County Commissioners '2f
5. Minutes and Records Clerk of Court's Office ()
PRIMARY CONTACT INFORMATION
(The primary contact i:. the holder of the original document pending BCe approval. Normally the primary contact is the person who created/prepared the executive
summary. Primary contact information is needed in the event one of the addressees above. including Sue Filson, need to contact staff for additional or missing
information. All original documents needing the Bee Chairman's signature are to be delivered to the Bee office only after the Bee has acted to approve the
item.)
Name of Primary Staff Terri Daniels Phone Number 252-2689
Contact
Agenda Date Item was 1/13/2009 Agenda Item Number 16D2
Aooroved bv the BCC
Type of Document Agreement Number of Original 2
Attached Documents Attached
1.
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark "N/A" in the Not Applicable column, whichever is
a ro date.
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 Artomey'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 ossibl State Officials,
All handwritten strike-through and revisions have been initialed by the County Attorney's
Office and all other arties exec t the BCC Chairman and the Clerk to the Board
The Chairman's signature line date has been entered as the date ofBCC approval of the
document or the final ne otiated contract date whichever is a licable.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
si nature and initials are re uired.
In most cases (some contracts are an exception), the original document and this routing slip
should be provided to Sue Filson in the BCC office within 24 hours ofBCC approval.
Some documents are time sensitive and require forwarding 10 Tallahassee within a certain
time frame or the Bee's actions are nullified. Be 'war of OUf deadlines!
The document was approved by the BeC on ) (enter date) and all changes
made during the meeting have been incorporat i tb attached document. The
Count Attorne 's Office has reviewed the chan es, if a lie able.
Yes
(Initial)
N/A(Not
A licable)
2,
3.
4.
5,
6,
.~
,
,
v
,i"~1
I
I: Forms! County Forms/ Bee Forms! Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
1602
AGREEMENT
THIS AGREEMENT, made and entered into on this 13th day of January, by and
between Physician Led Access Network of Collier County, authorized to do business in
the State of Florida whose business address is 1012 Goodlette-Frank Rd" Suite #201,
Naples, Florida 34101, hereinafter called the "Contractor" (or "Consultant") and Collier
County, a political subdivision of the State of Florida, Collier County, Naples,
hereinafter call the" County" :
WITNESSETH:
1. COMMENCEMENT, The contract shall be for a twenty (20) month period,
commencing on January 1 2009, and terminating on August 31, 2010, In the
event that additional grant funding becomes available or the grantor extends the
grant award, the County may, at its discretion and with the consent of the
Consultant, extend the Agreement under all of the terms and conditions
contained in this Agreement for two (2) additional one (1) year periods, The
County shall give the Consultant written notice of the County's intention to
extend the Agreement term not less than ten (10) days prior to the end of the
Agreement term then in effect,
2. STATEMENT OF WORK: The Contractor shall provide services in accordance
with the terms and conditions of Attachment" A", hereto attached and made an
integral part of this agreement. Additional related services may be provided by
the Contractor subject to the issuance of Change Orders as approved in advance
by the County. Services provided under this contract may include, but not be
limited to, the following:
a, Establish a shared information database to provide for a more effective
and efficient method of health care service for the uninsured population in
Collier County, Allowable costs associated with the project are included
in Attachment B and consist of the following:
1) Personnel costs and associated fringe benefits
2) Supplies
3) Travel in compliance with Chapter 112, Florida Statute
4) Communication/Marketing/Other
5) Other Contractual costs, i.e. consultants, rent,
telecommunications
3. COMPENSATION, The County shall pay for contracted services performed on
behalf of PLAN for the performance of this Agreement a total amount of One
hundred five thousand two hundred and eleven dollars, ($105,211) based on
16D2
allowable expenses incurred, Payment will be made to project vendors upon
receipt of a proper invoice and in compliance with Section 218.70 Florida
Statutes, otherwise known as the "Florida Prompt Payment Act" and a signed
affidavit from the PLAN Executive Director, attesting that the work has been
completed. Collier County reserves the right to withhold and/or reduce an
appropriate amount of any payments for work not performed or for
unsatisfactory performance of Contractual requirements.
The County and US Department of Health and Human Services, Health
Resources and Services Administration have agreed that these funds will only be
used to fund projects that demonstrate expertise in the area of Health
Information Technology.
4. NOTICES. All notices from the County to the Contractor shall be deemed duly
served if mailed or faxed to the Contractor at the following address:
Physician Led Access Network (PLAN)
of Collier County, Inc.
1012 Goodlette-Frank Rd., Suite #201
Naples, Florida 34101
Paul Mitchell, M.D., Board Vice-Chairman
Phone: (239) 434-0008
Fax: 239-417-8900
All notices from the Contractor to the County shall be deemed duly served if mailed or
faxed to the County to:
Collier County Government Center
Housing and Human Services Department
3301 Tamiami Trail East Bldg. H/211
Naples, Florida 34112
Attn: Marcy Krumbine, Director
Phone: 239-252-2273
Fax: 239-252-2638
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,
5. 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,
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16D2
6. CONDITIONS.
a, Special Conditions: The Contractor agrees to comply with the
requirements set forth in the Notice of Grant Award Terms and
Conditions (Attachment A),
b. Compliance with Local and Federal Rules, Regulations and Laws:
During the performance of this agreement, the Contractor agrees to
comply with any applicable laws, regulations and orders listed below by
reference and incorporated and made a part hereof. The Contractor
further agrees to abide by all other applicable laws:
1. 24 CFR Part 1 - The regulations promulgated pursuant to Title VI
of the 1984 Civil Rights Act.
ii. Age Discrimination Acts of 1973,
111. OMB Circular A-133 concerning audits.
IV, Executive Order 11914 - Prohibits discrimination with respect to
the handicapped in federally assisted projects,
v, Florida Statutes, Chapter 112 - which deals with conflict of interest.
vi. 45 CFR Part 74.25 Revision of budget and program plans.
VI1. OMB Circular A-122 - concerning cost principles.
viii. 24 CFR Part 84 - Uniform Administrative Requirements for Grants
and Agreements with Institutions of Higher Education, Hospitals
and Non-Profit Organizations.
7. SUBCONTRACTS. Any work or services subcontracts by the Contractor shall
be specifically by written contract or agreements, and such subcontracts shall be
subject to each provision of this Agreement and applicable County, State, and
Federal guidelines and regulations. Prior to execution by the Contractor of any
subcontract hereunder, such subcontracts must be submitted by the Contractor
to Housing and Human Services for its review and approval. None of the work
or services covered by the Agreement, including but not limited to consultant
work or services, shall be subcontracted by the Contractor or reimbursed by the
County without prior written approval of the Housing and Human Services
Director or his designee.
8. AMENDMENTS. The County may, at its discretion, amend this Agreement to
conform to changes required by Federal, State, County or Health Resources and
Services Administration (HRSA) guidelines, directives, and objectives, Such
amendments shall be incorporated by written amendment as a part of this
Agreement and shall be subject to approval of Collier County. Except as
otherwise provided herein, no amendment to this Agreement shall be binding on
3
1602
either party unless in writing, approved by the County and signed by each
Party's designee.
9, PERMITS: LICENSE TAXES. In compliance with Section 218,80, FS., all
permits necessary for the prosecution of the Work shall be obtained by the
Contractor, Payment for all such permits issued by the County shall be
processed internally by the County. All non-County permits necessary for the
prosecution of the Work shall be procured and paid for by the Contractor. The
Contractor shall also be solely responsible for payment of any and all taxes
levied on the Contractor. In addition, the Contractor shall comply with all rules,
regulations and laws of Collier County, the State of Florida, or the 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.
10. NO IMPROPER USE. The Contractor will not use, nor suffer or permit any
person to use in any manner whatsoever, County facilities for any improper,
immoral or offensive purpose, or for any purpose in violation of any federal,
state, county or municipal ordinance, rule, order or regulation, or of any
governmental rule or regulation now in effect or hereafter enacted or adopted,
In the event of such violation by the Contractor or if the County or its authorized
representative shall deem any conduct on the part of the Contractor to be
objectionable or improper, the County shall have the right to suspend the
contract of the Contractor. Should the Contractor fail to correct any such
violation, conduct, or practice to the satisfaction of the County within
twenty-four (24) hours after receiving notice of such violation, conduct, or
practice, such suspension to continue until the violation is cured. The Contractor
further agrees not to commence operation during the suspension period until the
violation has been corrected to the satisfaction of the County.
11. 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-
53, and County Administrative Procedure 5311. Violation of this provision may
result in one or more of the following consequences: a. Prohibition by the
individual, firm, and/ or any employee of the firm from contact with County staff
for a specified period of time; b, Prohibition by the individual and/ or firm from
doing business with the County for a specified period of time, including but not
limited to: submitting bids, RFP, and/ or quotes; and, c. immediate termination of
any contract held by the individual and/ or firm for cause,
4
1602
12. 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 immediately for cause; further the County
may terminate this Agreement for convenience with a seven (7) day written
notice, The County shall be sole judge of non-performance,
B. NO DISCRIMINATION. The Contractor agrees that there shall be no
discrimination as to race, sex, color, creed or national origin.
a. Executive Order 13166, August 11, 2000 requires recipients receiving
Federal financial assistance to take steps to ensure that people with
limited English proficiency can meaningfully access health and social
services, Contractor's organization must comply with this requirement as
set forth in Attachment A page 4 item 9.
14, INSURANCE. The Contractor shall provide insurance as follows:
A. Commercial General 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 Premises and Operations;
Independent Contractors; Products and Completed Operations and
Contractual Liability.
B. Business Auto Liability: Coverage shall have minimum limits of $500,000
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.
The coverage must include Employers' Liability with a minimum limit of
$1,000,000 for each accident.
Special Requirements: Collier County shall be listed as the Certificate
Holder and included as an Additional Insured on the Comprehensive
General Liability Policy.
Current, valid insurance policies meeting the requirement herein identified
shall be maintained by Contractor during the duration of this Agreement.
Renewal certificates shall be sent to the County 30 days prior to any
expiration date, There shall be a 30 day notification to the County in the
event of cancellation or modification of any stipulated insurance coverage,
5
16D2
Contractor shall insure that all subcontractors comply with the same
insurance requirements that he is required to meet. The same Contractor
shall provide County with certificates of insurance meeting the required
insurance provisions.
12. INDEMNIFICATION. To the maximum extent permitted by Florida law,
the Contractor or Consultant shall indemnify and hold harmless Collier
County, its officers and employees from any and all liabilities, damages,
losses and costs, including, but not limited to, reasonable attorneys' fees and
paralegals' fees, to the extent caused by the negligence, recklessness, or
intentionally wrongful conduct of Contractor or Consultant or anyone
employed or utilized by the Contractor or Consultant 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. CONTRACT ADMINISTRATION. This Agreement shall be administered on
behalf of the County by the Housing and Human Services Department.
14. CONFLICT OF INTEREST: Contractor represents that it presently has no interest
and shall acquire no interest, either direct or indirect, which would conflict in any
manner with the performance of services required hereunder. Contractor further
represents that no persons having any such interest shall be employed to perform
those services,
15, COMPONENT PARTS OF THIS CONTRACT. This Contract consists of the
attached component parts, all of which are as fully a part of the contract as if
herein set out verbatim: Notice of Grant Award Terms and Conditions
(Attachment A)
16, SUBJECT TO APPROPRIATION. It is further understood and agreed by and
between the parties herein that this agreement is subject to appropriation by the
Board of County Commissioners.
6
1602
IN WITNESS WHEREOF, the Contractor and the County, have each, respectively, by an
authorized person or agent, hereunder set their hands and seals on the date and year first
above written,
ATTEST: '.':
DwighfE, ~Btock:'C1E!rk of Courts
.....,
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
BY~~~.' 01..-
Dated: ?r"
Attest a. to ,"'"
)~. ..'
.t~ -GII('.,:
...~~.cn;"Ji.. .
B
,
Tom Henning, Cha' man
January 13, 2009
Physician Led Access Network (PLAN)
of Collier County
W~~l(u.
DE"e.oJ2.A1-t DA~ LM At-J,..J.S
tTypejprint witness namet
(~L\)',x1/( 1\.1..e(,
, . Se~ond Witness
By:f~6~/I#
Paul Mitchell, MD.
PLAN Board Vice-Chairman
January 13, 2009
----;-C--1Z ii'.-, -L':JruJi C Is
tTypej print witness name t
Approved as to form and
legal sufficiency:
CiJj~YvI ~
I
Colleen M. Greene
Assistant County Attorney
Item # \1a.b1L
Agenda \ .A'" ..r-a
Date ~ I
~:d l-~t'lfI
7
1, DATE ISSUED: 2. PROGRAM CFDA: 93.888
08/26/2008
3, SUPERCEDES AWARD NOTICE dated:
excepllh8tanyllll<lilionsorrellridionsprevioulltyimpoa8dfflmllininelfec:tunleS&spadficali>'reacindad
4a. AWARD NO,: 4b. GRANT NO,: 5. FORMER GRANT NO.:
1 D1BIT10769.01.00 D1BIT10769
6, PROJECT PERIOD:
FROM: 09/01/2008 THROUGH: 08/31/2010
7, BUDGET PERIOD:
FROM: 09/01/2008 THROUGH: 08/31/2010
Attachment A
2
Page 1
DEPARTMENT OF HEALTH AND HUMAN SERVICES
HEALTH RESOURCES AND SERVICES ADMINISTRATION
_RSA
NOTICE OF GRANT AWARD
AUTHORIZATION (Legislation/Regulation)
Public Health Service Act, Title III, Section 330(A) as Amended
Public Health Service Act, Title III, Section 330A
Public Health Service Act, Title III, Section 330(1), P.l. 107.251
8. TITLE OF PROJECT (OR PROGRAM): Congressionally-Mandated Health Information Technology Grants
9. GRANTEE NAME AND ADDRESS: 10. DIRECTOR: (PROGRAM DIRECTOR/PRINCIPAL INVESTIGATOR)
Collier County Marcy Krumbine
3301 Tamiami Trail E Collier County
Naples, FL 34112-3969 3301 Tamiami Trail East
Naples, FL 34112-3969
11. APPROVED BUDGET: (Excludes Direct Assistance)
[Xl Grant Funds Only
[] Total project costs including grant funds and all other financial
participation
a. Salaries and Wages:
b. Fringe Benefits:
c. Total Personnel Costs:
d. Consultant Costs:
e. Equipment:
f. Supplies:
g. Travel:
h. Construction/Alteration and Renovation:
i. Other:
j. Consortium/Contractual Costs:
k. Trainee Related Expenses:
I. Trainee Stipends:
m. Trainee Tuition and Fees:
n. Trainee Travel:
0, TOTAL DIRECT COSTS:
p, INDIRECT COSTS: (Rate: % of S&WITADC)
q. TOTAL APPROVED BUDGET:
i. Less Non.Federal Resources:
ii. Federal Share:
$ 26.250,00
$ 8.061.00
$ 34.311,00
$ 0,00
$ 0,00
$ 41.300.00
$ 4,400,00
$ 0,00
$ 82,400,00
$ 161.500,00
$ 000
$ 0,00
$ 0,00
$ 0,00
$ 323,911.00
$ 0,00
$ 323,911,00
$ 0.00
$323.911.00
12, AWARD COMPUTATION FOR FINANCIAL ASSISTANCE
a. Authorized Financial Assistance This Period $ 323,911.00
b. Less Unobligated Balance from Prior Budget Periods
i. Additional Authority
ii. Offset
c. Unawarded Balance of Current Year's Funds
d. Less Cumulative Prior Award(s) This Budget
Period
e, AMOUNT OF FINANCIAL ASSISTANCE THIS
ACTION
$ 000
$ 0.00
$ 0,00
$ 0.00
$ 323,911,00
13. RECOMMENDED FUTURE SUPPORT: (Subject to the availability of
funds and satisfactory progress of project)
YEAR
1 TOtAL COSTS 'I
Not Applicable .
14, APPROVED DIRECT ASSISTANCE BUDGET: (In lieu of cash)
a. Amount of Direct Assistance
b. Less Unawarded Balance of Current Year's
Funds
c. Less Cumulative Prior Awards(s) This Budget
Period
d, AMOUNT OF DIRECT ASSISTANCE THIS
ACTION
$ 0.00
$ 0,00
$ 0.00
$ 0,00
15. PROGRAM INCOME SUBJECT TO 45 CFR Part 74,24 OR 45 CFR 92.25 SHALL BE USED IN ACCORD WITH ONE OF THE FOLLOWING
ALTERNATIVES:
[A]
A=Addltlon B=Deductlon C=Cost Sharing or Matching D=Other
Estimated Program Income: $ 0.00
16, THIS AWARD IS BASED ON AN APPLICATION SUBMITTED TO, AND AS APPROVED BY HRSA, IS ON THE ABOVE TITLED PROJECT
AND IS SUBJECT TO THE TERMS AND CONDITIONS INCORPORATED EITHER DIRECTLY OR BY REFERENCE IN THE FOLLOWING:
a. The grant program 18!lIsl8tion dtOO above. b. The grant program f1Igulation cillld aoo'le_ c. This award noUoa Including Iam1lI and conditions. W any, oolDd balcw undar REMARKS. d. 45 CfR Part 74 or 45 CfR Part 92 u applicabla. In tha
ava~lth8",.",con.k:lln9 oro\harw,salncons..tantpolid611appllcabllllo thegranl,lhllllbovllordllfofprecedencashall prevail. Accaplanceoflhe granttarmsandcondltions...dmowledQ9d by the grantllewilen lunds ara drawn or clharwl."
ob[a,nOO from the grant paymenlsystllm.
REMARKS: (Other Terms and Conditions Attached [X] Yes [] No)
Electron/cally signed by Dorothy M. Kelley, Grants Management Officer on: 0812612008
17, OBJ. CLASS: 41,51 18, CRS.EIN: 1596000558A1 19. FUTURE RECOMMENDED FUNDING:
FYlcAN
08.3706311
93.888
D1BIT10769AO
$ 0,00
SU8RIlOGRAM
'CODE
N/A
..~..__=--_,__~~__._~.,~.wn_'~,'~"~~'__~__'. .
1602
NOTICE OF GRANT AWARD (Continuation Sheet)
I ~age 2 __ -~-- }D';te l~sued:-~08/26/2008--'----
r Awar_~~-~'mber: ~_ 01 BIT~~769-01-_?~==~---==--
-
]
HRSA Electronic Handbooks (EHBs) Registration Requirements
The Project Director of the grant (listed on this NGA) and the Authorizing Official of the grantee organization are
required to register (if not already registered) within HRSA's Electronic Handbooks (EHBs). Registration within
HRSA EHBs is required only once for each user for each organization they represent. To complete the
registration quickly and efficiently we recommend that you note the 10-digit grant number from box 4b of this
NGA. After you have completed the initial registration steps (Le" created an individual account and associated it
with the correct grantee organization record), be sure to add this grant to your portfolio, This registration in
HRSA EHBs is required for submission of noncompeting continuation applications, In addition, you can also use
HRSA EHBs to perform other activities such as updating addresses, updating email addresses and submitting
certain deliverables electronically, Visit htlps:llgrants.hrsa.gov/webexternalllogin.asp to use the system.
Additional help is available online and/or from the HRSA Call Center at 1-877-464-4772.
Terms and Conditions
Failure to comply with the special remarks and condition(s) may result in a draw down restriction being placed
on your Payment Management System account or denial of future funding.
Program Terms:
1, Telemedicine Projects: Whenever a third-party payer can be billed for a consult. the grantee may not provide the
involved clinician(s) with a grant-funded clinician incentive payment. This remains the rule even when the clinician
incentive payment is more than what the third-party payer will reimburse, This also applies when a State Medicaid
agency will reimburse for a consult. but the grantee has not yet established its own internal procedure to bill Medicaid,
2, The Universal Service Provisions of the Telecommunications Act of 1996 should make telecommunication rates for
eligible rural health providers comparable with rates for urban providers and in many cases thereby reduce
transmission costs to rural providers. All eligible applicants and their eligible grant - funded network members must
apply for a Universal Service subsidy as soon as possible or demonstrate to OHIT that applying would not provide any
financial advantage. Further information on Universal Service Is available at: (http://www,rhc,universalservice,org),
3, It is the policy of HRSA to make available to the public the results and accomplishments of the activities that it funds,
Therefore. it is incumbent upon project directors. program directors. and principal investigators to make results and
accomplishments of their activities available to the public, Prior approval is not required for publishing the results of an
activity under a grant. Recipients shall place an acknowledgement of HRSA grant support and a disclaimer. as
appropriate, on any publication. briefing paper. report. or other document that is written. published. or otherwise
produced (e,g,. website. electronic work products) with such support and. if feasible. on any document (electronic or
paper) reporting the results of or describing a grant-supported activity, The acknowledgement shall read:
"This publication (report. briefing paper. document. website. etc,) was made possible by grant number from the
Office of Health Information Technology. Health Resources and Services Administration. DHHS" or "The project
described was supported by grant number from the Office of Health Information Technology. Health
Resources and Services Administration. DHHS,"
THREE copies of documents or reports (electronic or paper). resulting from work performed under a HRSA
grant-supported project or activity MUST be submitted to OHIT. no matter what the media by which they are
disseminated (e,g,. publications in journals. reports. CD-Rom. web), In addition. copies of presentations to major
organizations should acknowledge HRSA support and be submitted to the OHIT project officer,
THREE reprints of publications or work products resulting from work performed under a HRSA grant supported project
or activity MUST be submitted to the OHIT project officer,
4, In the event the grantee organization anticipates that Federal funding available through this award will not be
expended by the project period end date. the grantee is required to submit to the grants management representative
and project officer indicated in the "contacts" section of this document a request for a no-cost extension to complete
goals and objectives. This request. under an original signature of an authorized grant official should be submitted at
least 60 days prior to the expiration of the project period and include: (a) the grant number. (b) the additional time
desired, (c) the grant project goals and objectives to be completed and (d) the Federal funds available to complete the
goals and objectives with categorical budget and justification,
1. DATE ISSUED: 2. PROGRAM CFDA: 93,666
06126/2006
3. SUPERCEDES AWARD NOTICE dated:
eJ<CePIIMI....yaddltion.or..llrIctIon.ptllVOnloly O"nj)oud remain In otffm u""'.. ,petillo'lIyr.ocinded
4a. AWARD NO.: 4b. GRANT NO.: 5. FORMER GRANT NO.:
1D1BIT10769.01.00 D1BIT10769
6. PROJECT PERIOD:
FROM: 09/01/2006 THROUGH: 06/31/2010
7. BUDGET PERIOD:
FROM: 09/01/2006 THROUGH: 06/31/2010
Attachment A
DEPARTMENT OF HEALTH AND HUMAN SERVIC
HEALTH RESOURCES AND SERVICES ADMINISTRATION
.-RSA
NOTICE OF GRANT AWARD
AUTHORIZA liON (Legislation/Regulation)
Public Health Service Act, Title III, Section 330(A) as Amended
Public Health Service Act, Title Ill. Section 330A
Public Health Service Act, Title III, Section 330(1), P.L. 107.251
8. TITLE OF PROJECT {OR PROGRAM}: Congressionally-Mandated Health Infonnaticn Technology Grants
9, GRANTEE NAME AND ADDRESS: 10. DIRECTOR: (PROGRAM DIRECTOR/PRINCIPAL INVESTIGATOR)
Collier County Marcy Krumbine
3301 Tamiami Trail E Collier County
Naples, FL 34112-3969 3301 Tamlami Trail East
Naples. FL 34112.3969
12. AWARD COMPUTATION FOR FINANCIAL ASSISTANCE
a. Authonzed Financial Assistance This Period $ 323,911.00
a. Salaries and Wages: $ 26,250.00
b. Fringe Benefits: $ 8,061.00
c. Total Personnel Costs: $ 34,311.00
d. Consultant Costs: $ 0.00
e. Equipment: $ 0.00
f, Supplies: $ 41.300.00
g. Travel: $ 4,400.00
h. Construction/Alteration and Renovation: $ 0.00
i. Other: $ 82,400.00
j. Consortium/Contractual Costs: $ 161,500.00
k. Trainee Related Expenses: $ 0.00
I. Trainee Stipends: $ 0.00
m. Trainee Tuition and Fees: $ 0.00
n. Trainee Travel: $ 0.00
0, TOTAL DIRECT COSTS: $ 323,911,00
p, INDIRECT COSTS: (Rate: % of S&WITADC) $ 0.00
q, TOTAL APPROVED BUDGET: $ 323.911.00
i. Less Non.Federal Resources: $ 0.00
ii. Federal Share: $ 323,911.00
15. PROGRAM INCOME SUBJECT TO 45 CFR Part 74.24 OR 45 CFR 92.25 SHALL BE USED IN ACCORD WITH ONE OF THE FOLLOWING
AL TERNA TIVES:
A"'Addltlon B=DeducUon C=Cost Sharing or Matching D=other
Estimated Program Income: $ 0.00
11. APPROVED BUDGET: (Excludes Direct Assistance)
[X] Grant Funds Only
[ ] Total project costs including grant funds and all other financial
participation
b. Less Unobligated Balance from Prior Budget Periods
i. Additional Authority
ii. Offset
c. Unawarded Balance of Current Year's Funds
d. Less Cumulative Prior Award(s) This Budget
Period
$ Q,OO
$ 0,00
$ 0,00
$ 0.00
e, AMOUNT OF FINANCIAL ASSISTANCE THIS
ACTION
$ 323.911.00
13. RECOMMENDED FUTURE SUPPORT: (Subject to the availability of
funds and satisfactory progress of project)
14. APPROVED DIRECT ASSISTANCE BUDGET: (In lieu of cash)
a. Amount of Direct Assistance
$ 0,00
$ 0,00
b. Less Unawarcled Balance of Current Year's
Funds
c. Less Cumulative Prior Awards(s) This Budget
Period
$ 0,00
d, AMOUNT OF DIRECT ASSISTANCE THIS
ACTION
$ 0.00
[AJ
16. THIS AWARD IS BASED ON AN APPLICATION SUBMITTED TO, AND AS APPROVED BY HRSA, IS ON THE ABOVE TITLED PROJECT
AND IS SUBJECT TO THE TERMS AND CONDITIONS INCORPORATED EITHER DIRECTLY OR BY REFERENCE IN THE FOLLOWING:
a. The gllmt program legillalion cited abova_ b. The grant Prtlllram "'llulatkln .,;ted above, c, Tr.. awanlnolice Including \alma and condillonl, if any, noted below undOlfREMI\RKS. d. 45 CFR Pan 74 Of 45 CFR Part92 81 appllCllble In lh-\l
evenllherealllconftldlngotolllerwl..lnconlillenlpollclelappliCllblalothagrant lhe above orrlarol pl'flOlld anCIIshaHprev&iI.AcceptanOlcflhaglllnlllrmaandoondltionlllackoowled9eclbythegran18awnanfundsellldlewnorolherw....
ob\lllnadfromlhegranlpaymanlayalam
REMARKS: (Other Terms and Conditions Attached [X] Yes [] No )
Electron/cally signed by Dorothy M. Kelley, Grants Management Officer on: 08/2612008
17. OBJ. CLASS: 41.51 16. CRS-EIN: 1596000558A1 19. FUTURE RECOMMENDED FUNDING:
08.3706311
'SU~'. . OGRAM
. .. "J!}~...".
;'<";~~'F:"':L
N/A
NOTICE OF GRANT AWARD (Continuation Sheet)
16D2
[PaIPage~ - -=-~~telssued 08/26/2008 ~-~j"
Award Number_1 ~!B'T10769 01-00 _ ___ _
5, The grantee Institution may retain the entire right. title and interest throughout the world to any invention (as defined in
45 CFR. Section 74.36) It conceives. develops. or implements in the performance of work under this grant. subject to
the provisions of the Department of Commerce's regulation 37 CFR Part 401 and 35 U,S,C, 203, The Federal
government. however. shall have a nonexclusive. nontransferable. irrevocable, paid-up license to obtain and use the
invention for or on behalf of the United States throughout the world,
6, Data Collection and Evaluation: Applicants accepting this award must. if requested, participate in the Office for the
Advancement of Telehealth (OAT) data collection and evaluation of telemedicine activities.
7, Telehealth Inventory Assessment: Applicants accepting this award must complete. if requested. a "HRSA Telehealth
Inventory," This inventory collects data about the Telehealth capabilities of the grantee's institution and those of the
network members, OHIT will provide information regarding this inventory at the time of request.
8, OAT Grantee Directory: Applicants accepting this award must provide information for OHIT's Grantee
Directory/Profiles, Further instructions will be provided by OHIT. The current Telehealth directory is available online at:
http://telehealth,hrsa,gov/grants/g rantee, htm.
9, Grantees are requested to attend and participate in the OHIT grantee meetings. Programmatic and logistical details
will be provided later,
10, When responding to reporting requirements. conditions. and requests for post award amendments to the Division of
Grants Management Operations. please send a courtesy copy of your correspondence to the designated project
officer.
Standard Terms:
1, All discretionary awards issued by HRSA on or after October 1. 2006, are subject to the HHS Grants Policy Statement
(HHS GPS) unless otherwise noted in the Notice of Award (NoA), Parts I through III of the HHS GPS are currently
available at ftp:/lftp,hrsa,gov/grants/hhsgrantspolicystatement.pdf and it is anticipated that Part IV, HRSA
program-specific guidance will be available at the website In the near future, In addition. HRSA-specific contacts will
be appended to Part III of the GPS which identifies Department-wide points of contact.
Please note that the Terms and Conditions explicitly noted in the award and the HHS GPS are in effect. Once
available. Part IV. HRSA program-specific guidance will take precedence over Parts I and II in situations where there
are conflicting or otherwise inconsistent policies.
2, The HHS Appropriations Act requires that when issuing statements. press releases. requests for proposals. bid
solicitations. and other documents describing projects or programs funded in whole or in part with Federal money. all
grantees receiving Federal funds. including but not limited to State and local governments. shall clearly state the
percentage of the total costs of the program or project which will be financed with Federal money. the dollar amount of
Federal funds for the project or program. and percentage and a dollar amount of the total costs of the project or
program that will be financed by nongovernmental sources,
3, Recipients and sub-recipients of Federal funds are subject to the strictures of the Medicare and Medicaid anti-kickback
statute (42 U,S,C, 1320a - 7b(b) and should be cognizant of the risk of criminal and administrative liability under this
statute. specifically under 42 U,S,C, 1320 7b(b) Illegal remunerations which states. in part. that whoever knowingly
and willfully:
(A) Solicits or receives (or offers or pays) any remuneration (including kickback. bribe. or rebate) directly or indirectly.
overtly or covertly. in cash or in kind. in return for referring (or to induce such person to refer) an individual to a person
for the furnishing or arranging for the furnishing of any item or service. OR
(6) In return for purchasing. leasing. ordering. or recommending purchasing. leasing. or ordering. or to purchase.
lease, or order, any goods, facility, services, or item
....For which payment may be made in whole or in part under subchapter XIII of this chapter or a State health care
program. shall be guilty of a felony and upon conviction thereof. shall be fined not more than $25.000 or imprisoned for
not more than five years. or both,
4, The HHS Appropriations Act requires that to the greatest extent practicable. all equipment and products purchased
with funds made available under this award should be American-made.
16D2
NOTICE OF GRANT AWARD (Continuation Sheet)
fage 4 __-~-~-:-_'~~~~~sued-:'^Ci8/26/26_~8---=~_l
IAwar~._~um~er: 1 D1_BI~1076g~~~_ ____ __ ___ .J
5, Items that require prior approval from the awarding office as indicated in 45 CFR Part 74.25 [Note: 74,25 (d) HRSA
has not waived cost-related or administrative prior approvals for recipients unless specificaliy stated on this Notice of
Grant Award] or 45 CFR Part 92,30 must be submitted in writing to the Grants Management Officer (GMO). Only
responses to prior approval requests signed by the GMO are considered valid, Grantees who take action on the basis
of responses from other officials do so at their own risk, Such responses wili not be considered binding by or upon the
HRSA,
in addition to the prior approval requirements identified in Part 74,25. HRSA requires grantees to seek prior approval
for significant rebudgetlng of project costs, Significant rebudgeting occurs when, under a grant where the Federal
share exceeds $100.000. cumulative transfers among direct cost budget categories for the current budget period
exceed 25 percent of the total approved budget (inclusive of direct and indirect costs and Federal funds and required
matching or cost sharing) for that budget period or $250.000, whichever is less, For example. under a grant in which
the Federal share for a budget period is $200.000. if the total approved budget is $300.000. cumulative changes within
that budget period exceeding $75.000 would require prior approval), For recipients subject to 45 CFR Part 92, this
requirement is in lieu of that in 45 CFR 92.30(c)(1 )(ii) which permits an agency to require prior approval for specified
cumulative transfers within a grantee's approved budget. [Note, even if a grantee's proposed rebudgeting of costs falis
below the significant rebudgeting threshold identified above. grantees are stili required to request prior approval. if
some or ali of the rebudgeting reflects either a change in scope. a proposed purchase of a unit of equipment
exceeding $25.000 (if not inciuded in the approved application) or other prior approval action identified in Parts 74,25
and 92,30 unless HRSA has specifically exempted the grantee from the requirement(s),]
6, Payments under this award will be made available through the DHHS Payment Management System (PMS), PMS is
administered by the Division of Payment Management. Financial Management Services. Program Support Center.
which will forward Instructions for obtaining payments, Inquiries regarding payment should be directed to: Payment
Management. DHHS. P,O, Box 6021. Rockvilie. MD 20852. http://www.dpm,psc,gov/ or Telephone Number:
1-877-614-5533,
7, The DHHS Inspector General maintains a toli-free holline for receiving information concerning fraud. waste. or abuse
under grants and cooperative agreements, Such reports are kept confidential and callers may deciine to give their
names if they choose to remain anonymous, Contact. Office of Inspector General. Department of Health and Human
Services. Attention: HOTLINE. 330 Independence Avenue Southwest. Cohen Building. Room 5140. Washington. D, C,
20201. Emall: Htips@os,dhhs,gov or Telephone: 1-800-447-8477 (1-800-HHS-TIPS),
8, Submit audits. if required. in accordance with OMB Circular A-133. to: Federal Audit Clearinghouse Bureau of the
Census 1201 East 10th Street Jefferson. IN 47132 PHONE: (310) 457-1551. (800)253-0696 toli free
http://harvester.census ,gov/sac/facconta ,htm
g, EO 13166. August 11. 2000. requires recipients receiving Federal financial assistance to take steps to ensure that
people with limited English proficiency can meaningfuliy access health and social services, A program of language
assistance should provide for effective communication between the service provider and the person with limited
English proficiency to facilitate participation in. and meaningful access to. services. The obligations of recipients are
explained on the OCR website at http://www.hhs.gov/ocr/lep/revisedlep.html.
10, This award Is subject to the requirements of Section 106 (g) of the Trafficking Victims Protection Act of 2000.as
amended (22 U,S,C, 7104), For the fuli text of the award term. go to http://www.hrsa.gov/grants/trafficking.htm. If you
are unable to access this link. please contact the Grants Management Specialist Identified in this Notice of Grant
Award to obtain a copy of the Term,
Reporting Requirements:
1, Due Date: Within 90 days of Budget End Date
The grantee must submit a Financial Status Report SF-269A1Short Form (http://www,psc,gov/forms/sf) within 90 days
after the budget period end date, This report should NOT reflect cumulative reporting from budget period to budget
period and must be submitted to the HRSA. Division of Grants Management Operations. 5600 Fishers Lane, Room
11A-02, Rockville. MD 20857-0001,
2, Due Date: Within 365 days of Award Issue Date
Technical progress reports are required at annual intervals. when the due date coincides with the conclusion of the
NOTICE OF GRANT AWARD (Continuation Sheet)
16D2
~;;g~~-------==t?ate Iss~'ed: 08/26i2008 _M_ ,.-------l
l~war~~~mbe~~-_D1BIT1_~769~-1-~~0 --~,=~:~-~____~
project. the final report will also serve as the progress report. Reports should include a summary of what has been
accomplished during the reporting period and what has been learned. as well as basic information required by OHIT to
measure the progress of the program, A copy of the format to be used. as well as instructions for submitting the
report. will be provided by OHIT,
Failure to comply with these reporting requirements will result in deferral or additional restrictions of future
funding decisions.
Contacts:
Program Contact: For assistance on programmatic issues, please contact Makeda Clement at:
OHIT
5600 Fishers Ln RM 7C-26
Rockville. MD 20857-0001
Phone: (301 )443-6977
Email: MClement@hrsa,gov
Division of Grants Management Operations: For assistance on grants administration Issues, please contact Hazel N,
Booker at:
HRSA/DGMO/GSFB
5600 Fishers Ln RM 11 A-02
Rockville. MD 20857-0001
Phone: (301 )443-4236
Email: nbooker@hrsa,gov
Fax: (301 )443-6686
Responses to reporting requirements, conditions. and requests for post award amendments must be mailed to the
attention of the Office of Grants Management contact indicated above, All correspondence should include the Federal
grant number (item 4 on the award document) and program title (item 8 on the award document), Failure to follow this
guidance will result in a delay in responding to your request.
1602
Admin Line item Yr 1 Yr2 Total CATEGOR
PLAN Personnel $ 30,400 $ 20.267 $ 50,667 PERS
PLAN fringe $ 9,120 $ 6.080 $ 15.200 PERS
PLAN travel $ 2.200 $ 1.000 $ 3.200 TRA
PLAN Office Supplies $ 2,000 $ 1.544 $ 3,544 SUP
PLAN Minor Office furniture $ 1.600 $ $ 1,600 SUP
PLAN telecommunications $ 3,000 $ 2.000 $ 5.000 OTHER
PLAN Rent $ 9.000 $ 6,000 $ 15,000 OTHER
PLAN Plan Accounting/IT ass!. (Contracl $ 6.000 $ 5,000 $ 11.000 CON
PLAN Total $ 105,211
COUNTY Minor Office Equip (Smart Board) $ 3,500 $ $ 3.500 SUP
COUNTY Consultant Staff $ 40.000 $ 28.500 $ 68.500 CON
COUNTY Consultant Travel $ 4,300 $ 2.000 $ 6.300 CON
COUNTY Consulting facilities $ 80.000 $ $ 80,000 CON
COUNTY Equip Computers 4 @ $1,250 $ 5.000 $ $ 5.000 SUP
COUNTY Equip Scanners 7 @ $2.200 $ 15,400 $ 15,400 SUP
COUNTY MarketinglWeb Development $ 5,000 $ 32.000 $ 37.000 OTHER
COUNTY Travel/Mise $ 1.500 $ 1,500 $ 3.000 SUP
COUNTY Total $ 218,700
ATTACHMENT B
Budget Category
A. Personnel
B. Fringe Benefits
C. Travel
D. Equipment
E. Supplies
F, Construction
G,
H.
Consultants / Contracts
Other
Total Direct Costs
Indirect Costs
1.
TOTAL PROJECT COSTS
Budget Summary
8
16D2
Amount
$ 50,667
$ 15,200
$ 3,200
$ 0
$ 5.144
$ 0
$ 11,000
$ 20,000
$105,211
o
$105.211
--------_._.._-_._.._-.--,._<_._..,...._~._'- ,