Backup Documents 01/14/2020 Item #16E1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING ;,, EtED n -�
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT l/ _.J
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNAT111
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the tylAtior 0
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 Risk Manage nt6
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 ejp-
tit-
2. County Attorney Office County Attorney Office
591 ii /.915
4. BCC Office Board of County Uaft
Commissioners 'AIN l I}_
4. Minutes and Records Clerk of Court's Office , , I 1 /"' ra'4
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 missing information.
Name of Primary Staff Ana Reynoso/PURCHASING Contact Information 239-252-8950
Contact/ Department
Agenda Date Item was JANUARY 14,2020 t ' Agenda Item Number 16.E.1. ,
Approved by the BCC /V
Type of Document AMENDMENT #2 ‘7 Number of Original 2 ✓/
Attached Documents Attached
PO number or account N/A 15-6474R Advanced Medical
number if document is Advanced Medical of Naples,LL,E„..".
to be recorded of Naples, LLC
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable colum s •• ever 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 addi 'onal sig .-,res? 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 aware of your deadlines!
8. The document was approved by the BCC on 01/14/2020 and all changes made during N/A is not
the meeting have been incorporated in the attached document. The Countyan option for
Attorney's Office has reviewed the changes,if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the /A is not
BCC,all changes directed by the BCC have been made,and the document is ready for the option for
Chairman's signature.
1 6 E 1
MEMORANDUM
Date: January 17, 2020
To: Ana Reynoso,
Procurement Services
From: Teresa Cannon, Sr. Deputy Clerk
Minutes & Records Department
Re: Second Amendment to Contract #15-6474R "Employment
Physicals and Drug Testing"
Contractor: Advanced Medical Center of Naples, LLC
Attached for your records is an original of the referenced document above,
(Item #16E1) adopted by the Board of County Commissioners on Tuesday,
January 14, 2020.
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
16E1
SECOND AMENDMENT TO AGREEMENT#15-6474R
FOR
MEDICAL DIRECTOR FOR COLLIER COUNTY AND EMPLOYMENT PHYSICALS AND
DRUG TESTING
THIS AMENDMENT, made and entered into on this I y day
of Jgnup,C' / 20 2.6, by and between Advanced Medical of Naples, LLC (the "Provider")
and Collier County, a political subdivision of the State of Florida, (the "County"):
WHEREAS, on February 9, 2016 (Agenda Item 16.E.1), the County entered into an
Agreement with Provider to provide medical oversight for the County's Occupational Health Program;
and
WHEREAS, on October 15, 2018, the County administratively approved the First
Amendment to the Agreement to add two additional testing categories to Exhibit B- Price, Part B to
include Pre-Placement Health Screening at a cost $45.00 and Hepatitis A/B Vaccination at a cost of
$110.00; and
WHEREAS, the Parties desire to amend the Agreement to extend the Agreement term an
additional five (5) years, beginning on February 9, 2020 and ending on February 8, 2025 and to include
Exhibit B-1 containing updated pricing.
NOW, THEREFORE, in consideration of the mutual promises and covenants herein
contained, it is agreed by the Parties as follows:
1. The Agreement is hereby extended an additional five (5) years from the Agreement end date of
February 8, 2020 with a new end date of February 8, 2025.
2. Exhibit B-1 Pricing is hereby incorporated to the Agreement containing revised pricing
effective on February 9, 2020.
3. Except as modified through this Amendment, all other terms and conditions of the Agreement
shall remain the same.
SIGNATURE PAGE TO FOLLOW
**Remainder of this page left blank intentionally**
Page 1 of 4
Second Amendment to Agreement# 15-6474R
G�'
16E1
IN WITNESS WHEREOF,the Parties have executed this Amendment by an authorized person or
agent on the date and year first written above.
ATTEST:
Crystal K. Kinzel, Clerk of Courts & BOARD OF COUNTY COMMISSIONERS
Comptroller w��a COLLIER COUNTY, FLORIDA
'iNr _%+ `mo AA
r°
B _ ,: 0 ' 4 . ,i By: —)• 41/ --�-�'
Wi , .m L. McDaniel,Jr. , airman
Date%:. '4,11;00.1. a .moi
(SEAL•
'-'/' 4 3t as to Chairman's
.skgnature only,
Provider's Witnesses: PROVIDER:
ADVANCED MEDICAL OF NAPLES,LLC
âWftness_ , L, By: j
_ .. „0,...
Signa re
TTYp P
e/ r t witness name1 a [)f .. Lti , r ,�bA
0 1'Ty3e/p 'nt signature and titlel'
u orinw, OA
econd Witness
i � Il Il1_1 o ►9
LL1Y\ - loiflf `lock,)\ Date
tType/print witness nameT
Appro e a,i�• Ft d egality:
Deputy County Attorney
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Print Name
Item# [ 10.0
Agenda 11191a/0D
Date
Date I, %
.„.00,.14
Rec'•
Page 2 of 4 4W 4 / 11'
Second Amendment to Agreement# 15-6474R 1 Deputy Clef(
11
4
EXHIBIT B-1 PRICING 1 6 E 1
(Effective 02/09/2020)
Annual Cost
PART A:Medical Director Services Annual Cost
$ 10,000.00
Unit of Pricing
PART B:Item Description Physical Exam/Testing Types: Measure
Pre-Placement Employment Physical ea $ 100.00
Pre-Placement Physical W/CDL Physical ea $ 120.00
Firefighter Physical ea $ 100.00
Respirator Medical Clearance Evaluation ea $ 120.00
SCUBA Diving Medical Examination and Certification ea $ 100.00
CDL Physical(DOT) ea $ 120.00
Fitness for Duty Examination ea $ 200.00
Asbestos Medical Examinations and Consultations ea $ 110.00
Laboratory Services:
Laboratory Work includes the following tests ea $ 50.00
Cbc
Chem
Lipid
UA
Creatinine ea $ 2.00
BUN ea $ 2.00
TSH Thyroid Stimulating Hormone ea $ 9.00
C Reactive Protein ea $ 9.00
Heavy Metals Test includes following: ea $ 137.00
Arsenic-Blood
Cadmium-Blood
Lead-Blood
Mercury-Blood
Heavy Metals Test-Blood-Aluminum ea $ 25.00
Heavy Metals Test-Blood-Antimony ea $ 135.00
Heavy Metals Test-Blood-Bismuth ea $ 125.00
Heavy Metals Test-Blood-Chromium ea $ 153.00
Heavy Metals Test-Blood-Copper ea $ 13.00
Heavy Metals Test-Blood-Nickel ea $ 121.00
Heavy Metals Test-Blood-Zinc ea $ 12.00
HbA1c ea $ 11.00
RBC Cholinesterase ea $ 95.00
Arsenic-Urine ea $ 87.00
Page 3 of 4
Second Amendment to Agreement# 15-6474R
16E1
Mercury-Urine ea $ 55.00
Polychlorinated Biphenyls ea $ 165.00
Hepatitis Panel Test ea $ 80.00
MMR Titer includes the following ea $ 42.00
Measles
Mumps
Rubeolla
Rabies Titer(if previously immunized) ea $ 33.00
Varicella Titer ea $ 25.00
Hepatitis Titer(if previously immunized) ea $ 16.00
HIV 1&2 Antibody Test ea $ 39.00
PAP Test ea $ 45.00
Drug Screening Services
Blood Alcohol Test ea $ 25.00
Breath Alcohol Test-(Administered by a Breath Alcohol Technician
meeting DOT Qualifications Only) ea $ 30.00
Drug Screen w/MRO - DOT 5 Panel (Collected per DOT Urine
Specimen Collection Guidelines-49 CFR Part 40) ea $ 36.00
Drug Screen w/MRO-HRS 5 Panel ea $ 36.00
Drug Screen w/MRO-HRS 10 Panel ea $ 46.00
Vaccines
Measles,Mumps,Rubella Vaccination(MMR) ea $ 90.00
Varicella Vaccination(Price per injection) ea $ 140.00
Hepatitis A Vaccination Series(Price per injection) ea $ 94.00
Hepatitis B Vaccination Series(Price per injection) ea $ 65.00
Pre-exposure Rabies Vaccination Series(Price per injection) ea $ 325.00
Tetanus/diphtheria Vaccination ea $ 30.00
Tdap Vaccination ea $ 51.00
Diagnostic Testing
Chest x-ray(2-view) ea $ 68.00
Chest x-ray(4-view) ea $ 85.00
Sigmoidoscopy ea $ 350.00
Chest CT without contrast ea $ 300.00
PPD Testing w/Reading(Induration measurement) ea $ 15.00
Audiometric Screening Test(per OSHA) ea $ 12.00
Pulmonary Function Test(with interpretation) ea $ 37.00
EKG-12 Lead(with interpretation and physician confirmation) ea $ 45.00
Cardiac Stress Test(with interpretation and physician confirmation) ea $ 170.00
Echocardiogram(with interpretation and physician confirmation) ea $ 240.00
Prostate Exam ea $ 2.00
Page 4 of 4
Second Amendment to Agreement# 15-6474R