Loading...
Backup Documents 10/12/2021 Item #16D 3 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP r� TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO ' 6 U 3 THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later than Monday preceding the Board meeting. **NEW** ROUTING SLIP Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office. Route to Addressee(s) (List in routing order) Office Initials Date 1. Todd Henry Public Services Administration 9/11/21 2. Jennifer Belpedio County Attorney Office Ct-X3 c1 I 1 E 1 i 4. BCC Office Board of County Commissioners D 1 ' Ott 305) b-00 5. Minutes and Records Clerk of Court's Office fitf PRIMARY CONTACT INFORMATION * M- 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/ Depai tment Alan Portis,DOH Finance&Accounting 252-8206 Please Call for Pick-up Agenda Date Item was Agenda Item N mber Approved by the BCC 10/12/2021 16D Type of Document FY21-22 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 s N/A(Not appropriate. (Initial) Applicable 1. Does the document require the chairman's original signa re?STAMPED SIGNATURE IS OK 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 10/12/2021 (enter date)and all is not changes made during the meeting have been incorporated in the attached document. AP ,ption for The County Attorney's Office has reviewed the changes,if applicable. line. 9. Initials of attorney verifying that the attached document is the version approved by the N/A is_w BCC,all changes directed by the BCC have been made,and the document is ready for the Chairman's signature. ��1 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 16D3 2rMEMORANDUM Date: October 19, 2021 To: Alan Portis, DOH Finance & Accounting Collier County Health Department From: Ann Jennejohn, Deputy Clerk Minutes and Records Department Re: FY21/22 Contract with State of Florida Department of Health for the operation of the Collier County Health Department Attached, please find two (3) originals of the document referenced above, (Item #16D3) approved by the Board of County Commissioners October 12, 2021. After it has been signed by the State, please return an original copy to this office for the Board's Official record, or email a fully executed copy to ann.jennejohn@collierclerk.com, so there is a signed copy for the record. If you have any questions, please feel free to contact me at 252-8406. Thank you. Attachments 1 6 D 3 Ann P. Jennejohn From: Portis, Alan L <Alan.Portis@flhealth.gov> Sent: Tuesday, December 14, 2021 3:33 PM To: Ann P.Jennejohn; Damone, Courtney A; LopezMaggie; SonntagKristi; HenryTodd Subject: FULLY EXECUTED COPY OF CORE CONTRACT BETWEEN COLLIER COUNTY AND HEALTH DEPARTMENT Attachments: Core Contract FY21-22 Final.pdf External Message: Please use caution when opening attachments, clicking links, or replying to this message. For your records. Originally approved (Item #16D3) by the BCC on Oct 12, 2021. AL Alan L. Portis Assistant County Health Department Administrator Florida Department of Health in Collier County 3339 Tamiami Trail East Naples, FL 34112 Office: (239) 252-8206 E-Mail: AIan.Portis(a�FLHealth.gov Mission: To protect, promote&improve the health of all people in Florida through integrated state, county&community efforts. 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. 1 I D3 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 2021-2022 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, 2021. 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, 2021, through September 30, 2022, 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 I D3 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 fisted on the Schedule C) as provided in Attachment II, Part II is an amount not to exceed $ 6,427,554 (State General Revenue, State Funds, Other State Funds and Federal Funds fisted 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 $1,495,900 (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 I6D3 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. O� 3 v 1603 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; N. 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 1603 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 O�t� 03 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, 2022 for the report period October 1, 2021 through December 31, 2021; ii. June 1, 2022 for the report period October 1, 2021 through March 31, 2022; iii. September 1, 2022 for the report period October 1, 2021 through June 30, 2022; and iv. December 1, 2022 for the report period October 1, 2021 through September 30, 2022. 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 1603 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, 2022, 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: Kimberly Kossler, MPH. RN, CPH Dan Rodriquez Name Name Administrator& Health Officer Public Service Department Head Title Title 3339 E. Tamiami Trail, Suite 145 3339 E. Tamiami Trail, Suite 217 Naples. FL 34112 Naples, FL 34112 OVO 1603 Address Address 239-252-8201 239-252-8366 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, 2021. BOARD OF COUNTY COMMISSIONERS STATE OF FLORIDA FOR COLLIER COUNTY DEPARTMENT OF HEALTH SIGNED B, .cifZ7 SIGNED BY: /'/. L NAME: Q) N y -TA-I i-.0 R NAME: Joseph A. Ladapo, MD, PhD TITLE: C• A E N k TITLE: State Surgeon General DATE: t O l l a ‘a` 1 DATE: l' bet /xr ATTESTED TO: SIGNED BY: ,t, } WO C • SIGNED BY: /�`/----;"..--„, L NAME . rOY Y) NAME: �1 M 1GSSI -v TIT Ir'4 'C,)[ ,(, ` C4-114- TITLE: CHD Director/Administrator ALE.. ' , D 1 DATE: Q 1 A / Ada I fdist as to:Gh.414ian's signatutre only: Approved as to form and legality • I Assistant County A y 6` o�� ova 8 I6D 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 16 3 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 $ 6El3 a a 10A N c) cn COO 00) co a) CI 0 N (h CO N _I N E UJ .cC A L_ a) To LY L r to co O M 0 CCO CO CD E a N In N a3 C N W W j U a) z 'Q 5 0. CO co a) O C H « o ❑ U w U. U 1 � U "1m aU) o a) 0 CO m IX a2a cW 2 IN It ti CO cn H Z C,) (') O O Y IX W0> 0) O.▪ I- r0) ro) °) MI re 0 Q N CV a 5 W aa) 0 V S JQ Q ? = a) 2 a O '2 ❑ m 3 C) Z V) I c c tz '• O a U 0 a N P c0 C J V CO m to CO J aL E e O a O O it CO 7 t C W W V) LL Q N a c p o W 7o Z > Z 0 C. C. T , C N _ ♦e C,Oj N C.) N 7 N 0 O N O LL c, ''j 0. 8 N C N >.N 2 O o M 0 M . M C a) C 0 c U CO -13 3 m � E yE cE a) O. Y O. C.) a c Y2c 2u) oV) co w W c o o c a . a O Y a r a) y C ` N Y N ZN wN O Li. Q N co N CL ri) � CU To O O I-❑ 30 8o co0 CO) I 00 m0 co U m U N vi ) Otto ATTACHMENT II 1 6 0 3 COLLIER COUNTY HEALTH DEPARTMENT Part II,Sources of Contributions to County Health Department October 1,2021 to September 30,2022 State CHD County Total CHD 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 69,671 0 69,671 0 69,571 015040 CHD•TB COMMUNITY PROGRAM 176,472 0 176,472 0 176,472 015040 DENTAL SPECIAL INITIATIVE PROJECTS 6,798 0 6,798 0 6,798 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 25,270 0 25,270 0 25,270 016040 PRIMARY CARE PROGRAM 313,432 0 313,432 0 313,432 015040 RACIAL&ETHNIC DISPARITIES•CHD EXPENSES 65,000 0 55,000 0 55,000 015040 SCHOOL HEALTH SERVICES•GENERAL REVENUE 218,073 0 218,073 0 218,073 015050 CHD GENERAL REVENUE NON-CATEGORICAL 2,259,339 0 2,259,339 0 2,259,339 GENERAL REVENUE TOTAL 3,417,645 0 3,417,645 0 3,417,645 2.NON GENERAL REVENUE-STATE 015010 ENVIRONMENTAL BIOMEDICAL WASTE PROGRAM 10,560 0 10,560 0 10,560 015010 TOBACCO STATE AND COMMUNITY INTERVENTIONS 184,466 0 184,466 0 184,466 NON GENERAL REVENUE TOTAL 196,026 0 195,026 0 195,026 3.FEDERAL FUNDS•STATE 007000 AIDS DRUG ASSISTANCE PROGRAM ADMIN HQ 104,059 0 104,059 0 104,059 007000 WIC BREASTFEEDING PEER COUNSELING PROG 67,094 0 67,094 0 67,094 007000 COASTAL BEACH WATER QUALITY MONITORING 12,365 0 12,365 0 12,365 007000 COMPREHENSIVE COMMUNITY CARDIO•PHBG 36,000 0 35,000 0 35,000 007000 FAMILY PLANNING TITLE X-GRANT 87,909 0 87,909 0 87,909 007000 IMMUNIZATION ACTION PLAN 87,500 0 87,500 0 87,500 007000 MCH SPECIAL PRJCT UNPLANNED PREGNANCY 40,012 0 40,012 0 40,012 007000 MCH BLOCK GRANT FLORIDA'S HEALTHY BABIES 17,816 0 17,816 0 17,816 007000 BASE COMMUNITY PREPAREDNESS CAPABILITY 132,213 0 132,213 0 132,213 007000 BASE ENVIROMENTAL HEALTH 71,857 0 71,857 0 71,857 007000 BASE PUB HLTH SURVEILLANCE&EPI INVESTIGATION 7.979 0 7,979 0 7.979 007000 AIDS PREVENTION 260,896 0 260,896 0 260,896 007000 RYAN WHITE TITLE II GRANT/CHD CONSORTIUM 305,143 0 305,143 0 305,143 007000 WIC PROGRAM ADMINISTRATION 1,304,199 0 1,304,199 0 1,304,199 016075 SUPPLEMENTAL SCHOOL HEALTH 33,690 0 33,690 0 33,690 015075 REFUGEE HEALTH SCREENING REIMBURSEMENT ADMIN 42,567 0 42,557 0 42,557 015075 REFUGEE HEALTH SCREENING REIMBURSEMENT SERVICES 236,611 0 236,611 0 236,611 FEDERAL FUNDS TOTAL 2,846,900 0 2,846,900 0 2,846,900 4.FEES ASSESSED BY STATE OR FEDERAL RULES•STATE 001020 CHD STATEWIDE ENVIRONMENTAL FEES 472,946 0 472,946 0 472,945 001092 ON SITE SEWAGE DISPOSAL PERMIT FEES 319,067 0 319,067 0 319,067 001092 CHD STATEWIDE ENVIRONMENTAL FEES 7,301 0 7,301 0 7,301 001206 ON SITE SEWAGE DISPOSAL PERMIT FEES 24,000 0 24,000 0 24,000 001206 SANITATION CERTIFICATES(FOOD INSPECTION) 3,577 0 3,577 0 3,677 Attachment_I I_Part_II-Page 1 of 4 ATTACHMENT II II 6 0 3 COLLIER COUNTY HEALTH DEPARTMENT Part II,Sources of Contributions to County Health Department October 1,2021 to September 30,2022 State CHD County Total CHD Trust Fund CHD Trust Fund Other (cash) Trust Fund (cash) Contribution Total 001206 SEPTIC TANK RESEARCH SURCHARGE 5,185 0 5,185 0 5,185 001206 SEPTIC TANK VARIANCE FEES 50% 300 0 300 0 300 001206 PUBLIC SWIMMING POOL PERMIT FEES•10%HQ TRANSFER 28,333 0 28,333 0 28,333 001206 DRINKING WATER PROGRAM OPERATIONS 1,305 0 1,305 0 1,305 001206 REGULATION OF BODY PIERCING SALONS 120 0 120 0 120 001206 TANNING FACILITIES 214 0 214 0 214 001206 ONSITE SEWAGE TRAINING CENTER 1,680 0 1,680 0 1,680 001206 TATTO PROGRAM ENVIRONMENTAL HEALTH 2,866 0 2,866 0 2,866 001206 MOBILE HOME&RV PARK FEES 2,391 0 2,391 0 2,391 FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 869,284 0 869,284 0 869,284 5.OTHER CASH CONTRIBUTIONS-STATE: 0 0 0 0 0 090001 DRAW DOWN FROM PUBLIC HEALTH UNIT 253,093 0 253,093 0 263,093 OTHER CASH CONTRIBUTION TOTAL 253,093 0 253,093 0 253,093 6.MEDICAID•STATE/COUNTY: 001050 CHD CLINIC FEES 0 4,321 4,321 0 4,321 001057 CHD CLINIC FEES 0 5,166 5,166 0 5,166 001147 CHD CLINIC FEES 0 41 41 0 41 001148 CHD CLINIC FEES 0 614,694 614,694 0 614,694 001148 GENERAL CLINIC RABIES SERVICES&DRUG PURCHASES 0 600 600 0 600 MEDICAID TOTAL 0 624,822 624,822 0 624,822 7.ALLOCABLE REVENUE•STATE: 001004 CHD CLINIC FEES 1 0 1 0 1 018000 CHD CLINIC FEES 5,025 0 6,025 0 5,025 018000 CHD LOCAL ENVIRONMENTAL FEES 0 0 0 0 0 031005 GENERAL CLINIC RABIES SERVICES&DRUG PURCHASES 16,000 0 16,000 0 16,000 038000 CHD CLINIC FEES 4 0 4 0 4 ALLOCABLE REVENUE TOTAL 21,030 0 21,030 0 21,030 8.OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND-STATE ADAP 0 0 0 231,608 231,608 PHARMACY DRUG PROGRAM 0 0 0 1,364 1,364 WIC PROGRAM 0 0 0 4,136,671 4,136,671 BUREAU OF PUBLIC HEALTH LABORATORIES 0 0 0 43,673 43,673 IMMUNIZATIONS 0 0 0 648,619 648,619 OTHER STATE CONTRIBUTIONS TOTAL 0 0 0 5,061,935 5,061,936 9.DIRECT LOCAL CONTRIBUTIONS•BCC/TAX DISTRICT 008005 CHD LOCAL REVENUE&EXPENDITURES 0 1,495,900 1,495,900 0 1,495,900 DIRECT COUNTY CONTRIBUTIONS TOTAL 0 1,495,900 1,495,900- 0 1,495,900 10.FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION COUNTY 001025 CIID CLINIC FEES 0 1 1 0 1 Attachment_II_Part_II-Page 2 of 4 1 6 03 ATTACH ENT II COLLIER COUNTY HEALTH DEPARTMENT Part II,Sources of Contributions to County Health Department October 1,2021 to September 30,2022 State CHD County Total CHD Trust Fund CHD Trust Fund Other (cash) Trust Fund (cash) Contribution Total 001077 CHD CLINIC FEES 0 243,461 243,461 0 243,461 001077 GENERAL CLINIC RABIES SERVICES&DRUG PURCHASES 0 1,000 1,000 0 1,000 001094 CHD LOCAL ENVIRONMENTAL FEES 0 882,085 882,085 0 882,085 001110 VITAL STATISTICS CERTIFIED RECORDS 0 500,000 500,000 0 500,000 FEES AUTHORIZED BY COUNTY TOTAL 0 1,626,547 1,626,547 0 1,626,547 11.OTHER CASH AND LOCAL CONTRIBUTIONS-COUNTY 001029 340B PRESCRIPTION DRUG SERVICE AGREEMENT 0 250,000 260,000 0 250,000 001029 CHD CLINIC FEES 0 89,439 89,439 0 89,439 001090 CHD CLINIC FEES 0 15,802 15,802 0 15,802 010300 STATE UNDERGROUND PETROLEUM RESPONSE ACT 0 1,000 1,000 0 1,000 010300 MIGRANT LABOR HOUSING INSPECTION H-2A PROGRAM 0 6,260 6,260 0 6,260 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 0 100 100 0 100 011000 RYAN WHITE 0 58,681 58,681 0 58,681 011000 CHD CLINIC FEES 0 11 11 0 11 011000 CHD CASH DONATION/NON-SPECIFIC 0 3,000 3,000 0 3,000 011000 EARLY LEARNING COALITION OF SOUTHWEST FLORIDA 0 60,900 60,900 0 60,900 011001 CHD HEALTHY START COALITION CONTRACT 0 579,070 579,070 0 579,070 012020 CHD LOCAL ENVIRONMENTAL FEES 0 380 380 0 380 028000 CHD CLINIC FEES 0 0 0 0 0 090002 DRAW DOWN FROM PUBLIC HEALTH UNIT 0 -581,818 -581,818 0 •581,818 OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 0 483,200 483,200 0 483,200 12.ALLOCABLE REVENUE-COUNTY 001004 CHD CLINIC FEES 0 1 1 0 1 018000 CHD CLINIC FEES 0 5,026 5,025 0 5,025 018000 CHD LOCAL ENVIRONMENTAL FEES 0 1 1 0 1 031005 GENERAL CLINIC RABIES SERVICES&DRUG PURCHASES 0 16,000 16,000 0 16,000 038000 CHD CLINIC FEES 0 4 4 0 4 COUNTY ALLOCABLE REVENUE TOTAL 0 21,031 21,031 0 21,031 18.BUILDINGS•COUNTY ANNUAL RENTAL EQUIVALENT VALUE 0 0 0 525,048 525,048 IT ALLOCATION 0 0 0 60,700 60,700 UTILITIES 0 0 0 163,100 163,100 BUILDING MAINTENANCE 0 0 0 0 0 GROUNDS MAINTENANCE 0 0 0 195,149 196,149 INSURANCE 0 0 0 0 0 OTHER(Specify) 0 0 0 0 0 OTHER(Specify) 0 0 0 0 0 BUILDINGS TOTAL 0 0 0 943,997 943,997 14.OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND•COUNTY EQUIPMENT I VEHICLE PURCHASES 0 0 0 0 0 VEHICLE INSURANCE 0 0 0 0 0 0143 Attachment_II_Part_II-Page 3 of 4 ATTACHMENT II 1 6 D 3 COLLIER COUNTY HEALTH DEPARTMENT Part II,Sources of Contributions to County Health Department October 1,2021 to September 30,2022 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 7,602,978 4,251,500 11,854,478 6,005,932 17,860,410 01,0 Attachment II_Part II-Page 4 of 4 ATTACHMENT II 1 6 9 4 COLLIER COUNTY HEALTH DEPARTMENT Part Ill Planned Staffing.Clients,Services and Expenditures By Program Service Area Within Each Level of Service October 1,2021 to September S0,2022 Quarterly Expenditure Plan FTE's Clients Services/ 1st 2nd 3rd 4th Grand (0.00) Unite Visits (Whole dollars only) State County Total A. COMMUNICABLE DISEASE CONTROL: IMMUNIZATION(101) 7.76 3,260 3,660 161,634 138,492 161,634 138,493 352,615 247,438 600,053 SEXUALLY TRANS.DIS. (102) 6.56 792 1,098 97,643 83,716 97,643 83,714 300,290 62,425 362,716 HIV/AIDS PREVENTION (03A1) 4.71 0 1,581 89,524 76,764 89,624 76,765 322,519 10,038 332,557 HIV/AIDS SURVEILLANCE (03A2) 1.36 0 6 27,049 23,191 27,049 23,191 100,480 0 100,480 HIV/AIDS PATIENT CARE (03A3) 9.73 495 2,175 237,428 203,660 237,428 203,560 531,068 350,908 881,976 ADAP (03A4) 2.16 28 188 42,041 36,044 42,041 36,044 166,170 0 156,170 TUBERCULOSIS (104) 4.20 237 1,776 90,721 77,780 90,721 77,779 333,866 3,136 337,001 COMM.DIS.SURV. (106) 4.08 0 919 96,123 81,554 95,123 81,553 95,145 258,208 363,353 HEPATITIS (109) 1.61 383 432 33,672 28,869 33,672 28,870 125,077 6 125,083 PREPAREDNESS AND RESPONSE (116) 2,70 0 868 71,068 60,930 71,068 60,990 159,314 104,682 263,996 REFUGEE HEALTH (118) 5.45 342 946 128,678 110,237 128,578 110,236 477,629 0 477,629 VITAL RECORDS (180) 3.40 14,108 62,438 64,209 55,050 64,209 55,050 0 238,518 238,518 COMMUNICABLE DISEASE SUBTOTAL 52.62 19,645 76,077 1,138,590 976,176 1,138,590 976,175 2,954,173 1,275,358 4,229,531 B. PRIMARY CARE: CHRONIC DISEASE PREVENTION PRO (210) 2.39 0 0 52,088 44,657 62,088 44,667 78,050 115,440 193,490 WIC (21W1) 25.41 10,451 62,073 462,139 396,217 462,139 396,218 1,716,713 0 1,716,713 TOBACCO USE INTERVENTION (212) 3.45 0 29 60,473 51,847 60,473 51,847 224,640 0 224,640 WIC BREASfFEEDING PEER COUNSELING (21W2) 3.44 0 1,409 38,164 32,721 38,164 32,721 141,770 0 141,770 FAMILY PLANNING (223) 2.66 704 1,422 70,292 60,265 70,292 60,264 222,112 39,001 261,113 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 1,592 5,504 182,207 156,216 182,207 156,217 194,163 532,684 676,847 COMPREHENSIVE CHILD HEALTH (229) 0.99 125 217 22,931 19,660 22,931 19,659 0 85,181 85,181 HEALTHY START CHILD (231) 2.21 966 4,138 43,578 37,362 43,578 37,362 0 161,880 161,880 SCHOOL HEALTH (234) 9.54 0 453,808 166,484 133,305 166,484 133,304 441,860 136,717 577,577 COMPREHENSIVE ADULT HEALTH (237) 2.48 2,053 3,326 112,693 96,617 112,693 96,617 145,490 273,130 418,620 COMMUNITY HEALTH DEVELOPMENT(238) 2.65 0 4 67,737 58,075 67,737 58,074 251,623 0 251,623 DENTAL HEALTH (240) 10.96 3,668 7,371 266,819 220,1)35 256,819 220,185 224,652 729,356 954,008 PRIMARY CARE SUBTOTAL 74.63 19,658 539,300 1,610,749 1,380,983 1,610,749 1,380,981 3,591,073 2,392,389 5,983,462 C. ENVIRONMENTAL HEALTH: Water and Onsite Sewage Programs COSTAL BEACH MONITORING (947) 0.91 1,230 1,232 21,084 18,076 21,084 18,077 78,321 0 78,321 LIMITED USE PUBLIC WATER SYSTEMS (357) 1.57 513 2,952 34,002 29,162 34,002 29,152 105,848 20,460 126,308 PUBLIC WATER SYSTEM (358) 0.14 0 0 3,302 2,831 3,302 2,831 12,266 0 12,266 PRIVATE WATER SYSTEM (359) 0.30 0 8 7,137 6,119 7,137 6,118 0 26,511 26,611 ONSITE SEWAGE TREATMENT&DISPOSAL(361) 6.40 2,316 6,926 112,400 96,366 112,400 96,366 199,218 218,314 417,632 Group Total 8.32 9,059 10,118 177,925 152,544 177,926 152,544 395,653 265,285 660,938 Facility Programs TATTOO FACILITY SERVICES (344) 0.47 281 420 10,510 9,011 10,510 9,010 39,041 0 39,041 FOOD HYGIENE (348) 1.88 325 810 38,425 32,944 38,425 32,943 142,737 0 142,737^^ 0 Attachment_II_Pert 111-Page 1 of 2 ATTACHMENT II $ 6 0 3 COLLIER COUNTY HEALTH DEPARTMENT Part III,Planned Staffing.Clients,Services and Expenditures By Program Service Area Within Each Level of Service October 1,2021 to September 80,2022 Quarterly Expenditure Plan ?PE's Clients Services/ 1st 2nd 8rd 4th Grand (0.00) Unite Visits (Whole dollars only) State County Total BODY PIERCING FACILITIES SERVICES (349) 0.04 2 12 956 819 956 819 3,550 0 3,650 GROUP CARE FACILITY (351) 0.90 190 324 18,727 16,066 18,727 16,056 22,066 47,500 69,566 MIGRANT LABOR CAMP(352) 1.68 103 1,067 29,834 26,678 29,834 25,577 59,863 50,960 110,823 HOUSING&PUB.BLDG. (353) 0.00 0 0 0 0 0 0 0 0 0 MOBILE HOME AND PARK(354) 0.63 237 720 11,002 9,433 11,002 9,432 40,869 0 40,869 POOLS/BATHING PLACES (360) 4.38 1,401 7,830 92,367 79,192 92,367 79,192 141,570 201,648 343,118 BIOMEDICAL WASTE SERVICES (364) 1.47 1,126 871 33,664 28,862 33,664 28,861 125,051 0 125,051 TANNING FACILITY SERVICES (369) 0.12 48 42 2,206 1,890 2,205 1,890 8,190 0 8,190 Group Total 11.47 3,713 12,096 237,690 203,785 237,690 203,780 682,937 300,008 882,946 Groundwater Contamination STORAGE TANK COMPLIANCE SERVICES (356) 0.00 0 0 0 0 0 0 0 0 0 SUPER ACT SERVICES (356) 0.32 0 64 6,608 6,666 6,608 5,665 6,086 18,460 24,546 Group Total 0.32 0 64 6,608 5,665 6,608 6,665 6,086 18,460 24,546 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 0 750 643 750 642 2,785 0 2,786 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 0 750 643 750 642 2,786 0 2,785 ENVIRONMENTAL HEALTH SUBTOTAL 20.14 7,772 22,278 422,973 362,637 422,973 362,631 957,461 583,753 1,571,214 D. NON-OPERATIONAL COSTS: NONOPERATIONAL 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 16,150 69,971 0 69,971 MEDICAID BUYBACK(611) 0.00 0 0 81 69 81 69 300 0 300 NONOPERATIONAL COSTS SUBTOTAL 0.00 0 0 18,917 16,218 18,917 16,219 70,271 0 70,271 TOTAL CONTRACT 147.39 46,975 637,655 3,191,229 2,736,014 3,191,229 2,736,006 7,602,978 4,251,500 11,854,478 CIO Attachment_II_Part_III-Page 2 of 2 I 6 3 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 0 3 f ■ / � e a. a > o 3 o E § ■ N ...1 t . \w c .. . . , . 7 0 2 § P. 9 k 2 LL$ an / K ) A _ t z » § o R § 0 , ■ ■ ■ 0 � k m § c flf§ e ® � Z a ■ o ■ § a 0 § & ° E ° ® ) ® E U ■ o � o o , _1 o u m 2 ƒ k \ f t Q a $ § 2 § & c • 0 o t E a # 0 k � k / - j u u @ 0) C0. Z ° k f f ] ts 0 � Z Cal & _� ® ) 0 u E t I COCM c. ( - \ k / Csl e = a E a » . . - - a co # I a — - en ± b § oi CO o t § a r z - © / a 2 ha › 7 & o § E k § a k k g « — 0 a 0 § 0 0 0 @ % I .- 0 < o \ _ % k tt o = 3 U 0 § - - o Q. >-- Q s f @ Q 77) E 2 # 1 ■ , .. . .0 k uE k 0E 0 $ § Q x % a 5 e 2 2 ■ m o / a a \ r> 2 % 2 ! E 3 A § E I • a E Qa. k \ J 2 ■ 7 t § 2 t 8 o 3 \ n ? o I i 7 " % \ C _ ii ON E § k # } ■ rt k Co (6 o5 ƒ 2g ■ a \ k 7 j a - 1iXII� a i G , f . o ■ - E �: $ .56 k $ k E } � � � Etta � ' / w � 0 e m■,■ .- � � 2 k in v § ■ § m % U. / Cito 6 n .J ATTACHMENT V COLLIER COUNTY HEALTH DEPARTMENT SPECIAL PROJECTS SAVINGS PLAN CASH RESERVED OR ANTICIPATED TO BE RESERVED FOR PROJECTS CONTRACT YEAR STATE COUNTY TOTAL 2020-2021* $ 0 $ 0 $ 0 2021-2022•• $ 0 $ 0 $ 0 2022-2023"* $ 0 $ 0 $ 0 2023-2024"" $ 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 9/30/21 **Cash to be transferred to FCO account. ***Cash anticipated for future contract years. CA O Attachment_V-Page 1 of 1