Loading...
Backup Documents 10/13/2020 Item #16D1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIT TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 6 1 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 Attomey Office. Route to Addressee(s) (List in routing order) Office Initials Date 1. Todd Henry Public Services Administration 9/11/20 2. Jennifer Belpedio County Attorney Office n a Ip !12,, p.1b 4. BCC Office Board of County Commissioners jt5D 5. Minutes and Records Clerk of Court's Office fr-lw �cl/ y PRIMARY CONTACT INFORMATION1�' 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 Phone Number x-8206 Contact/ Department Alan Portis, DOH Finance&Accounting 252-8206 Please Call for Pick-up Agenda Date Item was Agenda Item Number Approved by the BCC 10/13/2020 16D Type of Document FY20-21 Collier County Health Number of Original Attached Department Annual Core Contract Documents Attached (Between Collier County and DOH) 3 PO number or account number if document is to be recorded 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? MPED SIGNATURE IS OK PP 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 signed by the Chairman,with the exception of most letters,must be reviewed and signed AP 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 AP 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 AP signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip should be provided to the County Attorney Office at the time the item is input into SIRE. N/A 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 10/13/2020 (enter date)and all Ft is not changes made during the meeting have been incorporated in the attached document. AP an option for The County Attorney's Office has reviewed the changes,if applicable. 1:s line. 9. Initials of attorney verifying that the attached document is the version approved by the is not BCC, all changes directed by the BCC have been made, and the document is ready for the !lb • e e ,a Chairman's signature. I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12 160 1 MEMORANDUM Date: October 19, 2020 To: Alan Portis, DOH Finance & Accounting Collier County Health Department From: Ann Jennejohn, Deputy Clerk Minutes and Records Department Re: FY20-21 Contract with State of Florida Department of Health for the operation of the Collier County Health Department Attached, please find two (2) originals and one (1) certified copy of the document referenced above, (Item #16D1) approved by the Board of County Commissioners on October 13, 2020. If you have any questions, please feel free to contact me at 252-8406. Thank you. Attachments 1 60 1 Portis, Alan L From: Hollingsworth, Kristine M on behalf of Vick, Stephanie Sent: Friday, September 4, 2020 1:44 PM To: Vick, Stephanie; County Health Systems Cc: stevecarnell@colliergov.net; dansummers@colliergov.net; Abbasi, Muhammad J; Gomez, Jennifer L; Lemke, Mark A; Marr, Kathleen J; Portis, Alan L;VanBlaricom, Rachel M;Aviles, Cassandra G; Lucas, Selena F Subject: [INFO] Delegation of Authority Please note: Alan will be my delegated authority for both COVID-19 and budgetary and personnel issues. I will be out of the office beginning Tuesday, September 8, 2020 and returning to the office on Monday, September 21, 2020. Thank you, Stephanie Vick, M.S., B.S.N., RN Administrator Florida Department of Health -Collier County 3339 East Tamiami Trail Suite 145 Naples, FL 34112 (239) 252-8201 Mission: To protect, promote&improve the health of all people in Florida through integrated state, county&community efforts. Vision: To be the Healthiest State in the Nation Values: (ICARE) I nnovation:We search for creative solutions and manage resources wisely. C ollaboration:We use teamwork to achieve common goals&solve problems. A ccountability:We perform with integrity&respect. R esponsiveness:We achieve our mission by serving our customers&engaging our partners. E xcellence:We promote quality outcomes through learning&continuous performance improvement. Please note: Florida has a very broad public records law.Most written communications to or from state officials regarding state business are public records available to the public and media upon request. Your e-mail communications may therefore be subject to public disclosure. From: Hollingsworth, Kristine M Sent: Monday,July 27, 2020 4:04 PM To:Vick, Stephanie<Stephanie.Vick@flhealth.gov>; County Health Systems<CountyHealthSystems@flhealth.gov> Cc: stevecarnell@colliergov.net; dansummers@colliergov.net; Abbasi, Muhammad J <Muhammad.Abbasi@flhealth.gov>; Gomez,Jennifer L<Jennifer.Gomez2@flhealth.gov>; Lemke, Mark A <Mark.Lemke@flhealth.gov>; Marr, Kathleen J <Kathleen.Marr@flhealth.gov>; Portis,Alan L <Alan.Portis@flhealth.gov>;VanBlaricom, Rachel M <Rachel.VanBlaricom@flhealth.gov>; Aviles, Cassandra G <CASSANDRA.AVILES@flhealth.gov>; Lucas, Selena F<Selena.Lucas@flhealth.gov> Subject: [INFO] Delegation of Authority I will be out of the office beginning Wednesday, September 9, 2020 through Friday, September 18, 2020. During this time, Kathleen Marr will be covering and has my delegated authority for all COVID-19 related matters. Alan Portis will be covering and has my delegated authority for all budgetary and personnel issues. Thank you, 1 Stephanie Vick, M.S., B.S.N., RN 1 D 1 Administrator 6 Florida Department of Health -Collier County 3339 East Tamiami Trail Suite 145 Naples, FL 34112 (239) 252-8201 Mission: To protect,promote&improve the health of all people in Florida through integrated state, county&community efforts. Vision: To be the Healthiest State in the Nation Values: (ICARE) I nnovation:We search for creative solutions and manage resources wisely. C ollaboration:We use teamwork to achieve common goals&solve problems. A ccountability:We perform with integrity&respect. R esponsiveness:We achieve our mission by serving our customers&engaging our partners. E xcellence:We promote quality outcomes through learning&continuous performance improvement. Please note: Florida has a very broad public records law.Most written communications to or from state officials regarding state business are public records available to the public and media upon request. Your e-mail communications may therefore be subject to public disclosure. 2 1601 CONTRACT BETWEEN COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS AND STATE OF FLORIDA DEPARTMENT OF HEALTH FOR OPERATION OF THE COLLIER COUNTY HEALTH DEPARTMENT CONTRACT YEAR 2020-2021 This contract is made and entered into between the State of Florida, Department of Health ("State") and the Collier County Board of County Commissioners ("County"), through their undersigned authorities, effective October 1 , 2020. RECITALS A. Pursuant to Chapter 154, Florida Statutes, the intent of the legislature is to "promote, protect, maintain, and improve the health and safety of all citizens and visitors of this state through a system of coordinated county health department services." B. County Health Departments were created throughout Florida to satisfy this legislative intent through "promotion of the public's health, the control and eradication of preventable diseases, and the provision of primary health care for special populations." C. Collier County Health Department ("CHD") is one of the created County Health Departments. D. It is necessary for the parties hereto to enter into this contract in order to ensure coordination between the State and the County in the operation of the CHD. NOW THEREFORE, in consideration of the mutual promises set forth herein, the sufficiency of which are hereby acknowledged, the parties hereto agree as follows: 1. RECITALS. The parties mutually agree that the foregoing recitals are true and correct and incorporated herein by reference. 2. TERM. The parties mutually agree that this contract shall be effective from October 1, 2020, through September 30, 2021, or until a written contract replacing this contract is entered into between the parties, whichever is later, unless this contract is otherwise terminated pursuant to the termination provisions set forth in paragraph 8. below. 3. SERVICES MAINTAINED BY THE CHD. The parties mutually agree that the CHD shall provide those services as set forth on Part III of Attachment II hereof, in order to maintain the following three levels of service pursuant to section 154.01(2), Florida Statutes, as defined below: a. "Environmental health services" are those services which are organized and operated to protect the health of the general public by monitoring and regulating activities in the environment which may contribute to the occurrence or transmission of disease. 1 6 ti Environmental health services shall be supported by available federal, state and local funds and shall include those services mandated on a state or federal level. Examples of environmental health services include, but are not limited to, food hygiene, safe drinking water supply, sewage and solid waste disposal, swimming pools, group care facilities, migrant labor camps, toxic material control, radiological health, and occupational health. b. "Communicable disease control services" are those services which protect the health of the general public through the detection, control, and eradication of diseases which are transmitted primarily by human beings. Communicable disease services shall be supported by available federal, state, and local funds and shall include those services mandated on a state or federal level. Such services include, but are not limited to, epidemiology, sexually transmissible disease detection and control, HIV/AIDS, immunization, tuberculosis control and maintenance of vital statistics. c. "Primary care services" are acute care and preventive services that are made available to well and sick persons who are unable to obtain such services due to lack of income or other barriers beyond their control. These services are provided to benefit individuals, improve the collective health of the public, and prevent and control the spread of disease. Primary health care services are provided at home, in group settings, or in clinics. These services shall be supported by available federal, state, and local funds and shall include services mandated on a state or federal level. Examples of primary health care services include, but are not limited to: first contact acute care services; chronic disease detection and treatment; maternal and child health services; family planning; nutrition; school health; supplemental food assistance for women, infants, and children; home health; and dental services. 4. FUNDING. The parties further agree that funding for the CHD will be handled as follows: a. The funding to be provided by the parties and any other sources is set forth in Part II of Attachment II hereof. This funding will be used as shown in Part I of Attachment II. i. The State's appropriated responsibility (direct contribution excluding any state fees, Medicaid contributions or any other funds not listed on the Schedule C) as provided in Attachment II, Part II is an amount not to exceed $ 8,807,763 (State General Revenue, State Funds, Other State Funds and Federal Funds listed on the Schedule C). The State's obligation to pay under this contract is contingent upon an annual appropriation by the Legislature. ii. The County's appropriated responsibility (direct contribution excluding any fees, other cash or local contributions) as provided in Attachment II, Part II is an amount not to exceed $1,491,500 (amount listed under the "Board of County Commissioners Annual Appropriations section of the revenue attachment). b. Overall expenditures will not exceed available funding or budget authority, whichever is less, (either current year or from surplus trust funds) in any service category. Unless requested otherwise, any surplus at the end of the term of this contract in the County Health 2 I6D1 Department Trust Fund that is attributed to the CHD shall be carried forward to the next contract period. c. Either party may establish service fees as allowed by law to fund activities of the CHD. Where applicable, such fees shall be automatically adjusted to at least the Medicaid fee schedule. d. Either party may increase or decrease funding of this contract during the term hereof by notifying the other party in writing of the amount and purpose for the change in funding. If the State initiates the increase/decrease, the CHD will revise the Attachment II and send a copy of the revised pages to the County and the Department of Health, Office of Budget and Revenue Management. If the County initiates the increase/decrease, the County shall notify the CHD. The CHD will then revise the Attachment II and send a copy of the revised pages to the Department of Health, Office of Budget and Revenue Management. e. The name and address of the official payee to whom payments shall be made is: County Health Department Trust Fund Collier County 3339 E. Tamiami Trail, Suite 145 Naples, FL 34112 5. CHD DIRECTOR/ADMINISTRATOR. Both parties agree the director/administrator of the CHD shall be a State employee or under contract with the State and will be under the day-to-day direction of the Deputy Secretary for County Health Systems. The director/administrator shall be selected by the State with the concurrence of the County. The director/administrator of the CHD shall ensure that non-categorical sources of funding are used to fulfill public health priorities in the community and the Long Range Program Plan. 6. ADMINISTRATIVE POLICIES AND PROCEDURES. The parties hereto agree that the following standards should apply in the operation of the CHD: a. The CHD and its personnel shall follow all State policies and procedures, except to the extent permitted for the use of County purchasing procedures as set forth in subparagraph b., below. All CHD employees shall be State or State-contract personnel subject to State personnel rules and procedures. Employees will report time in the Health Management System compatible format by program component as specified by the State. b. The CHD shall comply with all applicable provisions of federal and state laws and regulations relating to its operation with the exception that the use of County purchasing procedures shall be allowed when it will result in a better price or service and no statewide Department of Health purchasing contract has been implemented for those goods or services. In such cases, the CHD director/administrator must sign a justification therefore, and all County purchasing procedures must be followed in their entirety, and such compliance shall be documented. Such justification and compliance documentation shall be maintained by the CHD in accordance with the terms of this contract. State procedures must be followed for all leases on facilities not enumerated in Attachment IV. 3 I 6 D 1 c. The CHD shall maintain books, records and documents in accordance with the Generally Accepted Accounting Principles (GAAP), as promulgated by the Governmental Accounting Standards Board (GASB), and the requirements of federal or state law. These records shall be maintained as required by the Department of Health Policies and Procedures for Records Management and shall be open for inspection at any time by the parties and the public, except for those records that are not otherwise subject to disclosure as provided by law which are subject to the confidentiality provisions of paragraphs 6.i. and 6.k., below. Books, records and documents must be adequate to allow the CHD to comply with the following reporting requirements: i. The revenue and expenditure requirements in the Florida Accounting Information Resource (FLAIR) System; ii. The client registration and services reporting requirements of the minimum data set as specified in the most current version of the Client Information System/Health Management Component Pamphlet; iii. Financial procedures specified in the Department of Health's Accounting Procedures Manuals, Accounting memoranda, and Comptroller's memoranda; iv. The CHD is responsible for assuring that all contracts with service providers include provisions that all subcontracted services be reported to the CHD in a manner consistent with the client registration and service reporting requirements of the minimum data set as specified in the Client Information System/Health Management Component Pamphlet. d. All funds for the CHD shall be deposited in the County Health Department Trust Fund maintained by the state treasurer. These funds shall be accounted for separately from funds deposited for other CHDs and shall be used only for public health purposes in Collier County. e. That any surplus/deficit funds, including fees or accrued interest, remaining in the County Health Department Trust Fund account at the end of the contract year shall be credited/debited to the State or County, as appropriate, based on the funds contributed by each and the expenditures incurred by each. Expenditures will be charged to the program accounts by State and County based on the ratio of planned expenditures in this contract and funding from all sources is credited to the program accounts by State and County. The equity share of any surplus/deficit funds accruing to the State and County is determined each month and at contract year-end. Surplus funds may be applied toward the funding requirements of each participating governmental entity in the following year. However, in each such case, all surplus funds, including fees and accrued interest, shall remain in the trust fund until accounted for in a manner which clearly illustrates the amount which has been credited to each participating governmental entity. The planned use of surplus funds shall be reflected in Attachment II, Part I of this contract, with special capital projects explained in Attachment V. 4 6 0 i f. There shall be no transfer of funds between the three levels of services without a contract amendment unless the CHD director/administrator determines that an emergency exists wherein a time delay would endanger the public's health and the Deputy Secretary for County Health Systems has approved the transfer. The Deputy Secretary for County Health Systems shall forward written evidence of this approval to the CHD within 30 days after an emergency transfer. g. The CHD may execute subcontracts for services necessary to enable the CHD to carry out the programs specified in this contract. Any such subcontract shall include all aforementioned audit and record keeping requirements. h. At the request of either party, an audit may be conducted by an independent CPA on the financial records of the CHD and the results made available to the parties within 180 days after the close of the CHD fiscal year. This audit will follow requirements contained in OMB Circular A-133 and may be in conjunction with audits performed by County government. If audit exceptions are found, then the director/administrator of the CHD will prepare a corrective action plan and a copy of that plan and monthly status reports will be furnished to the contract managers for the parties. i. The CHD shall not use or disclose any information concerning a recipient of services except as allowed by federal or state law or policy. j. The CHD shall retain all client records, financial records, supporting documents, statistical records, and any other documents (including electronic storage media) pertinent to this contract for a period of five (5) years after termination of this contract. If an audit has been initiated and audit findings have not been resolved at the end of five (5) years, the records shall be retained until resolution of the audit findings. k. The CHD shall maintain confidentiality of all data, files, and records that are confidential under the law or are otherwise exempted from disclosure as a public record under Florida law. The CHD shall implement procedures to ensure the protection and confidentiality of all such records and shall comply with sections 384.29, 381.004, 392.65 and 456.057, Florida Statutes, and all other state and federal laws regarding confidentiality. All confidentiality procedures implemented by the CHD shall be consistent with the Department of Health Information Security Policies, Protocols, and Procedures. The CHD shall further adhere to any amendments to the State's security requirements and shall comply with any applicable professional standards of practice with respect to client confidentiality. I. The CHD shall abide by all State policies and procedures, which by this reference are incorporated herein as standards to be followed by the CHD, except as otherwise permitted for some purchases using County procedures pursuant to paragraph 6.b. m. The CHD shall establish a system through which applicants for services and current clients may present grievances over denial, modification or termination of services. The CHD will advise applicants of the right to appeal a denial or exclusion from services, of failure to take account of a client's choice of service, and of his/her right to a fair hearing to the final 5 6fl1 governing authority of the agency. Specific references to existing laws, rules or program manuals are included in Attachment I of this contract. n. The CHD shall comply with the provisions contained in the Civil Rights Certificate, hereby incorporated into this contract as Attachment III. o. The CHD shall submit quarterly reports to the County that shall include at least the following: i. The DE385L1 Contract Management Variance Report and the DE580L1 Analysis of Fund Equities Report; ii. A written explanation to the County of service variances reflected in the year end DE385L1 report if the variance exceeds or falls below 25 percent of the planned expenditure amount for the contract year. However, if the amount of the service specific variance between actual and planned expenditures does not exceed three percent of the total planned expenditures for the level of service in which the type of service is included, a variance explanation is not required. A copy of the written explanation shall be sent to the Department of Health, Office of Budget and Revenue Management. p. The dates for the submission of quarterly reports to the County shall be as follows unless the generation and distribution of reports is delayed due to circumstances beyond the CHD's control: i. March 1, 2021 for the report period October 1 , 2020 through December 31, 2020; ii. June 1, 2021 for the report period October 1, 2020 through March 31, 2021; iii. September 1, 2021 for the report period October 1, 2020 through June 30, 2021; and iv. December 1 , 2021 for the report period October 1, 2020 through September 30, 2021. 7. FACILITIES AND EQUIPMENT. The parties mutually agree that: a. CHD facilities shall be provided as specified in Attachment IV to this contract and the County shall own the facilities used by the CHD unless otherwise provided in Attachment IV. b. The County shall ensure adequate fire and casualty insurance coverage for County- owned CHD offices and buildings and for all furnishings and equipment in CHD offices through either a self-insurance program or insurance purchased by the County. 6 6 ri 1 c. All vehicles will be transferred to the ownership of the County and registered as County vehicles. The County shall ensure insurance coverage for these vehicles is available through either a self-insurance program or insurance purchased by the County. All vehicles will be used solely for CHD operations. Vehicles purchased through the County Health Department Trust Fund shall be sold at fair market value when they are no longer needed by the CHD and the proceeds returned to the County Health Department Trust Fund. 8. TERMINATION. a. Termination at Will. This contract may be terminated by either party without cause upon no less than one-hundred eighty (180) calendar days notice in writing to the other party unless a lesser time is mutually agreed upon in writing by both parties. Said notice shall be delivered by certified mail, return receipt requested, or in person to the other party's contract manager with proof of delivery. b. Termination Because of Lack of Funds. In the event funds to finance this contract become unavailable, either party may terminate this contract upon no less than twenty-four (24) hours notice. Said notice shall be delivered by certified mail, return receipt requested, or in person to the other party's contract manager with proof of delivery. c. Termination for Breach. This contract may be terminated by one party, upon no less than thirty (30) days notice, because of the other party's failure to perform an obligation hereunder. Said notice shall be delivered by certified mail, return receipt requested, or in person to the other party's contract manager with proof of delivery. Waiver of breach of any provisions of this contract shall not be deemed to be a waiver of any other breach and shall not be construed to be a modification of the terms of this contract. 9. MISCELLANEOUS. The parties further agree: a. Availability of Funds. If this contract, any renewal hereof, or any term, performance or payment hereunder, extends beyond the fiscal year beginning July 1, 2021, it is agreed that the performance and payment under this contract are contingent upon an annual appropriation by the Legislature, in accordance with section 287.0582, Florida Statutes. b. Contract Managers. The name and address of the contract managers for the parties under this contract are as follows: For the State: For the County: Stephanie Vick, M.S., B.S.N., R.N. Steve Carnell Name Name Administrator, Florida Department of Public Service Division Administrator Health in Collier County Title Title 3339 E. Tamiami Trail, Suite 145 3339 E. Tamiami Trail, Suite 217 Naples, FL 34112 Naples, FL 34112 6► Dl Address Address 239-252-5332 239-252-8468 Telephone Telephone If different contract managers are designated after execution of this contract, the name, address and telephone number of the new representative shall be furnished in writing to the other parties and attached to originals of this contract. c. Captions. The captions and headings contained in this contract are for the convenience of the parties only and do not in any way modify, amplify, or give additional notice of the provisions hereof. In WITNESS THEREOF, the parties hereto have caused this 8 page contract, with its attachments as referenced, including Attachment I (two pages), Attachment II (seven pages), Attachment III (one pages), Attachment IV (one pages), and Attachment V (one pages), to be executed by their undersigned officials as duly authorized effective the 1st day of October, 2020. BOARD OF COUNTY COMMISSIONERS STATE OF FLORIDA FOR COLLIER COUNTY DEPARTMENT OF HEALTH Aedi% SIGNED QY: SIGNED BY: NAME: Burt L.Saunders NAME: Scott A. Rivkees, MD TITLE: Chairman TITLE: State urgeon General DATE: 10 I 1 �.\aoa0 DATE: 9 (2-.'()\114 ATTESTED TO: SIGNED BY: SIGNED BY: Cis NAME: NAME: S7`ef/i un� TITLE: TITLE: CHD Director/Administrator DATE: DATE: y/6/,,2.0 2 U ATTEST Approved as to form and legality CRYSTAL K. KINZEL,CLERK ^' ""— 527 Assistant County Atu ley `/ 09*0 Attest as to C 111111� • signature only. ` 8 6 0 t ATTACHMENT I COLLIER COUNTY HEALTH DEPARTMENT PROGRAM SPECIFIC REPORTING REQUIREMENTS AND PROGRAMS REQUIRING COMPLIANCE WITH THE PROVISIONS OF SPECIFIC MANUALS Some health services must comply with specific program and reporting requirements in addition to the Personal Health Coding Pamphlet(DHP 50-20), Environmental Health Coding Pamphlet(DHP 50-21)and FLAIR requirements because of federal or state law, regulation or rule. If a county health department is funded to provide one of these services, it must comply with the special reporting requirements for that service. The services and the reporting requirements are listed below: Service Requirement 1. Sexually Transmitted Disease Requirements as specified in F.A.C.64D-3, F.S.381 and F.S.384. Program 2. Dental Health Periodic financial and programmatic reports as specified by the program office. 3. Special Supplemental Nutrition Service documentation and monthly financial reports as specified in Program for Women, Infants and DHM 150-24*and all federal,state and county requirements Children(including the WIC detailed in program manuals and published procedures. Breastfeeding Peer Counseling Program) 4. Healthy Start/Improved Pregnancy Requirements as specified in the 2007 Healthy Start Standards and Outcome Guidelines and as specified by the Healthy Start Coalitions in contract with each county health department. 5. Family Planning Requirements as specified in Public Law 91-572,42 U.S.C.300,et seq.,42 CFR part 59,subpart A,45 CFR parts 74&92,2 CFR 215 (OMB Circular A-110)OMB Circular A-102, F.S. 381.0051, F.A.C. 64F-7, F.A.C. 64F-16,and F.A.C.64F-19. Requirements and Guidance as specified in the Program Requirements for Title X Funded Family Planning Projects(Title X Requirements)(2014)and the Providing Quality Family Planning Services(QFP): Recommendations of CDC and the U.S.Office of Population Affairs published on the Office of Population Affairs website. Programmatic annual reports as specified by the program office as specified in the annual programmatic Scope of Work for Family Planning and Maternal Child Health Services, including the Family Planning Annual Report(FPAR), and other minimum guidelines as specified by the Policy Web Technical Assistance Guidelines. 6. Immunization Periodic reports as specified by the department pertaining to immunization levels in kindergarten and/or seventh grade pursuant to instructions contained in the Immunization Guidelines-Florida Schools,Childcare Facilities and Family Daycare Homes(DH Form 150-615)and Rule 64D-3.046, F.A.C. In addition, periodic reports as specified by the department pertaining to the surveillance/investigation of reportable vaccine-preventable diseases, adverse events,vaccine accountability,and assessment of immunization ATTACHMENT I(Continued) Attachment_I-Page 1 of 2 I6D levels as documented in Florida SHOTS and supported by CHD Guidebook policies and technical assistance guidance. 7. Environmental Health Requirements as specified in Environmental Health Programs Manual 150-4*and DHP 50-21* 8. HIV/AIDS Program Requirements as specified in F.S.384.25 and F.A.C.64D-3.030 and 64D-3.031.Case reporting should be on Adult HIV/AIDS Confidential Case Report CDC Form DH2139 and Pediatric HIV/AIDS Confidential Case Report CDC Form DH2140. Requirements as specified in F.A.C.64D-2 and 64D-3, F.S. 381 and F.S. 384. Socio-demographic and risk data on persons tested for HIV in CHD clinics should be reported on Lab Request DH Form 1628 in accordance with the Forms Instruction Guide. Requirements for the HIV/AIDS Patient Care programs are found in the Patient Care Contract Administrative Guidelines. 9. School Health Services Requirements as specified in the Florida School Health Administrative Guidelines(May 2012). Requirements as specified in F.S. 381.0056, F.S.381.0057, F.S.402.3026 and F.A.C.64F-6. 10. Tuberculosis Tuberculosis Program Requirements as specified in F.A.C.64D-3 and F.S.392. 11. General Communicable Disease Carry out surveillance for reportable communicable and other acute Control diseases,detect outbreaks, respond to individual cases of reportable diseases, investigate outbreaks, and carry out communication and quality assurance functions,as specified in F.A.C.64D-3, F.S.381, F.S.384 and the CHD Epidemiology Guide to Surveillance and Investigations. 12. Refugee Health Program Programmatic and financial requirements as specified by the program office. *or the subsequent replacement if adopted during the contract period. Attachment_I-Page 2 of 2 ATTACHMENT II 16 f 1 COLLIER COUNTY HEALTH DEPARTMENT Part II,Sources of Contributions to County Health Department October 1,2020 to September 30,2021 State CHD County Total CHD I Trust Fund CHD Trust Fund Other (cash) Trust Fund (cash) Contribution Total 1.GENERAL REVENUE•STATE 015040 AIDS PATIENT CARE 140,000 0 140,000 0 140,000 015040 AIDS PREVENTION&SURVEILLANCE•GENERAL REVENUE 69,571 0 69,571 0 69,571 015040 CHD•TB COMMUNITY PROGRAM 160,313 0 160,313 0 160,313 015040 CORONAVIRUS GENERAL REVENUE 2,577,376 0 2,577,376 0 2,577,376 015040 DENTAL SPECIAL INITIATIVE PROJECTS 6,191 0 6,191 0 6,191 015040 HEALTHY BEACHES MONITORING 17,920 0 17,920 0 17,920 015040 FAMILY PLANNING GENERAL REVENUE 64,404 0 64,404 0 64,404 015040 HEPATITIS AND LIVER FAILURE PREVENTION&CONTROL 89,286 0 89,286 0 89,286 015040 MIGRANT LABOR CAMP SANITATION 25,830 0 25,830 0 25,830 015040 PRIMARY CARE PROGRAM 313,432 0 313,432 0 313,432 015040 SCHOOL HEALTH SERVICES•GENERAL REVENUE 218,073 0 218,073 0 218,073 015050 CHD GENERAL REVENUE NON•CATEGORICAL 2,049,403 0 2,049,403 0 2,049,403 GENERAL REVENUE TOTAL 5,731,799 0 5,731,799 0 5,731,799 2.NON GENERAL REVENUE-STATE 015010 ENVIRONMENTAL BIOMEDICAL WASTE PROGRAM 12,042 0 12,042 0 12,042 015010 TOBACCO STATE AND COMMUNITY INTERVENTIONS 183,885 0 183,885 0 183,885 NON GENERAL REVENUE TOTAL 195,927 0 195,927 0 195,927 3.FEDERAL FUNDS•STATE 007000 WIC BREASTFEEDING PEER COUNSELING PROG 84,309 0 84,309 0 84,309 007000 COASTAL BEACH WATER QUALITY MONITORING 11,443 0 11,443 0 11,443 007000 COMPREHENSIVE COMMUNITY CARDIO-PHBG 35,000 0 35,000 0 35,000 007000 EPID&LAB FOR INFECTIOUS DISEASE COVID•19 124,546 0 124,546 0 124,546 007000 FAMILY PLANNING TITLE X•GRANT 87,909 0 87,909 0 87,909 007000 IMMUNIZATION ACTION PLAN 87,564 0 87,564 0 87,564 007000 MCH SPECIAL PRJCT UNPLANNED PREGNANCY 38,181 0 38,181 0 38,181 007000 MCH BLOCK GRANT FLORIDA'S HEALTHY BABIES 17,816 0 17,816 0 17,816 007000 BASE COMMUNITY PREPAREDNESS CAPABILITY 132,011 0 132,011 0 132,011 007000 BASE PUB HLTH SURVEILLANCE&EPI INVESTIGATION 71,857 0 71,857 0 71,857 007000 AIDS PREVENTION 253,200 0 253,200 0 253,200 007000 WIC PROGRAM ADMINISTRATION 1,248,394 0 1,248,394 0 1,248,394 015075 SUPPLEMENTAL SCHOOL HEALTH 33,690 0 33,690 0 33,690 015075 REFUGEE HEALTH SCREENING REIMBURSEMENT ADMIN 42,557 0 42,557 0 42,557 015075 REFUGEE HEALTH SCREENING REIMBURSEMENT SERVICES 236,611 0 236,611 0 236,611 018005 AIDS DRUG ASSISTANCE PROGRAM ADMIN HQ 102,470 0 102,470 0 102,470 018005 RYAN WHITE TITLE II GRANT/CHD CONSORTIUM 305,146 0 305,146 0 305,146 FEDERAL FUNDS TOTAL 2,912,704 0 2,912,704 0 2,912,704 4.FEES ASSESSED BY STATE OR FEDERAL RULES•STATE 001020 CHD STATEWIDE ENVIRONMENTAL FEES 456,795 0 456,795 0 456,795 001092 CHD STATEWIDE ENVIRONMENTAL FEES 263,953 0 263,953 0 263,953 001206 ON SITE SEWAGE DISPOSAL PERMIT FEES 21,332 0 21,332 0 21,332 001206 SANITATION CERTIFICATES(FOOD INSPECTION) 3,310 0 3,310 0 3,310 Attachment_II_Part_II-Page 1 of 4 ATTACHMENT II 1 6 D 1 COLLIER COUNTY HEALTH DEPARTMENT Part II,Sources of Contributions to County Health Department October 1,2020 to September 30,2021 State CHD County Total CHD Trust Fund CHD Trust Fund Other (cash) Trust Fund (cash) Contribution Total ill 001206 SEPTIC TANK RESEARCH SURCHARGE 3,735 0 3,735 0 3,735 001206 SEPTIC TANK VARIANCE FEES 50% 300 0 300 0 300 001206 PUBLIC SWIMMING POOL PERMIT FEES-10%HQ TRANSFER 33,110 0 33,110 0 33,110 001206 DRINKING WATER PROGRAM OPERATIONS 1,305 0 1,305 0 1,305 001206 REGULATION OF BODY PIERCING SALONS 71 0 71 0 71 001206 TANNING FACILITIES 239 0 239 0 239 001206 ONSITE SEWAGE TRAINING CENTER 1,310 0 1,310 0 1,310 001206 TATTO PROGRAM ENVIRONMENTAL HEALTH 2,865 0 2,865 0 2,865 001206 MOBILE HOME&RV PARK FEES 2,391 0 2,391 0 2,391 FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 790,716 0 790,716 0 790,716 5.OTHER CASH CONTRIBUTIONS-STATE: 0 0 0 0 0 090001 DRAW DOWN FROM PUBLIC HEALTH UNIT 0 0 0 0 0 OTHER CASH CONTRIBUTION TOTAL 0 0 0 0 0 6.MEDICAID•STATE/COUNTY: 001057 CHD CLINIC FEES 0 14,930 14,930 0 14,930 001147 CHD CLINIC FEES 0 10 10 0 10 001148 CHD CLINIC FEES 0 775,010 775,010 0 775,010 001148 GENERAL CLINIC RABIES SERVICES&DRUG PURCHASES 0 100 100 0 100 MEDICAID TOTAL 0 790,050 790,050 0 790,050 7.ALLOCABLE REVENUE•STATE: 001004 CHD CLINIC FEES 1 0 1 0 1 001009 CHD CLINIC FEES 1 0 1 0 1 018000 CHD CLINIC FEES 4,200 0 4,200 0 4,200 031005 GENERAL CLINIC RABIES SERVICES&DRUG PURCHASES 10,000 0 10,000 0 10,000 ALLOCABLE REVENUE TOTAL 14,202 0 14,202 0 14,202 8.OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND-STATE ADAP 0 0 0 347,566 347,566 PHARMACY DRUG PROGRAM 0 0 0 11,766 11,766 WIC PROGRAM 0 0 0 4,692,189 4,692,189 BUREAU OF PUBLIC HEALTH LABORATORIES 0 0 0 41,730 41,730 IMMUNIZATIONS 0 0 0 865,220 865,220 OTHER STATE CONTRIBUTIONS TOTAL 0 0 0 5,958,471 5,958,471 9.DIRECT LOCAL CONTRIBUTIONS•BCC/TAX DISTRICT 008005 CHD LOCAL REVENUE&EXPENDITURES 0 1,491,500 1,491,500 0 1,491,500 DIRECT COUNTY CONTRIBUTIONS TOTAL 0 1,491,500 1,491,500 0 1,491,500 10.FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION•COUNTY 001025 CHD CLINIC FEES 0 1 1 0 1 001077 CHD CLINIC FEES 0 258,336 258,336 0 258,336 001077 GENERAL CLINIC RABIES SERVICES&DRUG PURCHASES 0 100 100 0 100 Attachment_II_Part_II-Page 2 of 4 ATTACHMENT II 1 6 iJ n 1 COLLIER COUNTY HEALTH DEPARTMENT Part II,Sources of Contributions to County Health Department October 1,2020 to September 30,2021 State CHD County Total CHD MIMI Trust Fund CHD Trust Fund Other (cash) Trust Fund (cash) Contribution Total 001094 CHD LOCAL ENVIRONMENTAL FEES 0 795,435 795,435 0 795,435 001110 VITAL STATISTICS CERTIFIED RECORDS 0 412,000 412,000 0 412,000 FEES AUTHORIZED BY COUNTY TOTAL 0 1,465,872 1,465,872 0 1,465,872 11.OTHER CASH AND LOCAL CONTRIBUTIONS-COUNTY 001029 340B PRESCRIPTION DRUG SERVICE AGREEMENT 0 250,000 250,000 0 250,000 001029 CHD CLINIC FEES 0 109,350 109,350 0 109,350 001029 GENERAL CLINIC RABIES SERVICES&DRUG PURCHASES 0 5,000 5,000 0 5,000 001090 CHD CLINIC FEES 0 24,580 24,580 0 24,580 001090 GENERAL CLINIC RABIES SERVICES&DRUG PURCHASES 0 100 100 0 100 005000 CHD LOCAL REVENUE&EXPENDITURES 0 1 1 0 1 010300 STATE UNDERGROUND PETROLEUM RESPONSE ACT 0 5,000 5,000 0 5,000 010300 MIGRANT LABOR HOUSING INSPECTION H-2A PROGRAM 0 2,500 2,500 0 2,500 010303 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 0 375 375 0 375 010500 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 0 375 375 0 375 011000 RYAN WHITE 0 58,681 58,681 0 58,681 011000 CHD CLINIC FEES 0 2 2 0 2 011000 CHD CASH DONATION/NON-SPECIFIC 0 2,000 2,000 0 2,000 011000 EARLY LEARNING COALITION OF SOUTHWEST FLORIDA 0 60,000 60,000 0 60,000 011000 CHD LOCAL REVENUE&EXPENDITURES 0 10,000 10,000 0 10,000 011001 CHD HEALTHY START COALITION CONTRACT 0 448,113 448,113 0 448,113 012020 CHD LOCAL ENVIRONMENTAL FEES 0 2,219 2,219 0 2,219 090002 DRAW DOWN FROM PUBLIC HEALTH UNIT 0 -25,586 -25,586 0 -25,586 OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 0 952,710 952,710 0 952,710 12.ALLOCABLE REVENUE-COUNTY 001004 CHD CLINIC FEES 0 1 1 0 1 001009 CHD CLINIC FEES 0 1 1 0 1 018000 CHD CLINIC FEES 0 4,200 4,200 0 4,200 031005 GENERAL CLINIC RABIES SERVICES&DRUG PURCHASES 0 10,000 10,000 0 10,000 COUNTY ALLOCABLE REVENUE TOTAL 0 14,202 14,202 0 14,202 13.BUILDINGS-COUNTY ANNUAL RENTAL EQUIVALENT VALUE 0 0 0 525,048 525,048 IT ALLOCATION&GOLDEN GATE RENTAL 0 0 0 102,100 102,100 UTILITIES 0 0 0 165,100 165,100 BUILDING MAINTENANCE 0 0 0 0 0 GROUNDS MAINTENANCE 0 0 0 195,149 195,149 INSURANCE 0 0 0 0 0 OTHER(Specify) 0 0 0 0 0 OTHER(Specify) 0 0 0 0 0 BUILDINGS TOTAL 0 0 0 987,397 987,397 14.OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND-COUNTY EQUIPMENT/VEHICLE PURCHASES 0 0 0 0 0 VEHICLE INSURANCE 0 0 0 0 0 Attachment_II_Part_II-Page 3 of 4 ATTACHMENT II COLLIER COUNTY HEALTH DEPARTMENT Part II,Sources of Contributions to County Health Department October 1,2020 to September 30,2021 State CHD County Total CHD Trust Fund CHD Trust Fund Other (cash) Trust Fund (cash) Contribution Total VEHICLE MAINTENANCE 0 0 0 0 0 OTHER COUNTY CONTRIBUTION(SPECIFY) 0 0 0 0 0 OTHER COUNTY CONTRIBUTION(SPECIFY) 0 0 0 0 0 OTHER COUNTY CONTRIBUTIONS TOTAL 0 0 0 0 0 GRAND TOTAL CHD PROGRAM 9,645,348 4,714,334 14,359,682 6,945,868 21,305,550 Attachment_II_Part_II-Page 4 of 4 ATTACHMENT II COLLIER COUNTY HEALTH DEPARTMENT Part III,Planned Staffing.Clients,Services and Expenditures By Program Service Area Within Each Level of Service October 1,2020 to September 30,2021 Quarterly Expenditure Plan FTE's Clients Services/ 1st 2nd 3rd 4th Grand (0.00) Units Visite (Whole dollars only) State County Total A. COMMUNICABLE DISEASE CONTROL: IMMUNIZATION (101) 8.10 7,028 9,415 147,764 126,686 147,764 126,685 298,237 250,662 548,899 SEXUALLY TRANS.DIS. (102) 5.50 1,025 1,403 94,232 80,790 94,232 80,790 0 350,044 350,044 HIV/AIDS PREVENTION (03A1) 4.70 0 7,895 82,311 70,569 82,311 70,569 295,650 10,110 305,760 HIV/AIDS SURVEILLANCE (03A2) 1.34 0 25 25,836 22,151 25,836 22,150 95,973 0 95,973 HIV/AIDS PATIENT CARE (03A3) 9.46 526 2,824 221,975 190,312 221,975 190,312 454,205 370,369 824,574 ADAP (03A4) 2.03 28 169 40,327 34,575 40,327 34,575 149,799 5 149,804 TUBERCULOSIS (104) 4.79 343 1,867 106,103 90,968 106,103 90,969 302,140 92,003 394,143 COMM.DIS.SURV. (106) 6.25 0 15,101 832,846 714,045 832,846 714,046 2,968,117 125,666 3,093,783 HEPATITIS (109) 1.56 1,364 1,665 32,321 27,711 32,321 27,710 119,986 77 120,063 PREPAREDNESS AND RESPONSE (116) 3.40 0 1,378 87,500 75,019 87,500 75,020 291,659 33,380 325,039 REFUGEE HEALTH (118) 5.40 253 746 115,225 98,789 115,225 98,790 428,029 0 428,029 VITAL RECORDS (180) 3.40 10,883 48,155 58,083 49,797 58,083 49,797 0 215,760 215,760 COMMUNICABLE DISEASE SUBTOTAL 55.93 21,450 90,643 1,844,523 1,581,412 1,844,523 1,581,413 5,403,795 1,448,076 6,851,871 B. PRIMARY CARE: CHRONIC DISEASE PREVENTION PRO (210) 1.43 0 23 28,987 24,852 28,987 24,851 73,750 33,927 107,677 WIC (21W1) 25.11 10,342 71,172 408,254 350,018 408,254 350,018 1,516,544 0 1,516,544 TOBACCO USE INTERVENTION (212) 3.46 0 30 57,490 49,290 57,490 49,290 213,560 0 213,560 WIC BREASTFEEDING PEER COUNSELING (21W2) 2.69 0 2,147 31,792 27,257 31,792 27,258 118,099 0 118,099 FAMILY PLANNING (223) 2.95 757 1,644 73,022 62,605 73,022 62,605 229,452 41,802 271,254 IMPROVED PREGNANCY OUTCOME (225) 0.00 0 0 86,144 73,856 86,144 73,856 0 320,000 320,000 HEALTHY START PRENATAL (227) 8.46 1,720 5,895 194,565 166,812 194,565 166,812 274,641 448,113 722,754 COMPREHENSIVE CHILD HEALTH (229) 1.23 179 254 27,832 23,861 27,832 23,861 0 103,386 103,386 HEALTHY START CHILD (231) 2.16 378 1,560 39,179 33,591 39,179 33,591 0 145,540 145,540 SCHOOL HEALTH (234) 8.85 0 466,675 136,110 116,694 136,110 116,694 340,027 165,581 505,608 COMPREHENSIVE ADULT HEALTH (237) 5.61 3,679 5,580 195,316 167,455 195,316 167,454 240,001 485,540 725,541 COMMUNITY HEALTH DEVELOPMENT (238) 4.76 0 62 94,461 80,987 94,461 80,988 350,897 0 350,897 DENTAL HEALTH (240) 11.97 3,725 6,522 267,059 228,964 267,059 228,965 6,241 985,806 992,047 PRIMARY CARE SUBTOTAL 78.68 20,780 561,564 1,640,211 1,406,242 1,640,211 1,406,243 3,363,212 2,729,695 6,092,907 C. ENVIRONMENTAL HEALTH: Water and Onsite Sewage Programs COSTAL BEACH MONITORING (347) 1.03 611 615 22,294 19,114 22,294 19,113 82,815 0 82,815 LIMITED USE PUBLIC WATER SYSTEMS (357) 1.41 163 1,244 27,608 23,670 27,608 23,671 80,042 22,515 102,557 PUBLIC WATER SYSTEM (358) 0.14 0 0 3,044 2,609 3,044 2,609 11,306 0 11,306 PRIVATE WATER SYSTEM (359) 0.21 0 74 5,026 4,309 5,026 4,308 0 18,669 18,669 ONSITE SEWAGE TREATMENT&DISPOSAL (361) 5.64 1,923 5,214 116,691 100,045 116,691 100,045 205,515 227,957 433,472 Group Total 8.43 2,697 7,147 174,663 149,747 174,663 149,746 379,678 269,141 648,819 Facility Programa TATTOO FACILITY SERVICES (344) 0.40 222 212 8,147 6,984 8,147 6,984 30,262 0 30,262 FOOD HYGIENE (348) 1.24 195 512 25,520 21,880 25,520 21,881 94,801 0 94,801 Attachment_II_Part_III-Page 1 of 2 ATTACHMENT II COLLIER COUNTY HEALTH DEPARTMENT Part III,Planned Staffing.Clients,Services and Expenditures By Program Service Area Within Each Level of Service f 6 0 1 October 1,2020 to September 30,2021 Quarterly Expenditure Plan FTE's Clients Services/ 1st 2nd 3rd 4th Grand (0.00) Units Visits (Whole dollars only) State County Total BODY PIERCING FACILITIES SERVICES (349) 0.04 3 13 910 781 910 781 3,382 0 3,382 GROUP CARE FACILITY (351) 0.72 140 206 14,657 12,566 14,657 12,565 0 54,445 54,445 MIGRANT LABOR CAMP (352) 1.46 133 994 26,209 22,470 26,209 22,470 47,858 49,500 97,358 HOUSING&PUB.BLDG. (353) 0.00 0 0 0 0 0 0 0 0 0 MOBILE HOME AND PARK (354) 0.45 187 450 7,911 6,783 7,911 6,783 29,388 0 29,388 POOLS/BATHING PLACES (360) 3.03 1,789 5,647 66,989 57,433 66,989 57,434 102,458 146,387 248,845 BIOMEDICAL WASTE SERVICES (364) 1.40 710 835 30,972 26,554 30,972 26,554 115,052 0 115,052 TANNING FACILITY SERVICES (369) 0.03 14 20 778 667 778 667 2,890 0 2,890 Group Total 8.77 3,393 8,889 182,093 156,118 182,093 156,119 426,091 250,332 676,423 Groundwater Contamination STORAGE TANK COMPLIANCE SERVICES (355) 0.00 0 0 0 0 0 0 0 0 0 SUPER ACT SERVICES (356) 0.23 0 26 4,601 3,944 4,601 3,944 0 17,090 17,090 Group Total 0.23 0 26 4,601 3,944 4,601 3,944 0 17,090 17,090 Community Hygiene COMMUNITY ENVIR.HEALTH (345) 0.00 0 0 0 0 0 0 0 0 0 INJURY PREVENTION (346) 0.00 0 0 0 0 0 0 0 0 0 LEAD MONITORING SERVICES (350) 0.00 0 0 0 0 0 0 0 0 0 PUBLIC SEWAGE (362) 0.00 0 0 0 0 0 0 0 0 0 SOLID WASTE DISPOSAL SERVICE (363) 0.00 0 0 0 0 0 0 0 0 0 SANITARY NUISANCE (365) 0.03 0 0 620 532 620 531 2,303 0 2,303 RABIES SURVEILLANCE (366) 0.00 0 0 0 0 0 0 0 0 0 ARBORVIRUS SURVEIL. (367) 0.00 0 0 0 0 0 0 0 0 0 RODENT/ARTHROPOD CONTROL (368) 0.00 0 0 0 0 0 0 0 0 0 WATER POLLUTION (370) 0.00 0 0 0 0 0 0 0 0 0 INDOOR AIR (371) 0.00 0 0 0 0 0 0 0 0 0 RADIOLOGICAL HEALTH (372) 0.00 0 0 0 0 0 0 0 0 0 TOXIC SUBSTANCES (373) 0.00 0 0 0 0 0 0 0 0 0 Group Total 0.03 0 0 620 532 620 531 2,303 0 2,303 ENVIRONMENTAL HEALTH SUBTOTAL 17.46 6,090 16,062 361,977 310,341 361,977 310,340 808,072 536,563 1,344,635 D. NON-OPERATIONAL COSTS: NON-OPERATIONAL COSTS (599) 0.00 0 0 0 0 0 0 0 0 0 ENVIRONMENTAL HEALTH SURCHARGE (399) 0.00 0 0 18,836 16,149 18,836 16,148 69,969 0 69,969 MEDICAID BUYBACK (611) 0.00 0 0 81 69 81 69 300 0 300 NON-OPERATIONAL COSTS SUBTOTAL 0.00 0 0 18,917 16,218 18,917 16,217 70,269 0 70,269 TOTAL CONTRACT 152.07 48,320 668,269 3,865,628 3,314,213 3,865,628 3,314,213 9,645,348 4,714,334 14,359,682 Attachment_II_Part_III-Page 2 of 2 613 ATTACHMENT III COLLIER COUNTY HEALTH DEPARTMENT CIVIL RIGHTS CERTIFICATE The applicant provides this assurance in consideration of and for the purpose of obtaining federal grants, loans, contracts(except contracts of insurance or guaranty), property, discounts, or other federal financial assistance to programs or activities receiving or benefiting from federal financial assistance. The provider agrees to complete the Civil Rights Compliance Questionnaire, DH Forms 946 A and B(or the subsequent replacement if adopted during the contract period), if so requested by the department. The applicant assures that it will comply with: 1. Title VI of the Civil Rights Act of 1964,as amended, 42 U.S.C.,2000 Et seq.,which prohibits discrimination on the basis of race, color or national origin in programs and activities receiving or benefiting from federal financial assistance. 2. Section 504 of the Rehabilitation Act of 1973, as amended,29 U.S.C. 794,which prohibits discrimination on the basis of handicap in programs and activities receiving or benefiting from federal financial assistance. 3. Title IX of the Education Amendments of 1972,as amended,20 U.S.C. 1681 et seq.,which prohibits discrimination on the basis of sex in education programs and activities receiving or benefiting from federal financial assistance. 4. The Age Discrimination Act of 1975, as amended, 42 U.S.C. 6101 et seq.,which prohibits discrimination on the basis of age in programs or activities receiving or benefiting from federal financial assistance. 5. The Omnibus Budget Reconciliation Act of 1981, P.L. 97-35,which prohibits discrimination on the basis of sex and religion in programs and activities receiving or benefiting from federal financial assistance. 6. All regulations,guidelines and standards lawfully adopted under the above statutes.The applicant agrees that compliance with this assurance constitutes a condition of continued receipt of or benefit from federal financial assistance,and that it is binding upon the applicant, its successors,transferees,and assignees for the period during which such assistance is provided. The applicant further assures that all contracts, subcontractors, subgrantees or others with whom it arranges to provide services or benefits to participants or employees in connection with any of its programs and activities are not discriminating against those participants or employees in violation of the above statutes, regulations, guidelines,and standards. In the event of failure to comply,the applicant understands that the grantor may, at its discretion, seek a court order requiring compliance with the terms of this assurance or seek other appropriate judicial or administrative relief,to include assistance being terminated and further assistance being denied. Attachment_III-Page 1 of 1 1 6 01 \ \ > I¥ _No o a)\ - \E Q \ nw \ \ \/ cn 2 Ti CO ,- ® / • # e \ \ • » o .. \ a) @ 12 £ $ \ e 2 \ t o 0kk f | � | oea fa Z E � J j ) \ 0 / j \ \ 3 � % � ) ° E J \ ± 7 / % \ W E f \ \ ( 2 ) 2 < t. /\ e _ C ) \ I k w E } 0 E. 0 0 \ \ E >, A \ ) \ o 0 0 2 % .E. a) e o a b - f f k _ G E f - ) ) ) k \ \ _ § $ o \ { > \ a. Q. E 2 a Q. ( $ I ® a § / \ } 2 © L. \ / ° ° ° ° » ƒ k § f ( k ƒ k 2 § -I " o 0 0 / 0 - Ci 2 o e % § / \ / \ § 0o .- \ \ C ° \ o E 2 2 - k L. e i ® § \ 2 -CB \ E ® 2 E. $ 1 = n e 0 \ \\ \ \ \ \ c J § / \ as 6� � \ / / co o CO \ \ / w ® ± Q \ 0 \ 9 0 a I a \ / . \ Q \ \ \\ � � � � E / / \ I- co %co � \ \ � \ k \ moo % � % ° $ f = � 43- £ = 3 % _ CD 73 - w F- # k } ƒI / \ \ E ! u ƒ n t 3 65 mz ,- ( Z ' ` 0 \ 0 ATTACHMENT V i 13 I COLLIER COUNTY HEALTH DEPARTMENT SPECIAL PROJECTS SAVINGS PLAN CASH RESERVED OR ANTICIPATED TO BE RESERVED FOR PROJECTS CONTRACT YEAR STATE COUNTY TOTAL 2019-2020* $ 0 $ 0 $ 0 2020-2021** $ 0 $ 0 $ 0 2021-2022*** $ 0 $ 0 $ 0 2022-2023*** $ 0 $ 0 $ 0 PROJECT TOTAL $ 0 $ 0 $ 0 SPECIAL PROJECTS CONSTRUCTION/RENOVATION PLAN PROJECT NUMBER: PROJECT NAME: LOCATION/ADDRESS: PROJECT TYPE: NEW BUILDING ROOFING RENOVATION PLANNING STUDY NEW ADDITION OTHER SQUARE FOOTAGE: 0 PROJECT SUMMARY: Describe scope of work in reasonable detail. START DATE (Initial expenditure of funds) : COMPLETION DATE: DESIGN FEES: $ 0 CONSTRUCTION COSTS: $ 0 FURNITURE/EQUIPMENT: $ 0 TOTAL PROJECT COST: $ 0 COST PER SQ FOOT: $ 0 Special Capital Projects are new construction or renovation projects and new furniture or equipment associated with these projects and mobile health vans. *Cash balance as of 9/30/20 **Cash to be transferred to FCO account. ***Cash anticipated for future contract years. Attachment_V-Page 1 of 1