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Agenda 01/11/2022 Item #16D 5 (RFP Contract #18-747OS for Services for Seniors)16.D.5 01/11/2022 EXECUTIVE SUMMARY Recommendation to award Request for Proposal ("RFP") #18-7470S, Services for Seniors, to Hemo Medika Care LLC d/b/a Harmonia The Club, Sunshine Health Care Services, LLC d/b/a A Better Solution of Sarasota, Home Health Care Resources, Corp. and authorize the Chair to sign the attached agreements. (Estimated Annual Fiscal Impact $2,934,443, Human Services Grant Fund 707) OBJECTIVE: To provide comprehensive in -home and out -of -home services to the elderly in Collier County. CONSIDERATION: Collier County's Services for Seniors program has been providing support services to the County's frail elderly population for the past thirty (30) years through the Older American Act ("OAA"), Community Care for the Elderly ("CCE"), Alzheimer's Disease Initiative ("ADI") programs. The Collier County Services for Seniors Program is a comprehensive program offered to qualified seniors aged sixty (60) and older, who need services to prevent, decrease or delay premature or inappropriate expensive placement in nursing homes or other institutions. The goal of the program is to assist the elderly in living as independently as possible in their own homes or the homes of relatives or caregivers. Collier County, as the lead agency, is required to enter into contractual agreements with area service providers to administer homemaking, personal care, respite, chore adult daycare, nursing, transportation, and shopping assistance services. Annually, services provided to program participants have cost approximately $2,934,443 in OAA IIB & IIE, CCE, and ADI. The cost of services is reimbursed through agreements between Collier County and the Area Agency on Aging for Southwest Florida, Inc. On July 7, 2021, the Procurement Services Division released RFP #18-7470S, Services for Seniors, and the County received four proposals by the August 10, 2021, deadline. Three of the four proposers were contacted to resolve minor irregularities due to incomplete documents. A selection committee met on October 6, 2021, to review the proposals. The evaluation criteria included the proposer's ability to comply with the scope of services, the organizational capabilities and experience, financial and human resources capabilities, general service delivery, acceptance of cost, and cost of services to the County. The RFP required a minimum of three references from the proposers' clients on projects of a similar size for which the firms provided services similar in scope and complexity within the past five years. After review of the proposals and deliberation, the committee scored the proposals and ranked the firms as follows: Respondents: Company Name Final Ranking Hemo Medika Care LLC d/b/a Harmonia The Club 1 Sunshine Health Care Services, LLC d/b/a A Better Solution of Sarasota 2 Home Health Care Resources, Corp 3 Mar-J-Medical Supply, Inc. 4 Staff is recommending award to the top three ranked firms Hemo Medika Care LLC d/b/a Harmonia The Club, Sunshine Health Care Services, LLC d/b/a Better Solution of Sarasota, and Home Health Care Resources, Corp. Hemo Medika Care LLC opened in October 2020, is an independently owned and operated business providing Adult Day Care for residents of Naples and surrounding counties. Sunshine Health Care Services, Packet Pg. 576 16.D.5 01/11/2022 LLC has been servicing elderly and disabled adults since 1998 and is a licensed home health agency servicing Collier County, working with CCE and ADI programs in Manatee, Sarasota, Lee, and DeSoto counties for the past three years. Home Health Care Resources, Corp is a Private Duty Agency contracted with the Long -Term Medicaid Program and Charlotte County Senior Services Program, licensed to provide care in Charlotte, De Soto, Sarasota, Lee, Collier, and Hendry counties. This solicitation was prepared to supplement the services under Request for Proposal #18-7470. The term of this award will run concurrently with the existing term of Agreement RFP #18-7470 Services for Seniors, which is for an initial term of three years expiring December 10, 2022, with two one-year renewal term options, consistent with the period of the grant funds awarded. Prices shall remain firm for the initial term of the award. FISCAL IMPACT: Funds for vendor services are available in Human Services Grant Fund (707) for the OAA IIB 33727, OAA IIE 33730, CCE 33753, ADI 33749. Annually, services provided to program participants have cost approximately $2,934,443. GROWTH MANAGEMENT IMPACT: There is no Growth Management impact associated with this Executive Summary. LEGAL CONSIDERATIONS: This item is approved as to form and legality and requires majority vote for Board approval. -SRT RECOMMENDATION: To approve award of Request for Proposal #18-7470S, Services for Seniors, to: Hemo Medika Care LLC d/b/a Harmonia The Club, Sunshine Health Care Services, LLC d/b/a Better Solution of Sarasota, and Home Health Care Resources, Corp., and authorize the Chair to sign the attached agreements. Prepared By: Wendy Klopf, Grants Coordinator Community & Human Services Division ATTACHMENT(S) 1. 18-7470S Solicitation (2) (PDF) 2. (Linked) 18-7470S A Better Solution Home Care Proposal (PDF) 3. (Linked) 18-7470S - Home Health Care Resources_ Proposal (PDF) 4. (Linked) 18-7470S - Hemo Medika Proposal (PDF) 5. 18-7470S Final Ranking (PDF) 6. 18-7470S NORA (PDF) 7. 18-7470S A Better Solution Home Care_ Contract _VendorSigned (PDF) 8. 18-7470S Home Health Care Resources_ Contract VendorSigned (PDF) 9. 18-7470S Hemo Medika Contract VendorSigned (PDF) 10. 18-7470S SunshineHealth dba ABetterSolutionHome_COI (PDF) 11. 18-7470S SunshineHealth dba ABetterSolutionHome_DishonestyBond_Insurance (PDF) 12. 18-7470S - Home Health Care Resources_ Crime-Dishonesty_COI (PDF) 13. 18-7470S Hemo Medika Insurance (PDF) Packet Pg. 577 16.D.5 01 / 11 /2022 COLLIER COUNTY Board of County Commissioners Item Number: 16.D.5 Doe ID: 20424 Item Summary: Recommendation to award Request for Proposal (RFP) #18-7470S, Services for Seniors, to Hemo Medika Care LLC d/b/a Harmonia The Club, Sunshine Health Care Services, LLC d/b/a A Better Solution of Sarasota, Home Health Care Resources, Corp. and authorize the Chair to sign the attached agreements. (Estimated Annual Fiscal Impact $2,934,443, Human Services Grant Fund 707) Meeting Date: 01/11/2022 Prepared by: Title: Operations Coordinator — Community & Human Services Name: Wendy Klopf 11/09/2021 1:52 PM Submitted by: Title: Manager - Federal/State Grants Operation — Community & Human Services Name: Kristi Sonntag 11/09/2021 1:52 PM Approved By: Review: Community & Human Services Wendy Klopf CHS Review Community & Human Services Blanca Aquino Luque Additional Reviewer Community & Human Services Maggie Lopez Additional Reviewer Operations & Veteran Services Kimberley Grant Additional Reviewer Procurement Services Ana Reynoso Level 1 Purchasing Gatekeeper Procurement Services Barbara Lance Additional Reviewer Procurement Services Sue Zimmerman Additional Reviewer Procurement Services Sandra Herrera Additional Reviewer Public Services Department Todd Henry Public Services Department Grants Erica Robinson Level 2 Grants Review County Attorney's Office Scott Teach Level 2 Attorney Review Public Services Department Dan Rodriguez PSD Department Head Office of Management and Budget Debra Windsor Level 3 OMB Gatekeeper Review County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Grants Therese Stanley Additional Reviewer Growth Management Operations Support Christopher Johnson Skipped 11/09/2021 1:52 PM Completed 11/09/2021 4:24 PM Completed 11/09/2021 6:14 PM Completed 11/10/2021 5:42 PM Completed 11/23/2021 2:47 PM Completed 11/23/2021 4:39 PM Completed 11/24/2021 4:21 PM Completed 11/29/2021 5:55 AM Completed 12/06/2021 11:33 AM Completed 12/08/2021 2:07 PM Completed 12/13/2021 10:14 AM Completed 12/14/2021 4:12 PM Completed 12/15/2021 9:28 AM Completed 12/17/2021 8:39 AM Completed 01/04/2022 9:12 AM Additional Reviewer Completed Packet Pg. 578 16.D.5 01 / 11 /2022 County Manager's Office Board of County Commissioners Amy Patterson Level 4 County Manager Review Geoffrey Willig Meeting Pending Completed 01/05/2022 9:30 AM 01/11/2022 9:00 AM Packet Pg. 579 16.D.5.a collier county Administrative Services Department Procurement Services Division COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS REQUEST FOR PROPOSAL (RFP) FOR SERVICES FOR SENIORS SOLICITATION NO. 18-7470S BARBARA LANCE, PROCUREMENT STRATEGIST PROCUREMENT SERVICES DIVISION 3295 TAMIAMI TRAIL EAST, BLDG C-2 NAPLES, FLORIDA 34112 TELEPHONE: (239) 252-8998 Barbara.Lancekcolliercountyfl.gov (Email) This solicitation document is prepared in a Microsoft Word format (Rev 8/7/2017). Any alterations to this document made by the Vendor may be grounds for rejection of proposal, cancellation of any subsequent award, or any other legal remedies available to the Collier County Government. N a Packet Pg. 580 16.D.5.a SOLICITATION PUBLIC NOTICE REQUEST FOR PROPOSAL (RFP) NUMBER: 18-7470S PROJECT TITLE: SERVICES FOR SENIORS PRE -PROPOSAL CONFERENCE: July 21, 2021 at 10:00 am LOCATION: PROCUREMENT SERVICES DIVISION, CONFERENCE ROOM A, 3295 TAMIAMI TRAIL EAST, BLDG C-2, NAPLES, FLORIDA 34112 DUE DATE: August 10 2021 at 3:00 gm PLACE OF RFP OPENING: PROCUREMENT SERVICES DIVISION 3295 TAMIAMI TRAIL EAST, BLDG C-2 NAPLES, FL 34112 All proposals shall be submitted online via the Collier County Procurement Services Division Online Bidding System: hllps://www.bidsy!lc.com/bidsync-cas/ INTRODUCTION As requested by the Community and Human Services Division (hereinafter, the "Division or Department"), the Collier County Board of County Commissioners Procurement Services Division (hereinafter, "County") has issued this Request for Proposal (hereinafter, "RFP") with the intent of obtaining proposals from interested and qualified vendors in accordance with the terms, conditions and specifications stated or attached. The vendor, at a minimum, must achieve the requirements of the Specifications or Scope of Work stated. The results of this solicitation may be used by other County departments once awarded according to the Board of County Commissioners Procurement Ordinance. Historically, County departments have spent approximately $2,000,000 of grant program funds annually; however, this may not be indicative of future buying patterns. BACKGROUND The purpose of this solicitation is to secure vendors for the provision of home and community -based services, to be delivered to persons sixty years and older under Older American's Act (OAA), Community Care for the Elderly (CCE) and Health Care for the Elderly (HCE), and to qualified persons eighteen years or older under Alzheimer's Disease Initiative (ADI), within the geographic area of Collier County. Unless otherwise stated, minimum hours of availability are 7:00 a.m. to 5:00 p.m. Monday through Saturday, with the exception of federal and state holidays. Respite services and emergency services must be available 24 hours/day, 365 days/year if needed. Definitions, standards, and requirements of these services are included in the Department of Elder Affairs' Home and Community - Based Services Handbook (DOEA Handbook) link below: hqp:Helderaffairs.state.fl.us/doea/nois.php TERM OF CONTRACT This solicitation was prepared to supplement the services under Request for Proposal 418-7470. The term of the agreement for this solicitation will run concurrently with the existing term of Agreement 418-7470, Services for Seniors. Prices shall remain firm for the initial term of this contract. Surcharges will not be accepted in conjunction with this contract, and such charges should be incorporated into the pricing structure. The County Manager, or designee, may, at his discretion, extend the Agreement under all of the terms and conditions contained in this Agreement for up to one hundred eighty (180) days. The County Manager, or designee, shall give the Contractor written notice of the County's intention to extend the Agreement term not less than ten (10) days prior to the end of the Agreement term then in effect. All goods are FOB destination and must be suitably packed and prepared to secure the lowest transportation rates and to comply with all carrier regulations. Risk of loss of any goods sold hereunder shall transfer to the COUNTY at the time and place of delivery; provided that risk of loss prior to actual receipt of the goods by the COUNTY nonetheless remain with VENDOR. `0 c m 3 m z 0 ti ti 00 IL a, N 14 0 N N c 0 M 0 Cn U) 0 ti ti c m s ea .r a 2 Packet Pg. 581 Those interested in providing the services detailed below must adhere to all requirements in this RFP, in addition to maintaining adherence with the guidelines set forth by the current DOEA Handbook. Lack of knowledge of all requirements of a service listed in the proposal SHALL NOT relieve the provider of liability and obligations under the resultant agreement. Collier County Community & Human Services (CHS) shall lead all service authorization and coordination. In an effort to comply with the requirements of the OAA, ADI, CCE and HCE Programs, clients entering the service system will be assessed and prioritized by CHS. Upon determination of the service level to be provided, the CHS will offer the client a listing of service vendors for the specific service(s) outlined within their care plan. The client will be encouraged to pick a service provider of their choice and have the option of interviewing potential service providers. Should the client not have a preference, CHS will select a service provider from the centralized provider list, using a rotation basis (rotating to the next vendor on the list). In this manner, all service providers will be equally treated unless the client has a preference. CHS shall not endorse one service provider over another. Upon the determination of the service, the service levels, and the selected vendor, CHS will contact the vendor agency, and authorize the service, number of hours, and frequency. In keeping with the state policy of client choice of service providers, Collier County 0 does not guarantee a minimum or maximum number of clients that will be referred, nor a minimum or maximum number of service hours that will be requested during the contract period. > Should a client later indicate dissatisfaction with the chosen service provider, they will again be offered their choice of provider. CHS Z shall send the agreed -upon Service Authorization to the chosen provider. These "service authorizations" or "service orders" must y contain necessary client information, such as street address, telephone number, and services or items needed, as well as the name and ti telephone number of the CHS case manager authorizing the service. In order to meet client needs, some services may be required ti outside of normal office hours (8:00 AM to 5:00 PM, Monday - Friday). 00 CHS reserves the right to request adding additional service providers throughout the resultant agreement period. The County may do IL LL so through a competitive and publicly announced selection process, which shall be coordinated through the County's Procurement Department. Services shall be provided in the manner described in the most current DOEA manual and outlined herein. Should N funding for additional Senior Services be identified the County reserves the right to add to the resultant agreements the services, c descriptions, rates, etc. by way of a contract addendum. Services covered by this agreement include, but are not limited to: N 0 1. Adult Day Care: A program of therapeutic social and health activities and services provided to adults who have functional M impairments, in a protective environment that provides as non -institutional an environment as possible. .2 2. Chore: Performance of routine house or and tasks including such jobs as seasonal cleaning, and work lifting and moving Y g J g, Y � g g 0 U) y furniture, appliances, or heavy objects, household repairs which do not require a permit or specialist, and household maintenance. Q qV ti 3. Enhanced Chore: This service is beyond the scope of chore due to the level of service needed. The service includes a more 00 intensified, thorough cleaning to address more demanding circumstances. c m 4. Homemaking: Specific home management duties including housekeeping, laundry, cleaning refrigerators, clothing repair, minor E home repairs, assistance with budgeting and paying bills, client transportation, meal planning and preparation, shopping assistance, U and routine house -hold activities by a trained homemaker. Q 5. Personal Care: Assistance with eating, dressing, personal hygiene and other activities of daily living. This service may include assistance with meal preparation, housekeeping chores such as bed making, dusting, and vacuuming incidental to the care furnished or essential to the health and welfare of the individual. Personal care can include accompanying the client to clinics, physician office visits, or trips for the purpose of health care provided that the client does not require special medical transportation. Personal care can also include shopping assistance to purchase food, clothing, and other items needed for the client's personal care needs. 6. In Home Respite: Relief or rest for a primary caregiver from the constant/continued supervision, companionship, therapeutic and/or personal care, of a functionally impaired older person for a specified period of time. 7. Skilled Nursing: Part-time or intermittent nursing care administered to an individual by a licensed practical nurse, registered nurse, or advanced registered nurse practitioner, in the client's place of residence, pursuant to a care plan approved by a licensed physician. 8. Emergency Alert Response Services: Emergency alert/response service is defined as a community based electronic surveillance Packet Pg. 582 16.D.5.a service which monitors the frail homebound elder by means of an electronic communication link with a response center. 9. Specialized Medical Equipment, Services, and Supplies: Adaptive devices, controls, appliances, or services, which enable individuals to increase their ability to perform activities of daily living and repair of such services which may include: dentures, walkers, reaching devices, bedside commodes, telephone amplifiers, touch lamps, adaptive eating equipment, glasses, hearing aids, and other mechanical or non -mechanical, electronic, and non -electronic adaptive devices. Supplies may include such things as adult briefs, bed pads, oxygen or nutritional supplements. 10. Facility Respite: 24-hour care in a State of Florida Licensed Nursing home. 11. Establish protocols for contacting CHS Case Managers in emergency or unusual circumstances and include the documentation requirements (oral and written) in the Service Provider Application. 12. Provide disaster response protocols, plans and services: In the event of a natural disaster (hurricane, tropical storm, tornado, flood, heat wave, etc.), the provider will have staff available to serve those clients in critical need of services, as designated by the CHS Case Managers. 13. Establish a client grievance process: Each service provider agency must have a policy addressing client grievances and/or 2 complaints. -0a c m 14. Establish and provide staff training: All services provided with funding from DOEA require service delivery personnel to have 3 general pre -service orientation and training specific to the service being provided. Lead Agencies are responsible for provision of the pre -service training (on program and billing requirements, in particular) for all paid staff, volunteer staff and assigned staff of service Z providers. o ti Pre -service orientation must also include: 00 • An overview of the aging process • An overview of the aging network U_ • Communication techniques with the elderly • Observation of abuse, neglect, exploitation and incident reporting N • Local agency service procedures and protocol c • Client confidentiality cD NOTE: All "hands-on" service personnel must receive training emphasizing the necessity of Universal Precautions. Home Health 04 Aides must have documentation of successful completion of 40 hours required training, and CNAs must have on file a copy of their o State of Florida certification. In-service training hours and topics are to be provided at the discretion of the service provider agency and shall meet state requirements. 15. Compile and report program service delivery statistics and other data as identified by CHS. This may be required to be provided 0 N in an electronic format at the choosing of CHS. These are reported to the Area Agency on Aging and Department of Elder Affairs in 0 accordance with the reporting requirements developed by the Department. Lead agencies are responsible for entry of data in the Client Information and Registration Tracking System (CIRTS), which generates payment to the service provider agency. Therefore, 00 service provider agencies are required to provide Lead Agencies with correct and timely service data to comply with these requirements. Timely submission is no later than noon on Wednesday of the week following the week services are performed c (service week defined as Monday through Sunday). E z 16. Maintain complete and accurate records: Service delivery logs, at a minimum, must be legible and contain the name of client, type(s) of services and date(s) and hour(s) of delivery. The client/caregiver must sign the log at the time of each service visit. The Q service worker must sign and date the log upon completion and submit it to the service provider agency. Provide complete, clear and accurate invoices: Weekly invoices, which may be required to be provided electronically in a system provided by CHS, must be submitted by noon on the Wednesday following the week that the service was provided and shall include service provided. The service week is defined as Monday through Sunday. Monthly reporting requirements for CIRTS dictate that all client and service data for the previous month to be entered into CIRTS by the 1 Oth day of the month. Collier County "Services for Seniors" will coordinate with vendors to determine due dates for invoices. This will ensure compliance with DOEA reporting requirements. Failure to record or report units of service will result in nonpayment (or delayed payment) for such services. Data required on weekly invoices and weekly timesheets include: • Vendor name • Vendor address • Vendor telephone number • Client name 4 Packet Pg. 583 16.D.5.a • Service Provider employee who delivered the service(s) • Services ordered and services delivered date • Number of service hours, cost per hour and total cost • Person preparing the report and the date it was prepared • Weekly timesheets signed and dated by the client and Service Provider employee • Additional information as determined by CHS 17. Prepare for annual on -site compliance audits by CHS or members of the Collier County staff as directed by the CHS or grant requirements. REQUEST FOR PROPOSAL (RFP) PROCESS 1.1 The Proposers will submit a qualifications proposal which will be scored based on the criteria in Evaluation Criteria for Development of Shortlist, which will be the basis for short -listing firms. The Proposers will need to meet the minimum requirements outlined herein in order for their proposal to be evaluated and scored by the COUNTY. The COUNTY will then score and rank the firms and enter into negotiations with the top ranked firm to establish cost for the services needed. The COUNTY reserves the right to issue an invitation for oral presentations to obtain L additional information after scoring and before the final ranking. With successful negotiations, a contract will be developed with 0 the selected firm, based on the negotiated price and scope of services and submitted for approval by the Board of County m Commissioners. > 3 1.2 The COUNTY will use a Selection Committee in the Request for Proposal selection process. m z 1.3 The intent of the scoring of the proposal is for respondents to indicate their interest, relevant experience, financial capability, c staffing and organizational structure. ti 1.4 The intent of the oral presentations, if deemed necessary, is to provide the vendors with a venue where they can conduct 06 discussions with the Selection Committee to clarify questions and concerns before providing a final rank. a U. 1.5 Based upon a review of these proposals, the COUNTY will rank the Proposers based on the discussion and clarifying questions on their approach and related criteria, and then negotiate in good faith an Agreement with the top ranked Proposer. N 1.6 If, in the sole judgment of the COUNTY, a contract cannot be successfully negotiated with the top -ranked firm, negotiations o with that firm will be formally terminated and negotiations shall begin with the firm ranked second. If a contract cannot be successfully negotiated with the firm ranked second, negotiations with that firm will be formally terminated and negotiations V shall begin with the third ranked firm, and so on. The COUNTY reserves the right to negotiate any element of the proposals in the best interest of the COUNTY. C M RESPONSE FORMAT AND EVALUATION CRITERIA FOR DEVELOPMENT OF SHORTLIST: 0 1.7 For the development of a shortlist, this evaluation criterion will be utilized by the COUNTY'S Selection Committee to score CO each proposal. Proposers are encouraged to keep their submittals concise and to include a minimum of marketing materials. c Proposals must address the following criteria: � ti Evaluation Criteria Maximum Points w l . Cover Letter / Management Summary 5 Points 2. Organizational Capabilities and Experience 20 Points E 3. Financial and Human Resources Capabilities 20 Points 4. General Service Delivery 25 Points Q 5. Acceptance of Cost 20 Points 6. Cost of Services to the County 10 Points TOTAL POSSIBLE POINTS 100 Points Tie Breaker: In the event of a tie at final ranking, award shall be made to the proposer with the lower volume of work previously awarded. Volume of work shall be calculated based upon total dollars paid to the proposer in the twenty-four (24) months prior to the RFP submittal deadline. Payment information will be retrieved from the County's financial system of record. The tie breaking procedure is only applied in the final ranking step of the selection process and is invoked by the Procurement Services Division Director or designee. In the event a tie still exists, selection will be determined based on random selection by the Procurement Services Director before at least three (3) witnesses. Each criterion and methodology for scoring is further described below. Packet Pg. 584 16.D.5.a ***Proposals must be assembled, at minimum, in the order of the Evaluation Criteria listed or Vour proposal may be deemed non -responsive*** EVALUATION CRITERIA NO. 1: COVER LETTER/MANAGEMENT SUMMARY (5 Total Points) Provide a cover letter, signed by an authorized officer of the firm, indicating the underlying philosophy of the firm in providing the services stated herein. Include the name(s), telephone number(s) and email(s) of the authorized contact person(s) concerning proposal. Submission of a signed Proposal is Vendor's certification that the Vendor will accept any awards as a result of this RFP. Submit proposer's Agency for Health Card Administration (AHCA) Certification: If certification is not provided at time of proposal submission, the firm will be deemed non -responsive. Indicate by selecting any one, or multiple services which the proposer is interested in providing to the County (descriptive information is outlined in the above scope of work. Item Services Interested in Providing Service (Place X) Not Interested in Providing Service (Place X) 1 Adult Day Care 2 Chore 3 Chore (Enhanced) 4 Homemaking 5 Personal Care 6 Respite (In -home) 7 Skilled Nursing S Emergency Alert Response Services EARS 9 Specialized Medical Equipment, Services, and Supplies 10 Respite (Facility Based) EVALUATION CRITERIA NO. 2: ORGANIZATIONAL CAPABILITIES AND EXPERIENCE (20 Total Points) Complete each of the items below in the format requested and submit evidence of documentations where indicated. Proposers who do not complete in the format indicated below may be deemed non -responsive. Yes/No 1. The proposer has received license from Agency for Health Care Administration (AHCA). Provide evidence of license. 2. The proposer has by-laws which describe how business will be conducted. 3. The proposer has the appropriate license for the services it intends to rovide to Collier County. Provide license evidence. 4. Board members are required to sign a conflict of interest statement. 5. The proposer has a written business plan that is updated regularly. N c 0 M 2 0 Cn W 0 ti ti 00 c d E z U 0 Q 6 Packet Pg. 585 16.D.5.a 6. Organizational Chart: Proposer has to provide a copy of the organizational chart indicating lines of authority and permanent and full-time positions. Provide evidence. 7. Total number of years that the proposer has been in business. 8. Proposer has supervisory staff on call 24 hours per day/ 365 days per year. 9. roposer's Owner/Operator license has never been denied, suspended or evoked by Medicare, Medicaid, any Federal and/or any State Agency. If es, please attach a letter or explanation. The County requests that the vendor submits no fewer than three (3) and no more than ten (10) completed reference forms from clients during a period of the last 5 years whose services provided are of a similar nature to this solicitation as a part of their proposal. Provide information on the services completed by the Proposer that best represent services of similar size, scope and complexity of this scope of work using Form 5 — Reference Questionnaire. Proposers may include two (2) additional pages for each reference to illustrate aspects of the completed services that provides the information to assess the experience of the Proposer on relevant work. EVALUATION CRITERIA NO 3: FINANCIAL AND HUMAN RESOURCES CAPABILITIES (20 Total Points) Complete each of the items below in the format requested and submit evidence of documentations where indicated. Proposers who do not complete in the format indicated below may be deemed non -responsive. Yes/No I Proposer maintains daily, monthly and annual financial records of payroll, benefits, operating and capital equipment. 2. Proposer prepares annual 1099 forms for all employees. 3. Proposer has a certified public accountant or an independent accounting/auditing firm to prepare financial records. 4. Proposer uses an accounting software product. 5. Proposer has an accounting staff produce monthly financial statements. 6. Proposer has annual audit completed. Provide copy recently completed. 7. Proposer has written recruitment policy. 8. Proposer provides criminal background check for employees on this contract. 9. Proposer conducts formal orientation for all new staff. 10. Proposer distributes written personnel policies to staff. Q 7 Packet Pg. 586 16.D.5.a 11. Proposer distributes written personnel policies. 12. orkman's Compensation Policy information clearly posted for staff. 13. Proposer maintains written, signed Job Descriptions. 14. roposer's employees are evaluated at least annually in writing. 15. Proposer has written hiring practices. 16. Proposer has written retention policies. 17. Proposer has formal progressive disciplinary procedures. 18. Proposer has written policies regarding theft and falsification of time sheets 19. Proposer has policy to prevent fraud and formalized methods to report suspected incidents. 20. Agency has written disaster plan. 21. Proposer agrees to utilize electronic means to submit documentation, as determined by CHS, to include invoices. EVALUATION CRITERIA NO 4: GENERAL SERVICE DELIVERY (25 total points) Complete each of the items below in the format requested and submit evidence of documentations where indicated. Proposers who do not complete in the format indicated below may be deemed non -responsive. Yes/No 1. Proposer maintains a formal record of in -services, available for review. 2. Proposer maintains copies of training schedule for last year, available for review. 3. Proposer maintains sign in sheets for in-service training, available for review. 4. Proposer maintains evidence of attendance and completion in employee files. 5. Proposer has copies on file of training materials. N c 0 M .2 0 0 ti ti 00 c d E t 0 Q Packet Pg. 587 16.D.5.a 6. Proposer has written Quality Assurance plan. Provide plan. 7. Proposer surveys clients for satisfaction in writing at least once per year. Provide sample. 8. Proposer analyzes surveys and uses reports for transmission to administration and to employees. 9. Proposer incorporates results of Quality Assurance activities to annual plan. 10. Proposer has Quality Assurance Committee as standing subcommittee of Board 11. Proposer has written policy for reporting incidents. Provide copy and a sample of the incident report. 12. Proposer has formal training for staff regarding reporting of suspected cases of abuse or neglect. 13. Proposer maintains anti -discrimination policies related to service consumer. 14. Proposer has written policy regarding consumers rights. 15. Proposer has written system for registering consumers' complaints. 16. Proposer has written policy to follow up on consumers' complaints. 17. Proposer has written description of how service is delivered from point of request through provision and termination. Provide copy. 18. Proposer has written procedures for assuring confidentiality of consumer records. EVALUATION CRITERIA NO. 5: ACCEPTANCE OF COST (20 Total Points) In this criterion you will be provided a list of services needed by the County. Those services with rates, In -kind match and Cost already completed are standard rates in which you will be required to accept. Please sign as an acceptance to the rates if you deem these standard rates to be acceptable. I accept the standard contract rates listed below. Cost Per Service In -kind 10% Reimbursement Unit (Cost your Match (Grant Rate Per Unit Item Services Grant Service Unit company charges for Amount your (Amount the County will the service) company will be reimburse your paying) company for a given service) 1. Skilled Nursing CCE, OAA Per Hour $40.00 $4.00 $36.00 N Q 9 Packet Pg. 588 16.D.5.a 2. Enhance Chore ADI, CCE, OAA Per Hour $40.00 $4.00 $36. 3. Respite (In -Home) ADI, CCE, OAA Per Hour $24.11 $2.41 $21.70 4. Respite (Facility Based) ADI, CCE, OAA Daily Rate $225.00 0 $225.00 5. Personal Care ADI, CCE, OAA Per Hour $24.11 $2.41 $21.70 6. Chore ADI, CCE, OAA Per Hour $24.00 $2.40 $21.60 7. Homemaking ADI, CCE, OAA Per Hour $23.33 $2.33 $21.00 8. Adult Day Care ADI, CCE, OAA Per Hour $13.89 $1.39 $12.50 9. Emergency Alert Response ADI, CCE, OAA Per Day $1.09 $0.11 $0.98 EVALUATION CRITERIA NO. 6: COST OF SERVICES TO THE COUNTY (10 Total Points) In this tab, insert your cost for the services listed below. Reimbursement Cost Per Service In -kind 10% Rate Per Unit Unit (Cost your Match (Grant (Amount the Item Services Grant Service company charges Amount your County will Unit for the service) company will be reimburse your paying) company for a given service) Specialized Medical ADI, CCE, OAA Per Episode 10. Equipment, Services, and Supplies VENDOR CHECKLIST ***Vendor should check off each of the following items as the necessary action is completed (please see, Vendor Check List)*** N 0 N N c 0 M .2 0 Cn W 0 ti ti ao c d E t 0 Q 10 Packet Pg. 589 16.D.5.e Collier County Administrative Sendces Division Procurement Services RFP #: 18-74705 Title: Services for Seniors Selection Committee Final Ranking Name of Firm Laurie Beard Maria Pizarro Heather Louise Pelletier Wendy Klopf Total Scores Selection Committee Bilodeau Final Rank Hemo Medika Care LLC dba Harmonia The Club 98 90 98 90 73 449.00 1.0000 A Better Solution Home Care dba Sunshine Health Care Services, LLC 80 80 98 95 72 425.00 2.0000 Home Health Care Resources Corp 82 75 95 90 73 415.00 3.0000 MAR-J-Medical Supply, Inc. 75 80 87 85 71 398.00 4.0000 Procurement Professional I Ba vbvwa, La rw► 10/6/2021 Q Page 1 of 1 Packet Pg. 590 DocuSign Envelope ID: D2E5647E-04E1-426C-8F57-68385356DB8A 001[iev County Administrative Services Department Procurement Services Division Notice of Recommended Award Solicitation: 18-74705 Title: Services for Seniors Due Date and Time: August 10, 2021 @ 3:00 pm Respondents: Company Name City County State Final Ranking Responsive/Responsible Hemo Medika Care LLC dba Naples Collier FL 1 Yes/Yes Harmonia The Club A Better Solution Home Sarasota Sarasota FL 2 Yes/Yes Care dba Sunshine Health Care Services, LLC Home Health Care Port Charlotte Charlotte FL 3 Yes/Yes Resources Corp MAR-J-Medical Supply, Inc. Boca Raton Palm Beach FL 4 Yes/Yes Utilized Local Vendor Preference: Yes 0 No - Recommended Vendors) For Award: On July 7, 2021, the Procurement Services Division released Request for Proposal ("RFP") 18-7470S for Services for Seniors to twenty-six thousand eighteen (26,018) vendors. Eighty-two (82) bid packages were viewed, and four (4) submittals were received by the August 10, 2021 deadline. Three (3) of the proposers were contacted to resolve minor irregularities due to incomplete documents. The Selection Committee met on October 6, 2021. After review of the proposals and deliberation, the Committee scored the proposals and ranked the firms as shown above. Staff has recommended to award to the top three (3) firms: - Hemo Medika Care LLC dba Harmonia The Club - A Better Solution Home Care dba Sunshine Health Care Services, LLC - Home Health Care Resources Corp Contract Driven = Purchase Order Driven 0 Required Signatures DocuSigned by: Project Manager: Louise Pelletier I 1.6wSt, PaLt itr 1V/15/LVL1 Procurement Strategist: Barbara Lance I &"M� '-tanc , 10/13/2021 14490C19A3D448F... Procurement Services Director: 5 DocuSigned by: J� H Sandra Herrera 10/13/2021 Date Packet Pg. 591 16.D.5.g FIXED FEE PROFESSIONAL SERVICE AGREEMENT # 18-7470S for SERVICES FOR SENIORS THIS AGREEMENT, made and entered into on this day of , 20_, by and between Sunshine Health Care Services, LLC d/b/a A Better Solution of Sarasota authorized to do business in the State of Florida, whose business address is 5600 Bee Ridge Road, Suite B, Sarasota, FL 34233 —,(the "Contractor") and Collier County, a political subdivision of the State of Florida, (the "County"): WITNESS ETH: The Agreement shall commence upon the date of Board approval and terminating on December 10, 2022 or until all outstanding Purchase Order(s) issued prior to the expiration of the Agreement period have been completed or terminated. The County may, at its discretion and with the consent of the Contractor, renew the Agreement under all of the terms and conditions contained in this Agreement for two ( 2 ) additional one ( 1 ) year(s) periods. The County shall give the Contractor written notice of the County's intention to renew the Agreement term prior to the end of the Agreement term then in effect. The County Manager, or his designee, may, at his discretion, extend the Agreement under all of the terms and conditions contained in this Agreement for up to one hundred and eighty (180) days. The County Manager, or his designee, shall give the Contractor written notice of the County's intention to extend the Agreement term prior to the end of the Agreement term then in effect. 2. COMMENCEMENT OF SERVICES. The Contractor shall commence the work y upon issuance of a FEI Purchase Order ❑ ❑ WeFk4)rder. L 3. STATEMENT OF WORK. The Contractor shall provide services in accordance m with the terms and conditions of ■❑ Request for Proposal (RFP) ❑ 4w#atk), - Q Bid -(ITB) ❑ 8the� # 18-7470S including all Attachment(s), Exhibit(s) and Addenda and the Contractor's proposal referred to herein and made an integral part of this co r Agreement. W IN The Contractor shall also provide services in accordance with Exhibit A — E Scope of Services attached hereto. o a Page 1 of 15 Fixed Price Professional Service Agreement 2021_Ver. I ✓ , Packet Pg. 592 16.D.5.g 3.1 This Agreement contains the entire understanding between the parties and any modifications to this Agreement shall be mutually agreed upon in writing by the Parties, in compliance with the County's Procurement Ordinance, as amended, and Procurement Procedures in effect at the time such services are authorized. 3.2 The execution of this Agreement shall not be a commitment to the Contractor to order any minimum or maximum amount. The County shall order items/services as required but makes no guarantee as to the quantity, number, type or distribution of items/services that will be ordered or required by this Agreement. 4. THE AGREEMENT SUM. The County shall pay the Contractor for the performance of this Agreement based on Exhibit B- Fee Schedule, attached hereto and the price methodology as defined in Section 4.1. Payment will be made upon receipt of a proper invoice and upon approval by the County's Contract Administrative Agent/Project Manager, and in compliance with Chapter 218, Fla. Stats., otherwise known as the "Local Government Prompt Payment Act". 4.1 Price Methodology (as selected below): DUE FN� Time and Materials: The County agrees to pay the contractor for the amount of labor time spent by the contractor's employees and subcontractors to perform the work (number of hours times hourly rate), and for materials and equipment o used in the project (cost of materials plus the contractor's markup). This = methodology is generally used in projects in which it is not possible to accurately o estimate the size of the project, or when it is expected that the project requirements would most likely change. As a general business practice, these y contracts include back-up documentation of costs; invoices would include number of hours worked and billing rate by position (and not company (or subcontractor) co or payroll records), material or equipment invoices, and other a reimbursable documentation for the project. 0 r C i t V f0 r 4.2 Any County agency may obtain services under this Agreement, provided a sufficient funds are included in their budget(s). Page 2 of 15 Fixed Price Professional Service Agreement 2021_Ver.1 Packet Pg. 593 16.D.5.g 4.3 Payments will be made for services furnished, delivered, and accepted, upon receipt and approval of invoices submitted on the date of services or within six (6) months after completion of the Agreement. Any untimely submission of invoices beyond the specified deadline period is subject to non-payment under the legal doctrine of "laches" as untimely submitted. Time shall be deemed of the essence with respect to the timely submission of invoices under this Agreement. 4.4 The County, or any duly authorized agents or representatives of the County, shall have the right to conduct an audit of Contractor's books and records to verify the accuracy of the Contractor's claim with respect to Contractor's costs associated with any Payment Application, Change Order, or Work Directive Change. ems expenses sh-all limited to the-felievVinq 0 �IephGne—leng and ++ ++ """" M m a 5. SALES TAX. Contractor shall pay all sales, consumer, use and other similar taxes associated with the Work or portions thereof, which are applicable during the co performance of the Work. Collier County, Florida as a political subdivision of the State of Florida, is exempt from the payment of Florida sales tax to its vendors under Chapter 212, Florida Statutes, Certificate of Exemption # 85-8015966531 C. E o r a Page 3 of 15 Fixed Price Professional Service Agreement 2021_Ver.1 Packet Pg. 594 16.D.5.g 6. NOTICES. All notices from the County to the Contractor shall be deemed duly served if mailed or emailed to the Contractor at the following: Company Name: Address: Authorized Agent: Attention Name & Title: Telephone: E-Mail(s): Sunshine Health Care Services, LLC ........__. 5600 Bee Ridge Rd, Suite B Sarasota, FL 34233 Barbara Cogswell, Manager Daniel Dellapina, CFO (941) 906-1881 bcogswell@abs.care; ddellapina@abs.care All Notices from the Contractor to the County shall be deemed duly served if mailed or emailed to the County to: Board of County Commissioners for Collier County, Florida Division Director: Kristi Sonntag Division Name: Community and Human Services Division Address: 3339 East Tamiami Trail, Suite 211 Naples, FL 34112 Administrative Agent/PM: Wendy Klopf, Grants Coordinator > Telephone: (239) 252-29001 E-Mail(s): Wendy.Klopf@colliercountyfl.gov c 0 The Contractor and the County may change the above mailing address at any time upon giving the other party written notification. All notices under this Agreement must be in writing. E 7. NO PARTNERSHIP. Nothing herein contained shall create or be construed as x° creating a partnership between the County and the Contractor or to constitute the o Contractor as an agent of the County. 0 8. PERMITS: LICENSES: TAXES. In compliance with Section 218.80, F.S., all L permits necessary for the prosecution of the Work shall be obtained by the Contractor. The County will not be obligated to pay for any permits obtained by m Subcontractors. Q 0 Payment for all such permits issued by the County shall be processed internally by the County. All non -County permits necessary for the prosecution of the Work co shall be procured and paid for by the Contractor. The Contractor shall also be solely responsible for payment of any and all taxes levied on the Contractor. In addition, the Contractor shall comply with all rules, regulations and laws of Collier E County, the State of Florida, or the U. S. Government now in force or hereafter adopted. The Contractor agrees to comply with all laws governing the a responsibility of an employer with respect to persons employed by the Contractor. Page 4 of 15 Fixed Price Professional Service Agreement 2021_Ver.I ;F1 Packet Pg. 595 16.D.5.g 9. NO IMPROPER USE. The Contractor will not use, nor suffer or permit any person to use in any manner whatsoever, County facilities for any improper, immoral or offensive purpose, or for any purpose in violation of any federal, state, county or municipal ordinance, rule, order or regulation, or of any governmental rule or regulation now in effect or hereafter enacted or adopted. In the event of such violation by the Contractor or if the County or its authorized representative shall deem any conduct on the part of the Contractor to be objectionable or improper, the County shall have the right to suspend the Agreement of the Contractor. Should the Contractor fail to correct any such violation, conduct, or practice to the satisfaction of the County within twenty-four (24) hours after receiving notice of such violation, conduct, or practice, such suspension to continue until the violation is cured. The Contractor further agrees not to commence operation during the suspension period until the violation has been corrected to the satisfaction of the County. 10. TERMINATION. Should the Contractor be found to have failed to perform his services in a manner satisfactory to the County as per this Agreement, the County may terminate said Agreement for cause; further the County may terminate this Agreement for convenience with a thirty (30) day written notice. The County shall be the sole judge of non-performance. In the event that the County terminates this Agreement, Contractor's recovery against the County shall be limited to that portion of the Agreement Amount earned through the date of termination. The Contractor shall not be entitled to any other or further recovery against the County, including, but not limited to, any damages or any anticipated profit on portions of the services not performed. 11. NO DISCRIMINATION. The Contractor agrees that there shall be no discrimination as to race, sex, color, creed or national origin. 12. INSURANCE. The Contractor shall provide insurance as follows: A. 0 Commercial General Liability: Coverage shall have minimum limits of $1,000,0000 Per Occurrence, $ 2,000,000 aggregate for Bodily Injury Liability and Property Damage Liability. This shall include Premises and Operations; Independent Contractors; Products and Completed Operations and Contractual Liability. B. 0 Business Auto Liability: Coverage shall have minimum limits of $ 500,000 Per Occurrence, Combined Single Limit for Bodily Injury Liability and Property Damage Liability. This shall include: Owned Vehicles, Hired and co Non -Owned Vehicles and Employee Non -Ownership. aD C. 0 Workers' Compensation: Insurance covering all employees meeting Statutory Limits in compliance with the applicable state and federal laws. a The coverage must include Employers' Liability with a minimum limit of $1,000,000 for each accident. Page 5 of 15 Fixed Price Professional Service Agreement 2021_Ver.I Packet Pg. 596 16.D.5.g D. 0 Professional Liability: Shall be maintained by the Contractor to ensure its legal liability for claims arising out of the performance of professional services under this Agreement. Contractor waives its right of recovery against County as to any claims under this insurance. Such insurance shall have limits of not less than $1,000,000 each claim and aggregate. & ❑ Cybefi Geveracde shalt ha-ve 4m+t6 of rd!- �7Gr vvv 1FF8RGe. of GUFrenee. G, ❑ �4- ❑ LW1111ililil rentan's OOG ir,F row i t- Act): Coverage shall have minimum limits of -000 $ per occurrence. L. FM-] Crime/Employee Dishonesty (other): Coverage shall have minimum limits of $ 50,000 per occurrence. 0 U Special Requirements: Collier County Board of County Commissioners, OR, Board of County Commissioners in Collier County, OR, Collier County Government shall be listed as the Certificate Holder and included as an "Additional Insured" on the Insurance Certificate for Commercial General o Liability where required. This insurance shall be primary and non-contributory with = respect to any other insurance maintained by, or available for the benefit of, the 0 Additional Insured and the Contractor's policy shall be endorsed accordingly. 0 Current, valid insurance policies meeting the requirement herein identified shall be maintained by Contractor during the duration of this Agreement. The Contractor co provide County with certificates of insurance meeting the required insurance a provisions. Renewal certificates shall be sent to the County thirty (30) days prior 4 to any expiration date. Coverage afforded under the policies will not be canceled or allowed to expire until the greater of: thirty (30) days prior written notice, or in accordance with policy provisions. Contractor shall also notify County, in a like co manner, within twenty-four (24) hours after receipt, of any notices of expiration, cancellation, non -renewal or material change in coverage or limits received by E Contractor from its insurer, and nothing contained herein shall relieve Contractor of this requirement to provide notice. r Contractor shall ensure that all subcontractors comply with the same insurance a requirements that the Contractor is required to meet. Page 6 of 15 Fixed Price Professional Service Agreement 2021_Ver.l Packet Pg. 597 16.D.5.g 13. INDEMNIFICATION. To the maximum extent permitted by Florida law, the Contractor shall defend, indemnify and hold harmless Collier County, its officers and employees from any and all liabilities, damages, losses and costs, including, but not limited to, reasonable attorneys' fees and paralegals' fees, whether resulting from any claimed breach of this Agreement by Contractor, any statutory or regulatory violations, or from personal injury, property damage, direct or consequential damages, or economic loss, to the extent caused by the negligence, recklessness, or intentionally wrongful conduct of the Contractor or anyone employed or utilized by the Contractor in the performance of this Agreement. This indemnification obligation shall not be construed to negate, abridge or reduce any other rights or remedies which otherwise may be available to an indemnified party or person described in this paragraph. This section does not pertain to any incident arising from the sole negligence of Collier County. 13.1 The duty to defend under this Article 13 is independent and separate from the duty to indemnify, and the duty to defend exists regardless of any ultimate liability of the Contractor, County and any indemnified party. The duty to defend arises immediately upon presentation of a claim by any party and written notice of such claim being provided to Contractor. Contractor's obligation to indemnify and defend under this Article 13 will survive the expiration or earlier termination of this Agreement until it is determined by final judgment that an action against the County or an indemnified party for the matter indemnified hereunder is fully and finally barred by the applicable statute of limitations. 14. AGREEMENT ADMINISTRATION. This Agreement shall be administered on behalf of the County by the Community and Human Services Division 15. CONFLICT OF INTEREST. Contractor represents that it presently has no interest and shall acquire no interest, either direct or indirect, which would conflict in any manner with the performance of services required hereunder. Contractor further represents that no persons having any such interest shall be employed to perform those services. 16. COMPONENT PARTS OF THIS AGREEMENT. This Agreement consists of the 4) following component parts, all of which are as fully a part of the Agreement as if m herein set out verbatim: Contractor's Proposal, Insurance Certificate(s), RM-1 Exhibit Q A Scope of Services, Exhibit B Fee Schedule, R RFP/ ❑ IT43/ ❑ +t-- - l # 18-7470S including Exhibits, Attachments and Addenda/Addendum, ❑ subsequent quotes, and FE-1 Other Exhibit/Attachment: Federal Grant Provisions aD 17. APPLICABILITY. Sections corresponding to any checked box (0) will expressly apply to the terms of this Agreement. r a 18. SUBJECT TO APPROPRIATION. It is further understood and agreed by and between the parties herein that this Agreement is subject to appropriation by the Board of County Commissioners. Page 7 of 15 Fixed Price Professional Service Agreement 2021_Ver.1 Packet Pg. 598 16.D.5.g 19. PROHIBITION OF GIFTS TO COUNTY EMPLOYEES. No organization or individual shall offer or give, either directly or indirectly, any favor, gift, loan, fee, service or other item of value to any County employee, as set forth in Chapter 112, Part III, Florida Statutes, Collier County Ethics Ordinance No. 2004-05, as amended, and County Administrative Procedure 5311. Violation of this provision may result in one or more of the following consequences: a. Prohibition by the individual, firm, and/or any employee of the firm from contact with County staff for a specified period of time; b. Prohibition by the individual and/or firm from doing business with the County for a specified period of time, including but not limited to: submitting bids, RFP, and/or quotes; and, c. immediate termination of any Agreement held by the individual and/or firm for cause. 20. COMPLIANCE WITH LAWS. By executing and entering into this Agreement, the Contractor is formally acknowledging without exception or stipulation that it agrees to comply, at its own expense, with all federal, state and local laws, codes, statutes, ordinances, rules, regulations and requirements applicable to this Agreement, including but not limited to those dealing with the Immigration Reform and Control Act of 1986 as located at 8 U.S.C. 1324, et seq. and regulations relating thereto, as either may be amended; taxation, workers' compensation, equal employment and safety including, but not limited to, the Trench Safety Act, Chapter 553, Florida Statutes, and the Florida Public Records Law Chapter 119, if applicable, including specifically those contractual requirements at F.S. § 119.0701(2)(a)-(b) as stated as follows: IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT: Division of Communications, Government and Public Affairs 3299 Tamiami Trail East, Suite 102 Naples, FL 34112-5746 Telephone: (239) 252-8999 Email: PubiicRecordReguest@coIIiercountyfl.gov The Contractor must specifically comply with the Florida Public Records Law to: 1. Keep and maintain public records required by the public agency to perform the service. 2. Upon request from the public agency's custodian of public records, provide the public agency with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law. Page 8 of 15 Fixed Price Professional Service Agreement 2021_Ver.1 Packet Pg. 599 16.D.5.g 3. Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law for the duration of the contract term and following completion of the contract if the Contractor does not transfer the records to the public agency. 4. Upon completion of the contract, transfer, at no cost, to the public agency all public records in possession of the Contractor or keep and maintain public records required by the public agency to perform the service. If the Contractor transfers all public records to the public agency upon completion of the contract, the Contractor shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the Contractor keeps and maintains public records upon completion of the contract, the Contractor shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to the public agency, upon request from the public agency's custodian of public records, in a format that is compatible with the information technology systems of the public agency. If Contractor observes that the Contract Documents are at variance therewith, it shall promptly notify the County in writing. Failure by the Contractor to comply with the laws referenced herein shall constitute a breach of this Agreement and the County shall have the discretion to unilaterally terminate this Agreement immediately. 21. OFFER EXTENDED TO OTHER GOVERNMENTAL ENTITIES. Collier County encourages and agrees to the successful Contractor extending the pricing, terms and conditions of this solicitation or resultant Agreement to other governmental entities at the discretion of the successful Contractor. 22. AGREEMENT TERMS. If any portion of this Agreement is held to be void, invalid, or otherwise unenforceable, in whole or in part, the remaining portion of this Agreement shall remain in effect. 23. ADDITIONAL ITEMS/SERVICES. Additional items and/or services may be added to this Agreement in compliance with the Procurement Ordinance, as amended, and Procurement Procedures. 24. DISPUTE RESOLUTION. Prior to the initiation of any action or proceeding permitted by this Agreement to resolve disputes between the parties, the parties shall make a good faith effort to resolve any such disputes by negotiation. The negotiation shall be attended by representatives of Contractor with full decision -making authority and by co County's staff person who would make the presentation of any settlement reached during negotiations to County for approval. Failing resolution, and prior to the commencement of depositions in any litigation between the parties arising out of this Agreement, the parties shall attempt to resolve the dispute through Mediation before r an agreed -upon Circuit Court Mediator certified by the State of Florida. The mediation a shall be attended by representatives of Contractor with full decision -making authority and by County's staff person who would make the presentation of any settlement Page 9 of 15 Fixed Price Professional Service Agreement 2021_Ver. I Packet Pg. 611 16.D.5.g reached at mediation to County's board for approval. Should either party fail to submit to mediation as required hereunder, the other party may obtain a court order requiring mediation under section 44.102, Fla. Stat. 25. VENUE. Any suit or action brought by either party to this Agreement against the other party relating to or arising out of this Agreement must be brought in the appropriate federal or state courts in Collier County, Florida, which courts have sole and exclusive jurisdiction on all such matters. 24 ITM FMI AGREEMENT STAFFING. The Contractor's personnel and management to be utilized for this Agreement shall be knowledgeable in their areas of expertise. The County reserves the right to perform investigations as may be deemed necessary to ensure that competent persons will be utilized in the performance of the Agreement. The Contractor shall assign as many people as necessary to complete required services on a timely basis, and each person assigned shall be available for an amount of time adequate to meet required services. NO • ... . .... . ..... .... ., - -. . � ORDER OF PRECEDENCE (Grant Funded). In the event of any conflict between or among the terms of any of the Contract Documents and/or the County's Board CO approved Executive Summary, the terms of the Agreement shall take precedence over Q the terms of all other Contract Documents, except the terms of any Supplemental o Conditions shall take precedence over the Agreement. To the extent any conflict in the terms of the Contract Documents cannot be resolved by application of the CO Supplemental Conditions, if any, or the Agreement, the conflict shall be resolved by imposing the more strict or costly obligation under the Contract Documents upon the Contractor at County's discretion. �o 28. ASSIGNMENT. Contractor shall not assign this Agreement or any part thereof, without a the prior consent in writing of the County. Any attempt to assign or otherwise transfer this Agreement, or any part herein, without the County's consent, shall be void. If Contractor does, with approval, assign this Agreement or any part thereof, it shall Page 10 of 15 Fixed Price Professional Service Agreement 2021_Ver.I Packet Pg. 601 16.D.5.g require that its assignee be bound to it and to assume toward Contractor all of the obligations and responsibilities that Contractor has assumed toward the County. 29. SECURITY. The Contractor is required to comply with County Ordinance 2004-52, as amended. Background checks are valid for five (5) years and the Contractor shall be responsible for all associated costs. If required, Contractor shall be responsible for the costs of providing background checks by the Collier County Facilities Management Division for all employees that shall provide services to the County under this Agreement. This may include, but not be limited to, checking federal, state and local law enforcement records, including a state and FBI fingerprint check, credit reports, education, residence and employment verifications and other related records. Contractor shall be required to maintain records on each employee and make them available to the County for at least four (4) years. All of Contractor's employees and subcontractors must wear Collier County Government Identification badges at all times while performing services on County facilities and properties. Contractor ID badges are valid for one (1) year from the date of issuance and can be renewed each year at no cost to the Contractor during the time period in which their background check is valid, as discussed below. All technicians shall have on their shirts the name of the contractor's business. The Contractor shall immediately notify the Collier County Facilities Management Division via e-mail (DL-FMOPS@colliergov.net) whenever an employee assigned to Collier County separates from their employment. This notification is critical to ensure the continued security of Collier County facilities and systems. Failure to notify within four (4) hours of separation may result in a deduction of $500 per incident. (Intentionally left blank -signature page to follow) Page 11 of 15 Fixed Price Professional Service Agreement 2021_Ver. I Packet Pg. 612 16.D.5.g IN WITNESS WHEREOF, the parties hereto, by an authorized person or agent, have executed this Agreement on the date and year first written above. ATTEST: Crystal K. Kinzel, Clerk of Courts & Comptroller Dated: (SEAL) Contractor's Witnesses: Contractor's First / itness TType/prA wig nameT Conftctor's Second Witness �Iui C TTyp6lprint witness nameT Approved as to Form and Legality: County Attorney Print Name BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY, FLORIDA 13y: Chairman Sunshine Health Care Services, LLC dlbla A Better Solution of Sarasota Contractor By: �Nlzk,41,11614( Signature VI, f' t S I Page 12 of 15 Type/print signature��d titleT Fixed Price Professional Service Agreement 202I_Ver.1 0 r- 1* ti ao c m E U a r r Q Packet Pg. 603 16.D.5.g Exhibit A Scope of Services Fm-1 following this page (containing 3 page/s) ❑ this exhibit is not applicable Page 13 of 15 Fixed Price Professional Service Agreement 2021_Ver.1 Packet Pg. 604 16.D.5.g REQUEST FOR PROPOSAL (RFP) # 18-7470S "SERVICES FOR SENIORS" SCOPE OF SERVICES BACKGROUND The purpose of this Agreement is for home and community -based services, to be delivered to persons/clients sixty years and older under Older American's Act (OAA), Community Care for the Elderly (CCE) and Health Care for the Elderly (HCE), and to qualified persons/clients eighteen years or older under Alzheimer's Disease Initiative (ADI), within the geographic area of Collier County. Unless otherwise stated, minimum hours of availability are 7:00 a.m, to 5:00 p.m. Monday through Saturday, with the exception of federal and state holidays. Respite services and emergency services must be available 24 hours/day, 365 days/year if needed. Definitions, standards, and requirements of these services are included in the Department of Elder Affairs' Home and Community -Based Services Handbook (DOEA Handbook) link: http•//elderaffairs.state.fl.us/doea/nois.php DETAILED SCOPE OF WORK v The Contractor/s (also may be referred to as "Vendor" or "Provider") must adhere to the scope outlined herein, in addition N N to maintaining adherence with the guidelines set forth by the current DOEA Handbook. Lack of knowledge of all requirements of a service listed in the proposal SHALL NOT relieve the provider of liability and obligations under the resultant agreement. co L Collier County Community & Human Services (CHS) shall lead all service authorization and coordination under this -°a Agreement. In an effort to comply with the requirements of the OAA, ADI, CCE and HCE Programs, clients entering the service system will be assessed and prioritized by CHS. Upon determination of the service level to be provided, CHS >i will offer the client a listing of service vendors for the specific service(s) outlined within their care plan. L The client will be encouraged to pick a service provider of their choice and have the option of interviewing potential v service providers. Should the client not have a preference, CHS will select a service provider from the centralized provider d1 list, using a rotation basis (rotating to the next vendor on the list). In this manner, all service providers will be equally treated unless the client has a preference. CHS shall not endorse one service provider over another. v m E Upon the determination of the service, the service levels, and the selected vendor, CHS will contact the vendor agency, _ and authorize the service, number of hours, and frequency. In keeping with the state policy of client choice of service = providers, Collier County does not guarantee a minimum or maximum number of clients that will be referred, nor a minimum or maximum number of service hours that will be requested during the contract period. ' 0 co Should a client later indicate dissatisfaction with the chosen service provider, they will again be offered their choice of 4, provider. CHS shall send the agreed -upon Service Authorization to the chosen provider. These "service authorizations" m or "service orders" must contain necessary client information, such as street address, telephone number, and services or m a items needed, as well as the name and telephone number of the CHS case manager authorizing the service. In order to meet client needs, some services may be required outside of normal office hours (8:00 AM to 5:00 PM, Monday - Friday). o CHS reserves the right to request adding additional service providers throughout the agreement period. The County may C; do so through a competitive and publicly announced selection process, which shall be coordinated through the County's Procurement Department. Services shall be provided in the manner described in the most current DOEA manual and d outlined herein. Should funding for additional Senior Services be identified, the County reserves the right to add to the E resultant agreements the services, descriptions, rates, etc. by way of a contract addendum. Services covered by this agreement include, but are not limited to: Q 1. Adult Day Care: A program of therapeutic social and health activities and services provided to adults who have functional impairments, in a protective environment that provides as non -institutional an environment as possible. Pagel of 3 Exhibit A — Scope of Services Packet Pg. 605 16.D.5.g REQUEST FOR PROPOSAL (RFP) # 18-7470S "SERVICES FOR SENIORS" 2. Chore: Performance of routine house or yard tasks including such jobs as seasonal cleaning, yard work, lifting and moving furniture, appliances, or heavy objects, household repairs which do not require a permit or specialist, and household maintenance. 3. Enhanced Chore: This service is beyond the scope of chore due to the level of service needed. The service includes a more intensified, thorough cleaning to address more demanding circumstances. 4. Homemaking: Specific home management duties including housekeeping, laundry, cleaning refrigerators, clothing repair, minor home repairs, assistance with budgeting and paying bills, client transportation, meal planning and preparation, shopping assistance, and routine house -hold activities by a trained homemaker. 5. Personal Care: Assistance with eating, dressing, personal hygiene and other activities of daily living. This service may include assistance with meal preparation, housekeeping chores such as bed making, dusting, and vacuuming incidental to the care furnished or essential to the health and welfare of the individual. Personal care can include accompanying the client to clinics, physician office visits, or trips for the purpose of health care provided that the client does not require special medical transportation. Personal care can also include shopping assistance to purchase food, clothing, and other items needed for the client's personal care needs. 6. In Home Respite: Relief or rest for a primary caregiver from the constant/continued supervision, companionship, therapeutic and/or personal care, of a functionally impaired older person for a specified period of time. 7. Skilled Nursing: Part-time or intermittent nursing care administered to an individual by a licensed practical nurse, registered nurse, or advanced registered nurse practitioner, in the client's place of residence, pursuant to a care plan approved by a licensed physician. 8. Emergency Alert Response Services: Emergency alert/response service is defined as a community based electronic surveillance service which monitors the frail homebound elder by means of an electronic communication link with a response center. 9. Specialized Medical Equipment, Services, and Supplies: Adaptive devices, controls, appliances, or services, which enable individuals to increase their ability to perform activities of daily living and repair of such services which may include: dentures, walkers, reaching devices, bedside commodes, telephone amplifiers, touch lamps, adaptive eating equipment, glasses, hearing aids, and other mechanical or non -mechanical, electronic, and non -electronic adaptive devices. Supplies may include such things as adult briefs, bed pads, oxygen or nutritional supplements. 10. Facility Respite: 24-hour care in a State of Florida Licensed Nursing home. 0 co 11. Establish protocols for contacting CHS Case Managers in emergency or unusual circumstances and include the (, documentation requirements (oral and written) in the Service Provider Application. m 12. Provide disaster response protocols, plans and services: In the event of a natural disaster (hurricane, tropical storm, a tornado, flood, heat wave, etc.), the provider will have staff available to serve those clients in critical need of services, as o designated by the CHS Case Managers. 00 13. Establish a client grievance process: Each service provider agency must have a policy addressing client grievances and/or complaints.CD E 14. Establish and provide staff training: All services provided with funding from DOEA require service delivery personnel to have general pre -service orientation and training specific to the service being provided. Lead Agencies are responsible for provision of the pre -service training (on program and billing requirements, in particular) for all paid staff, Q volunteer staff and assigned staff of service providers. Page 2 of 3 Exhibit A — Scope of Services f Packet Pg. 606 16.D.5.g REQUEST FOR PROPOSAL (RFP) # 18-7470S "SERVICES FOR SENIORS" Pre -service orientation must also include: • An overview of the aging process • An overview of the aging network • Communication techniques with the elderly • Observation of abuse, neglect, exploitation and incident reporting • Local agency service procedures and protocol • Client confidentiality NOTE: All "hands-on" service personnel must receive training emphasizing the necessity of Universal Precautions. Home Health Aides must have documentation of successful completion of 40 hours required training, and CNAs must have on file a copy of their State of Florida certification. In-service training hours and topics are to be provided at the discretion of the service provider agency and shall meet state requirements. 15. Compile and report program service delivery statistics and other data as identified by CHS. This may be required to be provided in an electronic format at the choosing of CHS. These are reported to the Area Agency on Aging and Department of Elder Affairs in accordance with the reporting requirements developed by the Department. Lead agencies are responsible for entry of data in the Client Information and Registration Tracking System (CIRTS), which generates payment to the service provider agency. Therefore, service provider agencies are required to provide Lead Agencies with correct and timely service data to comply with these requirements. Timely submission is no later than noon on Wednesday of the week following the week services are performed (service week defined as Monday through Sunday). 16. Maintain complete and accurate records: Service delivery logs, at a minimum, must be legible and contain the name of client, type(s) of services and date(s) and hour(s) of delivery. The client/caregiver must sign the log at the time of each service visit. The service worker must sign and date the log upon completion and submit it to the service provider agency. Provide complete, clear and accurate invoices: Weekly invoices, which may be required to be provided electronically in a system provided by CHS, must be submitted by noon on the Wednesday following the week that the service was provided and shall include service provided. The service week is defined as Monday through Sunday. Monthly reporting requirements for CIRTS dictate that all client and service data for the previous month to be entered into CIRTS by the 10th day of the month. Collier County "Services for Seniors" will coordinate with vendors to determine due dates for invoices. This will ensure compliance with DOEA reporting requirements. Failure to record or report units of service will result in nonpayment (or delayed payment) for such services. Data required on weekly invoices and weekly timesheets include: c • Vendor name CIOL • Vendor address 4' • Vendor telephone number m m • Client name a • Service Provider employee who delivered the service(s) Cn • Services ordered and services delivered date c • Number of service hours, cost per hour and total cost • Person preparing the report and the date it was prepared 00 • Weekly timesheets signed and dated by the client and Service Provider employee • Additional information as determined by CHS = d E 17. Prepare for annual on -site compliance audits by CHS or members of the Collier County staff as directed by the CHS or grant requirements. Q Page 3 of 3 Exhibit A — Scope of Services Packet Pg. 607 16.D.5.g Fee Schedule following this page (pages 1 through 1 Page 14 of IS Fixed Price Professional Service Agreement 2021_Ver.I Packet Pg. 608 16.D.5.g REQUEST FOR PROPOSAL (RFP) # 18-7470S "SERVICES FOR SENIORS" EXHIBIT B FEESCHEDULE Sunshine Health Care Services, LLC d/b/a A Better Solution of Sarasota Cost Per Service In -kind 10% Reimbursement Rate Per Unit' Unit (Cost your Match (Grant (Amount the Item Services Grant Service Unit company charges Amount your County will for the service) company will be 'reimburse your paying) company for a given service) 1. Skilled Nursing CCE, OAA Per Hour $40.00 $4.00 $36.00 2. Enhance Chore ADI, CCE, OAA Per Hour $40.00 $4.00 $36.00 3. Respite (In -Home) ADI, CCE, OAA Per Hour $24.11 $2.41 $21.70 4. Respite (Facility ADI, CCE, OAA Daily Rate $225.00 0 $225.00 Based) 5. Personal Care ADI, CCE, OAA Per Hour $24.11 $2.41 $21.70 6. Chore ADI, CCE, OAA Per Hour $24.00 $2.40 $21.60 7. Homemaking ADI, CCE, OAA Per Hour $23.33 $2.33 $21.00 8. Adult Day Care ADI, CCE, OAA Per Hour $13.89 $1.39 $12.50 9. Emergency Alert ADI, CCE, OAA Per Day $1.09 $0.11 $0.98 Response Reimbursement Cost Per Service In -kind 10% Rate Per Unit Unit (Cost your Match (Grant (Amount the Item Services Grant Service company charges Amount your County will Unit for the service) company will be reimburse your paying) company for a given service) Specialized Medical ADI, CCE, OAA Per Episode N/A N/A N/A 10. Equipment, Services, and Supplies Page 1 of 1 Exhibit B - Fee Schedule Cn 0 co c d s 0 2 Q Packet Pg. 609 16.D.5.g Description: Other Exhibit/Attachment Federal Contract Provisions 0 following this page (pages I through 25 ) ❑ this exhibit is not applicable Page 15 of 15 Fixed Price Professional Service Agreement 2021_Ver, I Packet Pg. 610 16.D.5.g Collier County Solicitation 18-7470S EXHIBIT LA FEDERAL CONTRACT PROVISIONS U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (ADMINISTRATION ON AGING) AND FLORIDA DEPARTMENT OF ELDER AFFAIRS CFDA 93.OXX (CSFA 65.010) The supplemental conditions contained in this section are intended to cooperate with, to supplement, and to modify the general conditions and other specifications. In cases of disagreement with any other section of this contract, the Supplemental Conditions shall govern. Contractor means an entity that receives a contract. The services performed by the awarded Contractor shall be in compliance with the provisions of Title 45 CFR Part 75; and/, 2 CFR Part 200; and/or Title 45 Chapter XIII Part 1321 and/or other applicable regulations. It shall be the awarded Contractor's responsibility to acquire and utilize the necessary manuals and guidelines that apply to the work required to complete this project. In general, 1) The contractor (including all subcontractors) must insert these contract provisions in each lower tier contracts (e.g. subcontract or sub -agreement); 2) The contractor (or subcontractor) must incorporate the applicable requirements of these contract provisions by reference for work done under any purchase orders, rental agreements and other agreements for supplies or services; 3) The prime contractor is responsible for compliance with these contract provisions by any subcontractor, lower -tier subcontractor or service provider. FEDERAL STATUTORY AUTHORITY Older Americans Act of 1965 (OAA), as amended (42 U.S.0 § 3001 et seq., as amended by Public Law 114-144; 106-501; Section 20.41) OLDER AMERICANS ACT PROGRAM FUNDS OAA Title III B - Supportive Services; OAA, Title III, Section 307(a)(I0) Title 45 Public Welfare (45 CFR 1321) Chapter XIII Office of Human Development Set -vices, Department of Health and Human Services Part 1321.65 Grants to State and Community Programs on Aging; Part 1321.67 Service Contributions FLORIDA STATUTORY AUTHORITY Q TITLE XXX (Social Welfare); Chapter 430 (Elder Affairs) Cn 0 CONTRACT COMPLIANCE OVERVIEW Under the Florida Department of Elder Affairs Older Americans Act, the contractor must comply with the ao contract documentation, conform to state and AAA policies, and comply with federal and state statutory and regulatory requirements. (Ref. - Department of Elder Affairs Programs and Services Handbook, Chapter 4, Page 22; July 2018: Older Americans Act.). The contractor will comply with the intent of Title E III to provide for formula grants to State agencies on aging to stimulate the development or enhancement of comprehensive and coordinated community -based systems resulting in a continuum of services to older persons Q with special emphasis on older individuals with the greatest economic or social need, with particular attention to low-income minority individuals. (Ref. - Title 45 CFR 1321) FCP-I 7/16/2021 2:56 PM P. 26-` Packet Pg. 611 Collier County 16.D.5.g Solicitation 18-7470S EXHIBIT LA FEDERAL CONTRACT PROVISIONS U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES FEDERAL CONTRACT PROVISIONS Administrative, Contractual, or Legal Remedies (Ref. 41 U.S.C. 1908, 2 CFR § 200 Appendix II (A) Unless otherwise provided in this contract, all claims, counter -claims, disputes and other matters in question between the local government and the contractor, arising out of or relating to this contract, or the breach of it, will be decided by arbitration, if the parties mutually agree, or in a Florida court of competent jurisdiction. Access to Records and Reports (Reference: 2 CFR § 200.333, 2 CFR § 200.336) The contractor/vendor agrees to maintain all books, records, accounts and reports required under this contract for a period of not less than three years after the date of termination or expiration of this contract, except in the event of litigation or settlement of claims arising fi•om the performance of this contract, in which case the Contractor agrees to maintain same until the Purchaser, the Grantor Administrator, the Comptroller General, or any of their duly authorized representatives, have disposed of all such litigation, appeals, claims or exceptions related thereto. Furthermore, the County shall maintain written policies and procedures for computer system backup and recovery and shall have the same requirement of its Contractors. Byrd Anti -Lobbying Amendment (31 U.S.C. 1352) (Reference 2 CFR § 200 Appendix II (J) Vendors must certify it will not and has not used Federal appropriated funds have been paid or will be paid, by or to any person or organization for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the malting of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. The certification includes any lobbying with non -Federal funds that takes place in connection with obtaining any Federal award. Civil Rights Compliance The contractor or a subcontractor who is the recipient of Federal funds (or assumes others with whom it arranges to provide services or benefits in connection with any of its programs and activities or assures others with whom it arranges to provide services or benefits to participants or employees) must comply with Title VI of the Civil Rights Act of 1964, which prohibits discrimination on the basis of race, color, or national origin (45 CFR 80), and Statutes and Regulations enforced by the Office of Civil Rights, U.S. Department of Health and Human Services, as follow: Section 504 of the Rehabilitation Act of 1973, as amended (29 USC § 794), prohibits discrimination against otherwise qualified individuals on the basis of disability in programs and activities receiving financial assistance from HHS 45 CFR 84 and/or programs or activities conducted by HHS 45 CFR 85 in the provision of benefits and under the ADA that does not: a. Exclude a person with a disability from a program or activity; Cn b. Deny a person with a disability the benefits of a program or activity; o c. Afford a person with a disability an opportunity to participate in or benefit from a benefit or service that is not equal to what is afforded others;00 d. Provide a benefit or service to a person with a disability that is not as effective as what is provided others; e. Provide different or separate benefits or services to a person with a disability unless necessary to provide benefits or services that are as effective as what is provided others; or, s f. Apply eligibility criteria that tend to screen out persons with disabilities unless necessary for the W provision of the service, program or activity. Q FCP-2 7/16/2021 2:56 PM P. Packet Pg. 612 16.D.5.g Collier County Solicitation 18-7470S EXHIBIT LA FEDERAL CONTRACT PROVISIONS Section 508 of the Rehabilitation Act of 1973, as amended, (29 USC § 794(d)) prohibits discrimination on the basis of disability in electronic and information technology as they relate to programs and activities conducted by HHS. The Age Discrimination Act of 1975, as amended (42 USC § 6101) prohibits discrimination on the basis of age in programs or activities receiving Federal financial assistance 45 CFR 90; and/or programs or services receiving HHS financial assistance 45 CFR 91; Title II of the Americans with Disabilities Act (28 CFR Part 35), relating to Nondiscrimination on the Basis of Disability in State and Local Government Services 2010 ADA Standards for Accessible Design; The Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §290 dd-3 and 290 ee 3), as amended, as relating to confidentiality of alcohol and drug abuse patient records; Section 1908 of the Public Health Service Act (42 USC § 300w-7) prohibits discrimination on the basis of age, race, color, national origin, disability, sex (gender), or religion in programs, services, and activities funded by Preventative Health and Health Services Block Grants. Federal Health Care Conscience Protection Statutes (42 USC § 300a-7; 42 USC § 300a-7; 42 USC § 238n and the Weldon Amendment (Continuing Appropriations Resolution, Pub. L. No. 113-164, Sec. 101(a) (Sept. 19, 2015); Regulation for the Enforcement of Federal Health Care Provider Conscience Protection Laws, which prohibit recipients of certain Federal funds from discriminating against certain health care providers who refuse to participate in certain health care services on religious or moral grounds. Section 1557 of the Affordable Care Act prohibits discrimination on the basis of disability by entities that operate a health program or activity. 45 CFR 80. The contractor must have on file an assurance that the program will be conducted in compliance with all nondiscriminatory provisions as required in 45 CFR 80. Debarment and Suspension (Reference 2 CFR § 200 Appendix II (I) Contract awards that exceed the small purchase threshold and certain other contract awards shall not be made to parties listed on the government wide Excluded Parties List System in the System for Award Management (SAM), in accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR Part 1986 Comp., p. 189) and 12689 (3 CFR Part 1989 Comp., p. 235), "Debarment and Suspension." The Excluded Parties List System in SAM contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549. The successful bidder, by administering each lower tier subcontract that exceeds $25,000 as a "covered transaction", must verify each lower tier participant of a "covered transaction" under the project is not presently debarred or otherwise disqualified from participation in this federally assisted project. The Contractor shall comply with these provisions before doing business or entering into subcontracts receiving federal funds pursuant to this contract. The Contractor shall complete and sign the Certifications and Assurances Attachment prior to the execution of this contract. Diversity (Reference 2 CFR § 200.321) The County is dedicated to fostering the continued development and economic growth of small, minority-, women-, and service -disabled veteran business enterprises. All contracting and subcontracting opportunities afforded by this solicitation/contract are strongly encouraged to contribute as both Contractors and Sub - Contractors. Firms may be required to submit documentation addressing diversity and describing the efforts being trade to encourage the participation of small, minority-, women-, and service -disabled veteran business enterprises. Information on Certified Minority Business Enterprises (CMBE) and Certified Service -Disabled Veteran Business Enterprises (CSDVBE) is available from the Office of Supplier Diversity at: http://dms.myflorida.com/other programs/office of supplier diversity osd/ FCP-3 Q 7/16/2021 2:56 PM P.Al`Z _.= Packet Pg. 613 Collier County 16.D.5.g Solicitation 18-7470S EXHIBIT LA FEDERAL CONTRACT PROVISIONS Energy Policy and Conservation Act - (Reference 2 CFR § 200 Appendix II (H) The contractor shall comply with any mandatory standards and policies relating to energy efficiency which are contained in the F 1 o r i d a state energy conservation plan issued in compliance with the Energy Policy and Conservation Act (Pub. L. 94-163, 89 Stat. 871, 42 U.S.0 Section 6201) Equal Employment Opportunity (Appendix II, 2 CFR Part 200; Department of Labor 41 CFR Part 60; Dept. of Health and Human Services 45 CFR Part 92, if applicable). The Contractor shall not discriminate against any employee or applicant for employment because of race, age, creed, color, sex or national origin. The Agency will take affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to their race, age, creed, color, sex, or national origin. Such action shall include, but not be limited to, the following: Employment upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. Contractors must insert a similar provision in all subcontracts, except subcontracts for standard commercial supplies or raw materials. E-verify, Presidential Executive Order 12989; Florida Executive Order Number 11-116 Vendors/Contractors/Subcontracts: 1. Agree to utilize the U.S. Department of Homeland Security's E-verify system to verify the employment of all new employees hired by Contractor during the contract term; and 2. Contractor shall include in related subcontracts a requirement that Subcontractors performing work or providing services pursuant to the state contract utilize the E-verify system to verify employment eligibility of all new employees hired by the Subcontractor during the contract term. The HIPAA Privacy Rules, 4 CFR Part 160 and Subparts A and E of part 164 The Third Party subrecipient will comply with HIPAA requirements to appropriate safeguards to protect the privacy of personal health information, and sets limits and conditions on the uses and disclosures that may be made of such information without patient authorization. No Government Obligation to Third Parties - The Federal Government is not a party to this contract and is not subject to any obligations or liabilities to the non -Federal entity, contractor, or any other party pertaining to any matter resulting from the contract." Procurement of Recovered Materials (Reference 2 CFR § 200.323) Contractor and subcontractor agree to comply with Section 6002 of the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act, and the regulatory provisions of 40 CFR Part 247. (1) In the performance of this contract, the Contractor shall make maximum use of products containing recovered materials that are EPA designated items unless the product cannot be acquired (i) Competitively within a timeframe providing for compliance with the contract performance schedule; (ii) Meeting contract performance requirements; or (iii) At a reasonable price. (2) Information about this requirement is available at EPA's Comprehensive Procurement Guidelines web site.http://www.epa.gov/. The list of EPA -designate items is available at https://www.epa.gov/smm/comprehensive-procurement-guideline-cpg-program. Program Fraud and False or Fraudulent Statements of Related Acts The contractor acknowledges that 31 U.S.C. Chap. 38 (Administrative Remedies for False Claims and Statements) applies to the contractor's actions pertaining to this contract. Termination for Cause and Convenience See County's Standard Terrns and Conditions. Trafficking in Persons The Contractor and subcontractors shall comply with Title 2 CFR Part 175 and 2 CFR § 175.15 provisions applicable to a private entity, as defined in 2 CFR 175.25, FCP-4 Q 7/16/2021 2:56 PM P£9 Packet Pg. 614 Collier County 16.D.5.g Solicitation 18-7470S EXHIBIT LA FEDERAL CONTRACT PROVISIONS Transparency Act Unless exempt under 2 CFR § 170.11 O(b), the Contractor shall comply with the reporting requirements of the Transparency Act as expressed in 2 CFR Part 170. Clean Air Act and Federal Water Pollution Control Act (Reference: 2 CFR § 200 Appendix II (G)) Contracts and subgrants of amounts in excess of $150,000 shall contain a provision that requires the Contractor or recipient to comply with all applicable standards, orders, or requirements issued pursuant to Section 306 of the Clean Air Act as amended (42 U.S.C. 7401-7671q.), Executive Order 11738, as amended, where applicable, the Federal Water Pollution Control Act as amended (33 U.S.C. 1251-1387), and Environmental Protection Agency regulations 2 CFR Part 1500. The Contractor shall report any violations of the above to the Federal awarding agency and the Regional Office of the Environmental Protection Agency (EPA). Unlawful Employment of Aliens (Reference Immigration and Nationality Act (8 U.S.C. § 1324a) and the Immigration Reform and Control Act of 1986 (8 U.C. § 1101) (a) Malting Employment of Unauthorized Aliens Unlawful (1) In General It is unlawful for a person or other entity— (A) to hire, or to recruit or refer for a fee, for employment in the United States an alien knowing the alien is an unauthorized alien (as defined in subsection (h)(3)) with respect to such employment. (2) Continuing Employment It is unlawful for a person or other entity, after hiring an alien for employment in accordance with paragraph (1), to continue to employ the alien in the United States knowing the alien is (or has become) an unauthorized alien with respect to such employment. Such violation will be cause for unilateral cancellation of this contract by the Federal awarding Agency. Prohibition on Certain Telecommunications and Video Surveillance Services or Equipment (2 CFR § 200.216) The Federal awarding agency prohibits the County to enter into a contract to procure or obtain equipment, services or systems that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. As described in Public Law 115-232, section 889, covered telecommunications equipment is = telecommunications equipment produced by Huawei Technologies Company or ZTE Corporation (or any o subsidiary or affiliate of such entities). (i) For the purpose of public safety, security of government facilities, ., physical security surveillance of critical infrastructure, and other national security purposes, video surveillance and telecommunications equipment produced by Hytera Communications Corporation, Hangzhou Hikvision v°� Digital Technology Company, or Dahua Technology Company (or any subsidiary or affiliate of such entities). (ii) Telecommunications or video surveillance services provided by such entities or using such equipment. (i)(iii) Telecommunications or video surveillance equipment or services produced or provided by an entity that the m Secretary of Defense, in consultation with the Director of the National Intelligence or the Director of the Federal Q Bureau of Investigation, reasonably believes to be an entity owned or controlled by, or otherwise connected to, c the government of a covered foreign country. (b) In implementing the prohibition under Public Law 115-232, section 889, subsection (0, paragraph (1), heads of executive agencies administering loan, grant, or subsidy programs shall prioritize available funding and technical support to assist affected businesses, institutions and 00 organizations as is reasonably necessary for those affected entities to transition from covered communications equipment and services, to procure replacement equipment and services, and to ensure that communications service to users and customers is sustained. (c) See Public Law 115-232, section 889 for additional information. s Domestic Preference for Procurements (2 CFR § 200.322) Q (a) As appropriate and to the extent consistent with law, the non -Federal entity should, to the greatest extent practicable under a Federal award, provide a preference for the purchase, acquisition, or use of goods, products, FCP-5 7/16/2021 2:56 PM P. 30 Packet Pg. 615 Collier County 16.D.5.g Solicitation 18-7470S EXHIBIT LA FEDERAL CONTRACT PROVISIONS or materials produced in the United States (including but not limited to iron, aluminum, steel, cement, and other manufactured products). The requirements of this section must be included in all subawards including all contracts and purchase orders for work or products under this award. (b) For purposes of this section: (1) "Produced in the United States" means, for iron and steel products, that all manufacturing processes, from the initial melting stage through the application of coatings, occurred in the United States. (2) "Manufactured products" means items and construction materials composed in whole or in part of non-ferrous metals such as aluminum; plastics and polymer based products such as polyvinyl chloride pipe; aggregates such as concrete; glass, including optical fiber; and lumber. STATE CONTRACT PROVISIONS Administrative Procedures Act, Section 120.57(2), F.S. Additional procedures for particular cases. In a matter initiated as a result of agency action proposing to determine the substantial interests of a party, the party's timely petition for hearing may challenge the proposed agency action based on a rule that is an invalid exercise of delegated legislative authority or based on an alleged unadopted rule. Data Integrity and Safeguarding Information, Uniform Electronic Transaction Act, Section 668.50, F.S.; Public Records Law, Chapter 119, Section 29, F.S The Contractor shall ensure an appropriate level of data security for the information the Contractor is collecting or using in the perfonnance of this contract. An appropriate level of security includes approving and tracking all Contractor employees that request system or information access and ensuring that user access has been removed from all terminated employees. The Contractor, among other requirements, must anticipate and prepare for the loss of information processing capabilities. All data and software shall be routinely backed up to ensure recovery from losses or outages of the computer system. The security over the backed -up data is to be as stringent as the protection required of the primary systems. The Contractor shall ensure all Subcontractors maintain written procedures for computer system backup and recovery. The Contractor shall complete and sign the Certification Regarding Data Integrity Compliance for Agreements, Grants, Loans, and Cooperative Agreements prior to the execution of this contract. Discriminatory Vendors List, Section 287.134, F.S. In accordance with Section 287.134, Florida Statutes, an entity or affiliate who has been placed on the discriminatory vendor list may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to a public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity, and may not transact business with any public entity. Equal Employment Opportunity Cn The Contractor shall not discriminate against any employee or applicant for employment because of race, age, CD creed, color, sex or national origin. The Agency will take affirmative action to ensure that applicants are I employed, and that employees are treated during employment, without regard to their race, age, creed, color, ao sex, or national origin. Such action shall include, but not be limited to, the following: Employment upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms = d of compensation; and selection for training, including apprenticeship. Contractors must insert a similar provision E in all subcontracts, except subcontracts for standard commercial supplies or raw materials. 0 Interest of Members of Congress Q No member of or delegate to the Congress of the United States shall be admitted to any share or part of this contract or to any benefit arising therefrom. FCP-6 7/16/2021 2:56 PM P•,31--\ Packet Pg. 616 Collier County 16.D.5.g Solicitation 18-7470S EXHIBIT 1.A FEDERAL CONTRACT PROVISIONS Interest of Public Officials No member, officer, or employee of the public body or of a local public body during his tenure or for two years thereafter shall have any interest, direct or indirect, in this contract or the proceeds thereof. For purposes of this provision, public body shall include municipalities and other political subdivisions of States; and public corporations, boards, and commissions established under the laws of any State. No member, officer, or employee of the MPO or of a local public body during his tenure or for two years thereafter shall have any interest, direct or indirect, in this contract or the proceeds thereof. Inspections (Meals) The Contractor must agree to notify the Nutrition Provider within 24 hours of any sanitation inspection and provide a copy of the report. Inspector General Cooperation, Section 20.055(5), F.S. The Parties agree to comply with Section 20.055(5), Florida Statutes, for the inspector general to have access to any records, data and other information deemed necessary to carry out his or her duties and incorporate into all subcontracts the obligation to comply with Section 20.055(5), Florida Statutes. Lobbying No funds received pursuant to this Agreement may be expended for lobbying the Legislature, the judicial branch or a state agency. Computer Use and Social Media Policy The Florida Department of Elder Affairs has implemented a Social Media Policy, in addition to its Computer Use Policy, which applies to all employees, contracted employees, consultants, OPS and volunteers, including all personnel affiliated with third parties, such as, but not limited to, contractors and subcontractors. Any entity that uses the Department's computer resource systems must comply with the Department's policy regarding social media. Social Media includes, but is not limited to blogs, podcasts, discussion forums, Wikis, RSS feeds, video sharing, social networks like MySpace, Facebook and Twitter, as well as content sharing networks such as flickr and YouTube. This policy is available on the Department's website at: http://elderaffairs.state.fl.us/doea/financia1.php. Public Entity Crime Pursuant to Section 287.133, F.S., a person or affiliate who has been placed on the Convicted Vendor List o following a conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to 3 provide any goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a y public entity for the construction or repair of a public building or public work; may not submit bids, proposals, `- or replies on leases of real property to a public entity; may not be awarded or perform work, as a Contractor, Supplier, Subcontractor, or Consultant under a contract with any public entity; and may not transact business m with any public entity in excess of the threshold amount 7.017, F.S., for CATEGORY TWO for a period of Q thirty six (36) months following the date of being placed on the Convicted Vendor List. Cn 0 ao c d E s t� cC Q FCP-7 7/16/2021 2:56 PM p. 32 ,. 6 Packet Pg. 617 Collier County 16.D.5.g Solicitation 18-7470S 1;XHIBIT 1.1 t:il� f ive"I' C`1;,I 1 iI"1C;f1'T`ii�li AND ASMJR/kN E GRANT CERTIFICATIONS AND ASSURANCES THE FOLLOWING DOCUMENTS NEED TO BE RETURNED WITH SOLICITATION DOCUMENTS BY DEADLINE TO BE CONSIDERED RESPONSIVE. Page Certification and Form GCA 2-6 Attachment III - Certifications and Assurances (A-J) A. Debarment and Suspension Certification (29 CFR Part 95 and 45 CFR Part 75) B. Certification Regarding Lobbying (29 CFR Part 93 and 45 CFR Part 93) C. Nondiscrimination & Equal Opportunity Assurance (29 CFR Part 37 and 45 CFR Part 80) D. Certification Regarding Public Entity Crimes, section 287.133. F.S. E. Association of Community Organizations for Reform Now (ACORN) Funding Restrictions Assurances (Pub. L. I I 1-117) F. Scrutinized Companies Lists and No Boycott of Israel Certification, section 287.135. F.S. G. Certification Regarding Data Integrity Compliance for Contracts, Agreements, Grants, Loans and Cooperative Agreements H. Verification of Employment Status Certification I. Records and Documentation J. Certification Regarding Inspection of Public Records GCA - 7-9 Attachment IV — Assurances Non -Construction Programs GCA - 10-13 Attachment V — Civil Rights Compliance Checklist GCA - 14 GCA - 15 GCA - 16 GCA - 17 GCA - 18 Attachment VII — Background Screening Affidavit of Compliance - Employer Conflict of Interest Certification Anticipated DBE, M/WBE or VETERAN Participation Statement Bid Opportunity List for Commodities and Contractual Services and Professional Consultant Services Acknowledgement of Terms, Conditions, and Grant Clauses Q 7/16/2021 2:56 PM GCA - 1 P. 331— Packet Pg. 618 16.D.5.g Collier County Solicitation 18-7470S EXH. 1.13 GRANT ASSURANCES AND CERTIFICATIONS ATTACHMENT III CERTIFICATIONS AND ASSURANCES Agency will not award this Contract unless Contractor completes this CERTIFICATIONS AND ASSURANCES. In performance of this contract, Contractor provides the following certifications and assurances: A. Debarment 411 SusUension Certification 'CFR Part 95 ,11 45 CFR Part 75) B. 4 it Regarding LobbXing ' CFR Part 93 41) 45 CFR Part ' C. Nondiscrimination _1 III _.L ' P: s ' Part4' � D. 4 1 1 Regarding Public I Crimes. 1 1 287,133, E. Assoegation of CommuniU' t i 4 1 1 1 Reform N1 \ i t 1' Restrieflons Assurance (Pub. F. Scrutinized I l l s l and 1 Boycott of Israel Certification.section G. 11 Regarding Data Integrelyce for Contracts.Agreements, slts, Loans. and Coollerative Agreements H. Verification of EmIlloyment4 1 1 1. Records and Documentation 11 ►'' 4 1 RIT-1 111ITTI' 11 1I Wn1fm►' 1 1 A. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS — PRIMARY COVERED TRANSACTION. The undersigned Contractor certifies, to the best of its knowledge and belief, that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by a Federal department or agency; 2. Have not within a three-year period preceding this Contract been convicted or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; 3. Are not presently indicted or otherwise criminally or civilly charged by a government entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph A.2. of this certification; and/or 4. Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State, or local) terminated for cause of default. The undersigned shall require that language of this certification be included in the documents for all subcontracts at all tiers (including subcontracts, sub -grants, and contracts under grants, loans, and cooperative agreements) and that all sub -recipients and contractors shall provide this certification accordingly. GCA-2 0 I" d s Q 7/16/2021 2:56 PM p. 34 Packet Pg. 619 16.D.5.g Collier County Solicitation 18-7470S EXH. 1,13 GRANT ASSURANCES AND CERTIFICATIONS B. CERTIFICATION REGARDING LOBBYING — CERTIFICATION FOR CONTRACTS, GRANTS, LOANS, AND COOPERATIVE AGREEMENTS. The undersigned Contractor certifies, to the best of its knowledge and belief, that: No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of Congress or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, arnendment, or modification of any Federal contract, grant, loan, or cooperative agreement. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or employee of a Member of Congress in connection with a Federal contract, grant, loan, or cooperative agreement, the undersigned shall also complete and submit Standard Form — LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. The undersigned shall require that language of this certification be included in the documents for all subcontracts atall tiers (including subcontracts, sub -grants, and contracts under grants, loans, and cooperative agreements) and that all sub -recipients and contractors shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this Contract was made or entered into. Submission of this certification is a prerequisite for making or entering into this Contract imposed by 31 U.S.C. 1352, Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. C. NON- DISCRIMINATION & EQUAL OPPORTUNITY ASSURANCE (29 CFR PART 37 AND 45 CFR PART 80). - As a condition of the Contract, Contractor assures that it will comply fully with the nondiscrimination and equal opportunity provisions of the following laws: 1. Section 188 of the Workforce Investment Act of 1998 (WIA), (Pub. L. 105-220), which prohibits discrimination 8 against all individuals in the United States on the basis of race, color, religion, sex, national origin, age, disability, _ political affiliation, or belief, and against beneficiaries on the basis of either citizenship/status as a lawfully admitted c immigrant authorized to work in the United States or participation in any WIA Title I -financially assisted program or activity, c 2. Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352), as amended, and all requirements imposed by or pursuant CIO the Regulation of the Department of Health and Human Services (45 CFR Part 80), to the end that, in accordance 4; with Title VI of that Act and the Regulation, no person in the United States shall, on the ground of race, color, or m national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to a discrimination under any program or activity for which the Applicant receives Federal financial assistance from the rn Agency. 3. Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-112), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 84), to the end that, in o0 accordance with Section 504 of that Act and the Regulation, no otherwise qualified handicapped individual in the United States shall, solely by reason of his handicap, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial E assistance from the Agency. Q GCA-3 7/16/2021 2:56 PM p•115 Packet Pg. 620 Collier County 16.D.5.g Solicitation 18-7470S EXH. 1.13 GRANT ASSURANCES AND CERTIFICATIONS 4. The Age Discrimination Act of 1975 (Pub. L. 94-135), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 91), to the end that, in accordance with the Act and the Regulation, no person in the United States shall, on the basis of age, be denied the benefits of, be excluded from participation in, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Agency. 5. Title IX of the Education Amendments of 1972 (Pub. L. 92-318), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 86), to the end that, in accordance with Title IX and the Regulation, no person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any education program or activity for which the Applicant receives Federal financial assistance from theAgency. 6. The American with Disabilities Act of 1990 (Pub. L. 101-336), which prohibits discrimination in all employment practices, including job application procedures, hiring, firing, advancement, compensation, training, and other terms, conditions, and privileges of employment. It applies to recruitment, advertising, tenure, layoff, leave, fringe benefits, and all other employment -related activities. 7. Contractor also assures that it will comply with 29 CFR Pant 37 and all other regulations implementing the laws listed above. This assurance applies to Contractor's operation of the WIA Title I — financially assisted program or activity, and to all contracts Contractor makes to carry out the WIA Title I — financially assisted program or activity. Contractor understands that the Agency and/or DOEA and the United States have the right to seek judicial enforcement of the assurance. The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all tiers (including subcontracts, sub -grants, and contracts under grants, loans, and cooperative agreements) and that all sub -recipients and contractors shall provide this assurance accordingly. D. CERTIFICATION REGARDING PUBLIC ENTITY CRIMES, SECTION 287.133, F.S. Contractor hereby certifies that neither it, nor any person or affiliate of Contractor, has been convicted of a Public Entity Crime as defined in section 287.133, F.S., nor placed on the convicted vendor list. Contractor understands and agrees that it is required to inform Agency immediately upon any change of circumstances regarding this status. E. ASSOCIATION OF COMMUNITY ORGANIZATIONS FOR REFORM NOW (ACORN) FUNDING RESTRICTIONS ASSURANCE (Pub. L. 111-117). As a condition of the Contract, Contractor assures that it will comply fully with the federal funding restrictions pertaining to ACORN and its subsidiaries per the Consolidated Appropriations Act, 2010, Division E, Section 511 (Pub. �o L. I I1-117). The Continuing Appropriations Act, 2011, Sections 101 and 103 (Pub. L. 111-242), provides that `m appropriations made under Pub. L. 111-117 are available under the conditions provided by Pub. L. 111-117. m The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all a tiers (including subcontracts, sub -grants and contracts under grants, loans and cooperative agreements) and that all sub - recipients and contractors shall provide this assurance accordingly. CD 0 r` ao F. SCRUTINIZED COMPANIES LISTS AND NO BOYCOTT OF ISRAEL CERTIFICATION, SECTION 287.135, F.S. In accordance with section 287.135, F.S., Contractor hereby certifies that it has not been placed on the Scrutinized E Companies that Boycott Israel List and that it is not participating in a boycott of Israel. Q GCA-4 7/16/2021 2:56 PM p. 36 Packet Pg. 621 16.D.5.g Collier County Solicitation 18-7470S EXH. 1.13 GRANT ASSURANCES AND CERTIFICATIONS If this Contract is in the amount of $1 million or more, in accordance with the requirements of section 287.135, F.S., Contractor hereby certifies that it is not listed on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List and that it does not have business operations in Cuba or Syria. Contractor understands that pursuant to section 287.135, F.S., the submission of a false certification may result in the Agency terminating this contract and the submission of a false certification may subject Contractor to civil penalties and attorney fees and costs, including any costs for investigations that led to the finding of false certification. If Contractor is unable to certify any of the statements in this certification, Contractor shall attach an explanation to this Contract. G. CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR CONTRACTS, AGREEMENTS, GRANTS, LOANS, AND COOPERATIVE AGREEMENTS 1. The Contractor and any Subcontractors of services under this contract have financial management systems capable of providing certain information, including: (1) accurate, current, and complete disclosure of the financial results of each grant -funded project or program in accordance with the prescribed reporting requirements; (2) the source and application of funds for all contract supported activities; and (3) the comparison of outlays with budgeted amounts for each award. The inability to process information in accordance with these requirements could result in a return of grant funds that have not been accounted for properly. 2. Management Information Systems used by the Contractor, Subcontractors, or any outside entity on which the Contractor is dependent for data that is to be reported, transmitted, or calculated have been assessed and verified to be capable of processing data accurately, including year -date dependent data. For those systems identified to be non -compliant, Contractors will take immediate action to assure data integrity. 3. If this contract includes the provision of hardware, software, firmware, microcode, or imbedded chiptechnology, the undersigned warrants that these products are capable of processing year -date dependent data accurately. All versions of these products offered by the Contractor (represented by the undersigned) and purchased by the state will be verified for accuracy and integrity of data prior to transfer. 4. In the event of any decrease in functionality related to time and date related codes and internal subroutines that = impede the hardware or software programs from operating properly, the Contractor agrees to immediatelymake c required corrections to restore hardware and software programs to the same level of functionality as warranted ., herein, at no charge to the state, and without interruption to the ongoing business of the state, time being of the c essence. co L 5. The Contractor and any Subcontractors of services under this contract warrant that their policies and procedures include a disaster plan to provide for service delivery to continue in case of an emergency, including emergencies m arising from data integrity compliance issues. Q to 0 r` H. VERIFICATION OF EMPLOYMENT STATUS CERTIFICATION 11� 00 As a condition of contracting with the Agency, Contractor certifies the use of the U.S. Department of Homeland Security's E-verify system to verify the employment eligibility of all new employees hired by Contractor during the contract term to perform employment duties pursuant to this contract, and that any subcontracts include an express E requirement that Subcontractors performing work or providing services pursuant to this Contract utilize the E-verify system to verify the employment eligibility of all new employees hired by the Subcontractor during the entire contract term. Q GCA-5 7/16/2021 2:56 PM P- 37 .,, Packet Pg. 622 16.D.5.g Collier County Solicitation 18-7470S EXH. 1.13 GRANT ASSURANCES AND CERTIFICATIONS The Contractor shall require that the language of this certification be included in all sub -agreements, sub -grants, and other agreements/contracts and that all Subcontractors shall certify compliance accordingly. This certification is a material representation of fact upon which reliance was placed when this Contract was made or entered into. Submission of this certification is a prerequisite for making or entering into this Contract imposed by Circulars A-102 and 2 CFR Part 200 and 215 (formerly OMB Circular A-110). I. RECORDS AND DOCUMENTATION The Contractor agrees to make available to Agency staff and/or any party designated by the Agency any and all contract related records and documentation. The Contractor shall ensure the collection and maintenance of all program related information and documentation on any such system designated by the Agency. Maintenance includes valid exports and backups of all data and systems according to Agency standards. J. CERTIFICATION REGARDING INSPECTION OF PUBLIC RECORDS 1. In addition to the requirements of sections 10.1 and 10.2 of the Standard Contract, sections 119.0701(3) and (4) F.S., and any other applicable law, if a civil action is commenced as conternplated by section 119.0701(4), F.S., and the Agency is named in the civil action, Contractor agrees to indemnify and hold harmless the Agency for any costs incurred by the Agency and any attorneys' fees assessed or awarded against the Agency from a Public Records Request made pursuant to Chapter 119, F.S., concerning this contract or services performed thereunder. a. Notwithstanding section 119.0701, F.S., or other Florida law, this section is not applicable to contracts executed between the Agency and state agencies or subdivisions defined in section 768.28(2), F.S. 2. Section 119.01(3), F.S., states if public funds are expended by an agency in payment of dues or membership contributions for any person, corporation, foundation, trust, association, group, or other organization, all the financial, business, and membership records of such an entity which pertain to the public agency (Area Agency on Aging for Southwest Florida, Inc.) are public records. Section 119.07, F.S, states that every person who has custody of such a public record shall permit the record to be inspected and copied by any person desiring to do so, under reasonable circumstances. Additionally, I certify this organization does does notprovide for institutional memberships. Contractor's signature below attests that records pertaining to the dues or membership application by the Agency are available for inspection if applicable, as stated above. By execution of this contract, Contractor must include these provisions (A-J) in all related subcontract agreements (if applicable). By signing below, Contractor certifies that the representations outlined in parts A through J above are true and correct. Pcty a De.(,ta-� CFO 5600 Bee Ridge Rd. Suite B Signature and Title of Authorized Representative Street Address A Better Solution 8/4/2021 Sarasota, FL 34233 Contractor Date City, State, Zip code UCA-6 Q 7/16/2021 2:56 PM p. 38 Packet Pg. 623 16.D.5.g Collier County Solicitation 18-7470S EXHIBIT 1.13 GRANT CERTIFICATIONS AND ASSURANCES ATTACHMENT IV ASSURANCES--NON-CONSTRUCTION PROGRAMS Public reporting burden for this collection of information is estimated to average forty-five (45) minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget. Paperwork Reduction Project (0348-0043), Washington, DC 20503, PLEASE DO NOT RETURN YOUR COMPL>h Et) NURM 1U 1HE Urr1UL ter rvtAivAGEIVIr.ry i ArvL BUDGET, SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. ti 00 Note: Certain of these assurances may not be applicable to your project or program. If you have questions please LL contact the awarding agency. Further, certain federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. N I . Has the legal authority to apply for federal assistance, and the institutional, managerial and financial capability N (including funds sufficient to pay the non-federal share of project cost) to ensure proper planning, management, and completion of the project described in this application. c a 2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the state, throughany cnO authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives. 3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain. v 4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awardingagency. T v S. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. §4728-4763) relating to prescribed standards E for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's = Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F). _ 0 6. Will comply with all federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of 3 the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; co (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §1681-1683, and 1685-1686), which (, prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. m §794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended Q (42 U.S.C. §6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment < Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive CD Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §523 and 527 of the Public Health Service 00 Act of 1912 (42 U.S.C. §290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §3601 et seq.), as amended, relating to d nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific E statute(s) under which application for federal assistance is being made; and 0) the requirements of any other nondiscrimination statute(s) which may apply to the application. Q GCA-7 7/16/2021 2:56 PM p. 39 Packet Pg. 624 Collier County 16.D.5.g Solicitation 18-7470S EXHIBIT 1.13 GRANT CERTIFICATIONS AND ASSURANCES 7. Will comply, or has already complied, with the requirements of Titles II and III of the uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of federal or federally assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of federal participation inpurchases. 8. Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C. §1501-1508 and 7324-7328), which limit the political activities of employees whose principal employment activities are funded in whole or in part with federal funds. 9. Will comply, as applicable, with the provisions of the Davis -Bacon Act (40 U.S.C. §276a to 276a-7), the Copeland Act (40 U.S.C. 276c and 18 U.S.C. §874) and the Contract Work Hours and Safety Standards Act (40 U.S.C. §327-333), regarding labor standards for federally assisted construction sub -contracts. 10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000.00 or more. 11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. §1451 et seq.); (f) conformity of federal actions to State (Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. §7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-523); and (h) protection of endangered species under the Endangered Species Act of 1973, as amended, (P.L. 93-205). 12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. §1721 et seq.) related to protecting components or potential components of the national wild and scenic rivers system. 13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. §470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. §469a-1 et seq.). 14. Will comply with P.L. 93-348 regarding the protection of hurnan subjects involved in research, development, and related activities supported by this award of assistance. 15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. §2131 et seq.) c pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities I supported by this award of assistance. 00 16. Will comply with the Lead -Based Paint Poisoning Prevention Act (42 U.S.C. §4801 et seq), which prohibits the use of d lead- based paint in construction or rehabilitation of residence structures. E Q GCA-8 7/16/2021 2:56 PM P. 4A t Packet Pg. 625 16.D.5.g Collier County Solicitation 18-7470S EXHIBIT 1.13 GRANT CERTIFICATIONS AND ASSURANCES 17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and 2 CFR Part 200. 18. Will comply with all applicable requirements of all other federal laws, executive orders, regulations and policies governing this program. SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE CFO APPLICANT ORGANIZATION DATE SUBMITTED 8/4/2021 A Better Solution Cn 0 r, co E ,r a GCA-9 7/16/2021 2:56 PM p'-1' Packet Pg. 626 16.D.5.g EXHIBIT LB / ATTACHMENT V Collier County Solicitation 18-7470S CTATL` "V V1 "DITAA 1111T tAD'rX4 NT nlW Ti T n117I2 A7`i RATT2C CIVIT. RT(_HT.0 ('(1MPI.IANCF. CHRCKT,TCT Program/Facility Name: County: AAA/Contractor A Better Solution Collier Address: Completed By: 5600 Bee Ridge Rd. Suite B Barbara Co swell City, State, Zip Code: Sarasota, FL 34233 Date: 1 8/3/2021 Telephone: 1 941-906-1881 PART I: READ THE ATTACHED INSTRUCTIONS FOR ILLUS'1KA11VE INPUKMAI IUIN wHIL H WILL HELY YvU t.vlvir1,1"1 r, THIS FORM. 1. Briefly describe the geographic area served by the program/facility and the type of service provided: Polk, Manatee, Sarasota, Charlotte, Lee, Collier Counties For questions 2-5, please indicate the following: Total I White Black Hispanic Other Female Disabled Over 40 2.Population of area served Source of data 433,742 82.8 4.7 9.6 2.9 52.4 8.4 3.Staff currently employed Source of data 150 29 58 9 4 88 1 4.Clients currently enrolled/registered Source of data 5.Advisory/Governing Board if applicable Source of data PART II: USE A NEYAKA'IE NHEEI UP YAYLK NUK AIN Y LAYLAINAIIU1NJ KEY UHC11Nkj 1v1Ut%r. 3rA%_z. 1. Is an Assurance of Compliance on file with DOER? N/A YES NO ❑ ❑ ❑ L O 2. Compare the staff composition to the population. Is staff representative of the population? N/A YES NO ❑ X ❑ �I v Iv L 3. Are eligibility requirements for services applied to clients and applicants without regard to race, color, C national origin, sex, age, religion or disability? N/A YES NO V ❑ � El OI L V 4. Are all benefits, set -vices and facilities available to applicants and participants in an equally effective m manner regardless of race, sex, color, age, national origin, religion or disability? N/A YES NO p O 5. For in -patient set -vices, are room assignments made without regard to race, color, national origin or disability? N/A �o L m m 6. Is the program/facility accessible to non-English speaking clients? N/A YES NO Q ❑ m ❑ D r, 7. Are employees, participants informed of their protection against discrimination? If YES, °r° {applican�ts {and how? Verbal Written PosterX N/A YES N❑O Jul Jul c d E s Q 8. Give the number and current status of any discrimination complaints regarding services or employment filed against the program/facility. N/A NUMBER 0 1 7/16/2021 2:56 PM P• 42 GCA -10 Packet Pg. 627 EXHIBIT 1.B / ATTACHMENT V Collier County 16.D.5.g Solicitation 18-7470S 9. Is the program/facility physically accessible to mobility, hearing, and sight -impaired individuals? N/A X YES NO ❑ ❑ PART III: THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15 OR MORE EMPLOYEES. IF NO EXPLAIN 10. Has a self -evaluation been conducted to identify any barriers to serving disabled individuals, and to make any necessary modifications? YES NO 11. Is there an established grievance procedure that incorporates due process in the resolution of complaints? YEE{S tv VN NO ❑ 12. Has a person been designated to coordinate Section 504 compliance activities? YES k NO ❑ 13, Do recruitment and notification materials advise applicants, employees and participants of nondiscrimination on the basis of disability? YES NO 14. Are auxiliary aids available to assure accessibility of services to hearing and sight -impaired individuals? YES NX lZX NO PART IV: FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF $50,000.00 OR MORE, 15. Do you have a written affirmative action plan? If NO, explain. YES NO t/�l ❑ DOEA USE ONLY Reviewed By In Com Hance: YES ❑ NO* ❑ Program Office *Notice of Corrective Action Sent Date Telephone Response Due / / On -Site ❑ Desk Review ❑ Response Received Revised August 2010, Page 2 of 2 GCA - 11 2 0 c m 3 m z 0 ti ti 0 rZ LL N 0 r Q 7/16/2021 2:56 PM p. 43 Packet Pg. 628 EXHIBIT LB / ATTACHMENT V Collier County 16.D.5.g Solicitation 18-7470S INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST Describe the geographic service area such as a district, county, city or other locality. If the program/facility serves a specific target population such as adolescents, describe the target population. Also, define the type of service provided. N L 2. O Enter the percent of the population served by race and sex. The population served includes persons in the geographical area for which services are provided such as a city, county or other regional area. Population statistics a) can be obtained from local chambers of commerce, libraries, or any publication from the 1980 Census containing 3 Florida population statistics. Include the source of your population statistics. ("Other" races include Asian/Pacific a) Islanders and American Indian/Alaskan Natives.) co 3. 0 ti Enter the total number of full-time staff and their percent by race, sex and disability. Include the effective date of ti your summary. 06 4. (L Enter the total number of clients who are enrolled, registered or currently served by the program or facility, and list U. their percent by race, sex and disability. Include the date that enrollment was counted. 5. N Enter the total number of advisory board members and their percent by race, sex, and disability. If there is no c advisory or governing board, leave this section blank. N 6. Each recipient of federal financial assistance must have on file an assurance that the program will be conducted in a compliance with all nondiscriminatory provisions as required in 45 CFR 80. This is usually a standard part of the contract language for DOEA recipients and their sub -grantees, 45 CFR 80.4 (a). `p c 7. Is the race, sex, and national origin of the staff reflective of the general population? For example, if 10% of the a) population is Hispanic, is there a comparable percentage of Hispanic staff? 8. Where there is a significant variation between the race, sex or ethnic composition of the clients and their availability in the population, the program/facility has the responsibility to determine the reasons for such variation and take V whatever action may be necessary to correct any discrimination. Some legitimate disparities may exist when programs are sanctioned to serve target populations such as elderly or disabled persons, 45 CFR 80.3 (b) (6). v 9. Do eligibility requirements unlawfully exclude persons in protected groups from the provision of services or E employment? Evidence of such may be indicated in staff and client representation (Questions 3 and 4) and also = through on -site record analysis of persons who applied but were denied services or employment, 45 CFR 80.3 (a) and 45 CFR 80.1 (b) (2). 10. Participants or clients must be provided services such as medical, nursing and dental care, laboratory services, C co physical and recreational therapies, counseling and social services without regard to race, sex, color, national origin, `m religion, age or disability. Courtesy titles, appointment scheduling and accuracy of record keeping must be applied m uniformly and without regard to race, sex, color, national origin, religion, age or disability. Entrances, waiting m rooms, reception areas, restrooms and other facilities must also be equally available to all clients, 45 CFR 80.3 (b). Q 11. Cn For in -patient services, residents must be assigned to rooms, wards, etc., without regard to race, color, national origin r- or disability. Also, residents must not be asked whether they are willing to share accommodations with persons of a 11� different race, color, national origin, or disability, 45 CFR 80.3 (a). °r° 12. The program/facility and all services must be accessible to participants and applicants, including those persons who 0) may not speak English. In geographic areas where a significant population of non-English speaking people live, E program accessibility may include the employment of bilingual staff. In other areas, it is sufficient to have a policycc or plan for service, such as a current list of names and telephone numbers of bilingual individuals who will assist in Q the provision of services, 45 CFR 80.3 (a). GCA - 12 7/16/2021 2:56 PM p' 4 ""` Packet Pg. 629 16.D.5.g EXHIBIT LB /ATTACHMENT V Collier County Solicitation 18-7470S 13. Programs/facilities must make information regarding the nondiscriminatory provisions of Title VI available to their participants, beneficiaries or any other interested parties. This should include information on their right to file a complaint of discrimination with either the Florida Department of Elder Affairs or the U.S. Department of HHS. The information may be supplied verbally or in writing to every individual, or may be supplied through the use of an equal opportunity policy poster displayed in a public area of the facility, 45 CFR 80.6 (d). 14. Report number of discrimination complaints filed against the program/facility. Indicate the basis, e.g., race, color, creed, sex, age, national origin, disability, retaliation; the issues involved, e.g., services or employment, placement, termination, etc. Indicate the civil rights law or policy alleged to have been violated along with the name and address of the local, state or federal agency with whom the complaint has been filed. Indicate the current status, e.g., settled, no reasonable cause found, failure to conciliate, failure to cooperate, under review, etc. 15. The program/facility must be physically accessible to disabled individuals. Physical accessibility includes designated parking areas, curb cuts or level approaches, ramps and adequate widths to entrances. The lobby, public telephone, restroom facilities, water fountains, information and admissions offices should be accessible. Door widths and traffic areas of administrative offices, cafeterias, restrooms, recreation areas, counters and serving lines should be observed for accessibility. Elevators should be observed for door width, and Braille or raised numbers. Switches and controls for light, heat, ventilation, fire alarms, and other essentials should be installed at an appropriate height for mobility impaired individuals. 16. Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance conduct a self - evaluation to identify any accessibility barriers. Self -evaluation is a four step process: a. With the assistance of a disabled individual/organization, evaluate current practices and policies which do not comply with Section 504. b. Modify policies and practices that do not meet Section 504 requirements. c. Take remedial steps to eliminate any discrimination that has been identified. d. Maintain self -evaluation on file. (This checklist may be used to satisfy this requirement if these four steps have been followed.), 45 CFR 84.6. 17, Programs or facilities that employ 15 or more persons must adopt grievance procedures that incorporate appropriate due process standards and provide for the prompt and equitable resolution of complaints alleging any action prohibited by Section 504.45 CFR 84.7 (b). 18. Programs or facilities that employ 15 or more persons must designate at least one person to coordinate efforts to comply with Section 504.45 CFR 84.7 (a). 19. Continuing steps must be taken to notify employees and the public of the program/facility's policy of nondiscrimination on the basis of disability. This includes recruitment material, notices for hearings, newspaper ads, and other appropriate written communication, 45 CFR 84.8 (a). 20. Programs/facilities that employ 15 or more persons must provide appropriate auxiliary aids to persons with impaired sensory, manual or speaking skills where necessary. Auxiliary aids may include, but are not limited to, interpreters for hearing impaired individuals, taped or Braille materials, or any alternative resources that can be used to provide equally effective services, 45 CFR 84.52 (d). 21. Programs/facilities with 50 or more employees and $50,000.00 in federal contracts must develop, implement and maintain a written affirmative action compliance program in accordance with Executive Order 11246, 41 CFR 60 and Title VI of the Civil Rights Act of 1964, as amended. DOEA Form 101-B, Revised August 2010 GCA - 13 4 r Q 7/16/2021 2:56 PM P. �6,._.,,.N Packet Pg. 630 rA=1L 1.D!i\11til.tLV1I:1V1 Vil 16.D.5.g Collier County Solicitation 18-7470S DFTI A:RTNIENT OF E L El AFFAIRS sTA,rE or- FLORIDA AUTHORITY: This form is required annually of all employers to comply with the attestation requirements set forth in section 435.05(3), Florida Statutes. > The term "employer" means any person or entity required by law to conduct background screening, including but not limited to, Area Agencies on Aging, Aging Resource Centers, Aging and Disability Resource Centers, Lead Agencies, Long -Term Care Ombudsman Program, Serving Health Insurance Needs of Elders Program, Service Providers, Diversion Providers, and any other person or entity which hires employees or has volunteers in service who meet the definition of a direct service provider. See §§ 435.02, 430,0402, Fla. Stat, A A direct service provider is "a person 18 years of age or older who, pursuant to a program to provide services to the elderly, has direct, face-to-face contact with a client while providing services to the client and has access to the client's living area, funds, personal property, or personal identification information as defined in s. 817.568. The term includes coordinators, managers, and supervisors of residential facilities; and volunteers." § 430.0402(1)(b), Fla. Stat. ATTESTATION: As the duly authorized representative of A Better Solution Employer Name located at 5600 Bee Ridge Rd. Suite B Sarasota, FL 34233 Street Address city State ZIP code 1, Daniel Dellapina do hereby affirm under penalty of perjury Name of Representative that the above named employer is in compliance with the provisions of Chapter 435 and section 430.0402, Florida Statutes, regarding level 2 background screening. y L Signature of R ` resentative Date m a fn 0 STATE OF FLORIDA, COUNTY OF�'�' c t7•oy S`>�'" ` �; 00 Sworn to (or affirmed) and subscribed before me this day of Ay661 i 204: , by aD L_ J31 }- (Name of Representative) who is personally known E to me or produced , as proof of identification. � ,'( MATTHEW CLEARY Commisslon#Gd255897 u� � eptsmber 19, 2022 Print, Type, or StampCommissioneA `AotBev$tr'fwulgotNman5ervices Notary Public DOEA Form 235, Affidavit of Compliance -Employer, Effective April 2012 Section 435.05(3), F.S. Form available at: http://eideraffairs.state.fl.us/enolish/backgroundscreenina.pho 7/16/2021 2:56 PM P. Packet Pg. 631 Collier County 16.D.5.g Solicitation 18-7470S I";X1-1113H, 1,13 (i1Z= N'1' C'I,.1L't ll'I( A"l'l(.}N<)'.kN1:3 ASS[A ANC.F ; COLLIER COUNTY Conflict of Interest Certification 18-7470S Collier County Solicitation No. 1, Daniel Dellapina , hereby certify that to the best of my knowledge, neither I nor my spouse, dependent child, general partner, or any organization for which I am serving as an officer, director, trustee, general partner or employee, or any person or organization with whom I am negotiating or have an arrangement concerning prospective employment has a financial interest in this matter. I further certify to the best of my knowledge that this matter will not affect the financial interests of any member of my household. Also, to the best of my knowledge, no member of my household; no relative with whom I have a close relationship; no one with whom my spouse, parent or dependent child has or seeks employment; and no organization with which I am seeking a business relationship nor which I now serve actively or have served within the last year are parties or represent a party to the matter. I also acknowledge my responsibility to disclose the acquisition of any financial or personal interest as described above that would be affected by the matter, and to disclose any interest I, or anyone noted above, has in any person or organization that does become involved in, or is affected at a later date by, the conduct of this matter. Name Signature CFO 8/4/2021 Position Date Privacy Act Statement Title I of the Ethics in Government Act of 1978 (5 U.S.C. App.), Executive Order 12674 and 5 CFR Part m 2634, Subpart I require the reporting of this information. The primary use of the information on this form m is for review by officials of The Justice Department to determine compliance with applicable federal a conflict of interest laws and regulations. Additional disclosures of the information on this report may be o made: (1) to a federal, state or local law enforcement agency if the Justice Department becomes aware of I a violation or potential violation of law or regulations; (2) to a court or party in a court or federal ao administrative proceeding if the government is a party or in order to comply with a judge -issued subpoena; (3) to a source when necessary to obtain information relevant to a conflict of interest investigation or decision; (4) to the National Archives and Records Administration or the General E Services Administration in records management inspections; (5) to the Office of Management and Budget during legislative coordination on private relief legislation; and (6) in response to a request for discovery or for the appearance of a witness in a judicial or administrative proceeding, if the information is relevant Q to the subject matter. This confidential certification will not be disclosed to any requesting person unless authorized by law. See also the OGE/GOVT-2 executive branch -wide Privacy Act system of records. GCA - 15 7/16/2021 2:56 PM P Packet Pg. 632 Collier County Solicitation 18-7470S 1"XIIJBI-T 113 AND ASS(JRANCES COLLIER COUNTY ANTICIPATED DISADVANTAGED, (MINORITY, WOMEN OR VETERAN PARTICIPATION STATEMENT will be,.T-rift". Urrverifaee statusesve-111 require the PRwE to either proirvcle a reAsed Statement or provide source documentation that validates PRIME NAME PRIME FE"D NUMBER CONTRACT DOLLAR AMOUNT Sunshine Health Care Service, LLC 474121839 i5 THE PRIME A FLOP; DA-CERTIFIED DISADVANTAGED, VET RAIIJ Y N 6 THE ACnVM Of THIS CONTRACT.- MINORITe OR WOVEN BLISMESS EtilElIPAISE? DBE? y N CONSTRUCTION ? y 14 PBf,iI.IBEj%'iBEI ORHAVE ASNIAILDISA.DVAN7TAGED COUSULTAT,4014? y N a - ERTIMATION, FROM THE SMALL BUSINES'S 1,113 N ADMINISTRATION? ASERVICE DISABLED VETERAN? WBE? N OTHER? El N FDB SA? Y N 15 THiS 5UBMISS'ON A REVISION? l Y M IFVFS,RE` ISIONNUMBER 1 DBE m/WBE I SUBCONTRACTOR OR SUPPLIER I TYPE OF WORK OR I ETHNICITY CODE I SUBISUPPLIER I PERCE14T OF C014TRACT NAME OF SUBMITTER, DATE 7TTLE OF SUBIAMER Barbara Cogswell 8/25/2021 CEO/President ENML_ADDRESS Of PRIME (SUBMITTER) TELEPHONE NUMBER FAX NUMBER BlCogswell@abs.care 941-906-1881 941-906-1190 NOTE: This information is used to track and report anticipated DBE of ME PilrtidPatiOn in federally -funded contracts. The anticipated DBE or rom amount is voluntar; and will not becorne part of the contractual terms. This form must be submitted at time of r's'sportseto a Solicitation. J and vhen awarded a County contrart, the prime will be asked to update the information for the grant compliance files. Black American BA KispanicAmerican HA NativeAmefican NA SUbcont. Asian American SAA Asian -Pad ificAmerican APA Non -Minority Mmen I Other: not 6 f any,other group listed 0 NAME I COWER I[ACCEPTED BY. .1 DATE GCA - 16 7/16/2021 2:56 PM F—Packet Pg. 633 Collier County Solicitation 18-7470S FIXI 11BfT I Al GRANT ASM-RAN(TS 0 PID OPPORTUNITY LIST FOR COMMODITIES AND CONTRACTUAL SERVICES AND PROFESSIONAL CONSULTANT SERVICES > ?t is tY'ep'oficy of cof.14F county that disadvontogedbusinesms orld m1non4yvendors, as defirrdin Ill. codegf FedfrolRegul'ov'ons (CFA) cr Florldo RarUtes fFS), MUST hGVe the 00aortunizy to portf-ripatzoR contfactsMthfederal o*d/zr stertle grant assis Once, z Sunshine Health Care Services, LLC Phme Contnctor/Prime consultant: 5600 Bee Ridge Rd., Suite B, Sarasota, FL. 34233 941-906-18E "r Address and Phonetiumber 00 18-4740S Procurement Number,'Ad4ertisement Num�--r: U. The list below is intended to be a listing of firms that are, or attempting ro, participate on the project numbered above. The I ist must include the firm bidding or quoting as prime, as wall as subs and suppliers qjoting for participation. Prime contractvs and consultants must pr&0de informatiort for Numbers 1, 2, 3, and 4; and, should provide any information they have for Numbers 5, 6, 7, and "6. Thal form must C14 11 be Submit Ited With the bid pacliage. 0 1. Federal Tax 10 Number., 474121839 & R DBE 2, Annual Gross Receipts than 1 N D $ million 2. Krm Name: Sunshine Health Care Services, LLC Non -DBE Less 3. Phone number; 941-906-1881 Between s 1-5 n-01ion 4. Address 5600 Bee Ridge Rd BeV&een S 5-10 million 1) Suite B TRSubcontractor Between 5 10-15 million 0 Sarasota FL 34233 5ubconsuftant more than 5 15 million 5. Year FtrmEstablished' 2015 1. federal Tax ID Number: 6. DOE R. Annual Gross Receipts Less than $ i million 2. Firm Name: Non -DBE 3. Phone Number Between 5 1-5 mi'lion 4. Addrers Between 5-16 million TRSubcontractor Betvieen 5 10-15 million subconsu"tant More than 5 15 million E 5. Year Firm Established. 0 X 1. Federal Tax 10 dumber: Z. Firm Name'.6f ] DBE Non -DBE 8. Annual Gross Receipts r— Less than 5 1 rMlion 0 3, Phone Number Between S 1.5 mIrliOn 4. Address Between $ 5-10 million 7,8 Sbcontracwr Between 5 10-13 mMicq subconsdItant more than S 15 million 4) 4) 5. Year Firm Established S. Federal Tax iD number: 6' R DBE 3, Annual Gross Receipts CD 2. firm Name: Less than i mi0jon 3. Phone Number: Between 13 m0iian 4. Address Between 5 5-10 mAliOrt C; subcontractor Between 5 iG-13 miffion sut'ronsuftant more than 5 15 million 5, Year Firm established: E 0 GCA - 17 7/16/2021 2:56 PM p. 49 F—Packet Pg. 634 Collier County 16.D.5.g Solicitation 18-7470S EXI11131T 1.13 GRAN"'I- ('LI011"1 I -VI 1C N�) AMID AS[`IZANCES COLLIER COUNTY Acknowledgement of Terms, Conditions, and Grant Clauses Flow Down of Terms and Conditions from the Grant Agreement Subcontracts: If the Contractor subcontracts any of the work required under this Agreement, a copy of the signed subcontract must be available to the County for review and approval. The Contractor agrees to include in the subcontract that (1) the subcontractor is bound by the terms of this Agreement, (ii) the subcontractor is bound by all applicable state and federal laws and regulations, and (iii) the subcontractor shall hold the County and the Grantor Agency harmless against all claims of whatever nature arising out of the subcontractor's performance of work under this Agreement, to the extent allowed and required by law. The County may document in the quarterly report the Contractor's progress in performing its work under this agreement. Certification On behalf of my firm, I acknowledge, and agree to perform all of the specifications and grant requirements identified in this solicitation document(s). Vendor/Contractor Name A Better Solution Authorized Signature Address 5600 Bee Ridge Rd. Suite B Sarasota, FL 34233 Solicitation/Contract # 18-7470S GCA-18 Date 8/4/2021 05/20 R4 7/16/2021 2:56 PM p•:50-,:4s Packet Pg. 635 FIXED FEE PROFESSIONAL SERVICE AGREEMENT # 18-7470S for SERVICES FOR SENIORS THIS AGREEMENT, made and entered into on this day of 2021 , by and between Home Health Care Resources, Corp authorized to do business in the State of Florida, whose business address is 2475 Mercer Ave, Suite 207, West Palm Beach, FL 33401 ,(the "Contractor") and Collier County, a political subdivision of the State of Florida, (the "County"): WITNESSETH: The Agreement shall commence upon the date of Board approval and terminating on December 10, 2022 or until all outstanding Purchase Order(s) issued prior to the expiration of the Agreement period have been completed or terminated. The County may, at its discretion and with the consent of the Contractor, renew the Agreement under all of the terms and conditions contained in this Agreement for two ( 2 ) additional one ( 1 ) year(s) periods. The County shall give the Contractor written notice of the County's intention to renew the Agreement term prior to the end of the Agreement term then in effect. The County Manager, or his designee, may, at his discretion, extend the Agreement under all of the terms and conditions contained in this Agreement for up to one hundred and eighty (180) days. The County Manager, or his designee, shall give the Contractor written notice of the County's intention to extend the Agreement term prior to the end of the Agreement term then in effect. 2. COMMENCEMENT OF SERVICES. The Contractor shall commence the work upon issuance of a * Purchase Order ❑ ❑ WG*- . 3. STATEMENT OF WORK. The Contractor shall provide services in accordance with the terms and conditions of 0 Request for Proposal (RFP) ❑ fi+en-le sid-FI-T-B} ❑ Gther �--3 # 18-7470S , including all Attachment(s), Exhibit(s) and Addenda and the Contractor's proposal referred to herein and made an integral part of this Agreement. * The Contractor shall also provide services in accordance with Exhibit A — Scope of Services attached hereto. Page 1 of 15 Fixed Price Professional Service Agreement 2021_Ver.I C Packet Pg. 636 3.1 This Agreement contains the entire understanding between the parties and any modifications to this Agreement shall be mutually agreed upon in writing by the Parties, in compliance with the County's Procurement Ordinance, as amended, and Procurement Procedures in effect at the time such services are authorized. 3.2 The execution of this Agreement shall not be a commitment to the Contractor to order any minimum or maximum amount. The County shall order items/services as required but makes no guarantee as to the quantity, number, type or distribution of items/services that will be ordered or required by this Agreement. 4. THE AGREEMENT SUM. The County shall pay the Contractor for the performance of this Agreement based on Exhibit B- Fee Schedule, attached hereto and the price methodology as defined in Section 4.1. Payment will be made upon receipt of a proper invoice and upon approval by the County's Contract Administrative Agent/Project Manager, and in compliance with Chapter 218, Fla. Stats., otherwise known as the "Local Government Prompt Payment Act". 4.1 Price Methodology (as selected below): FA 12, 1110 0* -0 ,..-. ---- . - - ❑■ Time and Materials: The County agrees to pay the contractor for the amount of labor time spent by the contractor's employees and subcontractors to perform the work (number of hours times hourly rate), and for materials and equipment used in the project (cost of materials plus the contractor's markup). This methodology is generally used in projects in which it is not possible to accurately estimate the size of the project, or when it is expected that the project requirements would most likely change. As a general business practice, these contracts include back-up documentation of costs; invoices would include number of hours worked and billing rate by position (and not company (or subcontractor) timekeeping or payroll records), material or equipment invoices, and other reimbursable documentation for the project. 4.2 Any County agency may obtain services under this Agreement, provided sufficient funds are included in their budget(s). Page 2 of 15 Fixed Price Professional Service Agreement 2021_Ver.I CA Packet Pg. 637 4.3 Payments will be made for services furnished, delivered, and accepted, upon receipt and approval of invoices submitted on the date of services or within six (6) months after completion of the Agreement. Any untimely submission of invoices beyond the specified deadline period is subject to non-payment under the legal doctrine of "laches" as untimely submitted. Time shall be deemed of the essence with respect to the timely submission of invoices under this Agreement. 4.4 The County, or any duly authorized agents or representatives of the County, shall have the right to conduct an audit of Contractor's books and records to verify the accuracy of the Contractor's claim with respect to Contractor's costs associated with any Payment Application, Change Order, or Work Directive Change. 5. SALES TAX. Contractor shall pay all sales, consumer, use and other similar taxes associated with the Work or portions thereof, which are applicable during the performance of the Work. Collier County, Florida as a political subdivision of the State of Florida, is exempt from the payment of Florida sales tax to its vendors under Chapter 212, Florida Statutes, Certificate of Exemption # 85-8015966531 C. Page 3 of 15 Fixed Price Professional Service Agreement 2021_Ver.1 ■ Packet Pg. 638 6. NOTICES. All notices from the County to the Contractor shall be deemed duly served if mailed or emailed to the Contractor at the following: Company Name: Home Health Care Resources, Corp Address: 866 Tamiami Trail, Suite 4 Port Charlotte, FL 33953 Authorized Agent: Carlos M. Pereira, President Attention Name & Title: Sullymar Alicia Telephone: (941) 883-4282 E-Mail(s): Sullymar@homehealthcrc.com All Notices from the Contractor to the County shall be deemed duly served if mailed or emailed to the County to: Board of County Commissioners for Collier County, Florida Division Director: Kristi Sonntag Division Name: Community and Human Services Division Address: 3339 East Tamiami Trail, Suite 211 Naples, FL 34112 Administrative Agent/PM: Wendy Klopf, Grants Coordinator Telephone: (239) 252-29001 E-Mail(s): Wendy.Klopf@colliercountyfl.gov The Contractor and the County may change the above mailing address at any time upon giving the other party written notification. All notices under this Agreement must be in writing. 7. NO PARTNERSHIP. Nothing herein contained shall create or be construed as creating a partnership between the County and the Contractor or to constitute the Contractor as an agent of the County. 8. PERMITS: LICENSES: TAXES. In compliance with Section 218.80, F.S., all = permits necessary for the prosecution of the Work shall be obtained by the Contractor. The County will not be obligated to pay for any permits obtained by o Subcontractors. _ 0 Payment for all such permits issued by the County shall be processed internally by the County. All non -County permits necessary for the prosecution of the Work shall be procured and paid for by the Contractor. The Contractor shall also be solely responsible for payment of any and all taxes levied on the Contractor. In a addition, the Contractor shall comply with all rules, regulations and laws of Collier E County, the State of Florida, or the U. S. Government now in force or hereafter U adopted. The Contractor agrees to comply with all laws governing the a responsibility of an employer with respect to persons employed by the Contractor. Page 4 of 15 Fixed Price Professional Service Agreement 2021_Ver.I CAO Packet Pg. 639 9. NO IMPROPER USE. The Contractor will not use, nor suffer or permit any person to use in any manner whatsoever, County facilities for any improper, immoral or offensive purpose, or for any purpose in violation of any federal, state, county or municipal ordinance, rule, order or regulation, or of any governmental rule or regulation now in effect or hereafter enacted or adopted. In the event of such violation by the Contractor or if the County or its authorized representative shall deem any conduct on the part of the Contractor to be objectionable or improper, the County shall have the right to suspend the Agreement of the Contractor. Should the Contractor fail to correct any such violation, conduct, or practice to the satisfaction of the County within twenty-four (24) hours after receiving notice of such violation, conduct, or practice, such suspension to continue until the violation is cured. The Contractor further agrees not to commence operation during the suspension period until the violation has been corrected to the satisfaction of the County. 10. TERMINATION. Should the Contractor be found to have failed to perform his services in a manner satisfactory to the County as per this Agreement, the County may terminate said Agreement for cause; further the County may terminate this Agreement for convenience with a thirty (30) day written notice. The County shall be the sole judge of non-performance. In the event that the County terminates this Agreement, Contractor's recovery against the County shall be limited to that portion of the Agreement Amount earned through the date of termination. The Contractor shall not be entitled to any other or further recovery against the County, including, but not limited to, any damages or any anticipated profit on portions of the services not performed. 11. NO DISCRIMINATION. The Contractor agrees that there shall be no discrimination as to race, sex, color, creed or national origin. 12. INSURANCE. The Contractor shall provide insurance as follows: A. 0 Commercial General Liability: Coverage shall have minimum limits of $1,000,0000 Per Occurrence, $2,000,000 aggregate for Bodily Injury Liability and Property Damage Liability. This shall include Premises and Operations; Independent Contractors; Products and Completed Operations and Contractual Liability. B. A- Business Auto Liability: Coverage shall have minimum limits of ti $ 500,000 Per Occurrence, Combined Single Limit for Bodily Injury Liability and Property Damage Liability. This shall include: Owned Vehicles, Hired and co Non -Owned Vehicles and Employee Non -Ownership. a� C. ❑■ Workers' Compensation: Insurance covering all employees meeting Statutory Limits in compliance with the applicable state and federal laws. a The coverage must include Employers' Liability with a minimum limit of $1,000,000 for each accident. Page 5 of 15 Fixed Price Professional Service Agreement 2021_Ver.1 fko'` Packet Pg. 640 D. � Professional Liability: Shall be maintained by the Contractor to ensure its legal liability for claims arising out of the performance of professional services under this Agreement. Contractor waives its right of recovery against County as to any claims under this insurance. Such insurance shall have limits of not less -00 than $1,000,000 each claim and aggregate. €- ❑Gevefage sha# have I m4s, of � Q ,per nnni irreR e. 4 N O ti i= ❑ ti se. a U_ G- ❑ ee6WfFeR6e: N O ❑ State I i+nn hnrnm�nlc �nri I.I�rhvn� rt�rL ti Yga�rrrvrc.T. �lni irk FeAGe. 2 L 1- ❑ Act): Coverage shall have minimum limits of $ per occurrence. L. 0 Crime/Employee Dishonesty (other): Coverage shall have minimum limits of $ 50,000 per occurrence. 0 U Special Requirements: Collier County Board of County Commissioners, OR, Board of County Commissioners in Collier County, OR, Collier County L Government shall be listed as the Certificate Holder and included as an 0 "Additional Insured" on the Insurance Certificate for Commercial General Liability where required. This insurance shall be primary and non-contributory with respect to any other insurance maintained by, or available for the benefit of, the Additional Insured and the Contractor's policy shall be endorsed accordingly. r Current, valid insurance policies meeting the requirement herein identified shall be = maintained by Contractor during the duration of this Agreement. The Contractor shall provide County with certificates of insurance meeting the required insurance 0 provisions. Renewal certificates shall be sent to the County thirty (30) days prior M to any expiration date. Coverage afforded under the policies will not be canceled ti or allowed to expire until the greater of: thirty (30) days prior written notice, or in accordance with policy provisions. Contractor shall also notify County, in a like co manner, within twenty-four (24) hours after receipt, of any notices of expiration, cancellation, non -renewal or material change in coverage or limits received by Contractor from its insurer, and nothing contained herein shall relieve Contractor of this requirement to provide notice. Contractor shall ensure that all subcontractors comply with the same insurance a requirements that the Contractor is required to meet. Page 6 of 15 Fixed Price Professional Service Agreement 2021_Ver.l Ic A Packet Pg. 641 13. INDEMNIFICATION. To the maximum extent permitted by Florida law, the Contractor shall defend, indemnify and hold harmless Collier County, its officers and employees from any and all liabilities, damages, losses and costs, including, but not limited to, reasonable attorneys' fees and paralegals' fees, whether resulting from any claimed breach of this Agreement by Contractor, any statutory or regulatory violations, or from personal injury, property damage, direct or consequential damages, or economic loss, to the extent caused by the negligence, recklessness, or intentionally wrongful conduct of the Contractor or anyone employed or utilized by the Contractor in the performance of this Agreement. This indemnification obligation shall not be construed to negate, abridge or reduce any other rights or remedies which otherwise may be available to an indemnified party or person described in this paragraph. This section does not pertain to any incident arising from the sole negligence of Collier County, 13.1 The duty to defend under this Article 13 is independent and separate from the duty to indemnify, and the duty to defend exists regardless of any ultimate liability of the Contractor, County and any indemnified party. The duty to defend arises immediately upon presentation of a claim by any party and written notice of such claim being provided to Contractor. Contractor's obligation to indemnify and defend under this Article 13 will survive the expiration or earlier termination of this Agreement until it is determined by final judgment that an action against the County or an indemnified party for the matter indemnified hereunder is fully and finally barred by the applicable statute of limitations. 14. AGREEMENT ADMINISTRATION. This Agreement shall be administered on behalf of the County by the Community and Human Services Division 15. CONFLICT OF INTEREST. Contractor represents that it presently has no interest and shall acquire no interest, either direct or indirect, which would conflict in any manner with the performance of services required hereunder. Contractor further represents that no persons having any such interest shall be employed to perform those services. 16. COMPONENT PARTS OF THIS AGREEMENT. This Agreement consists of the 4) following component parts, all of which are as fully a part of the Agreement as if o herein set out verbatim: Contractor's Proposal, Insurance Certificate(s), 0 Exhibit = A Scope of Services, Exhibit B Fee Schedule, FE-1 RFP/ ❑ IT-B/ ❑ ' # 18-7470S including Exhibits, Attachments and Addenda/Addendum, ❑ subsequent quotes, Co and ❑ Other Exhibit/Attachment: Federal Grant Provisions r c a� 17. APPLICABILITY. Sections corresponding to any checked box (N) will expressly apply to the terms of this Agreement. a 18. SUBJECT TO APPROPRIATION. It is further understood and agreed by and between the parties herein that this Agreement is subject to appropriation by the Board of County Commissioners. Page 7 of 15 Fired Price Professional Service Agreement 2021_Ver.l ti-0 9 Packet Pg. 642 19. PROHIBITION OF GIFTS TO COUNTY EMPLOYEES. No organization or individual shall offer or give, either directly or indirectly, any favor, gift, loan, fee, service or other item of value to any County employee, as set forth in Chapter 112, Part III, Florida Statutes, Collier County Ethics Ordinance No. 2004-05, as amended, and County Administrative Procedure 5311. Violation of this provision may result in one or more of the following consequences: a. Prohibition by the individual, firm, and/or any employee of the firm from contact with County staff for a specified period of time; b. Prohibition by the individual and/or firm from doing business with the County for a specified period of time, including but not limited to: submitting bids, RFP, and/or quotes; and, c. immediate termination of any Agreement held by the individual and/or firm for cause. 20. COMPLIANCE WITH LAWS. By executing and entering into this Agreement, the Contractor is formally acknowledging without exception or stipulation that it agrees to comply, at its own expense, with all federal, state and local laws, codes, statutes, ordinances, rules, regulations and requirements applicable to this Agreement, including but not limited to those dealing with the Immigration Reform and Control Act of 1986 as located at 8 U.S.C. 1324, et seq. and regulations relating thereto, as either may be amended; taxation, workers' compensation, equal employment and safety including, but not limited to, the Trench Safety Act, Chapter 553, Florida Statutes, and the Florida Public Records Law Chapter 119, if applicable, including specifically those contractual requirements at F.S. § 119.0701(2)(a)-(b) as stated as follows: IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT: Division of Communications, Government and Public Affairs 3299 Tamiami Trail East, Suite 102 Naples, FL 34112-5746 Telephone: (239) 252-8999 Email: PublicRecordReg uest@colIiercoun yfLgov The Contractor must specifically comply with the Florida Public Records Law to: 1. Keep and maintain public records required by the public agency to perform the service. 2. Upon request from the public agency's custodian of public records, provide the public agency with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law. Page 8 of 15 Fixed Price Professional Service Agreement 2021_Ver.I Packet Pg. 643 3. Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law for the duration of the contract term and following completion of the contract if the Contractor does not transfer the records to the public agency. 4. Upon completion of the contract, transfer, at no cost, to the public agency all public records in possession of the Contractor or keep and maintain public records required by the public agency to perform the service. If the Contractor transfers all public records to the public agency upon completion of the contract, the Contractor shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the Contractor keeps and maintains public records upon completion of the contract, the Contractor shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to the public agency, upon request from the public agency's custodian of public records, in a format that is compatible with the information technology systems of the public agency. If Contractor observes that the Contract Documents are at variance therewith, it shall promptly notify the County in writing. Failure by the Contractor to comply with the laws referenced herein shall constitute a breach of this Agreement and the County shall have the discretion to unilaterally terminate this Agreement immediately. 21. OFFER EXTENDED TO OTHER GOVERNMENTAL ENTITIES. Collier County encourages and agrees to the successful Contractor extending the pricing, terms and conditions of this solicitation or resultant Agreement to other governmental entities at the discretion of the successful Contractor. 22. AGREEMENT TERMS. If any portion of this Agreement is held to be void, invalid, or otherwise unenforceable, in whole or in part, the remaining portion of this Agreement shall remain in effect. 23. ADDITIONAL ITEMS/SERVICES. Additional items and/or services may be added to this Agreement in compliance with the Procurement Ordinance, as amended, and Procurement Procedures. 24, DISPUTE RESOLUTION. Prior to the initiation of any action or proceeding permitted by this Agreement to resolve disputes between the parties, the parties shall make a good faith effort to resolve any such disputes by negotiation. The negotiation shall be attended by representatives of Contractor with full decision -making authority and by 00 County's staff person who would make the presentation of any settlement reached during negotiations to County for approval. Failing resolution, and prior to the commencement of depositions in any litigation between the parties arising out of this Agreement, the parties shall attempt to resolve the dispute through Mediation before an agreed -upon Circuit Court Mediator certified by the State of Florida. The mediation a shall be attended by representatives of Contractor with full decision -making authority and by County's staff person who would make the presentation of any settlement Page 9 of 15 Fixed Price Professional Service Agreement 2021_Ver.1 nc&o Packet Pg. 644 reached at mediation to County's board for approval. Should either party fail to submit to mediation as required hereunder, the other party may obtain a court order requiring mediation under section 44.102, Fla. Stat. 25. VENUE. Any suit or action brought by either party to this Agreement against the other party relating to or arising out of this Agreement must be brought in the appropriate federal or state courts in Collier County, Florida, which courts have sole and exclusive jurisdiction on all such matters. 26. I�C�Y�QE_�cL1NINIE The GontFaGtOF'c_nnrsenn agement to he +ili`or1 fn� v �rrrc.-v vrrcracrro� v r.... .... TrT�P�dje�} oh.+ll ho Lnnu lcdry nhlo in_4h�ir +tone .,f ovr��yft�n Tho t`e iniir_r_oc__cr_i_roC. the F i g I#-" �`. GTnrJJ-ar+cr'-rt`�-t C-Gn�.,rvrmurn'rc� " o rn o n . The adequate-te-meet-m eter nh.,ll n F-gt 01,0rrge I-Y 1"'C1'3ae1'tiineti ,, lei Fem ��z ai �re-VeA:H'y is—riotifled—in vff+tin�far k-e e o The f or hr_rn4ain � C-i=iee�c..: r-�,c��c,ca,`;-cy-r�...,���,. I. ❑E AGREEMENT STAFFING. The Contractor's personnel and management to be utilized for this Agreement shall be knowledgeable in their areas of expertise. The County reserves the right to perform investigations as may be deemed necessary to ensure that competent persons will be utilized in the performance of the Agreement. The Contractor shall assign as many people as necessary to complete required services on a timely basis, and each person assigned shall be available for an amount of time adequate to meet required services. and/OF t Do ents shall take pfeeedenee. ❑E ORDER OF PRECEDENCE (Grant Funded). In the event of any conflict between E or among the terms of any of the Contract Documents and/or the County's Board o approved Executive Summary, the terms of the Agreement shall take precedence over = the terms of all other Contract Documents, except the terms of any Supplemental o Conditions shall take precedence over the Agreement. To the extent any conflict in the terms of the Contract Documents cannot be resolved by application of the Co Supplemental Conditions, if any, or the Agreement, the conflict shall be resolved by imposing the more strict or costly obligation under the Contract Documents upon the Contractor at County's discretion. 28. ASSIGNMENT. Contractor shall not assign this Agreement or any part thereof, without a the prior consent in writing of the County. Any attempt to assign or otherwise transfer this Agreement, or any part herein, without the County's consent, shall be void. If Contractor does, with approval, assign this Agreement or any part thereof, it shall Page 10 of 15 Fixed Price Professional Service Agreement 2021_Ver.I CAO Packet Pg. 645 require that its assignee be bound to it and to assume toward Contractor all of the obligations and responsibilities that Contractor has assumed toward the County. 29. SECURITY. The Contractor is required to comply with County Ordinance 2004-52, as amended. Background checks are valid for five (5) years and the Contractor shall be responsible for all associated costs. If required, Contractor shall be responsible for the costs of providing background checks by the Collier County Facilities Management Division for all employees that shall provide services to the County under this Agreement. This may include, but not be limited to, checking federal, state and local law enforcement records, including a state and FBI fingerprint check, credit reports, education, residence and employment verifications and other related records. Contractor shall be required to maintain records on each employee and make them available to the County for at least four (4) years. All of Contractor's employees and subcontractors must wear Collier County Government Identification badges at all times while performing services on County facilities and properties. Contractor ID badges are valid for one (1) year from the date of issuance and can be renewed each year at no cost to the Contractor during the time period in which their background check is valid, as discussed below. All technicians shall have on their shirts the name of the contractor's business. The Contractor shall immediately notify the Collier County Facilities Management Division via e-mail (DL-FMOPS@colliergov.net) whenever an employee assigned to Collier County separates from their employment. This notification is critical to ensure the continued security of Collier County facilities and systems. Failure to notify within four (4) hours of separation may result in a deduction of $500 per incident. (Intentionally left blank -signature page to follow) Page 11 of 15 Fixed Price Professional Service Agreement 2021_Ver.1 ( A(�` Packet Pg. 646 IN WITNESS WHEREOF, the parties hereto, by an authorized person or agent, have executed this Agreement on the date and year first written above. ATTEST: Crystal K. Kinzel, Clerk of Courts & Comptroller M Dated: (SEAL) Contractor's Witnesses: Contractor's First vVitness TTypelprint witness r>ameT CDntmcWf Second Witness 'Type tint witne. s name's Approved as to Farm and Legality: County Attorney Print Larne BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY, FLORIDA Horne Health Care Resources, Corp Contractor print signature and title a Page 22 of IS Fixed Price Professional Service Agreement 202 ]_Vet. € G� Packet Pg. 647 Exhibit A Scope of Services ❑■ following this page (containing 3 page/s) ❑ this exhibit is not applicable Q Page 13 of 15 Fixed Price Professional Service Agreement 2021_Ver.1 CEO O Packet Pg. 648 16.D.5.h REQUEST FOR PROPOSAL (RFP) # 18-7470S "SERVICES FOR SENIORS" SCOPE OF SERVICES BACKGROUND The purpose of this Agreement is for home and community -based services, to be delivered to persons/clients sixty years and older under Older American's Act (OAA), Community Care for the Elderly (CCE) and Health Care for the Elderly (HCE), and to qualified persons/clients eighteen years or older under Alzheimer's Disease Initiative (ADI), within the geographic area of Collier County. Unless otherwise stated, minimum hours of availability are 7:00 a.m. to 5:00 p.m. Monday through Saturday, with the exception of federal and state holidays. Respite services and emergency services must be available 24 hours/day, 365 days/year if needed. Definitions, standards, and requirements of these services are included in the Department of Elder Affairs' Home and Community -Based Services Handbook (DOEA Handbook) link: http://elderaffairs.state.fl.us/doea/nois.pht) DETAILED SCOPE OF WORK The Contractor/s (also may be referred to as "Vendor" or "Provider") must adhere to the scope outlined herein, in addition N N to maintaining adherence with the guidelines set forth by the current DOEA Handbook. Lack of knowledge of all requirements of a service listed in the proposal SHALL NOT relieve the provider of liability and obligations under = the resultant agreement. LM in L Collier County Community & Human Services (CHS) shall lead all service authorization and coordination under this 0 Agreement. In an effort to comply with the requirements of the OAA, ADI, CCE and HCE Programs, clients entering the > service system will be assessed and prioritized by CHS. Upon determination of the service level to be provided, CHS >i will offer the client a listing of service vendors for the specific service(s) outlined within their care plan. L The client will be encouraged to pick a service provider of their choice and have the option of interviewing potential C 0 service providers. Should the client not have a preference, CHS will select a service provider from the centralized provider yi list, using a rotation basis (rotating to the next vendor on the list). In this manner, all service providers will be equally treated unless the client has a preference. CHS shall not endorse one service provider over another. 3 Upon the determination of the service, the service levels, and the selected vendor, CHS will contact the vendor agency, 0 0 tY and authorize the service, number of hours, and frequency. In keeping with the state policy of client choice of service m providers, Collier County does not guarantee a minimum or maximum number of clients that will be referred, nor a v minimum or maximum number of service hours that will be requested during the contract period. r Should a client later indicate dissatisfaction with the chosen service provider, they will again be offered their choice of �a = provider. CHS shall send the agreed -upon Service Authorization to the chosen provider. These "service authorizations" or "service orders" must contain necessary client information, such as street address, telephone number, and services or 0 items needed, as well as the name and telephone number of the CHS case manager authorizing the service. In order to = meet client needs, some services may be required outside of normal office hours (8:00 AM to 5:00 PM, Monday - Friday). o CHS reserves the right to request adding additional service providers throughout the agreement period. The County may ti 00 do so through a competitive and publicly announced selection process, which shall be coordinated through the County's Procurement Department. Services shall be provided in the manner described in the most current DOEA manual and outlined herein. Should funding for additional Senior Services be identified, the County reserves the right to add to the resultant agreements the services, descriptions, rates, etc. by way of a contract addendum. Services covered by this agreement include, but are not limited to: ea Q 1. Adult Day Care: A program of therapeutic social and health activities and services provided to adults who have functional impairments, in a protective environment that provides as non -institutional an environment as possible. Page 1 of 3 Exhibit A — Scope of Services Packet Pg. 649 REQUEST FOR PROPOSAL (RFP) # 18-7470S "SERVICES FOR SENIORS" 2. Chore: Performance of routine house or yard tasks including such jobs as seasonal cleaning, yard work, lifting and moving furniture, appliances, or heavy objects, household repairs which do not require a permit or specialist, and household maintenance. 3. Enhanced Chore: This service is beyond the scope of chore due to the level of service needed. The service includes a more intensified, thorough cleaning to address more demanding circumstances. 4. Homemaking: Specific home management duties including housekeeping, laundry, cleaning refrigerators, clothing repair, minor home repairs, assistance with budgeting and paying bills, client transportation, meal planning and preparation, shopping assistance, and routine house -hold activities by a trained homemaker. 5. Personal Care: Assistance with eating, dressing, personal hygiene and other activities of daily living. This service may include assistance with meal preparation, housekeeping chores such as bed making, dusting,. and vacuuming incidental to the care furnished or essential to the health and welfare of the individual. Personal care can include accompanying the client to clinics, physician office visits, or trips for the purpose of health care provided that the client does not require special medical transportation. Personal care can also include shopping assistance to purchase food, clothing, and other items needed for the client's personal care needs. 6. In Home Respite: Relief or rest for a primary caregiver from the constant/continued supervision, companionship, therapeutic and/or personal care, of a functionally impaired older person for a specified period of time. 7. Skilled Nursing: Part-time or intermittent nursing care administered to an individual by a licensed practical nurse, registered nurse, or advanced registered nurse practitioner, in the client's place of residence, pursuant to a care plan approved by a licensed physician. 8. Emergency Alert Response Services: Emergency alert/response service is defined as a community based electronic surveillance service which monitors the frail homebound elder by means of an electronic communication link with a response center. 9. Specialized Medical Equipment, Services, and Supplies: Adaptive devices, controls, appliances, or services, which enable individuals to increase their ability to perform activities of daily living and repair of such services which may include: dentures, walkers, reaching devices, bedside commodes, telephone amplifiers, touch lamps, adaptive eating equipment, glasses, hearing aids, and other mechanical or non -mechanical, electronic, and non -electronic adaptive devices. Supplies may include such things as adult briefs, bed pads, oxygen or nutritional supplements. 10. Facility Respite: 24-hour care in a State of Florida Licensed Nursing home. r �a 11. Establish protocols for contacting CHS Case Managers in emergency or unusual circumstances and include the = documentation requirements (oral and written) in the Service Provider Application. E 0 12. Provide disaster response protocols, plans and services: In the event of a natural disaster (hurricane, tropical storm, _ tornado, flood, heat wave, etc.), the provider will have staff available to serve those clients in critical need of services, as c designated by the CHS Case Managers. 00 13. Establish a client grievance process: Each service provider agency must have a policy addressing client grievances and/or complaints. CD 14. Establish and provide staff training: All services provided with funding from DOEA require service delivery personnel to have general pre -service orientation and training specific to the service being provided. Lead Agencies are responsible for provision of the pre -service training (on program and billing requirements, in particular) for all paid staff, Q volunteer staff and assigned staff of service providers. Page 2 of 3 Exhibit A — Scope of Services OCA-0 Packet Pg. 650 16.D.5.h REQUEST FOR PROPOSAL (RFP) # 18-7470S "SERVICES FOR SENIORS" Pre -service orientation must also include: • An overview of the aging process • An overview of the aging network • Communication techniques with the elderly • Observation of abuse, neglect, exploitation and incident reporting • Local agency service procedures and protocol • Client confidentiality NOTE: All "hands-on" service personnel must receive training emphasizing the necessity of Universal Precautions. Home Health Aides must have documentation of successful completion of 40 hours required training, and CNAs must have on file a copy of their State of Florida certification. In-service training hours and topics are to be provided at the discretion of the service provider agency and shall meet state requirements. 15. Compile and report program service delivery statistics and other data as identified by CHS. This may be required to be provided in an electronic format at the choosing of CHS. These are reported to the Area Agency on Aging and Department of Elder Affairs in accordance with the reporting requirements developed by the Department. Lead agencies are responsible for entry of data in the Client Information and Registration Tracking System (CIRTS), which generates payment to the service provider agency. Therefore, service provider agencies are required to provide Lead Agencies with correct and timely service data to comply with these requirements. Timely submission is no later than noon on Wednesday of the week following the week services are performed (service week defined as Monday through Sunday). 16. Maintain complete and accurate records: Service delivery logs, at a minimum, must be legible and contain the name of client, type(s) of services and date(s) and hour(s) of delivery. The client/caregiver must sign the log at the time of each service visit. The service worker must sign and date the log upon completion and submit it to the service provider agency. Provide complete, clear and accurate invoices: Weekly invoices, which may be required to be provided electronically in a system provided by CHS, must be submitted by noon on the Wednesday following the week that the service was provided and shall include service provided. The service week is defined as Monday through Sunday. Monthly reporting requirements for CIRTS dictate that all client and service data for the previous month to be entered into CIRTS by the 10th day of the month. Collier County "Services for Seniors" will coordinate with vendors to determine due dates for invoices. This will ensure compliance with DOEA reporting requirements. Failure to record or report units of service will result in nonpayment (or delayed payment) for such services. Data required on weekly invoices and weekly timesheets include: r • Vendor name a� • Vendor address = • Vendor telephone number E • Client name • Service Provider employee who delivered the service(s) _ • Services ordered and services delivered date • Number of service hours, cost per hour and total cost • Person preparing the report and the date it was prepared 00 • Weekly timesheets signed and dated by the client and Service Provider employee • Additional information as determined by CHS E 17. Prepare for annual on -site compliance audits by CHS or members of the Collier County staff as directed by the CHS or grant requirements. Q Page 3 of 3 Exhibit A — Scope of Services Packet Pg. 651 Exhibit B Fee Schedule following this page (pages through Page 14 of 15 Fixed Price Professional Service Agreement 2021_Ver.I () Packet Pg. 652 16.D.5.h REQUEST FOR PROPOSAL (RFP) # 18-7470S "SERVICES FOR SENIORS" : FEE SCHEDULE Home Health Care Resources Corp. Cost Per Service In -kind 10% Reimbursement Rate Per Unit Unit (Cost your Match (Grant (Amount the Item Services Grant Service Unit company charges Amount your County will .for the service) company will be reimburse your paying) company for a given service) 1. Skilled Nursing CCE, OAA Per Hour $40.00 $4.00 $36.00 2. Enhance Chore ADI, CCE, OAA Per Hour $40.00 $4.00 $36.00 3. Respite (In -Home) ADI, CCE, OAA Per Hour $24.11 $2.41 $21.70 4. Respite (Facility ADI, CCE, OAA Daily Rate $225.00 0 $225.00 Based) 5. Personal Care ADI, CCE, OAA Per Hour $24.11 $2.41 $21.70 6. Chore ADI, CCE, OAA Per Hour $24.00 $2.40 $21.60 7. Homemaking ADI, CCE, OAA Per Hour $23.33 $2.33 $21.00 8. Adult Day Care ADI, CCE, OAA Per Hour $13.89 $1.39 $12.50 9. Emergency Alert ADI, CCE, OAA Per Day $1.09 $0.11 $0.98 Response Reimbursement Cost Per Service In -kind 10% Rate Per Unit Unit (Cost your Match (Grant (Amount the Item Services Grant Service company charges P Y g Amount our Y County will Unit for the service) company will be reimburse your paying) company for a given service) Specialized Medical ADI, CCE, OAA Per Episode N/A N/A N/A 10, Equipment, Services, and Supplies Page 1 of 1 Exhibit B - Fee Schedule Q kC O) Packet Pg. 653 Description: Other Exhibit/Attachment Federal Contract Provisions � following this page (pages 1 through 25 ) ❑ this exhibit is not applicable Page 15 of 15 Fixed Price Professional Service Agreement 2021_Ver.l Packet Pg. 654 16.D.5.h Collier County Solicitation 18-7470S EXHIBIT LA FEDERAL CONTRACT PROVISIONS U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (ADMINISTRATION ON AGING) AND FLORIDA DEPARTMENT OF ELDER AFFAIRS CFDA 93.OXX (CSFA 65.010) The supplemental conditions contained in this section are intended to cooperate with, to supplement, and to modify the general conditions and other specifications. In cases of disagreement with any other section of this contract, the Supplemental Conditions shall govern. Contractor means an entity that receives a contract. The services performed by the awarded Contractor shall be in compliance with the provisions of Title 45 CFR Part 75; and/, 2 CFR Part 200; and/or Title 45 Chapter XIII Part 1321 and/or other applicable regulations. It shall be the awarded Contractor's responsibility to acquire and utilize the necessary manuals and guidelines that apply to the work required to complete this project. In general, 1) The contractor (including all subcontractors) must insert these contract provisions in each lower tier contracts (e.g. subcontract or sub -agreement); 2) The contractor (or subcontractor) must incorporate the applicable requirements of these contract provisions by reference for work done under any purchase orders, rental agreements and other agreements for supplies or services; 3) The prime contractor is responsible for compliance with these contract provisions by any subcontractor, lower -tier subcontractor or service provider. FEDERAL STATUTORY AUTHORITY Older Americans Act of 1965 (OAA), as amended (42 U.S.0 § 3001 et seq., as amended by Public Law 114-144; 106-501; Section 20.41) OLDER AMERICANS ACT PROGRAM FUNDS OAA Title III B - Supportive Services; OAA, Title III, Section 307(a)(10) Title 45 Public Welfare (45 CFR 1321) Chapter XIII Office of Human Development Services, Department of Health and Human Services Part 1321.65 Grants to State and Community Programs on Aging; Part 1321.67 Service Contributions FLORIDA STATUTORY AUTHORITY TITLE XXX (Social Welfare); Chapter 430 (Elder Affairs) CONTRACT COMPLIANCE OVERVIEW o Under the Florida Department of Elder Affairs Older Americans Act, the contractor must comply with the contract documentation, conform to state and AAA policies, and comply with federal and state statutory 00 and regulatory requirements. (Ref - Department of Elder Affairs Programs and Services Handbook, Chapter 4, Page 22; July 2018: Older Americans Act.). The contractor will comply with the intent of Title III to provide for formula grants to State agencies on aging to stimulate the development or enhancement of d comprehensive and coordinated community -based systems resulting in a continuum of services to older persons s with special emphasis on older individuals with the greatest economic or social need, with particular attention to low-income minority individuals. (Ref. - Title 45 CFR 1321) Q FCP-1 7/7/2021 1:18 PM p. 26 ,C A 01 -------- _.. ----- ...—. Packet Pg. 655 16.D.5.h Colller County Solicitation 18-7470S EXHIBIT LA FEDERAL CONTRACT PROVISIONS U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES FEDERAL CONTRACT PROVISIONS Administrative, Contractual, or Legal Remedies (Ref. 41 U.S.C. 1908, 2 CFR § 200 Appendix lI (A) Unless otherwise provided in this contract, all claims, counter -claims, disputes and other matters in question between the local government and the contractor, arising out of or relating to this contract, or the breach of it, will be decided by arbitration, if the parties mutually agree, or in a Florida court of competent jurisdiction. Access to Records and Reports (Reference: 2 CFR § 200.333, 2 CFR § 200,336) The contractor/vendor agrees to maintain all books, records, accounts and reports required under this contract for a period of not less than three years after the date of termination or expiration of this contract, except in the event of litigation or settlement of claims arising from the performance of this contract, in which case the Contractor agrees to maintain same until the Purchaser, the Grantor Administrator, the Comptroller General, or any of their duly authorized representatives, have disposed of all such litigation, appeals, claims or exceptions related thereto. Furthermore, the County shall maintain written policies and procedures for computer system backup and recovery and shall have the same requirement of its Contractors. Byrd Anti -Lobbying Amendment (31 U.S.C. 1352) (Reference 2 CFR § 200 Appendix 11(J) Vendors must certify it will not and has not used Federal appropriated funds have been paid or will be paid, by or to any person or organization for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. The certification includes any lobbying with non -Federal finds that takes place in connection with obtaining any Federal award. Civil Rights Compliance The contractor or a subcontractor who is the recipient of Federal funds (or assumes others with whom it arranges to provide services or benefits in connection with any of its programs and activities or assures others with whom it arranges to provide services or benefits to participants or employees) must comply with Title VI of the Civil Rights Act of 1964, which prohibits discrimination on the basis of race, color, or national origin (45 CFR 80), and Statutes and Regulations enforced by the Office of Civil Rights, U.S. Department of Health and Human Services, as follow: Section 504 of the Rehabilitation Act of 1973, as amended (29 USC § 794), prohibits discrimination against otherwise qualified individuals on the basis of disability in programs and activities receiving financial assistance from HHS 45 CFR 84 and/or programs or activities conducted by HHS 45 CFR 85 in the provision of benefits and under the ADA that does not: a. Exclude a person with a disability from a program or activity; b. Deny a person with a disability the benefits of a program or activity; c, Afford a person with a disability an opportunity to participate in or benefit fiom a benefit or c service that is not equal to what is afforded others; ti d. Provide a benefit or service to a person with a disability that is not as effective as what is provided ti others; 00 e. Provide different or separate benefits or services to a person with a disability unless necessary to provide benefits or services that are as effective as what is provided others; or, f. Apply eligibility criteria that tend to screen out persons with disabilities unless necessary for the E provision of the service, program or activity. ea Q FCP-2 7r//2021 1:18 PM p. 27 4-A 01 ------- ... _. -___ . ... _ Packet Pg. 656 16.D.5.h Solicitation 18-7470S Collier County EXHIBIT LA FEDERAL CONTRACT PROVISIONS Section 508 of the Rehabilitation Act of 1973, as amended, (29 USC § 794(d)) prohibits discrimination on the basis of disability in electronic and information technology as they relate to programs and activities conducted by HHS. The Age Discrimination Act of 1975, as amended (42 USC § 6101) prohibits discrimination on the basis of age in programs or activities receiving Federal financial assistance 45 CFR 90; and/or programs or services receiving HHS financial assistance 45 CFR 91; Title II of the Americans with Disabilities Act (28 CFR Part 35), relating to Nondiscrimination on the Basis of Disability in State and Local Government Services 2010 ADA Standards for Accessible Design; The Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §290 dd-3 and 290 ee 3), as amended, as relating to confidentiality of alcohol and drug abuse patient records; Section 1908 of the Public Health Service Act (42 USC § 300w-7) prohibits discrimination on the basis of age, race, color, national origin, disability, sex (gender), or religion in programs, services, and activities funded by Preventative Health and Health Services Block Grants. Federal Health Care Conscience Protection Statutes (42 USC § 300a-7; 42 USC § 300a-7; 42 USC § 238n and the Weldon Amendment (Continuing Appropriations Resolution, Pub. L. No. 113-164, Sec. 101(a) (Sept. 19, 2015); Regulation for the Enforcement of Federal Health Care Provider Conscience Protection Laws, which prohibit recipients of certain Federal funds from discriminating against certain health care providers who refuse to participate in certain health care services on religious or moral grounds. Section 1557 of the Affordable Care Act prohibits discrimination on the basis of disability by entities that operate a health program or activity. 45 CFR 80. The contractor must have on file an assurance that the program will be conducted in compliance with all nondiscriminatory provisions as required in 45 CFR 80. Debarment and Suspension (Reference 2 CFR § 200 Appendix II (1) Contract awards that exceed the small purchase threshold and certain other contract awards shall not be made to parties listed on the government wide Excluded Parties List System in the System for Award Management (SAM), in accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR Part 1986 Comp., p. 189) and 12689 (3 CFR Part 1989 Comp., p. 235), "Debarment and Suspension." The Excluded Parties List System in SAM contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549, The successful bidder, by administering each lower tier subcontract that exceeds $25,000 as a "covered transaction", must verify each lower tier participant of a "covered transaction" under the project is not presently debarred or otherwise disqualified from participation in this federally assisted project. The Contractor shall comply with these provisions before doing business or entering into subcontracts receiving federal funds pursuant to this contract. The Contractor shall complete and sign the Certifications and Assurances Attachment prior to the execution of this contract. Diversity (Reference 2 CFR § 200.321) c The County is dedicated to fostering the continued development and economic growth of small, minority-, women-, and service -disabled veteran business enterprises. All contracting and subcontracting opportunities 00 afforded by this solicitation/contract are strongly encouraged to contribute as both Contractors and Sub - Contractors. Firms may be required to submit documentation addressing diversity and describing the efforts being made to encourage the participation of small, minority-, women-, and service -disabled veteran business E enterprises. Information on Certified Minority Business Enterprises (CMBE) and Certified Service -Disabled E Veteran Business Enterprises (CSDVBE) is available from the Office of Supplier Diversity at: http:t/dms.myflorida.com/other programs/office of supplier diversity osd/ Q FCP-3 7/7/2021 1:18 PM A• 28 ------ .. -- ~- Packet Pg. 657 16.D.5.h Collier County Solicitation 18-7470S EXHIBIT LA FEDERAL CONTRACT PROVISIONS Energy Policy and Conservation Act - (Reference 2 CFR § 200 Appendix 11(H) The contractor shall comply with any mandatory standards and policies relating to energy efficiency which are contained in the F 1 o r i d a state energy conservation plan issued in compliance with the Energy Policy and Conservation Act (Pub. L. 94-163, 89 Stat. 871, 42 U.S.0 Section 6201) Equal Employment Opportunity (Appendix 11, 2 CFR Part 200; Department of Labor 41 CFR Part 60; Dept. of Health and Human Services 45 CFR Part 92, if applicable). The Contractor shall not discriminate against any employee or applicant for employment because of race, age, creed, color, sex or national origin. The Agency will take affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to their race, age, creed, color, sex, or national origin. Such action shall include, but not be limited to, the following: Employment upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. Contractors must insert a similar provision in all subcontracts, except subcontracts for standard commercial supplies or raw materials. E-verify, Presidential Executive Order 12989; Florida Executive Order Number 11-116 Vendors/Contractors/Subcontracts: 1. Agree to utilize the U.S. Department of Homeland Security's E-verify system to verify the employment of all new employees hired by Contractor during the contract term; and 2. Contractor shall include in related subcontracts a requirement that Subcontractors performing work or providing services pursuant to the state contract utilize the E-verify system to verify employment eligibility of all new employees hired by the Subcontractor during the contract term. The RIPAA Privacy Rules, 4 CFR Part 160 and Subparts A and E of part 164 The Third Party subrecipient will comply with HIPAA requirements to appropriate safeguards to protect the privacy of personal health information, and sets limits and conditions on the uses and disclosures that may be made of such information without patient authorization. No Government Obligation to Third Parties - The Federal Government is not a party to this contract and is not subject to any obligations or liabilities to the non -Federal entity, contractor, or any other party pertaining to any matter resulting from the contract." Procurement of Recovered Materials (Reference 2 CFR § 200.323) Contractor and subcontractor agree to comply with Section 6002 of the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act, and the regulatory provisions of 40 CFR Part 247. (1) In the performance of this contract, the Contractor shall make maximum use of products containing recovered materials that are EPA designated items unless the product cannot be acquired (i) Competitively within a timeframe providing for compliance with the contract performance schedule; (ii) Meeting contract performance requirements; or (iii) At a reasonable price. (2) Information about this requirement is available at EPA's Comprehensive Procurement Guidelines web site—http://www.epa.gov/. The list of EPA -designate items is available at https://www.epa.gov/smm/comprehensive-procurement-guideline-cpg-program. Program Fraud and False or Fraudulent Statements of Related Acts o The contractor acknowledges that 31 U.S.C. Chap. 38 (Administrative Remedies for False Claims and zll Statements) applies to the contractor's actions pertaining to this contract. a~o Termination for Cause and Convenience See County s Standard Terms and Conditions. E s Trafficking in Persons The Contractor and subcontractors shall comply with Title 2 CFR Part 175 and 2 CFR §175.15 provisions Q applicable to a private entity, as defined in 2 CFR 175.25. FCP-4 7/7/2021 1:18 PM p. 29 Packet Pg. 658 16.D.5.h Collier County Solicitation 18-7470S EXHIBIT LA FEDERAL CONTRACT PROVISIONS Transparency Act Unless exempt under 2 CFR § 170.11 O(b), the Contractor shall comply with the reporting requirements of the Transparency Act as expressed in 2 CFR Part 170. Clean Air Act and Federal Water Pollution Control Act (Reference: 2 CFR § 200 Appendix II (G)) Contracts and subgrants of amounts in excess of $150,000 shall contain a provision that requires the Contractor or recipient to comply with all applicable standards, orders, or requirements issued pursuant to Section 306 of the Clean Air Act as amended (42 U.S.C. 7401-7671q.), Executive Order 11738, as amended, where applicable, the Federal Water Pollution Control Act as amended (33 U.S.C. 1251-1387), and Environmental Protection Agency regulations 2 CFR Part 1500. The Contractor shall report any violations of the above to the Federal awarding agency and the Regional Office of the Environmental Protection Agency (EPA). Unlawful Employment of Aliens (Reference immigration and Nationality Act (8 U.S.C. § 1324a) and the Immigration Reform and Control Act of 1986 (8 U.C. § 1101) (a) Making Employment of Unauthorized Aliens Unlawful (1) In General It is unlawful for a person or other entity— (A) to hire, or to recruit or refer for a fee, for employment in the United States an alien knowing the alien is an unauthorized alien (as defined in subsection (h)(3)) with respect to such employment. (2) Continuing Employment It is unlawful for a person or other entity, after hiring an alien for employment in accordance with paragraph (1), to continue to employ the alien in the United States knowing the alien is (or has become) an unauthorized alien with respect to such employment. Such violation will be cause for unilateral cancellation of this contract by the Federal awarding Agency. Prohibition on Certain Telecommunications and Video Surveillance Services or Equipment (2 CFR § 200.216) The Federal awarding agency prohibits the County to enter into a contract to procure or obtain equipment, services or systems that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. As described in Public Law 115-232, section 889, covered telecommunications equipment is m telecommunications equipment produced by Huawei Technologies Company or ZTE Corporation (or any W CD subsidiary or affiliate of such entities). (i) For the purpose of public safety, security of government facilities, physical security surveillance of critical infrastructure, and other national security purposes, video surveillance V and telecommunications equipment produced by Hytera Communications Corporation, Hangzhou Hikvision r Digital Technology Company, or Dahua Technology Company (or any subsidiary or affiliate of such entities). M (ii) Telecommunications or video surveillance services provided by such entities or using such equipment. (i)(iii) _ Telecommunications or video surveillance equipment or services produced or provided by an entity that the m Secretary of Defense, in consultation with the Director of the National Intelligence or the Director of the Federal E 0 Bureau of Investigation, reasonably believes to be an entity owned or controlled by, or otherwise connected to, x the government of a covered foreign country. (b) In implementing the prohibition under Public Law 115-232, section 889, subsection (f), paragraph (1), heads of executive agencies administering loan, grant, or subsidy Q programs shall prioritize available funding and technical support to assist affected businesses, institutions and ti organizations as is reasonably necessary for those affected entities to transition from covered communications ao equipment and services, to procure replacement equipment and services, and to ensure that communications service to users and customers is sustained. (c) See Public Law 115-232, section 889 for additional information. Domestic Preference for Procurements (2 CFR § 200.322) s (a) As appropriate and to the extent consistent with law, the non -Federal entity should, to the greatest extent practicable under a Federal award, provide a preference for the purchase, acquisition, or use of goods, products, Q FCP-5 7/7/2021 1:18 PM P. 30 16.D.5.h Solicitation 18-7470S Coli(er County EXHIBIT LA FEDERAL CONTRACT PROVISIONS or materials produced in the United States (including but not limited to iron, aluminum, steel, cement, and other manufactured products). The requirements of this section must be included in all subawards including all contracts and purchase orders for work or products under this award. (b) For purposes of this section: (1) "Produced in the United States" means, for iron and steel products, that all manufacturing processes, from the initial melting stage through the application of coatings, occurred in the United States. (2) "Manufactured products" means items and construction materials composed in whole or in part of non-ferrous metals such as aluminum; plastics and polymer based products such as polyvinyl chloride pipe; aggregates such as concrete; glass, including optical fiber; and lumber. STATE CONTRACT PROVISIONS Administrative Procedures Act, Section 120.57(2), F.S. Additional procedures forpaWcular cases. In a matter initiated as a result of agency action proposing to determine the substantial interests of a party, the party's timely petition for hearing may challenge the proposed agency action based on a rule that is an invalid exercise of delegated legislative authority or based on an alleged unadopted rule. Data Integrity and Safeguarding Information, Uniform Electronic Transaction Act, Section 668.50, F.S.; Public Records Law, Chapter 119, Section 29, F.S The Contractor shall ensure an appropriate level of data security for the information the Contractor is collecting or using in the performance of this contract. An appropriate level of security includes approving and tracking all Contractor employees that request system or information access and ensuring that user access has been removed from all terminated employees. The Contractor, among other requirements, must anticipate and prepare for the loss of information processing capabilities. All data and software shall be routinely backed up to ensure recovery from losses or outages of the computer system. The security over the backed -up data is to be as stringent as the protection required of the primary systems. The Contractor shall ensure all Subcontractors maintain written procedures for computer system backup and recovery. The Contractor shall complete and sign the Certification Regarding Data Integrity Compliance for Agreements, Grants, Loans, and Cooperative Agreements prior to the execution of this contract. Discriminatory Vendors List, Section 287.134, F.S. In accordance with Section 287.134, Florida Statutes, an entity or affiliate who has been placed on the discriminatory vendor list may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to a public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity, and may not transact business with any public entity. Equal Employment Opportunity O The Contractor shall not discriminate against any employee or applicant for employment because of race, age, _ creed, color, sex or national origin. The Agency will take affirmative action to ensure that applicants are c employed, and that employees are treated during employment, without regard to their race, age, creed, color, sex, or national origin. Such action shall include, but not be limited to, the following: Employment upgrading, 00 demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. Contractors must insert a similar provision in all subcontracts, except subcontracts for standard commercial supplies or raw materials. E s Interest of Members of Congress No member of or delegate to the Congress of the United States shall be admitted to any share or part of this contract or to any benefit arising therefrom. Q PCP-6 7/7/2021 1:18 PM p. 31 r ,a 16.D.5.h Collier County Solicitation 18-7470S EXHIBIT LA FEDERAL CONTRACT PROVISIONS Interest of Public Officials I\10 member, officer, or employee of the public body or of a local public body during his tenure or for two years thereafter shall have any interest, direct or indirect, in this contract or the proceeds thereof. For purposes of this provision, public body shall include municipalities and other political subdivisions of States; and public corporations, boards, and commissions established under the laws of any State. No member, officer, or employee of the MPO or of a local public body during his tenure or for two years thereafter shall have any interest, direct or indirect, in this contract or the proceeds thereof. Inspections (Meals) The Contractor must agree to notify the Nutrition Provider within 24 hours of any sanitation inspection and provide a copy of the report. Inspector General Cooperation, Section 20.055(5), F.S. The Parties agree to comply with Section 20.055(5), Florida Statutes, for the inspector general to have access to any records, data and other information deemed necessary to carry out his or her duties and incorporate into all subcontracts the obligation to comply with Section 20.055(5), Florida Statutes. Lobbying No funds received pursuant to this Agreement may be expended for lobbying the Legislature, the judicial branch or a state agency. Computer Use and Social Media Policy The Florida Department of Elder Affairs has implemented a Social Media Policy, in addition to its Computer Use Policy, which applies to all employees, contracted employees, consultants, OPS and volunteers, including all personnel affiliated with third parties, such as, but not limited to, contractors and subcontractors. Any entity that uses the Department's computer resource systems must comply with the Department's policy regarding social media. Social Media includes, but is not limited to blogs, podcasts, discussion forums, Wikis, RSS feeds, video sharing, social networks like MySpace, Facebook and Twitter, as well as content sharing networks such as flickr and YouTube. This policy is available on the Department's website at: http://elderaf£airs.state.fl.us/doea!financial.phn. Public Entity Crime Pursuant to Section 287.133, F.S., a person or affiliate who has been placed on the Convicted Vendor List following a conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the construction or repair of a public building or public work; may not submit bids, proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a Contractor, Supplier, Subcontractor, or Consultant under a contract with any public entity; and may not transact business with any public entity in excess of the threshold amount 7.017, F.S., for CATEGORY TWO for a period of thirty six (36) months following the date of being placed on the Convicted Vendor List. 7/7/2021 1:18 PM FCP-7 p. 32 Q fg"�f31 -...... ........... .. Packet Pg. bb1 Collier County Solicitation 18-7470S EXHIBIT 13 GRANT CERTIFICATIONS AND ASSURANCES GRANT CERTIFICATIONS AND ASSURANCES THE FOLLOWING DOCUMENTS NEED TO BE RETURNED WITH SOLICITATION DOCUMENTS BY DEADLINE TO BE CONSIDERED RESPONSIVE. Page Certification and. Form GCA 2-6 Attachment III - Certifications and Assurances A-J) A. Debarment and Suspension Certification (29 CFR Part 95 and 45 CFR Part 75) B. Certification Regarding Lobbying (29 CFR Part 93 and 45 CFR Part 93) C. Nondiscrimination & Equal Opportunity Assurance (29 CFR Part 37 and 45 CFR Part 80) D. Certification Regarding Public Entity Crimes, section 287.133. F.S. E. Association of Community Organizations for Reform Now (ACORN) Funding Restrictions Assurances (Pub. L. 111-117) F. Scrutinized Companies Lists and No Boycott of Israel Certification, section 287,135. F.S. G. Certification Regarding Data Integrity Compliance for Contracts, Agreements, Grants, Loans and Cooperative Agreements H. Verification of Employment Status Certification I. Records and Documentation J. Certification Regarding Inspection of Public Records GCA - 7 9 Attachment IV — Assurances Non -Construction Programs GCA -10-13 Attachment V — Civil Rights Compliance Checklist GCA -14 GCA -15 GCA -16 GCA -17 GCA - IS 7/7/2021 1:18 PM Attachment VII —Background Screening Affidavit of Compliance - Emplover Conflict of Interest Certification Anticipated DBE, M/WBE or VETERAN Participation Statement Bid Opportunity List for Commodities and Contractual Services and Professional Consultant Services Acknowledgement of Terms, Conditions, and Grant Clauses GCA-1 p. 33 _.__. Packet Pg. 662 Collier County Solicitation 18-7470S EXH. 1.13 GRANT ASSURANCES AND CERTIFICATIONS ATTACHMENT III CERTIFICATIONS AND ASSURANCES Agency will not award this Contract unless Contractor completes this CERTIFICATIONS AND ASSURANCES. In performance of this contract, Contractor provides the following certifications and assurances: A. Debarment and Suspension Certification l29 CFR Part 95 and 45 CFR Part 751 B. Certification Regarding Lobadng l29 CFR Part 93 and 45 CFR Part 93) C. Nondiscrimination & Equal Opjjortunity A§durance (29 CFR Part 37 and 45 CFR Part 80) D. Certification Regarding Public Entity Crimes, section 287,133, F.S. E. Association of Communityrganizations for Reform Now IACORNI Funding Restrictions_ Assurance_ ,(Pleb L. 11 -117) F. Scrutinized Companies Lists and No Boycott of Israel Certification, section 287,135, F.S. G. Certification Regarding Data Integrity Compliance for Contracts. Agreements, Grants. Loans. and Cooperative Agreements H. Verification of Empla=ent Status Certification I. Records and Documentation J. Certification Regarding Inspection of Public Records A. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS — PRIMARY COVERED TRANSACTION. The undersigned Contractor certifies, to the best of its knowledge and belief, that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by a Federal department or agency; 2. Have not within a three-year period preceding this Contract been convicted or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; 3. Are not presently indicted or otherwise criminally or civilly charged by a government entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph A.2. of this certification; and/or 4. Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State, or local) terminated for cause of default. The undersigned shall require that language of this certification be included in the documents for all subcontracts atall tiers (including subcontracts, sub -grants, and contracts under grants, loans, and cooperative agreements) and that all sub -recipients and contractors shall provide this certification accordingly. GCA-2 7M2021 1:18 PM P• 34 Packet Pg. 663 16.D.5.h Collier County Solicitation 18-74705 EXH. I.B GRANT ASSURANCES AND CERTIFICATIONS B. CERTIFICATION REGARDING LOBBYING — CERTIFICATION FOR CONTRACTS, GRANTS, LOANS, AND COOPERATIVE AGREEMENTS. The undersigned Contractor certifies, to the best of its knowledge and belief, that: No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of Congress or an employee of a Member of Congress in connection with the awarding of any Federal contract, the malting of any Federal grant, the making of any Federal loam, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or employee of a Member of Congress in connection with a Federal contract, grant, loan, or cooperative agreement, the undersigned shall also complete and submit Standard Form — LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. The undersigned shall require that language of this certification be included in the documents for all subcontracts at all tiers (including subcontracts, sub -grants, and contracts under grants, loans, and cooperative agreements) and that all sub -recipients and contractors shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this Contract was made or entered into. Submission of this certification is a prerequisite for making or entering into this Contract imposed by 31 U.S.C. 1352. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. C. NON- DISCRD41NA.TION & EQUAL OPPORTUNITY ASSURANCE (29 CFR PART 37 AND 45 CFR PART V 80). - As a condition of the Contract, Contractor assures that it will comply fully with the nondiscrimination and equal N opportunity provisions of the following laws: L 1. Section 188 of the Workforce Investment Act of 1998 (WIA), (Pub. L. 105-220), which prohibits discrimination c against all individuals in the United States on the basis of race, color, religion, sex, national origin, age, disability, political affiliation, or belief, and against beneficiaries on the basis of either citizenship/status as a lawfully admitted immigrant authorized to work in the United States or participation in any WIA Title I -financially assisted program L ea or activity. C) 2. Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352), as amended, and all requirements unposed by or pursuant r to the Regulation of the Department of Health and Human Services (45 CFR Part 80), to the end that, in accordance with Title VI of that Act and the Regulation, no person in the United States shall, on the ground of race, color, or = national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Agency. 3. Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-112), as amended, and all requirements imposed by or c pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 84), to the end that, in accordance with Section 504 of that Act and the Regulation, no otherwise qualified handicapped individual in the 00 United States shall, solely by reason of his handicap, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Agency. E s ea GCA - 3 Q 7/7/2021 1:18 PM p. 35 Packet Pg. 664 16.D.5.h Collier County Solicitation 18-7470S EXH. 1.B GRANT ASSURANCES AND CERTIFICATIONS 4. The Age Discrimination Act of 1975 (Pub. L. 94-135), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 91), to the end that, in accordance with the Act and the Regulation, no person in the United States shall, on the basis of age, be denied the benefits of, be excluded from participation in, or be subjected to discrimination under any program or activity for which the Applicant receives .Federal financial assistance from the Agency. 5. Title IX of the Education Amendments of 1972 (Pub. L. 92-318), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 86), to the end that, in accordance with Title IX and the Regulation, no person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any education program or activity for which the Applicant receives Federal financial assistance from the Agency. 6. The American with Disabilities Act of 1990 (Pub. L. 101-336), which prohibits discrimination in all employment practices, including job application procedures, hiring, firing, advancement, compensation, training, and other terms, conditions, and privileges of employment. It applies to recruitment, advertising, tenure, layoff, leave, fringe benefits, and all other employment -related activities. 7. Contractor also assures that it will comply with 29 CFR Part 37 and all other regulations implementing the laws listed above. This assurance applies to Contractor's operation of the WIA Title I — financially assisted program or activity, and to all contracts Contractor makes to carry out the WIA Title I — financially assisted program or activity. Contractor understands that the Agency and/or DOEA and the United States have the right to seek judicial enforcement of the assurance. The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all tiers (including subcontracts, sub -grants, and contracts under grants, loans, and cooperative agreements) and that all sub -recipients and contractors shall provide this assurance accordingly. D. CERTIFICATION REGARDING PUBLIC ENTITY CRIMES, SECTION 287.133, F.S. Contractor hereby certifies that neither it, nor any person or affiliate of Contractor, has been convicted of a Public Entity Crime as defined in section 287.133, F.S., nor placed on the convicted vendor list. Contractor understands and agrees that it is required to inform Agency immediately upon any change of circumstances regarding this status. E. ASSOCIATION OF COMMUNITY ORGANIZATIONS FOR REFORM NOW (ACORN) FUNDING RESTRICTIONS ASSURANCE (Pub. L. 111-117). As a condition of the Contract, Contractor assures that it will comply fully with the federal funding restrictions pertaining to ACORN and its subsidiaries per the Consolidated Appropriations Act, 2010, Division E, Section 511 (Pub. L. 111-117). The Continuing Appropriations Act, 2011, Sections 101 and 103 (Pub. L. 111-242), provides that appropriations made under Pub. L. 111-117 are available under the conditions provided by Pub. L. 111-117. The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all a) tiers (including subcontracts, sub -grants and contracts under grants, loans and cooperative agreements) and that all sub- o recipients and contractors shall provide this assurance accordingly. _ 0 ti F. SCRUTINIZED COMPANIES LISTS AND NO BOYCOTT OF ISRAEL CERTIFICATION, SECTION 287.135, F.S. °r° In accordance with section 287.135, F.S., Contractor hereby certifies that it has not been placed on the Scrutinized CD Companies that Boycott Israel List and that it is not participating in a boycott of Israel. E s GCA - 4 +� r Q 7/7/2021 1:18 PM p. 36 Afit Packet Pg. 665 16.D.5.h Collier County Solicitation 18-74708 EXH. LB GRANT ASSURANCES AND CERTIFICATIONS If this Contract is in the amount of $1 million or more, in accordance with the requirements of section 287.135, F.S., Contractor hereby certifies that it is not listed on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List and that it does not have business operations in Cuba or Syria. Contractor understands that pursuant to section 287.135, F.S., the submission of a false certification may result in the Agency terminating this contract and the submission of a false certification may subject Contractor to civil penalties and attorney fees and costs, including any costs for investigations that led to the finding of false certification. If Contractor is unable to certify any of the statements in this certification, Contractor shall attach an explanation to this Contract. G. CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR CONTRACTS, AGREEMENTS, GRANTS, LOANS, AND COOPERATIVE AGREEMENTS 1. The Contractor and any Subcontractors of services under this contract have financial management systems capable of providingcertain information, including: (1) accurate, current, and complete disclosure of the financial results of each grant -fielded project or program in accordance with the prescribed reporting requirements; (2) the source and application of funds for all contract supported activities; and (3) the comparison of outlays with budgeted amounts for each award. The inability to process information in accordance with these requirements could result in a return of grant funds that have not been accounted for properly. 2. Management Information Systems used by the Contractor, Subcontractors, or any outside entity on which the Contractor is dependent for data that is to be reported, transmitted, or calculated have been assessed and verified to be capable of processing data accurately, including year -date dependent data. For those systems identified to be non -compliant, Contractors will take immediate action to assure data integrity. 3. If this contract includes the provision of hardware, software, firmware, microcode, or imbedded chiptechnology, the undersigned warrants that these products are capable of processing year -date dependent data accurately. All versions of these products offered by the Contractor (represented by the undersigned) and purchased by the state will be verified for accuracy and integrity of data prior to transfer. 4. In the event of any decrease in functionality related to time and date related codes and internal subroutines that impede the hardware or software programs from operating properly, the Contractor agrees to immediatelymake required corrections to restore hardware and software programs to the same level of functionality as warranted herein, at no charge to the state, and without interruption to the ongoing business of the state, time being of the essence. 5. The Contractor and any Subcontractors of services under this contract warrant that their policies and procedures include a disaster plan to provide for service delivery to continue in case of an emergency, including emergencies arising from data integrity compliance issues. H. VERIFICATION OF EMPLOYMENT STATUS CERTIFICATION ti As a condition of contracting with the Agency, Contractor certifies the use of the U.S. Department of Homeland I Security's E-verify system to verify the employment eligibility of all new employees hired by Contractor during the °r° contract term to perform employment duties pursuant to this contract, and that any subcontracts include an express requirement that Subcontractors performing work or providing services pursuant to this Contract utilize the E-verify d system to verify the employment eligibility of all new employees hired by the Subcontractor during the entire contract E term. ea Q GCA-5 7/7/2021 1:18 PM p. 37 =C A 0 16.D.5.h Collier County Solicitation 18-7470S EXH. LB GRANT ASSURANCES AND CERTIFICATIONS The Contractor shall require that the language of this certification be included in all sub -agreements, sub -grants, and other agreements/contracts and that all Subcontractors shall certify compliance accordingly. This certification is a material representation of fact upon which reliance was placed when this Contract was made or entered into. Submission of this certification is a prerequisite for making or entering into this Contract imposed by Circulars A-102 and 2 CFR Part 200 and 215 (formerly OMB Circular A-110). I. RECORDS AND DOCUMENTATION The Contractor agrees to make available to Agency staff and/or any party designated by the Agency any and all contract related records and documentation, The Contractor shall ensure the collection and maintenance of all program related information and documentation on any such system designated by the Agency. Maintenance includes valid exports and backups of all data and systems according to Agency standards. J. CERTIFICATION REGARDING INSPECTION OF PUBLIC RECORDS 1. In addition to the requirements of sections 10.1 and 10.2 of the Standard Contract, sections 119.0701(3) and (4) F.S., and any other applicable law, if a civil action is commenced as contemplated by section 119.0701(4), F.S., and the Agency is named in the civil action, Contractor agrees to indemnify and hold harmless the Agency for any costs incurred by the Agency and any attorneys' fees assessed or awarded against the Agency from a Public Records Request made pursuant to Chapter 119, F.S., concerning this contract or services performed thereunder. a. Notwithstanding section 119.0701, F.S., or other Florida law, this section is not applicable to contracts executed between the Agency and state agencies or subdivisions defined in section 768.28(2), F.S. 2. Section 119,01(3), F.S., states if public funds are expended by an agency in payment of dues or membership contributions for any person, corporation, foundation, trust, association, group, or other organization, all the financial, business, and membership records of such an entity which pertain to the public agency (Area Agency on Aging for Southwest Florida, Inc.) are public records. Section 119.07, F.S, states that every person who has custody of such a public record shall permit the record to be inspected and copied by any person desiring to do so, under reasonable circumstances. Additionally, I certify this organization does does not provide for institutional memberships. Contractor's signature below attests that records pertaining to the dues or membership application by the Agency are available for inspection if applicable, as stated above. By execution of this contract, Contractor must include these provisions (A-J) in all related subcontract agreements (if applicable). By signing below, Contractor certifies that the representations outlined in parts A through J above are true and correct. zgn d Title of Aut or-1 d Representative Street Address apo �l f! CCISt] oil rp I Contractor Date City, State, Zip code GCA-6 7/7/2021 1:18 PM p. 38 W 0 ti ti 0 c d E s V M Q CAA Packet Pg. 667 Collier County Solicitation 18-7470S EXHIBIT 1.13 GRANT CERTIFICATIONS AND ASSURANCES ATTACHMENT IV ASSURANCES--NON-CONSTRUCTION PROGRAMS Public reporting burden for this collection of information is estimated to average forty-five (45) minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget. Paperwork Reduction Project (0348-0043), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET, SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. Note: Certain of these assurances may not be applicable to your project or program. If you have questions please contact the awarding agency. Further, certain federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. 1. Has the legal authority to apply for federal assistance, and the institutional, managerial and financial capability (including funds sufficient to pay the non-federal share of project cost) to ensure proper planning, management, and completion of the project described in this application. 2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the state, throughany authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives. 3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain. 4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awardingagency. 5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. §4728-4763) relating to prescribed standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F). 6. Will comply with all federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of v the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. §6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment o Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive x Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, cn relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug abuse r patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §3601 et seq.), as amended, relating to 00 T nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for federal assistance is being made; and 0) the requirements of any other nondiscrimination statute(s) which may apply to the application, t cCA-7 a 7/7/2021 1:18 PM P. 39 Cy Am Packet Pg. 668 Collier County Solleftatlon 18-7470S EXHIBIT 1.13 GRANT CERTIFICATIONS AND ASSURANCES 7. Will comply, or has already complied, with the requirements of Titles 11 and III of the uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of federal or federally assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of federal participation inpurchases. 8. Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C. §1501-1508 and 7324-7328), which limit the political activities of employees whose principal employment activities are funded in whole or in part with federal funds. 9. Will comply, as applicable, with the provisions of the Davis -Bacon Act (40 U.S.C. §276a to 276a-7), the Copeland Act (40 U.S.C. 276c and 18 U.S.C. §874) and the Contract Work Hours and Safety Standards Act (40 U.S.C. §327-333), regarding labor standards for federally assisted construction sub -contracts. 10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000,00 or more. 11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. §1451 et seq.); (f) conformity of federal actions to State (Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. §7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-523); and (h) protection of endangered species under the Endangered Species Act of 1973, as amended, (P.L. 93-205). 12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. §1721 et seq.) related to protecting components or potential components of the national wild and scenic rivers system. 13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. §470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. §469a-1 et seq.). 14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and related activities supported by this award of assistance. 15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. §2131 et seq.) _ pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities cn supported by this award of assistance. 16. Will comply with the Lead -Based Paint Poisoning Prevention Act (42 U.S.C. §4801 et seq.), which prohibits the use of ao T lead- based paint in construction or rehabilitation of residence structures. c a� E t GCA-8 a 7/7/2021 1:18 PM p• 40 ( Packet Pg. 669 Collier County Solicitation 18-74708 EXHIBIT I.B GRANT CERTIFICATIONS AND ASSURANCES 17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and 2 CFR Part 200. 18. Will comply with all applicable requirements of all other federal laws, executive orders, regulations and policies governing this program., ,WVN--A\TURF, OE.AUTHORIZED CERTIFYING OFFICIAL TITLE APPLICANT ORGANIZATION -4 we. pa Ca e. (;LkVl� DATE SUBMITTED o o9 1 -a GCA. - 9 71T12021 1:18 PM p. 41 Packet Pg. 670 Collier County Sollcitatlon 1 R-7a7nc E)GMr ' LB / ATTACHbfENT V STATE OF FLORIDA DEPARTMENT OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE CHECKLIST acility e: C Coun AAA/Contractor m � Address: Co m d B City, State, zip C de: t Date: Teleph e: PART I: READ THE ATTACHED INSTRUCTIONS FOR ILLUSTRATIVE INFORMATION WHICH WILL HELP YOU COMPLETE THIS FORM. 1. Briefly describe the geographic area served by the program/facility and the type of service provided: For questions 2-5, please indicate the following: Total # White Black Hispanic Other Female Disabled Over 40 2.Population of area served Source of data (`� 1; 3 v , UAC dc"la 3.Staffcurrently employed Source of data i� o�� 0% 0 dj� 4.CIients currently enrolled/registered Source of data older Colo, 5.Advisory/Governing Board if applicable Source of data PART II: USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE. 1. Is an Assurance of Compliance on file with DOEA? N//Ay YES NO LI ❑ Q 2. Compare the staff composition to the population. Is staff representative of the population? N/ YES NO 3. Are eligibility requirements for services applied to clients and applicants without regard to race, color, national origin, sex, age, religion or disability? N/A ❑ YES.", NO L'❑ 4. Are all benefits, services and facilities available to applicants and participants in an equally effective manner regardless of race, sex, color, age, national origin, religion or disability? N/A ❑ YES / NO l� ❑ 5. For in -patient services, are room assignments made without regard to race, color, national origin or disability? N/A ❑ YES NO Lr—.',v ❑ 6. Is the program/facility accessible to non-English speaking clients? N/A YE-S/ NO 7. Are employees, applicants an articip informed of their protection against discrimination? If YES, how? Verbal Written osier W N/A ❑ YES NO ❑ ❑ 8. Give the number and current status of any discrimination complaints regarding services or employment filed against the program/facility. NSA NUMBER L 0 c to 3 m z to 0 r` ti e0 a LL N 0 N 1 7/7/2021 1:18 PM p. 42 GCA -10 �F AO Packet Pg. 671 7. Are employees, applicants an articip informed of their protection against discrimination? If YES, how? Verbal M Written oster N/A PEES/ NO ❑ 1� ❑ 8. Give the number and current status of any discrimination complaints regarding services or employment filed against the program/facility. N/A NUMBER /A 9. Is the program/facility physically accessible to mobility, hearing, and sight -impaired individuals? N/❑A YES N❑0 PART III: THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15 OR MORE EMPLOYEES. IF NO EXPLAIN 10. Has a self -evaluation been conducted to identify any barriers to serving disabled individuals, and to make any necessary modifications? YES NO 11. Is there an established grievance procedure that incorporates due process in the resolution of complaints? YES NO 12. Has a person been designated to coordinate Section 504 compliance activities? YES NO 13. Do recruitment and notification materials advise applicants, employees and participants of nondiscrimination on the basis of disability? YES NO V ❑ 14. Are auxiliary aids available to assure accessibility of services to hearing and sight -impaired individuals? YES NO PART IV: FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF $50,000.00 OR MORE. 15. Do you have a written affirmative action plan? If NO, explain. YES NO ❑ ❑ DOEA Reviewed By USE ONLY 1n Compliance: YES ❑ NO* El Program Office Notice of Corrective Action Sent Date Telephone Response Due On -Site ❑ Desk Review ❑ Response Received ❑ / Revised August 2010, Page 2 of 2 1 Packet Pg. 672 EXHIBIT LB / ATTACIDAENT V Colller County Solicitation 18-7470S INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST 1. Describe the geographic service area such as a district, county, city or other locality. If the program/facility serves a specific target population such as adolescents, describe the target population. Also, define the type of service provided. 2, Enter the percent of the population served by race and sex. The population served includes persons in the geographical area for which services are provided such as a city, county or other regional area. Population statistics can be obtained from local chambers of commerce, libraries, or any publication from the 1980 Census containing Florida population statistics. Include the source of your population statistics. ("Other" races include AsianlPacific Islanders and American Indian/Alaskan Natives.) 3. Enter the total number of full-time staff and their percent by race, sex and disability. Include the effective date of your summary. 4. Enter the total number of clients who are enrolled, registered or currently served by the program or facility, and list their percent by race, sex and disability. Include the date that enrollment was counted. Enter the total number of advisory board members and their percent by race, sex, and disability. If there is no advisory or governing board, leave this section blank. 6. Each recipient of federal financial assistance must have on file an assurance that the program will be conducted in compliance with all nondiscriminatory provisions as required in 45 CFR 80. This is usually a standard part of the contract language for DOER recipients and their sub -grantees, 45 CFR 80.4 (a). 7. Is the race, sex, and national origin of the staff reflective of the general population? For example, if 10% of the population is Hispanic, is there a comparable percentage of Hispanic staff? Where there is a significant variation between the race, sex or ethnic composition of the clients and their availability in the population, the program/facility has the responsibility to determine the reasons for such variation and take whatever action may be necessary to correct any discrimination. Some legitimate disparities may exist when programs are sanctioned to serve target populations such as elderly or disabled persons, 45 CFR 80.3 (b) (6). Do eligibility requirements unlawfully exclude persons in protected groups from the provision of services or employment? Evidence of such may be indicated in staff and client representation (Questions 3 and 4) and also through on -site record analysis of persons who applied but were denied services or employment, 45 CFR 80.3 (a) and 45 CFR 80.1 (b) (2). 10. Participants or clients must be provided services such as medical, nursing and dental care, laboratory services, physical and recreational therapies, counseling and social services without regard to race, sex, color, national origin., religion, age or disability. Courtesy titles, appointment scheduling and accuracy of record keeping must be applied uniformly and without regard to race, sex, color, national origin, religion, age or disability. Entrances, waiting rooms, reception areas, restrooms and other facilities must also be equally available to all clients, 45 CFR 80.3 (b). 11. For in -patient services, residents must be assigned to rooms, wards, eta, without regard to race, color, national origin or disability. Also, residents must not be asked whether they are willing to share accommodations with persons of a ti different race, color, national origin, or disability, 45 CFR 80.3 (a). ao 12. The program/facility and all services must be accessible to participants and applicants, including those persons who r may not speak English. In geographic areas where a significant population of non-English speaking people live, program accessibility may include the employment of bilingual staff. In other areas, it is sufficient to have a policy or plan for service, such as a current list of names and telephone numbers of bilingual individuals who will assist in M the provision of services, 45 CFR 80.3 (a). a Q GCA -12 3 777/2021 1:18 PM p.44 MY Packet Pg. 673 16.D.5.h EXHIBIT LB / ATTACHMENT V Collier County Solicitation 18-7470S 13. Programs/facilities must make information regarding the nondiscriminatory provisions of Title VI available to their participants, beneficiaries or any other interested parties. This should include information on their right to file a complaint of discrimination with either the Florida Department of Elder Affairs or the U.S. Department of HHS. The information may be supplied verbally or in writing to every individual, or may be supplied through the use of an equal opportunity policy poster displayed in a public area of the facility, 45 CFR 80.6 (d). 14. Report number of discrimination complaints filed against the program/facility. Indicate the basis, e.g., race, color, creed, sex, age, national origin, disability, retaliation; the issues involved, e.g., services or employment, placement, termination, etc. Indicate the civil rights law or policy alleged to have been violated along with the name and address of the local, state or federal agency with whom the complaint has been filed. Indicate the current status, e.g., settled, no reasonable cause found, failure to conciliate, failure to cooperate, under review, etc. 15. The program/facility must be physically accessible to disabled individuals. Physical accessibility includes designated parking areas, curb cuts or level approaches, ramps and adequate widths to entrances. The lobby, public telephone, restroom facilities, water fountains, information and admissions offices should be accessible. Door widths and traffic areas of administrative offices, cafeterias, restrooms, recreation areas, counters and serving lines should be observed for accessibility. Elevators should be observed for door width, and Braille or raised numbers. Switches and controls for light, heat, ventilation, fire alarms, and other essentials should be installed at an appropriate height for mobility impaired individuals. 16. Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance conduct a self - evaluation to identify any accessibility barriers. Self -evaluation is a four step process: a. With the assistance of a disabled individual/organization, evaluate current practices and policies which do not comply with Section 504. b. Modify policies and practices that do not meet Section 504 requirements. c. Take remedial steps to eliminate any discrimination that has been identified. d. Maintain self -evaluation on file. (This checklist may be used to satisfy this requirement if these four steps have been followed.), 45 CFR 84.6. 17. Programs or facilities that employ 15 or more persons must adopt grievance procedures that incorporate appropriate due process standards and provide for the prompt and equitable resolution of complaints alleging any action prohibited by Section 50.4.45 CFR 84.7 (b). 18. Programs or facilities that employ 15 or more persons must designate at least one person to coordinate efforts to comply with Section 504.45 CFR 84.7 (a). 19. Continuing steps must be taken to notify employees and the public of the program/facility's policy of nondiscrimination on the basis of disability. This includes recruitment material, notices for hearings, newspaper ads, and other appropriate written communication, 45 CFR 84.8 (a). 20. Programs/facilities that employ 15 or more persons must provide appropriate auxiliary aids to persons with impaired = sensory, manual or speaking skills where necessary. Auxiliary aids may include, but are not limited to, interpreters m for hearing impaired individuals, taped or Braille materials, or any alternative resources that can be used to provide E equally effective services, 45 CFR 84.52 (d). _ 21. Programs/facilities with 50 or more employees and $50,000.00 in federal contracts must develop, implement and ti maintain a written affirmative action compliance program in accordance with Executive Order 11246, 41 CFR 60 and ti Title VI of the Civil Rights Act of 1964, as amended. CD DOEA Form 101-13, Revised August 2010 E s t) ev r r Q GCA - 13 4 7/7/2021 1:18 PM p. 45 :0i Packet Pg. 674 EX111H1T 13 / ATTACHMENT V 1 DEPARTMENT OF ELDER AFFAIRS STATE OF FLbR10A Collier County Sollebtlon 18-7470S BACKGROUND SCREENING Affidavit of Compliance - Employer AUTHORITY: This form Is required annually of all employers to comply with the attestation requirements set forth in section 435.05(3), Florida Statutes. ➢ The term "employer" means any person or entity required by law to conduct background screening, including but not limited to, Area Agencies on Aging, Aging Resource Centers, Aging and Disability Resource Centers, Lead Agencies, Long -Term Care Ombudsman Program, Serving Health Insurance Needs of Elders Program, Service Providers, Diversion Providers, and any other person or entity which hires employees or has volunteers in service who meet the definition of a direct service provider. See §§ 435.02, 430.0402, Fla. Stat. ➢ A direct service provider is "a person 18 years of age or older who, pursuant to a program to provide services to the elderly, has direct, face-to-face contact with a client while providing services to the client and has access to the client's living area, funds, personal property, or personal identification information as defined in s. 817.568. The term includes coordinators, managers, and supervisors of residential facilities; and volunteers." § 430.0402(1)(b), Fla. Stat. ATTESTATIQN: i As the duly authorized representative of CQ Ye- e� v"rc2S �� 10 p �� _ Employer meld loca ed at S �QI)'t G rn IC t `( Street City State ZiP hereby affirm under penalty of perjury that the above named employer is in compliance with the provisions of Chapter 435 and section 430.0402, Florida Statutes, regarding level 2 background screening. U t ure Representative Date ' tz of o x t,t aSTATE OF FLORIDA, COUNTY OF 1 Ull� -12 Sworn to (or affirmed) and subscribed before me this day of � � 21QA� , by 00 (Name of Representative) who is personally known ,��`, * YOjbo r : to me or produced YQv AWNDAPERTUCN as proof of identification. E t v ,�• • Commiss M # iiH M176 _ *? lF _�xplmr March 2 2026 Q Print, TNviAamPt&A*M lWii§TfttaryPublic Notary Public DOEA Form 235, Affidavit of Compliance- Employer, Effective April 2012 Section 435.05(3), F.S. Form available at: http://elderaffairs.state.Fl.us/enplish/backgroundscreening.php 7/7/2021 1:18 PM p. 46 GCA - 14 Packet Pg. 675 16.D.5.h Collier County Solicitation 18-7470S EXHIBIT 13 GRANT CERTIFICATIONS AND ASSURANCES COLLIER COUNTY Conflict of Interest Certification Collier County Solicitation No. I, &C— hereby certify that to the best of my knowledge, neither I nor: y spouse, dependent child, general partner, or any organization for which I am serving as an officer, director, trustee, general partner or employee, or any person or organization with whom I am negotiating or have an arrangement concerning prospective employment has a financial interest in this matter. I further certify to the best of my knowledge that this matter will not affect the financial interests of any member of my household. Also, to the best of my knowledge, no member of my household; no relative with whom I have a close relationship; no one with whom my spouse, parent or dependent child has or seeks employment; and no organization with which I am seeking a business relationship nor which I now serve actively or have served within the last year are parties or represent a party to the matter. I also acknowledge my responsibility to disclose the acquisition of any financial or personal interest as described above that would be affected by the matter, and to disclose any interest I, or anyone noted above, has in any person or organization that does become involved in, or is affected at a later date by, the c ct of this matter. �- Name i-V hy)IY1 Position Date Privacy Act Statement a Title I of the Ethics in Government Act of 1978 (5 U.S.C. App.), Executive Order 12674 and 5 CFR Part x 2634, Subpart I require the reporting of this information. The primary use of the information on this form is for review by officials of The Justice Department to determine compliance with applicable federal o conflict of interest laws and regulations. Additional disclosures of the information on this report may be = made: (1) to a federal, state or local law enforcement agency if the Justice Department becomes aware of c a violation or potential violation of law or regulations; (2) to a court or party in a court or federal administrative proceeding if the government is a party or in order to comply with a judge -issued subpoena; (3) to a source when necessary to obtain information relevant to a conflict of interest °r° investigation or decision; (4) to the National Archives and Records Administration or the General Services Administration in records management inspections; (5) to the Office of Management and Budget d during legislative coordination on private relief legislation; and (6) in response to a request for discovery E or for the appearance of a witness in a judicial or administrative proceeding, if the information is relevant to the subject matter. This confidential certification will not be disclosed to any requesting person unless Q authorized by law. See also the OGE/GOVT-2 executive branch -wide Privacy Act system of records. GCA -15 7/7/2021 1:18 PM p. 47 CA( t --- Packet Pg. 676 L:"'%'J['R1T 1.11 COLLUER COUNTY ANTICIPATED DISADVANTAGED, MINORITY, WOMEN OR VETERAN PARTICIPATION STATEMENT Status will be vedfle& Unverifiable statuses will require the PRIME to either prdvde a revised statement or pTvAde source documentrdon that validates a status. F0 V ON PRIME NAME PRIME FfJD NUNMER CONTRACT DOLLAR AMOUNT k elf-q , 44S,�C) (k co IS THE PRIMF A FLORIDA-CERTIFIED DISADVANTAGED, E5 THE ACTIVr1'Y OF THIS CONTRACr.- MINORITY Olt WOMEN BUSRJESSENJ RPRISE? ODE? Y CONSTRUCTION? y N (D9WBLf%V3E) OR HAV-c A SMALL DMADIVANTAGED 5LISINESS&A CIATIRCATION FROM'MESMALLSUSINESS 1, CONSULTATION? y N ADMINISTRATION? A SERVICE DISASUDMERAN? VIBE? y OTHER? Y N SOB IIA? Y 15 Tii1S5UbIMS=N ARIEVISION?l Y N 11F YES, RV4510N NUMBER KC. To R OR -S UP Pa E 9 W H b IS A 0 IS AD VAW.Aa ED:'?A N 0 R ff Y: w 0 ME W 4w N t 6.-s M A i1*---;' DBE MANGE 505COMRACTOR OR SUPPLIER TYPE OF WORK OR EmNrcrry CODE SUB/SUPPLER PERCEW OF CONTRACT VETETiANI NAME SPECIALTY I lSeL Be;owl DOLLAR AMOUNT DOLLARS ._ T PRIME. /,C'ON 'R JETJ�p $Y AIAW OFSUDMNTTER DATE no 0175031.117FTER 91 L; SmOtAmv M((-ec,- 0<319S I - EMk0AnDRRSSor- PRIME (SUBM"TER) TELEPHONE NUMBER FAX NUMBER 0"ll Mai 614ox- 01 Ll 8't3- Ll a � (9 NOTE: This iritfrmatinn is CJryali cored to track aad repor, cipated ODE or m5f participation in federally -funded contracts. The anticipated Dae or MBE amount is voluntary and will not become part of the contractual terms. This form must be submimd a, time efreTornsettpa solkitation. If and when awarded a county contract, the Prime will be asked to update the information forthe grant compliance files. C!Ty.-. blackAmerican BA Ktspaniv American KA MtiveAmerican NA wbcont. Asian American SAA Asiar,;PadficAnwadcan APA Nnn-fAinorily women N 41W Othei notarn xtf- group lwm 1 0 E6. iii-C& F C-TON: 1) EPARMIENTUA1.4 E COI f EP CONTRACT ;Pf If BrAPP POI REW GRAMT PROGRAM, II ACCEP j BY- I DATE I GCA - 16 1`lli3lT I. `;IA" l;S CCLUER cc :ar , ;! NT ^G;::Fh+NCE FOR."-4 O PID OPPORTUP41TY LIST FOR C010MODITIES AND CONTRACTUAL SERVICES � c AND PROFESSIONAL CONSULTANT SERVICES d It rs the polky of Galilee County that drsadvon£cged bUsinesses a. id mmarily mndors, as red in the Code a)T, edeml Regula£ions (CFR) or � Kaddastatutestn),trust have theoy cy1m (ty 'IQ part-kioate on contmets vhdifefferalonLS6i r en rantassisianncee. J/- Z Prime Contmdor/PnmeConsultant: QV`(� E cm,, ti�C�%Yf 6 J G)I Address and Phone Number. V(0t a omt 01-A vL (� t �2 00 PracurernentNumber/Aduertisam2tTtNumber —1 � f l J ^ a LL The list below Emended o be a cis affirms that are, or attempting to, partidpate err the project numbered abore. The 161 must indude the -Turn bidding or quoting as prime, as voell as subs and suppliers quoting ,or participation. Prime rantractors and consultants must provide iWonnation for Numbers 1, 2, 1, and 4; and, should provida arty information they have for Numbers 5, 6, 7, and B. This farm must be submitted with the bid package- G N 1. fed2Cal TaxlD Number: 6.8 DBE a. Arinual gross Receipts 3. ram Name: Non-D13E tens than 51 million tv 3. Phone Number: Eetwftn $1-5 million Ol 4. Addre-ss 5 Between $ -1G millionfn 7_R Suixontractor Betvraen $ ID-15 million L O 5uboara Bant More than $15 million C tv 5. Year firmestabiished: >I r V 1. federal Tax ID Number: 6. DBE S. Annual Grass Receipts 2. fiJril Name: i Non -DBE L&S, than I m'tl6on � 3. Phone Number: Berrven $1-5 million O 4. Address Betvmen55-10miliion UI 7.8 Subcontractor Betv,wn $1LFd5 million (A lA Subconsultant Morethan$.15million V 7 O 5. Year firm Established: N tv 1. Federal Tax aD Number: 6. E DBE 8. Annual Grass Rer_wipts y L 2. Firm Name: Ncn-DBE Lass than .$ 1 m➢➢on � 3. Phone Numbs Between $1-5 milli on U 4, Address Betvren 53-10 mdHian r 7.8 5ubcomra(,-or Between $10-15 million subconsuitant More chart $ 15 mUNon = tv S. Year firm Estabrtshed: E O M 1. federal TaxiDNumber. 6.8 DBE S. Annual Gross Receipts V) 2. firm Name: Nan -DBE Less than $ i million p 3. Phone Numb►:: Between $1-5 million ti 4. Address Ber een $ 5-10 million t 7. R 5ubcontrat'zor Between 510-15 million 00 T subconsuttant more than 5 as million C O 5. Y+F.dr firm established; E t V tC Q GCA-17 C 4 — ._ Packet Pg. 678 collier.county Solicitation 18-74703 i:Xf.�flC3l'"(` 1.1"3 t,1�,�1N'1'�'7::1t'1'!l�lt'A`I'1(�N;yriPJl);1ti�;til4rli�lt;'I:> COLLIER COUNTY Acknowledgement of Terms, Conditions, and Grant Clauses Flow Down of Terms and Conditions from the Grant Agreement Subcontracts: if the Contractor subcontracts any of the work required under this Agreement, a copy of the signed subcontract must be available to the County for review and approval. The Contractor agrees to include in the subcontract that (1) the subcontractor is bound by the terms of this Agreement, (ii) the subcontractor is bound by all applicable state and federal laws and regulations, and (iii) the subcontractor shall hold the County and the Grantor Agency harmless against all claims of whatever nature arising out of the subcontractor's performance of work under this Agreement, to the extent allowed and required by law. The County may document in the quarterly report the Contractor's progress in performing its work under this agreement, Certification On behalf of my firmrracknowledge, and agree to perform all of the specifications and grant requirements idftntified in this Gt*iLatlon document(s).' Vendor/Contractor Name .authorized Signature Address (IJ (,-7 Solicitation/Contract # ! "b Iq (V �1 COW- L'-OUVS Date (i) loci 191 GCA -18 05/20 R4 7/7/2021 1:18 PM P. 50 Packet Pg. 679 FIXED FEE PROFESSIONAL SERVICE AGREEMENT # 18-7470S for SERVICES FOR SENIORS THIS AGREEMENT, made and entered into on this day of 20 21 , by and between Hemo Medika Care LLC d/b/a Harmonia The Club , authorized to do business in the State of Florida, whose business address is 3425 10th Street N, Suite 1, Naples, Florida 34103 ,(the "Contractor") and Collier County, a political subdivision of the State of Florida, (the "County"): WITNESSETH: The Agreement shall commence upon the date of Board approval and terminating on December 10, 2022 or until all outstanding Purchase Order(s) issued prior to the expiration of the Agreement period have been completed or terminated. The County may, at its discretion and with the consent of the Contractor, renew the Agreement under all of the terms and conditions contained in this Agreement for two ( 2 ) additional one ( 1 ) year(s) periods. The County shall give the Contractor written notice of the County's intention to renew the Agreement term prior to the end of the Agreement term then in effect. The County Manager, or his designee, may, at his discretion, extend the Agreement under all of the terms and conditions contained in this Agreement for up to one hundred and eighty (180) days. The County Manager, or his designee, shall give the Contractor written notice of the County's intention to extend the Agreement term prior to the end of the Agreement term then in effect. 2. COMMENCEMENT OF SERVICES. The Contractor shall commence the work upon issuance of a INI Purchase Order ❑ ❑ VJbFk-Qfdef• 3. STATEMENT OF WORK. The Contractor shall provide services in accordance with the terms and conditions of ❑ Request for Proposal (RFP) ❑ 4w#a#s+a-f® d4TB) ❑ �i Qtlaer # 18-7470S , including all Attachment(s), Exhibit(s) and Addenda and the Contractor's proposal referred to herein and made an integral part of this Agreement. ❑ The Contractor shall also provide services in accordance with Exhibit A — Scope of Services attached hereto. Page 1 of 15 Fixed Price Professional Service Agreement 2021_Ver.1 Packet Pg. 680 3.1 This Agreement contains the entire understanding between the parties and any modifications to this Agreement shall be mutually agreed upon in writing by the Parties, in compliance with the County's Procurement Ordinance, as amended, and Procurement Procedures in effect at the time such services are authorized. 3.2 The execution of this Agreement shall not be a commitment to the Contractor to order any minimum or maximum amount. The County shall order items/services as required but makes no guarantee as to the quantity, number, type or distribution of items/services that will be ordered or required by this Agreement. 4. THE AGREEMENT SUM. The County shall pay the Contractor for the performance of this Agreement based on Exhibit B- Fee Schedule, attached hereto and the price methodology as defined in Section 4.1. Payment will be made upon receipt of a proper invoice and upon approval by the County's Contract Administrative Agent/Project Manager, and in compliance with Chapter 218, Fla. Stats., otherwise known as the "Local Government Prompt Payment Act". 4.1 Price Methodology (as selected below): F-I Lump _n; (Fixed PFOGe): A fiFrn fixed total PFiGe 9 FS-1 Time and Materials: The County agrees to pay the contractor for the amount of labor time spent by the contractor's employees and subcontractors to perform the work (number of hours times hourly rate), and for materials and equipment used in the project (cost of materials plus the contractor's markup). This methodology is generally used in projects in which it is not possible to accurately estimate the size of the project, or when it is expected that the project requirements would most likely change. As a general business practice, these contracts include back-up documentation of costs; invoices would include number of hours worked and billing rate by position (and not company (or subcontractor) timekeeping or payroll records), material or equipment invoices, and other reimbursable documentation for the project. D Unit, 4.2 Any County agency may obtain services under this Agreement, provided sufficient funds are included in their budget(s). Page 2 of 15 Fixed Price Professional Service Agreement 2021_Ver.I i, Packet Pg. 681 4.3 Payments will be made for services furnished, delivered, and accepted, upon receipt and approval of invoices submitted on the date of services or within six (6) months after completion of the Agreement. Any untimely submission of invoices beyond the specified deadline period is subject to non-payment under the legal doctrine of "laches" as untimely submitted. Time shall be deemed of the essence with respect to the timely submission of invoices under this Agreement. 4.4 The County, or any duly authorized agents or representatives of the County, shall have the right to conduct an audit of Contractor's books and records to verify the accuracy of the Contractor's claim with respect to Contractor's costs associated with any Payment Application, Change Order, or Work Directive Change. M. .... IM 5. SALES TAX. Contractor shall pay all sales, consumer, use and other similar taxes associated with the Work or portions thereof, which are applicable during the performance of the Work. Collier County, Florida as a political subdivision of the State of Florida, is exempt from the payment of Florida sales tax to its vendors under Chapter 212, Florida Statutes, Certificate of Exemption # 85-8015966531 C. Page 3 of 15 Fixed Price Professional Service Agreement 2021_Ver.1 Packet Pg. 682 6. NOTICES. All notices from the County to the Contractor shall be deemed duly served if mailed or emailed to the Contractor at the following: Company Name: Hemo Medika Care LLC d/b/a Harmonia The Club Address: 3425 10th Street N, Suite 1 Naples. Florida 34103 Authorized Agent: Miriam Leskanicova, Manager Attention Name & Title: Peter Spisak, Manager Telephone: (239) 234-4608 E-Mail(s): Miriam@harmoniatheclub.com All Notices from the Contractor to the County shall be deemed duly served if mailed or emailed to the County to: Board of County Commissioners for Collier County, Florida Division Director: Kristi Sonntag Division Name: Community and Human Services Division Address: 3339 East Tamiami Trail, Suite 211 Naples, FL 34112 Administrative Agent/PM: Wendy Klopf, Grants Coordinator Telephone: (239) 252-29001 E-Mail(s): Wendy.Klopf@colliercountyfl.gov The Contractor and the County may change the above mailing address at any time upon giving the other party written notification. All notices under this Agreement must be in writing. 7. NO PARTNERSHIP. Nothing herein contained shall create or be construed as creating a partnership between the County and the Contractor or to constitute the Contractor as an agent of the County. 8. PERMITS: LICENSES: TAXES. In compliance with Section 218,80, F.S., all permits necessary for the prosecution of the Work shall be obtained by the Contractor. The County will not be obligated to pay for any permits obtained by Subcontractors. Payment for all such permits issued by the County shall be processed internally by the County. All non -County permits necessary for the prosecution of the Work shall be procured and paid for by the Contractor. The Contractor shall also be solely responsible for payment of any and all taxes levied on the Contractor. In addition, the Contractor shall comply with all rules, regulations and laws of Collier County, the State of Florida, or the U. S. Government now in force or hereafter adopted. The Contractor agrees to comply with all laws governing the responsibility of an employer with respect to persons employed by the Contractor. Page 4 of 15 Fixed Price Professional Service Agreement 2021_Ver.1 Packet Pg. 683 9. NO IMPROPER USE. The Contractor will not use, nor suffer or permit any person to use in any manner whatsoever, County facilities for any improper, immoral or offensive purpose, or for any purpose in violation of any federal, state, county or municipal ordinance, rule, order or regulation, or of any governmental rule or regulation now in effect or hereafter enacted or adopted. In the event of such violation by the Contractor or if the County or its authorized representative shall deem any conduct on the part of the Contractor to be objectionable or improper, the County shall have the right to suspend the Agreement of the Contractor. Should the Contractor fail to correct any such violation, conduct, or practice to the satisfaction of the County within twenty-four (24) hours after receiving notice of such violation, conduct, or practice, such suspension to continue until the violation is cured. The Contractor further agrees not to commence operation during the suspension period until the violation has been corrected to the satisfaction of the County. 10. TERMINATION. Should the Contractor be found to have failed to perform his services in a manner satisfactory to the County as per this Agreement, the County may terminate said Agreement for cause; further the County may terminate this Agreement for convenience with a thirty (30) day written notice. The County shall be the sole judge of non-performance. In the event that the County terminates this Agreement, Contractor's recovery against the County shall be limited to that portion of the Agreement Amount earned through the date of termination. The Contractor shall not be entitled to any other or further recovery against the County, including, but not limited to, any damages or any anticipated profit on portions of the services not performed. 11. NO DISCRIMINATION. The Contractor agrees that there shall be no discrimination as to race, sex, color, creed or national origin. 12. INSURANCE. The Contractor shall provide insurance as follows: A. �■ Commercial General Liability: Coverage shall have minimum limits of $1,000,0000 Per Occurrence, $ 2,000,000 aggregate for Bodily Injury Liability and Property Damage Liability. This shall include Premises and Operations; Independent Contractors; Products and Completed Operations and Contractual Liability. B. 0 Business Auto Liability: Coverage shall have minimum limits of $ 500,000 Per Occurrence, Combined Single Limit for Bodily Injury Liability and Property Damage Liability. This shall include: Owned Vehicles, Hired and Non -Owned Vehicles and Employee Non -Ownership. C. Al Workers' Compensation: Insurance covering all employees meeting Statutory Limits in compliance with the applicable state and federal laws. The coverage must include Employers' Liability with a minimum limit of $1,000,000 for each accident. Page 5 of 15 Fixed Price Professional Service Agreement 2021_Ver.1 Packet Pg. 684 D. � Professional Liability: Shall be maintained by the Contractor to ensure its legal liability for claims arising out of the performance of professional services under this Agreement. Contractor waives its right of recovery against County as to any claims under this insurance. Such insurance shall have limits of not less than $1,000,000 each claim and aggregate. & ❑ Gevenage sha# have i m 4na+t9 of Q` r+or __G irarFnnoe °F- ❑ TeG f Q—peFGGGI li"-fE1�82c G- ❑ AG6bF eRGe. ❑ C4�}n� I �n.ngCri'io a-■.�iun■-■��-'a' 1 8seUFreRGe. I•- ❑ Act): Coverage shall have minimum limits of $ per occurrence. L. ■❑ Crime/Employee Dishonesty (other): Coverage shall have minimum limits of $ 50,000 per occurrence. Special Requirements: Collier County Board of County Commissioners, OR, Board of County Commissioners in Collier County, OR, Collier County Government shall be listed as the Certificate Holder and included as an "Additional Insured" on the Insurance Certificate for Commercial General Liability where required. This insurance shall be primary and non-contributory with respect to any other insurance maintained by, or available for the benefit of, the Additional Insured and the Contractor's policy shall be endorsed accordingly. Current, valid insurance policies meeting the requirement herein identified shall be maintained by Contractor during the duration of this Agreement. The Contractor shall provide County with certificates of insurance meeting the required insurance provisions. Renewal certificates shall be sent to the County thirty (30) days prior to any expiration date. Coverage afforded under the policies will not be canceled or allowed to expire until the greater of: thirty (30) days prior written notice, or in accordance with policy provisions. Contractor shall also notify County, in a like manner, within twenty-four (24) hours after receipt, of any notices of expiration, cancellation, non -renewal or material change in coverage or limits received by Contractor from its insurer, and nothing contained herein shall relieve Contractor of this requirement to provide notice. Contractor shall ensure that all subcontractors comply with the same insurance requirements that the Contractor is required to meet. Page 6 of 15 Fixed Price Professional Service Agreement 2021_Ver.1 Packet Pg. 685 13. INDEMNIFICATION. To the maximum extent permitted by Florida law, the Contractor shall defend, indemnify and hold harmless Collier County, its officers and employees from any and all liabilities, damages, losses and costs, including, but not limited to, reasonable attorneys' fees and paralegals' fees, whether resulting from any claimed breach of this Agreement by Contractor, any statutory or regulatory violations, or from personal injury, property damage, direct or consequential damages, or economic loss, to the extent caused by the negligence, recklessness, or intentionally wrongful conduct of the Contractor or anyone employed or utilized by the Contractor in the performance of this Agreement. This indemnification obligation shall not be construed to negate, abridge or reduce any other rights or remedies which otherwise may be available to an indemnified party or person described in this paragraph. This section does not pertain to any incident arising from the sole negligence of Collier County. 13.1 The duty to defend under this Article 13 is independent and separate from the duty to indemnify, and the duty to defend exists regardless of any ultimate liability of the Contractor, County and any indemnified party. The duty to defend arises immediately upon presentation of a claim by any party and written notice of such claim being provided to Contractor. Contractor's obligation to indemnify and defend under this Article 13 will survive the expiration or earlier termination of this Agreement until it is determined by final judgment that an action against the County or an indemnified party for the matter indemnified hereunder is fully and finally barred by the applicable statute of limitations. 14. AGREEMENT ADMINISTRATION. This Agreement shall be administered on behalf of the County by the Community and Human Services Division 15. CONFLICT OF INTEREST. Contractor represents that it presently has no interest and shall acquire no interest, either direct or indirect, which would conflict in any manner with the performance of services required hereunder. Contractor further represents that no persons having any such interest shall be employed to perform those services. 16. COMPONENT PARTS OF THIS AGREEMENT. This Agreement consists of the following component parts, all of which are as fully a part of the Agreement as if herein set out verbatim: Contractor's Proposal, Insurance Certificate(s), 0 Exhibit A Scope of Services, Exhibit B Fee Schedule, 0 RFP/ ❑ IT-W ❑ -heF ) # 18-7470S including Exhibits, Attachments and Addenda/Addendum, ❑ subsequent quotes, and FM-1 Other Exhibit/Attachment: Federal Grant Provisions 17. APPLICABILITY. Sections corresponding to any checked box (M) will expressly apply to the terms of this Agreement. 18. SUBJECT TO APPROPRIATION. It is further understood and agreed by and between the parties herein that this Agreement is subject to appropriation by the Board of County Commissioners. Page 7 of 15 Fixed Price Professional Service Agreement 2021_Ver.I Packet Pg. 686 19. PROHIBITION OF GIFTS TO COUNTY EMPLOYEES. No organization or individual shall offer or give, either directly or indirectly, any favor, gift, loan, fee, service or other item of value to any County employee, as set forth in Chapter 112, Part III, Florida Statutes, Collier County Ethics Ordinance No. 2004-05, as amended, and County Administrative Procedure 5311. Violation of this provision may result in one or more of the following consequences: a. Prohibition by the individual, firm, and/or any employee of the firm from contact with County staff for a specified period of time; b. Prohibition by the individual and/or firm from doing business with the County for a specified period of time, including but not limited to: submitting bids, RFP, and/or quotes; and, c. immediate termination of any Agreement held by the individual and/or firm for cause. 20. COMPLIANCE WITH LAWS. By executing and entering into this Agreement, the Contractor is formally acknowledging without exception or stipulation that it agrees to comply, at its own expense, with all federal, state and local laws, codes, statutes, ordinances, rules, regulations and requirements applicable to this Agreement, including but not limited to those dealing with the Immigration Reform and Control Act of 1986 as located at 8 U.S.C. 1324, et seq. and regulations relating thereto, as either may be amended; taxation, workers' compensation, equal employment and safety including, but not limited to, the Trench Safety Act, Chapter 553, Florida Statutes, and the Florida Public Records Law Chapter 119, if applicable, including specifically those contractual requirements at F.S. § 119.0701(2)(a)-(b) as stated as follows: IF THE CONTRACTOR HAS APPLICATION OF CHAPTER 11c, CONTRACTOR'S DUTY TO RELATING TO THIS CONTRACT, PUBLIC RECORDS AT: IUESTIONS REGARDING THE , FLORIDA STATUTES, TO THE IROVIDE PUBLIC RECORDS CONTACT THE CUSTODIAN OF Division of Communications, Government and Public Affairs 3299 Tamiami Trail East, Suite 102 Naples, FL 34112-5746 Telephone: (239) 252-8999 Email: PublicRecord Reguest .colIiercountyfl.gov The Contractor must specifically comply with the Florida Public Records Law to: 1. Keep and maintain public records required by the public agency to perform the service. 2. Upon request from the public agency's custodian of public records, provide the public agency with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law. Page 8 of 15 Fixed Price Professional Service Agreement 2021_Ver.1 Packet Pg. 687 3. Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law for the duration of the contract term and following completion of the contract if the Contractor does not transfer the records to the public agency. 4. Upon completion of the contract, transfer, at no cost, to the public agency all public records in possession of the Contractor or keep and maintain public records required by the public agency to perform the service. If the Contractor transfers all public records to the public agency upon completion of the contract, the Contractor shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the Contractor keeps and maintains public records upon completion of the contract, the Contractor shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to the public agency, upon request from the public agency's custodian of public records, in a format that is compatible with the information technology systems of the public agency. If Contractor observes that the Contract Documents are at variance therewith, it shall promptly notify the County in writing. Failure by the Contractor to comply with the laws referenced herein shall constitute a breach of this Agreement and the County shall have the discretion to unilaterally terminate this Agreement immediately. 21. OFFER EXTENDED TO OTHER GOVERNMENTAL ENTITIES. Collier County encourages and agrees to the successful Contractor extending the pricing, terms and conditions of this solicitation or resultant Agreement to other governmental entities at the discretion of the successful Contractor. 22. AGREEMENT TERMS. If any portion of this Agreement is held to be void, invalid, or otherwise unenforceable, in whole or in part, the remaining portion of this Agreement shall remain in effect. 23. ADDITIONAL ITEMS/SERVICES. Additional items and/or services may be added to this Agreement in compliance with the Procurement Ordinance, as amended, and Procurement Procedures. 24. DISPUTE RESOLUTION. Prior to the initiation of any action or proceeding permitted by this Agreement to resolve disputes between the parties, the parties shall make a good faith effort to resolve any such disputes by negotiation. The negotiation shall be attended by representatives of Contractor with full decision -making authority and by County's staff person who would make the presentation of any settlement reached during negotiations to County for approval. Failing resolution, and prior to the commencement of depositions in any litigation between the parties arising out of this Agreement, the parties shall attempt to resolve the dispute through Mediation before an agreed -upon Circuit Court Mediator certified by the State of Florida. The mediation shall be attended by representatives of Contractor with full decision -making authority and by County's staff person who would make the presentation of any settlement Page 9 of 15 Fixed Price Professional Service Agreement 2021_Ver.I Packet Pg. 688 reached at mediation to County's board for approval. Should either party fail to submit to mediation as required hereunder, the other party may obtain a court order requiring mediation under section 44,102, Fla. Stat. 25. VENUE. Any suit or action brought by either party to this Agreement against the other party relating to or arising out of this Agreement must be brought in the appropriate federal or state courts in Collier County, Florida, which courts have sole and exclusive jurisdiction on all such matters. NOW 11 217 EMMS ME -0i rA FE-1 AGREEMENT STAFFING. The Contractor's personnel and management to be utilized for this Agreement shall be knowledgeable in their areas of expertise. The County reserves the right to perform investigations as may be deemed necessary to ensure that competent persons will be utilized in the performance of the Agreement. The Contractor shall assign as many people as necessary to complete required services on a timely basis, and each person assigned shall be available for an amount of time adequate to meet required services. AM ---- - ❑E ORDER OF PRECEDENCE (Grant Funded). In the event of any conflict between or among the terms of any of the Contract Documents and/or the County's Board approved Executive Summary, the terms of the Agreement shall take precedence over the terms of all other Contract Documents, except the terms of any Supplemental Conditions shall take precedence over the Agreement. To the extent any conflict in the terms of the Contract Documents cannot be resolved by application of the Supplemental Conditions, if any, or the Agreement, the conflict shall be resolved by imposing the more strict or costly obligation under the Contract Documents upon the Contractor at County's discretion. 28. ASSIGNMENT. Contractor shall not assign this Agreement or any part thereof, without the prior consent in writing of the County. Any attempt to assign or otherwise transfer this Agreement, or any part herein, without the County's consent, shall be void. If Contractor does, with approval, assign this Agreement or any part thereof, it shall Page 10 of 15 Fixed Price Professional Service Agreement 2021_Ver.I Packet Pg. 689 require that its assignee be bound to it and to assume toward Contractor all of the obligations and responsibilities that Contractor has assumed toward the County. 29. SECURITY. The Contractor is required to comply with County Ordinance 2004-52, as amended. Background checks are valid for five (5) years and the Contractor shall be responsible for all associated costs. If required, Contractor shall be responsible for the costs of providing background checks by the Collier County Facilities Management Division for all employees that shall provide services to the County under this Agreement. This may include, but not be limited to, checking federal, state and local law enforcement records, including a state and FBI fingerprint check, credit reports, education, residence and employment verifications and other related records. Contractor shall be required to maintain records on each employee and make them available to the County for at least four (4) years. All of Contractor's employees and subcontractors must wear Collier County Government Identification badges at all times while performing services on County facilities and properties. Contractor ID badges are valid for one (1) year from the date of issuance and can be renewed each year at no cost to the Contractor during the time period in which their background check is valid, as discussed below. All technicians shall have on their shirts the name of the contractor's business. The Contractor shall immediately notify the Collier County Facilities Management Division via e-mail (DL-FMOPS@colliergov.net) whenever an employee assigned to Collier County separates from their employment. This notification is critical to ensure the continued security of Collier County facilities and systems. Failure to notify within four (4) hours of separation may result in a deduction of $500 per incident. (Intentionally left blank -signature page to follow) Page 11 of IS Fixed Price Professional Service Agreement 2021_Ver.1 Packet Pg. 690 IN WITNESS WHEREOF, the parties hereto, by an authorized person or agent, have executed this Agreement on the date and year first written above. ATTEST: Crystal K. Kinzel, Clerk of Courts & Comptroller Dated: BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY, FLORIDA PENNY I AYLOR (SEAL) Hemo Medika Care LLC Contractor's Witnesses: d/b/a Harmonia The Club Contractor /-6,., �� L� 11--7 By; Contractor's Fir itness Signature t7 lR i AEI G69&� Ay'160V , CiQ � L�Z—Z 5? lS/� TType/print signature and titleT TType/print witness nameT �a I(- QA N--Y�- Contrac or's Second Wifft6ss c �n�t � � � 1< ���� 2sor•f TType/print witness nameT Approved as to Form and Legality: County Attorney Print Name Page 12of15 Fixed Price Prol'essional Service Agreement 2021_Ver.l L41 Packet Pg. 691 Exhibit A Scope of Services *following this page (containing 3 page/s) ❑ this exhibit is not applicable Page 13 of 15 Fixed Price Professional Service Agreement 2021_Ver.1 E Packet Pg. 692 REQUEST FOR PROPOSAL (RFP) # 18-7470S "SERVICES FOR SENIORS" EXHIBIT A SCOPE OF SERVICES BACKGROUND The purpose of this Agreement is for home and community -based services, to be delivered to persons/clients sixty years and older under Older American's Act (OAA), Community Care for the Elderly (CCE) and Health Care for the Elderly (HCE), and to qualified persons/clients eighteen years or older under Alzheimer's Disease Initiative (ADI), within the geographic area of Collier County. Unless otherwise stated, minimum hours of availability are 7:00 a.m. to 5:00 p.m. Monday through Saturday, with the exception of federal and state holidays. Respite services and emergency services must be available 24 hours/day, 365 days/year if needed. Definitions, standards, and requirements of these services are included in the Department of Elder Affairs' Home and Community -Based Services Handbook (DOEA Handbook) link: http://elderaffairs.state.fl.us/doea/nois.php DETAILED SCOPE OF WORK The Contractor/s (also may be referred to as "Vendor" or "Provider") must adhere to the scope outlined herein, in addition to maintaining adherence with the guidelines set forth by the current DOER Handbook. Lack of knowledge of all requirements of a service listed in the proposal SHALL NOT relieve the provider of liability and obligations under the resultant agreement. Collier County Community & Human Services (CHS) shall lead all service authorization and coordination under this Agreement. In an effort to comply with the requirements of the OAA, ADI, CCE and HCE Programs, clients entering the service system will be assessed and prioritized by CHS. Upon determination of the service level to be provided, CHS will offer the client a listing of service vendors for the specific service(s) outlined within their care plan. The client will be encouraged to pick a service provider of their choice and have the option of interviewing potential service providers. Should the client not have a preference, CHS will select a service provider from the centralized provider list, using a rotation basis (rotating to the next vendor on the list). In this manner, all service providers will be equally treated unless the client has a preference. CHS shall not endorse one service provider over another. Upon the determination of the service, the service levels, and the selected vendor, CHS will contact the vendor agency, and authorize the service, number of hours, and frequency. In keeping with the state policy of client choice of service providers, Collier County does not guarantee a minimum or maximum number of clients that will be referred, nor a minimum or maximum number of service hours that will be requested during the contract period. Should a client later indicate dissatisfaction with the chosen service provider, they will again be offered their choice of provider. CHS shall send the agreed -upon Service Authorization to the chosen provider. These "service authorizations" or "service orders" must contain necessary client information, such as street address, telephone number, and services or items needed, as well as the name and telephone number of the CHS case manager authorizing the service. In order to meet client needs, some services may be required outside of normal office hours (8:00 AM to 5:00 PM, Monday - Friday). CHS reserves the right to request adding additional service providers throughout the agreement period. The County may do so through a competitive and publicly announced selection process, which shall be coordinated through the County's Procurement Department. Services shall be provided in the manner described in the most current DOEA manual and outlined herein. Should funding for additional Senior Services be identified, the County reserves the right to add to the resultant agreements the services, descriptions, rates, etc. by way of a contract addendum. Services covered by this agreement include, but are not limited to: 1. Adult Day Care: A program of therapeutic social and health activities and services provided to adults who have functional impairments, in a protective environment that provides as non -institutional an environment as possible. Page 1 of 3 Exhibit A — Scope of Services Packet Pg. 693 REQUEST FOR PROPOSAL (RFP) # 18-7470S "SERVICES FOR SENIORS" 2. Chore: Performance of routine house or yard tasks including such jobs as seasonal cleaning, yard work, lifting and moving furniture, appliances, or heavy objects, household repairs which do not require a permit or specialist, and household maintenance. 3. Enhanced Chore: This service is beyond the scope of chore due to the level of service needed. The service includes a more intensified, thorough cleaning to address more demanding circumstances. 4. Homemaking: Specific home management duties including housekeeping, laundry, cleaning refrigerators, clothing repair, minor home repairs, assistance with budgeting and paying bills, client transportation, meal planning and preparation, shopping assistance, and routine house -hold activities by a trained homemaker. 5. Personal Care: Assistance with eating, dressing, personal hygiene and other activities of daily living. This service may include assistance with meal preparation, housekeeping chores such as bed making, dusting, and vacuuming incidental to the care furnished or essential to the health and welfare of the individual. Personal care can include accompanying the client to clinics, physician office visits, or trips for the purpose of health care provided that the client does not require special medical transportation. Personal care can also include shopping assistance to purchase food, clothing, and other items needed for the client's personal care needs. 6. In Home Respite: Relief or rest for a primary caregiver from the constant/continued supervision, companionship, therapeutic and/or personal care, of a functionally impaired older person for a specified period of time. 7. Skilled Nursing: Part-time or intermittent nursing care administered to an individual by a licensed practical nurse, registered nurse, or advanced registered nurse practitioner, in the client's place of residence, pursuant to a care plan approved by a licensed physician. 8. Emergency Alert Response Services: Emergency alert/response service is defined as a community based electronic surveillance service which monitors the frail homebound elder by means of an electronic communication link with a response center. 9. Specialized Medical Equipment, Services, and Supplies: Adaptive devices, controls, appliances, or services, which enable individuals to increase their ability to perform activities of daily living and repair of such services which may include: dentures, walkers, reaching devices, bedside commodes, telephone amplifiers, touch lamps, adaptive eating equipment, glasses, hearing aids, and other mechanical or non -mechanical, electronic, and non -electronic adaptive devices. Supplies may include such things as adult briefs, bed pads, oxygen or nutritional supplements. 10. Facility Respite: 24-hour care in a State of Florida Licensed Nursing home. 11. Establish protocols for contacting CHS Case Managers in emergency or unusual circumstances and include the documentation requirements (oral and written) in the Service Provider Application. 12. Provide disaster response protocols, plans and services: In the event of a natural disaster (hurricane, tropical storm, tornado, flood, heat wave, etc.), the provider will have staff available to serve those clients in critical need of services, as designated by the CHS Case Managers, 13. Establish a client grievance process: Each service provider agency must have a policy addressing client grievances and/or complaints. 14. Establish and provide staff training: All services provided with funding from DOEA require service delivery personnel to have general pre -service orientation and training specific to the service being provided. Lead Agencies are responsible for provision of the pre -service training (on program and billing requirements, in particular) for all paid staff, volunteer staff and assigned staff of service providers. Page 2 of 3 Exhibit A — Scope of Services Packet Pg. 694 REQUEST FOR PROPOSAL (RFP) # 18-7470S "SERVICES FOR SENIORS" Pre -service orientation must also include: • An overview of the aging process • An overview of the aging network • Communication techniques with the elderly • Observation of abuse, neglect, exploitation and incident reporting • Local agency service procedures and protocol • Client confidentiality NOTE: All "hands-on" service personnel must receive training emphasizing the necessity of Universal Precautions. Home Health Aides must have documentation of successful completion of 40 hours required training, and CNAs must have on file a copy of their State of Florida certification. In-service training hours and topics are to be provided at the discretion of the service provider agency and shall meet state requirements. 15. Compile and report program service delivery statistics and other data as identified by CHS. This may be required to be provided in an electronic format at the choosing of CHS. These are reported to the Area Agency on Aging and Department of Elder Affairs in accordance with the reporting requirements developed by the Department. Lead agencies are responsible for entry of data in the Client Information and Registration Tracking System (CIRTS), which generates payment to the service provider agency. Therefore, service provider agencies are required to provide Lead Agencies with correct and timely service data to comply with these requirements. Timely submission is no later than noon on Wednesday of the week following the week services are performed (service week defined as Monday through Sunday). 16. Maintain complete and accurate records: Service delivery logs, at a minimum, must be legible and contain the name of client, type(s) of services and date(s) and hour(s) of delivery. The client/caregiver must sign the log at the time of each service visit. The service worker must sign and date the log upon completion and submit it to the service provider agency. Provide complete, clear and accurate invoices: Weekly invoices, which may be required to be provided electronically in a system provided by CHS, must be submitted by noon on the Wednesday following the week that the service was provided and shall include service provided. The service week is defined as Monday through Sunday. Monthly reporting requirements for CIRTS dictate that all client and service data for the previous month to be entered into CIRTS by the 10th day of the month. Collier County "Services for Seniors" will coordinate with vendors to determine due dates for invoices. This will ensure compliance with DOEA reporting requirements. Failure to record or report units of service will result in nonpayment (or delayed payment) for such services. Data required on weekly invoices and weekly timesheets include: • Vendor name • Vendor address • Vendor telephone number • Client name • Service Provider employee who delivered the service(s) • Services ordered and services delivered date • Number of service hours, cost per hour and total cost • Person preparing the report and the date it was prepared • Weekly timesheets signed and dated by the client and Service Provider employee • Additional information as determined by CHS 17. Prepare for annual on -site compliance audits by CHS or members of the Collier County staff as directed by the CHS or grant requirements. Page 3 of 3 Exhibit A — Scope of Services o Packet Pg. 695 Exhibit B Fee Schedule following this page (pages 1 through 1 Page 14 of 15 Fixed Price Professional Service Agreement 2021_Ver.I -, Packet Pg. 696 REQUEST FOR PROPOSAL (RFP) # 18-7470S "SERVICES FOR SENIORS" EXHIBIT B FEESCHEDULE HEMO MEDIKA CARE LLC D/B/A HARMONIA THE CLUB Cost Per Service In -kind 10% Reimbursement' Rate Per Unit Unit (Cost your Match (Grant (Amount the Item Services Grant Service Unit company charges Amount your County will for the service) company will be reimburse your paying) company for given service) 1. Skilled Nursing CCE, OAA Per Hour $40.00 $4.00 $36.00 2. Enhance Chore ADI, CCE, OAA Per Hour $40.00 $4.00 $36.00 3. Respite (In -Home) ADI, CCE, OAA Per Hour $24.11 $2.41 $21.70 4. Respite (Facility ADI, CCE, OAA Daily Rate $225.00 0 $225.00 Based) 5. Personal Care ADI, CCE, OAA Per Hour $24.11 $2.41 $21.70 6. Chore ADI, CCE, OAA Per Hour $24.00 $2.40 $21.60 7. Homemaking ADI, CCE, OAA Per Hour $23.33 $2.33 $21.00 8. Adult Day Care ADI, CCE, OAA Per Hour $13.89 $1.39 $12.50 9. Emergency Alert ADI, CCE, OAA Per Day $1.09 $0.11 $0.98 Response Reimbursement Cost Per Service In -kind 10%q Rate Per Unit Unit (Cost your Match (Grant (Amount the Item Services Grant Service company, charges Amount your County will Unit for the service) company will be reimburse your paying) company for a given service) Specialized Medical ADI, CCE, OAA Per Episode N/A N/A N/A 10. Equipment, Services, and Supplies Page 1 of 1 Exhibit B - Fee Schedule Packet Pg. 697 Description:. Other Exhibit/Attachment Federal Contract Provisions FE-1 following this page (pages 1 through 25 ) ❑ this exhibit is not applicable Page 15 of IS Fixed Price Professional Service Agreement 2021_Ver.l Packet Pg. 698 EXHIBIT 1.A FEDERAL CONTRACT PROVISIONS U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (ADMINISTRATION ON AGING) AND FLORIDA DEPARTMENT OF ELDER AFFAIRS CFDA 93.OXX (CSFA 65.010) The supplemental conditions contained in this section are intended to cooperate with, to supplement, and to modify the general conditions and other specifications. In cases of disagreement with any other section of this contract, the Supplemental Conditions shall govern. Contractor means an entity that receives a contract. The services performed by the awarded Contractor shall be in compliance with the provisions of Title 45 CFR Part 75; and/, 2 CFR Part 200; and/or Title 45 Chapter XIII Part 1321 and/or other applicable regulations. It shall be the awarded Contractor's responsibility to acquire and utilize the necessary manuals and guidelines that apply to the work required to complete this project. In general, 1) The contractor (including all subcontractors) must insert these contract provisions in each lower tier contracts (e.g. subcontract or sub -agreement); 2) The contractor (or subcontractor) must incorporate the applicable requirements of these contract provisions by reference for work done under any purchase orders, rental agreements and other agreements for supplies or services; 3) The prime contractor is responsible for compliance with these contract provisions by any subcontractor, lower -tier subcontractor or service provider. FEDERAL STATUTORY AUTHORITY Older Americans Act of 1965 (OAA), as amended (42 U.S.0 § 3001 et seq., as amended by Public Law 114-144; 106-501; Section 20.41) OLDER AMERICANS ACT PROGRAM FUNDS OAA Title III B - Supportive Services; OAA, Title III, Section 307(a)(10) Title 45 Public Welfare (45 CFR 1321) Chapter XIII Office of Human Development Services, Department of Health and Human Services Part 1321.65 Grants to State and Community Programs on Aging; Part 1321.67 Service Contributions FLORIDA STATUTORY AUTHORITY TITLE XXX (Social Welfare); Chapter 430 (Elder Affairs) CONTRACT COMPLIANCE OVERVIEW Under the Florida Department of Elder Affairs Older Americans Act, the contractor must comply with the contract documentation, conform to state and AAA policies, and comply with federal and state statutory and regulatory requirements. (Ref. - Department of Elder Affairs Programs and Services Handbook, Chapter 4, Page 22; July 2018: Older Americans Act.). The contractor will comply with the intent of Title III to provide for formula grants to State agencies on aging to stimulate the development or enhancement of comprehensive and coordinated community -based systems resulting in a continuum of services to older persons with special emphasis on older individuals with the greatest economic or social need, with particular attention to low-income minority individuals. (Ref. - Title 45 CFR 1321) FCP-I Packet Pg. 699 EXHIBIT LA FEDERAL CONTRACT PROVISIONS U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES FEDERAL CONTRACT PROVISIONS Administrative, Contractual, or Legal Remedies (Ref. 41 U.S.C. 1908, 2 CFR § 200 Appendix II (A) Unless otherwise provided in this contract, all claims, counter -claims, disputes and other matters in question between the local government and the contractor, arising out of or relating to this contract, or the breach of it, will be decided by arbitration, if the parties mutually agree, or in a Florida court of competent jurisdiction. Access to Records and Reports (Reference: 2 CFR § 200.333, 2 CFR § 200,336) The contractor/vendor agrees to maintain all books, records, accounts and reports required under this contract for a period of not less than three years after the date of termination or expiration of this contract, except in the event of litigation or settlement of claims arising from the performance of this contract, in which case the Contractor agrees to maintain same until the Purchaser, the Grantor Administrator, the Comptroller General, or any of their duly authorized representatives, have disposed of all such litigation, appeals, claims or exceptions related thereto. Furthermore, the County shall maintain written policies and procedures for computer system backup and recovery and shall have the same requirement of its Contractors. Byrd Anti -Lobbying Amendment (31 U.S.C. 1352) (Reference 2 CFR § 200 Appendix II (J) Vendors must certify it will not and has not used Federal appropriated funds have been paid or will be paid, by or to any person or organization for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. The certification includes any lobbying with non -Federal funds that takes place in connection with obtaining any Federal award. Civil Rights Compliance The contractor or a subcontractor who is the recipient of Federal funds (or assumes others with whom it arranges to provide services or benefits in connection with any of its programs and activities or assures others with whom it arranges to provide services or benefits to participants or employees) must comply with Title VI of the Civil Rights Act of 1964, which prohibits discrimination on the basis of race, color, or national origin (45 CFR 80), and Statutes and Regulations enforced by the Office of Civil Rights, U.S. Department of Health and Human Services, as follow: Section 504 of the Rehabilitation Act of 1973, as amended (29 USC § 794), prohibits discrimination against otherwise qualified individuals on the basis of disability in programs and activities receiving financial assistance from HHS 45 CFR 84 and/or programs or activities conducted by HHS 45 CFR 85 in the provision of benefits and under the ADA that does not: a. Exclude a person with a disability from a program or activity; b. Deny a person with a disability the benefits of a program or activity; c. Afford a person with a disability an opportunity to participate in or benefit from a benefit or service that is not equal to what is afforded others; d. Provide a benefit or service to a person with a disability that is not as effective as what is provided others; e. Provide different or separate benefits or services to a person with a disability unless necessary to provide benefits or services that are as effective as what is provided others; or, f. Apply eligibility criteria that tend to screen out persons with disabilities unless necessary for the provision of the service, program or activity. FCP-2 Packet Pg. 700 EXHIBIT 1.A FEDERAL CONTRACT PROVISIONS Section 508 of the Rehabilitation Act of 1973, as amended, (29 USC § 794(d)) prohibits discrimination on the basis of disability in electronic and information technology as they relate to programs and activities conducted by HHS. The Age Discrimination Act of 1975, as amended (42 USC § 6101) prohibits discrimination on the basis of age in programs or activities receiving Federal financial assistance 45 CFR 90; and/or programs or services receiving HHS financial assistance 45 CFR 91; Title II of the Americans with Disabilities Act (28 CFR Part 35), relating to Nondiscrimination on the Basis of Disability in State and Local Government Services 2010 ADA Standards for Accessible Design; The Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §290 dd-3 and 290 ee 3), as amended, as relating to confidentiality of alcohol and drug abuse patient records; Section 1908 of the Public Health Service Act (42 USC § 300w-7) prohibits discrimination on the basis of age, race, color, national origin, disability, sex (gender), or religion in programs, services, and activities funded by Preventative Health and Health Services Block Grants, Federal Health Care Conscience Protection Statutes (42 USC § 300a-7; 42 USC § 300a-7; 42 USC § 238n and the Weldon Amendment (Continuing Appropriations Resolution, Pub. L. No. 113-164, Sec. 101(a) (Sept. 19, 2015); Regulation for the Enforcement of Federal Health Care Provider Conscience Protection Laws, which prohibit recipients of certain Federal funds from discriminating against certain health care providers who refuse to participate in certain health care services on religious or moral grounds. Section 1557 of the Affordable Care Act prohibits discrimination on the basis of disability by entities that operate a health program or activity. 45 CFR 80. The contractor must have on file an assurance that the program will be conducted in compliance with all nondiscriminatory provisions as required in 45 CFR 80. Debarment and Suspension (Reference 2 CFR § 200 Appendix II (I) Contract awards that exceed the small purchase threshold and certain other contract awards shall not be made to parties listed on the government wide Excluded Parties List System in the System for Award Management (SAM), in accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR Part 1986 Comp., p. 189) and 12689 (3 CFR Part 1989 Comp., p. 235), "Debarment and Suspension." The Excluded Parties List System in SAM contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549. The successful bidder, by administering each lower tier subcontract that exceeds $25,000 as a "covered transaction", must verify each lower tier participant of a "covered transaction" under the project is not presently debarred or otherwise disqualified from participation in this federally assisted project. The Contractor shall comply with these provisions before doing business or entering into subcontracts receiving federal funds pursuant to this contract. The Contractor shall complete and sign the Certifications and Assurances Attachment prior to the execution of this contract. Diversity (Reference 2 CFR § 200.321) The County is dedicated to fostering the continued development and economic growth of small, minority-, women-, and service -disabled veteran business enterprises. All contracting and subcontracting opportunities afforded by this solicitation/contract are strongly encouraged to contribute as both Contractors and Sub - Contractors. Firms may be required to submit documentation addressing diversity and describing the efforts being made to encourage the participation of small, minority-, women-, and service -disabled veteran business enterprises. Information on Certified Minority Business Enterprises (CMBE) and Certified Service -Disabled Veteran Business Enterprises (CSDVBE) is available from the Office of Supplier Diversity at: http://dins.myflorida.com/other programs/office of supplier diversity osd/ FCP-3 Packet Pg. 701 EXHIBIT LA FEDERAL CONTRACT PROVISIONS Energy Policy and Conservation Act - (Reference 2 CFR § 200 Appendix II (H) The contractor shall comply with any mandatory standards and policies relating to energy efficiency which are contained in the F 1 o r i d a state energy conservation plan issued in compliance with the Energy Policy and Conservation Act (Pub. L. 94-163, 89 Stat. 871, 42 U.S.0 Section 6201) Equal Employment Opportunity (Appendix II, 2 CFR Part 200; Department of Labor 41 CFR Part 60; Dept. of Health and Human Services 45 CFR Part 92, if applicable). The Contractor shall not discriminate against any employee or applicant for employment because of race, age, creed, color, sex or national origin. The Agency will take affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to their race, age, creed, color, sex, or national origin. Such action shall include, but not be limited to, the following: Employment upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. Contractors must insert a similar provision in all subcontracts, except subcontracts for standard commercial supplies or raw materials. E-verify, Presidential Executive Order 12989; Florida Executive Order Number 11-116 Vendors/Contractors/Subcontracts: 1. Agree to utilize the U.S. Department of Homeland Security's E-verify system to verify the employment of all new employees hired by Contractor during the contract term; and 2. Contractor shall include in related subcontracts a requirement that Subcontractors performing work or providing services pursuant to the state contract utilize the E-verify system to verify employment eligibility of all new employees hired by the Subcontractor during the contract term. The HIPAA Privacy Rules, 4 CFR Part 160 and Subparts A and E of part 164 The Third Party subrecipient will comply with HIPAA requirements to appropriate safeguards to protect the privacy of personal health information, and sets limits and conditions on the uses and disclosures that may be made of such information without patient authorization. No Government Obligation to Third Parties - The Federal Government is not a party to this contract and is not subject to any obligations or liabilities to the non -Federal entity, contractor, or any other party pertaining to any matter resulting from the contract." Procurement of Recovered Materials (Reference 2 CFR § 200.323) Contractor and subcontractor agree to comply with Section 6002 of the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act, and the regulatory provisions of 40 CFR Part 247. (1) In the performance of this contract, the Contractor shall make maximum use of products containing recovered materials that are EPA designated items unless the product cannot be acquired (i) Competitively within a timeframe providing for compliance with the contract performance schedule; (ii) Meeting contract performance requirements; or (iii) At a reasonable price. (2) Information about this requirement is available at EPA's Comprehensive Procurement Guidelines web siteLhttp://www.epa.gov/. The list of EPA -designate items is available at https://www.epa.gov/smm/comprehensive-procurement-guideline-cpg-program. Program Fraud and False or Fraudulent Statements of Related Acts The contractor acknowledges that 31 U.S.C. Chap. 38 (Administrative Remedies for False Claims and Statements) applies to the contractor's actions pertaining to this contract. Termination for Cause and Convenience See County's Standard Terms and Conditions. Trafficking in Persons The Contractor and subcontractors shall comply with Title 2 CFR Part 175 and 2 CFR § 175.15 provisions applicable to a private entity, as defined in 2 CFR 175.25. FCP-4 Packet Pg. 702 EXHIBIT LA FEDERAL CONTRACT PROVISIONS Transparency Act Unless exempt under 2 CFR § 170.11 O(b), the Contractor shall comply with the reporting requirements of the Transparency Act as expressed in 2 CFR Part 170. Clean Air Act and Federal Water Pollution Control Act (Reference: 2 CFR § 200 Appendix II (G)) Contracts and subgrants of amounts in excess of $150,000 shall contain a provision that requires the Contractor or recipient to comply with all applicable standards, orders, or requirements issued pursuant to Section 306 of the Clean Air Act as amended (42 U.S.C. 7401-7671q.), Executive Order 11738, as amended, where applicable, the Federal Water Pollution Control Act as amended (33 U.S.C. 1251-1387), and Environmental Protection Agency regulations 2 CFR Part 1500. The Contractor shall report any violations of the above to the Federal awarding agency and the Regional Office of the Environmental Protection Agency (EPA). Unlawful Employment of Aliens (Reference Immigration and Nationality Act (8 U.S.C. § 1324a) and the Immigration Reform and Control Act of 1986 (8 U.C. § 1101) (a) Making Employment of Unauthorized Aliens Unlawful (1) In General It is unlawful for a person or other entity— (A) to hire, or to recruit or refer for a fee, for employment in the United States an alien knowing the alien is an unauthorized alien (as defined in subsection (h)(3)) with respect to such employment. (2) Continuing Employment It is unlawful for a person or other entity, after hiring an alien for employment in accordance with paragraph (1), to continue to employ the alien in the United States knowing the alien is (or has become) an unauthorized alien with respect to such employment. Such violation will be cause for unilateral cancellation of this contract by the Federal awarding Agency. Prohibition on Certain Telecommunications and Video Surveillance Services or Equipment (2 CFR § 200.216) The Federal awarding agency prohibits the County to enter into a contract to procure or obtain equipment, services or systems that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. As described in Public Law 115-232, section 889, covered telecommunications equipment is telecommunications equipment produced by Huawei Technologies Company or ZTE Corporation (or any subsidiary or affiliate of such entities). (i) For the purpose of public safety, security of government facilities, physical security surveillance of critical infrastructure, and other national security purposes, video surveillance and telecommunications equipment produced by Hytera Communications Corporation, Hangzhou Hikvision Digital Technology Company, or Dahua Technology Company (or any subsidiary or affiliate of such entities). (ii) Telecommunications or video surveillance services provided by such entities or using such equipment. (i)(iii) Telecommunications or video surveillance equipment or services produced or provided by an entity that the Secretary of Defense, in consultation with the Director of the National Intelligence or the Director of the Federal Bureau of Investigation, reasonably believes to be an entity owned or controlled by, or otherwise connected to, the government of a covered foreign country. (b) In implementing the prohibition under Public Law 115-232, section 889, subsection (f), paragraph (1), heads of executive agencies administering loan, grant, or subsidy programs shall prioritize available funding and technical support to assist affected businesses, institutions and organizations as is reasonably necessary for those affected entities to transition from covered communications equipment and services, to procure replacement equipment and services, and to ensure that communications service to users and customers is sustained. (c) See Public Law 115-232, section 889 for additional information. Domestic Preference for Procurements (2 CFR § 200.322) (a) As appropriate and to the extent consistent with law, the non -Federal entity should, to the greatest extent practicable under a Federal award, provide a preference for the purchase, acquisition, or use of goods, products, FCP-5 Packet Pg. 703 EXHIBIT LA FEDERAL CONTRACT PROVISIONS or materials produced in the United States (including but not limited to iron, aluminum, steel, cement, and other manufactured products). The requirements of this section must be included in all subawards including all contracts and purchase orders for work or products under this award. (b) For purposes of this section: (1) "Produced in the United States" means, for iron and steel products, that all manufacturing processes, from the initial melting stage through the application of coatings, occurred in the United States. (2) "Manufactured products" means items and construction materials composed in whole or in part of non-ferrous metals such as aluminum; plastics and polymer based products such as polyvinyl chloride pipe; aggregates such as concrete; glass, including optical fiber; and lumber. STATE CONTRACT PROVISIONS Administrative Procedures Act, Section 120.57(2), F.S. Adrlitioiral procedurev for particular cases. In a matter initiated as a result of agency action proposing to determine the substantial interests of a party, the party's timely petition for hearing may challenge the proposed agency action based on a rule that is an invalid exercise of delegated legislative authority or based on an alleged unadopted rule. Data Integrity and Safeguarding Information, Uniform Electronic Transaction Act, Section 668.50, F.S.; Public Records Law, Chapter 119, Section 29, F.S The Contractor shall ensure an appropriate level of data security for the information the Contractor is collecting or using in the performance of this contract. An appropriate level of security includes approving and tracking all Contractor employees that request system or information access and ensuring that user access has been removed from all terminated employees. The Contractor, among other requirements, must anticipate and prepare for the loss of information processing capabilities. All data and software shall be routinely backed up to ensure recovery from losses or outages of the computer system. The security over the backed -up data is to be as stringent as the protection required of the primary systems. The Contractor shall ensure all Subcontractors maintain written procedures for computer system backup and recovery. The Contractor shall complete and sign the Certification Regarding Data Integrity Compliance for Agreements, Grants, Loans, and Cooperative Agreements prior to the execution of this contract. Discriminatory Vendors List, Section 287.134, F.S. In accordance with Section 287.134, Florida Statutes, an entity or affiliate who has been placed on the discriminatory vendor list may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to a public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity, and may not transact business with any public entity. Equal Employment Opportunity The Contractor shall not discriminate against any employee or applicant for employment because of race, age, creed, color, sex or national origin. The Agency will take affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to their race, age, creed, color, sex, or national origin. Such action shall include, but not be limited to, the following: Employment upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. Contractors must insert a similar provision in all subcontracts, except subcontracts for standard commercial supplies or raw materials. Interest of Members of Congress No member of or delegate to the Congress of the United States shall be admitted to any share or part of this contract or to any benefit arising therefrom. FCP-6 Packet Pg. 704 EXHIBIT LA FEDERAL CONTRACT PROVISIONS Interest of Public Officials No member, officer, or employee of the public body or of a local public body during his tenure or for two years thereafter shall have any interest, direct or indirect, in this contract or the proceeds thereof. For purposes of this provision, public body shall include municipalities and other political subdivisions of States; and public corporations, boards, and commissions established under the laws of any State. No member, officer, or employee of the MPO or of a local public body during his tenure or for two years thereafter shall have any interest, direct or indirect, in this contract or the proceeds thereof. Inspections (Meals) The Contractor must agree to notify the Nutrition Provider within 24 hours of any sanitation inspection and provide a copy of the report. Inspector General Cooperation, Section 20.055(5), F.S. The Parties agree to comply with Section 20.055(5), Florida Statutes, for the inspector general to have access to any records, data and other information deemed necessary to carry out his or her duties and incorporate into all subcontracts the obligation to comply with Section 20.055(5), Florida Statutes. Lobbying No funds received pursuant to this Agreement may be expended for lobbying the Legislature, the judicial branch or a state agency. Computer Use and Social Media Policy The Florida Department of Elder Affairs has implemented a Social Media Policy, in addition to its Computer Use Policy, which applies to all employees, contracted employees, consultants, OPS and volunteers, including all personnel affiliated with third parties, such as, but not limited to, contractors and subcontractors. Any entity that uses the Department's computer resource systems must comply with the Department's policy regarding social media. Social Media includes, but is not limited to blogs, podcasts, discussion forums, Wikis, RSS feeds, video sharing, social networks like MySpace, Facebook and Twitter, as well as content sharing networks such as flickr and YouTube. This policy is available on the Department's website at: httD:Helderaffairs.state.fl.us/doea/financial.php. Public Entity Crime Pursuant to Section 287.133, F.S., a person or affiliate who has been placed on the Convicted Vendor List following a conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the construction or repair of a public building or public work; may not submit bids, proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a Contractor, Supplier, Subcontractor, or Consultant under a contract with any public entity; and may not transact business with any public entity in excess of the threshold amount 7.017, F.S., for CATEGORY TWO for a period of thirty six (36) months following the date of being placed on the Convicted Vendor List. FCP-7 Packet Pg. 705 EXHIBIT 1,13 trRAN l' i`t>R"1 IFIC;ATIONS AND , SSlJ1dAN( S GRANT CERTIFICATIONS AND ASSURANCES THE FOLLOWING DOCUMENTS NEED TO BE RETURNED WITH SOLICITATION DOCUMENTS BY DEADLINE TO BE CONSIDERED RESPONSIVE. Page Certification and Form GCA 2-6 Attachment III - Certifications and Assurances (A-,n A. Debarment and Suspension Certification (29 CFR Part 95 and 45 CFR Part 75) B. Certification Regarding Lobbying (29 CFR Part 93 and 45 CFR Part 93) C. Nondiscrimination & Equal Opportunity Assurance (29 CFR Part 37 and 45 CFR Part 80) D. Certification Regarding Public Entity Crimes, section 287.133, F.S. E. Association of Community Organizations for Reform Now (ACORN) Funding Restrictions Assurances (Pub. L. I I 1-117) F. Scrutinized Companies Lists and No Boycott of Israel Certification, section 287,135. F.S. G. Certification Regarding Data Integrity Compliance for Contracts, Agreements, Grants, Loans and Cooperative Agreements H. Verification of Employment Status Certification I. Records and Documentation J. Certification Regarding Inspection of Public Records GCA - 7-9 Attachment IV — Assurances Non -Construction Prolzrams GCA - 10-13 Attachment V — Civil Rights Compliance Checklist GCA - 14 Attachment VII — Background Screening Affidavit of Compliance - Employer GCA - 15 Conflict of Interest Certification GCA - 16 Anticipated DBE, M/WBE or VETERAN Participation Statement GCA - 17 Bid Opportunity List for Commodities and Contractual Services and Professional Consultant Services GCA - 18 Acknowledgement of Terms, Conditions, and Grant Clauses GCA-1 Packet Pg. 706 Collier County Solicitation 18-7470S EXi-1. 1,13 GRANT ASSURANCES AND CERTIFICATIONS ATTACHMENT III CERTIFICATIONS AND ASSURANCES Agency will not award this Contract unless Contactor completes this CERTIFICATIONS AND ASSURANCES. In performance of this contract, Contractor provides the following certifications and assurances: A. Debarment l 1 1n c Part 95 and 45 CFR Part 75) B. Certification Regarding Lobbying (29 CFR Part 93 and 45 CFR Part93) C. Nondiscrimination & Eilual 0111jortunily Assurance (29 CFR Part 37 and 45 CFR Part :) D. Certification ReLyarding Public Entity Crimes. E. Association of Community Organizations forReform 1 1.ding Restrictions Assurance F. Scrutinized Companies Lists and No Boycott of Israel Certification section 287,135, F.S. G. Certification Regarding Data Integrity Conijiliance for Contracts. Agreements. Grants, Loans, and oonerative Agreements H. Verification of Employment Status Certification I. Records and Documentation J. Certification Regarding inspection of Public Records A. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS — PRIMARY COVERED TRANSACTION. The undersigned Contractor certifies, to the best of its knowledge and belief, that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by a Federal department or agency; 2. Have not within a three-year period preceding this Contract been convicted or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, snaking false statements, or receiving stolen property; 3. Are not presently indicted or otherwise criminally or civilly charged by a government entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph A.2. of this certification; and/or 4. Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State, or local) terminated for cause of default. The undersigned shall require that language of this certification be included in the documents for all subcontracts atall tiers (including subcontracts, sub -grants, and contacts under grants, loans, and cooperative agreements) and that all sub -recipients and contractors shall provide this certification accordingly. ccA-2 7/8/2021 1:08 PM p. 34 Packet Pg. 707 1 Collier County Solicitation 18-7470S EXH. 1,13 GRANT ASSURANCES AND CERTIFICATIONS B. CERTIFICATION REGARDING LOBBYING — CERTIFICATION FOR CONTRACTS, GRANTS, LOANS, AND COOPERATIVE AGREEMENTS. The undersigned Contractor certifies, to the best of its knowledge and belief, that: No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of Congress or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or employee of a Member of Congress in connection with a Federal contract, grant, loan, or cooperative agreement, the undersigned shall also complete and submit Standard Form — LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. The undersigned shall require that language of this certification be included in the documents for all subcontracts atall tiers (including subcontracts, sub -grants, and contracts under grants, loans, and cooperative agreements) and that all sub -recipients and contractors shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this Contract was made or entered into. Submission of this certification is a prerequisite for making or entering into this Contract imposed by 31 U.S.C. 1352. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. C. NON- DISCRIMINATION & EQUAL OPPORTUNITY ASSURANCE (29 CFR PART 37 AND 45 CFR PART 80). - As a condition of the Contract, Contractor assures that it will comply fully with the nondiscrimination and equal opportunity provisions of the following laws: 1. Section 188 of the Workforce Investment Act of 1998 (WiA), (Pub. L. 105-220), which prohibits discrimination against all individuals in the United States on the basis of race, color, religion, sex, national origin, age, disability, political affiliation, or belief, and against beneficiaries on the basis of either citizenship/status as a lawfully admitted immigrant authorized to work in the United States or participation in any WIA Title I -financially assisted program or activity. 2. Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 80), to the end that, in accordance with Title VI of that Act and the Regulation, no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Agency. 3. Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-1 12), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 84), to the end that, in accordance with Section 504 of that Act and the Regulation, no otherwise qualified handicapped individual in the United States shall, solely by reason of his handicap, be excluded fi•om participation in, be denied the benefits of, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Agency. GCA-3 7/8/2021 1:08 PM p. 35 Packet Pg. 708 1 Collier County Solicitation 18-7470S EXH. 1.13 GRANT ASSURANCES AND CERTIFICATIONS 4. The Age Discrimination Act of 1975 (Pub, L. 94-135), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and I-Iuman Services (45 CFR Pant 91), to the end that, in accordance with the Act and the Regulation, no person in the United States shall, on the basis of age, be denied the benefits of, be excluded from participation in, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Agency. 5. 'Title IX of the Education Amendments of 1972 (Pub, L. 92-318), as amended, and all requirements imposed by or Pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 86), to the end that, in accordance with Title IX and the Regulation, no person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any education program or activity for which the Applicant receives Federal financial assistance from the Agency. 6. The American with Disabilities Act of 1990 (Pub. L, 101-336), which prohibits discrimination in all employment practices, including job application procedures, hiring, firing, advancement, compensation, training, and other terms, conditions, and privileges of employment. It applies to recruitment, advertising, tenure, layoff, leave, fringe benefits, and all other employment -related activities. 7. Contractor also assures that it will comply with 29 CFR Part 37 and all other regulations implementing the laws listed above. This assurance applies to Contractor's operation of the WIA Title I — financially assisted program or activity, and to all contracts Contractor makes to carry out the WIA Title 1— financially assisted program or activity. Contractor understands that the Agency and/or DOEA and the United States have the right to seek judicial enforcement of the assurance. The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all tiers (including subcontracts, sub -grants, and contracts under grants, loans, and cooperative agreements) and that all sub -recipients and contractors shall provide this assurance accordingly. D. CERTIFICATION REGARDING PUBLIC ENTITY CRIMES, SECTION 287.133, F.S. Contractor hereby certifies that neither it, nor any person or affiliate of Contractor, has been convicted of a Public Entity Crime as defined in section 287.133, F.S., nor placed on the convicted vendor list. Contractor understands and agrees that it is required to inform Agency immediately upon any change of circumstances regarding this status. E. ASSOCIATION OF COMMUNITY ORGANIZATIONS FOR REFORM NOW (ACORN) FUNDING RESTRICTIONS ASSURANCE (Pub. L. 111-117). As a condition of the Contract, Contractor assures that it will comply fully with the federal funding restrictions pertaining to ACORN and its subsidiaries per the Consolidated Appropriations Act, 2010, Division E, Section 511 (Pub. L. 111-117). The Continuing Appropriations Act, 2011, Sections 101 and 103 (Pub. L. 111-242), provides that appropriations made under• Pub. L. 1 l 1-117 are available underthe conditions provided by Pub. L. 1 11-117. The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all tiers (including subcontracts, sub -grants and contracts under grants, loans and cooperative agreements) and that all sub - recipients and contractors shall provide this assurance accordingly. F. SCRUTINIZED COMPANIES LISTS AND NO BOYCOTT OF ISRAEL CERTIFICATION, SECTION 287.135, F.S. In accordance with section 287,135, F.S., Contractor hereby certifies that it has not been placed on the Scrutinized Companies that Boycott Israel List and that it is not participating in a boycott of Israel. GCA-4 7/8/2021 1:08 PM p. 36 Packet Pg. 709 1 Collier County Solicitation 18-7470S EXH. 1,13 GRANT ASSURANCES AND CERTIFICATIONS If this Contract is in the amount of $1 million or more, in accordance with the requirements of section 287.135, F.S., Contractor hereby certifies that it is not listed on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List and that it does not have business operations in Cuba or Syria. Contractor understands that pursuant to section 287.135, F.S., the submission of a false certification may result in the Agency terminating this contract and the submission of a false certification may subject Contractor to civil penalties and attorney fees and costs, including any costs for investigations that led to the finding of false certification. If Contractor is unable to certify any of the statements in this certification, Contractor shall attach an explanation to this Contract, G, CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR CONTRACTS, AGREEMENTS, GRANTS, LOANS, AND COOPERATIVE AGREEMENTS 1. T'he Contractor and any Subcontractors of services under this contract have financial management systems capable of providingcertain information, including; (1) accurate, current, and complete disclosure of the financial results of each grant -funded project or program in accordance with the prescribed reporting requirements; (2) the source and application of funds for all contract supported activities; and (3) the comparison of outlays with budgeted amounts for each award. The inability to process information in accordance with these requirements could result in a return of grant funds that have not been accounted for properly. 2. Management Information Systems used by the Contractor, Subcontractors, or any outside entity on which the Contractor is dependent for data that is to be reported, transmitted, or calculated have been assessed and verified to be capable of processing data accurately, including year -date dependent data. For those systems identified to be non -compliant, Contractors will take immediate action to assure data integrity. 3. If this contract includes the provision of hardware, software, firmware, microcode, or imbedded chiptechnology, the undersigned warrants that these products are capable of processing year -date dependent data accurately. A]I versions of these products offered by the Contractor (represented by the undersigned) and purchased by the state will be verified for accuracy and integrity of data prior to transfer. 4. In the event of any decrease in functionality related to time and date related codes and internal subroutines that impede the hardware or software programs from operating properly, the Contractor agrees to immediatelymake required corrections to restore hardware and software programs to the same level of functionality as warranted herein, at no charge to the state, and without interruption to the ongoing business of the state, time being of the essence. 5. The Contractor and any Subcontractors of services under this contract warrant that their policies and procedures include a disaster plan to provide for service delivery to continue in case of an emergency, including emergencies arising from data integrity compliance issues. H. VERIFICATION OF EMPLOYMENT STATUS CERTIFICATION As a condition of contracting with the Agency, Contractor certifies the use of the U.S. Department of Homeland Security's E-verity system to verify the employment eligibility of all new employees hired by Contractor during the contract term to perform employment duties pursuant to this contract, and that any subcontracts include an express requirement that Subcontractors performing work or providing services pursuant to this Contract utilize the E-verify system to verify the employment eligibility of all new employees hired by the Subcontractor during the entire contract term. ccA -s 718/2021 1:08 PM p' 37 Packet Pg. 710 1 Collier County Solicitation 18-7470S EXH. 1.13 GRANT ASSURANCES AND CERTIFICATIONS The Contractor shall require that the language of this certification be included in all sub -agreements, sub -grants, and other agreements/contracts and that all Subcontractors shall certify compliance accordingly. This certification is a material representation of fact upon which reliance was placed when this Contract was made or entered into. Submission of this certification is a prerequisite for making or entering into this Contract imposed by Circulars A-102 and 2 CFR Part 200 and 215 (formerly OMB Circular A -I 10). I. RECORDS AND DOCUMENTATION The Contractor agrees to make available to Agency staff and/or any party designated by the Agency any and all contract related records and documentation. The Contractor shall ensure the collection and maintenance of all program related information and documentation on any such system designated by the Agency. Maintenance includes valid exports and backups of all data and systems according to Agency standards. J. CERTIFICATION REGARDING INSPECTION OF PUBLIC RECORDS 1. In addition to the requirements of sections 10.1 and 10.2 of the Standard Contract, sections 119.070](3) and (4) F.S., and any other applicable law, if a civil action is commenced as contemplated by section 119,070](4), F.S., and the Agency is named in the civil action, Contractor agrees to indemnify and hold harmless the Agency for any costs incurred by the Agency and any attorneys' fees assessed or awarded against the Agency from a Public Records Request made pursuant to Chapter 119, F.S., concerning this contract or services performed thereunder. a. Notwithstanding section 119.0701, F.S., or other Florida law, this section is not applicable to contracts executed between the Agency and state agencies or subdivisions defined in section 768.28(2), F.S. 2. Section 119.0](3), F.S., states if public funds are expended by an agency in payment of dues or membership contributions for any person, corporation, foundation, trust, association, group, or other organization, all the financial, business, and membership records of such an entity which pertain to the public agency (Area Agency on Aging for Southwest Florida, Inc.) are public records. Section 1 19.07, F.S, states that every person who has custody of such a public record shall permit the record to be inspected and copied by any person desiring to do so, under reasonable circumstances. Additionally, I certify this organization does does not provide for institutional memberships. Contractor's signature below attests that records pertaining to the dues or membership application by the Agency are available for inspection if applicable, as stated above. By execution of this contract, Contractor must include these provisions (A-J) in all related subcontract agreements (if applicable). By signing below, Contractor certifies that the representations outlined in parts A through J above are true and correct. 6 Signature and Title of Authorized Representative Street Address I i ME C/_L4Z Vshuvzl S '�l Q_Z Contractor Date City, State, Zip code cCA-6 7/8/2021 1:08 PM p. 38 Packet Pg. 711 1 EXHIBIT 1.13 Collier County Solicitation 18-7470S GRANT CERTIFICATIONS AND ASSURANCES ATTACHMENT IV ASSURANCES--NON-CONSTRUCTION PROGRAMS Public reporting burden for this collection of information is estimated to average forty-five (45) minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget. Paperwork Reduction Project (0348-0043), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEML+'Nl' ANll BUDGET, SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. Note: Certain of these assurances may not be applicable to your project or program. If you have questions please contact the awarding agency. Further, certain federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. 1. Has the legal authority to apply for federal assistance, and the institutional, managerial and financial capability (including funds sufficient to pay the non-federal share of project cost) to ensure proper planning, management, and completion of the project described in this application. 2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the state, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives. 3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain. 4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awardingagency 5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. §4728-4763) relating to prescribed standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F). Will comply with all federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title iX of the Education Amendments of 1972, as amended (20 U.S.C. §1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. §6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title Vlll of the Civil Rights Act of 1968 (42 U.S.C. §3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for federal assistance is being made; and 0) the requirements of any other nondiscrimination statute(s) which may apply to the application. GCA-7 7/8/2021 1:08 PM p. 39 3: t. € ?. __ _ _ Packet Pg. 712 Collier County Solicitation 18-7470S EXHIBIT 1.13 GRANT CERTIFICATIONS AND ASSURANCES 7. Will comply, or has already complied, with the requirements of Titles 11 and Iii of the uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of federal or federally assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of federal participation in purchases. 8. Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C. §1501-1508 and 7324-7328), which limit the political activities of employees whose principal employment activities are funded in whole or in part with federal funds. 9. Will comply, as applicable, with the provisions of the Davis -Bacon Act (40 U.S.C. §276a to 276a-7), the Copeland Act (40 U.S.C. 276c and 18 U.S.C. §874) and the Contract Work Hours and Safety Standards Act (40 U.S.C. §327-333), regarding labor standards for federally assisted construction sub -contracts. 10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000.00 or more. 11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control treasures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. §1451 et seq.); (f) conformity of federal actions to State (Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. §7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-523); and (h) protection of endangered species under the Endangered Species Act of 1973, as amended, (P.L. 93-205), 12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. §1721 et seq.) related to protecting components or potential components of the national wild and scenic rivers system. 13. Will assist the awarding agency in assuming compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. §470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. §469a-1 et seq.). 14. Will comply with P.L. 93-348 regardingthe protection of human subjects involved in research, development, and related activities supported by this award of assistance. 15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. §2131 et seq.) pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities supported by this award of assistance. 16. Will comply with the Lead -Based Paint Poisoning Prevention Act (42 U.S.C. §4801 et seq.), which prohibits the use of lead- based paint in construction or rehabilitation of residence structures. acA-8 7/8/2021 1:08 PM p. 40 Packet Pg. 713 EXHIBIT 1.13 Collier County Solicitation 18-7470S GRANT CERTIFICATIONS AND ASSURANCES 17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and 2 CFR Part 200. 18. Will comply with all applicable requirements of all other federal laws, executive orders, regulations and policies governing this program. SIGNATURE OF AUTHORIZED CERTIFYI�N-7G OFFICIAL TITLE APPLICANT ORGANIZATION DATE SUBMITTED HfT(O WTV110 ellp-C I -I- DP)jq1�� M��,�1�9 rrn l3 /Zv2.% GCA-9 7/8/2021 1:08 PM p. 41 t Packet Pg. 714 EXHIBIT I.B / Ai-l-ACi1MENT V Collier County Solicitation 18-7470S CTATV f-IF G9.(li2iilA n IVPARTMFATT nP VI .i)UP AiiPAii2C CIViL RIC:NTA (IOMPLIANCR CHECKLIST Program/Facility Name: County: AAA/Contractor Address: 3 iafh it 0 i Completed By: fl+ P- t-Ur5 L/� Of 60 09 City State, 'Lip Code: �i �s r-` V416225 Date: / 5 /,eo feleplioi e: 3'j -- .9 TART I: READ'I HE Al IMIMI) INSTRUCTIONS FOR ILLUN VE INFURIV1AI IUN WI111-11 WILL 11L'Ll' YVU t.VIVII'LCI L' THIS FORM. 1. Briefly describe the geographic area served by the program/facility and the type of service provided: 'LD,E�-2L q pc)PjU0-77©,v 20 For questions 2-5, please indicate the tolloaving: 'total # White Black Hispanic Other Female Disabled Over 40 2.Population of area served Sourcc of data V(ol'fo q 2 G). , . 3,Staff currently employed Source of data --4- r 1 CYJ �,� 4.Clients currently enrolled/registered Source ofdata �o 6 %©G� 5.Advisory/Governing Board if applicable Sourcc of data PART H: USE A SEPARATE SHEET' OF PAPER FOR ANN' EXPLAINA1 IONS REQUIKI Nh Ivnnct; SI'ACe.. 1. Is an Assurance of Compliance on file with DOEA? N/ YES NO 2. Compare the staff composition to the population, is staff representative of the population? WE HOVE C1�.1L`1 Fell 0LE gTnFF. VQ %Z�CN+�ti"1c,tLJ f�� N/A ❑ YES ❑ NO N TILE .5 i A Ff VC7 3. Are eligibility requirements for services applied to clients and applicants without regard to race, color, national origin, sex, age, religion or disability? N/A ❑ YES � NO El 4. Are all benefits, services and facilities available to applicants and participants in an equally effective manner regardless of race, sex, color, age, national origin, religion or disability? N/A ❑ YES K NO ❑ 5. For in -patient services, are room assignments made without regard to race, color, national origin or disability? N/A YES NO 6. Is the program/facility accessible to non-English speaking clients? N/A El, YES NO ❑ 7. Are employees, applicants and participants informed of their protection against discrimination? If YES, how? Verbal [ Written El Poster N/A ❑ YES Y NO ❑ 8. Give the number and current status of any discrimination complaints regarding services or employment filed against the program/facility, N/A ❑ NUMBER 0 7/8/2021 1:08 PM p, 42 GCA -10 N L O a� z In 0 r` ao a LL cm I* 0 N Packet Pg. 715 EXHIBIT LB / ATTACHMENT V Collier County Solicitation 18-7470S 9. Is the program/facility physically accessible to mobility, hearing, and sight -impaired individuals? N/A YES NO ❑ � El PART III: TILE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACH.,ITIES WITH 15 OR MORE. EMPLOYEES. IF NO EXPLAIN 10. Has a self -evaluation been conducted to identify any barriers to serving disabled individuals, and to make any necessary modifications? YES NO ❑ ❑ 11. Is there an established grievance procedure that incorporates due process in the resolution of complaints? YES NO ❑ ❑ 12, Has a person been designated to coordinate Section 504 compliance activities? YES NO ❑ ❑ 13. Do recruitment and notification materials advise applicants, employees and participants of nondiscrimination on the basis of disability? YES NO ❑ ❑ 14. Are auxiliary aids available to assure accessibility of services to hearing and sight -impaired individuals? YES NO ❑ ❑ PARTIV: FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF $50,000.00 OR MORE, 15. Do you have a written affirmative action plan? If NO, explain. YES NO ❑ ❑ DOEA USE ONLY Reviewed By In Compliance: YES ❑ NO* ❑ Program Office *Notice of Corrective Action Sent / ! Date Telephone Response Due / / On -Site ❑ Desk Review ❑ Response Received Revised August 2010, Page 2 of2 GCA • 11 2 7/8/2021 1:08 PM p, 43 N O C d 3 a� z to 0 r- 00 a LL N I* O N Packet Pg. 716 1 EXHIBIT 1.13 / ATTACHMENT V INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST l . Describe the geographic service area such as a district, county, city or other locality. If the program/facility serves a specific target population such as adolescents, describe the target population. Also, define the type of service provided. 2. Enter the percent of the population served by race and sex. The population served includes persons in the geographical area for which services are provided such as a city, county or other regional area. Population statistics can be obtained from local chambers of commerce, libraries, or any publication from the 1980 Census containing Florida population statistics. Include the source of your population statistics. ("Other" races include Asian/Pacific Islanders and American Indian/Alaskan Natives.) 3. Enter the total number of full-time staff and their percent by race, sex and disability. Include the effective date of your summary. 4. Enter the total number of clients who are enrolled, registered or currently served by the program or facility, and list their percent by race, sex and disability. Include the date that enrollment was counted. 5. Enter the total number of advisory board members and their percent by race, sex, and disability. If there is no advisory or governing board, leave this section blank. 6. Each recipient of federal financial assistance must have on file an assurance that the program will be conducted in compliance with all nondiscriminatory provisions as required in 45 CFR 80. This is usually a standard part of the contract language for DOEA recipients and their sub -grantees, 45 CFR 80.4 (a). 7. Is the race, sex, and national origin of the staff reflective of the general population? For example, if 10% of the population is Hispanic, is there a comparable percentage of Hispanic staff? 8. Where there is a significant variation between the race, sex or ethnic composition of the clients and their availability in the population, the program/facility has the responsibility to determine the reasons for such variation and take whatever action may be necessary to correct any discrimination. Some legitimate disparities may exist when programs are sanctioned to serve target populations such as elderly or disabled persons, 45 CFR 80.3 (b) (6). 9. Do eligibility requirements unlawfully exclude persons in protected groups fi•om the provision of services or employment? Evidence of such may be indicated in staff and client representation (Questions 3 and 4) and also through on -site record analysis of persons who applied but were denied services or employment, 45 CFR 80.3 (a) and 45 CFR 80.1 (b) (2). 10. Participants or clients must be provided services such as medical, nursing and dental care, laboratory services, physical and recreational therapies, counseling and social services without regard to race, sex, color, national origin, religion, age or disability. Courtesy titles, appointment scheduling and accuracy of record keeping must be applied uniformly and without regard to race, sex, color, national origin, religion, age or disability. Entrances, waiting rooms, reception areas, restrooms and other facilities must also be equally available to all clients, 45 CFR 80.3 (b). 11. For in -patient services, residents must be assigned to rooms, wards, etc., without regard to race, color, national origin or disability. Also, residents must not be asked whether they are willing to share accommodations with persons of a different race, color, national origin, or disability, 45 CFR 80.3 (a). 12. The program/facility and all services must be accessible to participants and applicants, including those persons who may not speak English. In geographic areas where a significant population of non-English speaking people live, program accessibility may include the employment of bilingual staff. In other areas, it is sufficient to have a policy or plan for service, such as a current list of names and telephone numbers of bilingual individuals who will assist in the provision of services, 45 CFR 80.3 (a). GCA - 12 Packet Pg. 717 EXHIBIT LB / ATTACHMENT V 13. Programs/facilities must make information regarding the nondiscriminatory provisions of Title VI available to their participants, beneficiaries or any other interested parties. This should include information on their right to file a complaint of discrimination with either the Florida Department of Elder Affairs or the U.S. Department of HHS. The information may be supplied verbally or in writing to every individual, or may be supplied through the use of an equal opportunity policy poster displayed in a public area of the facility, 45 CFR 80.6 (d). 14. Report number of discrimination complaints filed against the program/facility. Indicate the basis, e.g., race, color, creed, sex, age, national origin, disability, retaliation; the issues involved, e.g., services or employment, placement, termination, etc. Indicate the civil rights law or policy alleged to have been violated along with the name and address of the local, state or federal agency with whom the complaint has been fled. Indicate the current status, e.g., settled, no reasonable cause found, failure to conciliate, failure to cooperate, under review, etc. 15. The program/facility must be physically accessible to disabled individuals. Physical accessibility includes designated parking areas, curb cuts or level approaches, ramps and adequate widths to entrances. The lobby, public telephone, restroom facilities, water fountains, information and admissions offices should be accessible. Door widths and traffic areas of administrative offices, cafeterias, restrooms, recreation areas, counters and serving lines should be observed for accessibility. Elevators should be observed for door width, and Braille or raised numbers. Switches and controls for light, heat, ventilation, fire alarms, and other essentials should be installed at an appropriate height for mobility impaired individuals. 16. Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance conduct a self - evaluation to identify any accessibility barriers. Self -evaluation is a four step process: cm a. With the assistance of a disabled individual/organization, evaluate current practices and policies which do not 0 N comply with Section 504. b. Modify policies and practices that do not meet Section 504 requirements. c c. Take remedial steps to eliminate any discrimination that has been identified, aM d. Maintain self -evaluation on file. (This checklist may be used to satisfy this requirement if these four steps have c been followed.), 45 CFR 84.6. 0 17. Programs or facilities that employ 15 or more persons must adopt grievance procedures that incorporate appropriate m >1 due process standards and provide for the prompt and equitable resolution of complaints alleging any action 0 prohibited by Section 504.45 CFR 84.7 (b). 18. Programs or facilities that employ 15 or more persons must designate at least one person to coordinate efforts to 0 01 comply with Section 504.45 CFR 84.7 (a). Y 19. Continuing steps must be taken to notify employees and the public of the program/facility's policy of m 2 nondiscrimination on the basis of disability. This includes recruitment material, notices for hearings, newspaper ads, E and other appropriate written communication, 45 CFR 84.8 (a). _ 20, Programs/facilities that employ 15 or more persons must provide appropriate auxiliary aids to persons with impaired o sensory, manual or speaking skills where necessary. Auxiliary aids may include, but are not limited to, interpreters ti for hearing impaired individuals, taped or Braille materials, or any alternative resources that can be used to provide ao equally effective services, 45 CFR 84.52 (d). 21. Programs/facilities with 50 or more employees and $50,000.00 in federal contracts must develop, implement and E maintain a written affirmative action compliance program in accordance with Executive Order 11246, 41 CFR 60 and Title VI of the Civil Rights Act of 1964, as amended. 0 Q DOEA Form 101-B, Revised August 2010 GCA- 13 4 � �a Packet Pg. 718 FW 11131T 1.13 / ATrACI1MENT V I I _ Collier County Solicitation 18 7470S DE'llAWIMEN1 OF: BACKGROUND SCREENING ELDER 1AFFAIRS Affidavit of Compliance - Employer STATE OF FLORIDA AUTHORITY: This form is required annually of all employers to comply with the attestation requirements set forth in section 435.05(3), Florida Statutes. Y The term "employer" means any person or entity required by law to conduct background screening, including but not limited to, Area Agencies on Aging, Aging Resource Centers, Aging and Disability Resource Centers, Lead Agencies, Long -Term Care Ombudsman Program, Serving Health Insurance Needs of Elders Program, Service Providers, Diversion Providers, and any other person or entity which hires employees or has volunteers in service who meet the definition of a direct service provider. See §§ 435.02, 430.0402, Fla. Stat. Y A direct service provider is "a person 18 years of age or older who, pursuant to a program to provide services to the elderly, has direct, face-to-face contact with a client while providing services to the client and has access to the client's living area, funds, personal property, or personal identification information as defined In s. 817.568. The term includes coordinators, managers, and supervisors of residential facilities; and volunteers." § 430.0402(1)(b), Fla. Stat. ATTESTATION: As the duly authorized representative of 0010 Mt''W herJi 69er', U6 OW [OP010All 1-2 'i1/Ee4.(43 Employer Name located at 31,25 I 0,16 '�I- A) *`76ak i-dr & '1f I a,3 , Street Address City State ZIP code I, mK l o- o kl-) 1Vi rn//l do hereby affirm under penalty of perjury Name of Representative that the above named employer is in compliance with the provisions of Chapter 435 and section 430.0402, Florida Statutes, regarding level 2 background screening. Signature of Representative Date STATE OF FLORIDA, COUNTY OF Sworn to (or affirmed) and subscribed before me this �l'day of [\�Ao ^; , 20 .I, by (Name of Representative) who is personally known to me or produced i`;�L as proof of identification. 17111711 t3r1 'f Awt5F1SICi Pin fifv `Iate of Florida Print, Type, or Stamp Commis one eo'.Not�r{��'�iiR'U7ii`xU3".GA66 N1taryPublic ,. kiy conylm. expires July 6, 2023 DOEA Form 235, Affidavit of compliance- Employer, Effective April 2012 Form available at: littn://eldefaffairs.state.fl.us/eiiglisli/backgroundscreenin&.AL) 7/8/2021 1:08 PM Section 435.05(3), F.S. p. 46 GCA - 14 Packet Pg. 719 1 Collier County Solicitation 18-7470S FXI-IIBIT 1.13 GRANTCERTIFICATIONS RTIFICATIONS AND ASSURANCES COLLIER COUNTY Conflict of Interest Certification I1' - J et la s Collier County Solicitation No. 1, M I R I a H / �j' h A/, 6fl 0 - , hereby certify that to the best of my knowledge, neither I nor my spouse, dependent child, general partner, or any organization for which I am serving as an officer, director, trustee, general partner or employee, or any person or organization with whom I am negotiating or have an arrangement concerning prospective employment has a financial interest in this matter. I further certify to the best of my knowledge that this matter will not affect the financial interests of any member of my household. Also, to the best of my knowledge, no member of my household; no relative with whom I have a close relationship; no one with whom my spouse, parent or dependent child has or seeks employment; and no organization with which I am seeking a business relationship nor which i now serve actively or have served within the last year are parties or represent a party to the matter. I also acknowledge my responsibility to disclose the acquisition of any financial or personal interest as described above that would be affected by the matter, and to disclose any interest 1, or anyone noted above, has in any person or organization that does become involved in, or is affected at a later date by, the conduct of this matter. Name Signature Position Date Privacy Act Statement Title 1 of the Ethics in Government Act of 1978 (5 U.S.C. App.), Executive Order 12674 and 5 CFR Part 2634, Subpart I require the reporting of this information. The primary use of the information on this form is for review by officials of The Justice Department to determine compliance with applicable federal conflict of interest laws and regulations. Additional disclosures of the information on this report may be made: (1) to a federal, state or local law enforcement agency if the Justice Department becomes aware of a violation or potential violation of law or regulations; (2) to a court or party in a court or federal administrative proceeding if the government is a party or in order to comply with a judge -issued subpoena; (3) to a source when necessary to obtain information relevant to a conflict of interest investigation or decision; (4) to the National Archives and Records Administration or the General Services Administration in records management inspections; (5) to the Office of Management and Budget during legislative coordination on private relief legislation; and (6) in response to a request for discovery or for the appearance of a witness in a judicial or administrative proceeding, if the information is relevant to the subject matter. This confidential certification will not be disclosed to any requesting person unless authorized by law. See also the OGE/GOVT-2 executive branch -wide Privacy Act system of records. GCA-15 7/8/2021 1:08 PM p. 47 Packet Pg. 720 1 I x I If 13IT1,13 AND ASSURANCI.,S COLLIER COUNTY ANTICIPATED DISADVANTAGED, MINORITY, WOMEN OR VETERAN PARTICIPATION STATEMENT Status will be verified. Unverifiable statues will require the Pwtoe to either firm -de a revised statement or provide source documentation that validates a status. A. PRIME VENDOR/CONTRACTOR INFORMATION. PRIME NAME PRIME FEM NUMBER PACT DOLLAR AMOUNT JqrlttlQ�16) THE CLZE- 3,f;-40a5-//,21 L�f ISTHE PRIME A FILORIDA-CERTIFIED DISADVANTAGED, Of N ;5 THE ACTIVITY OF THIS CONTRACT., MINORIT'fGRWOIiENSUSitiESSEtITERPRISE? DBE? Y � oy COMTRUCTION ? y N (D8EjtARf,A1iBE) OR HAVE A SMALLOISADVANTAGED WSINESS&A CEPTIFICATIONfROMTHE SMALL BUSINESS MBE? y I t) CONSULTATION? y N ADMINISTRATION? ASE RVICE DISABLED VETERAN? WBE? y I OTHER? N SDB8A7 V 49 Q, — 15 THIS SUBMISSION A REVISION?y 'j 14 iF YES, REWSION NUMBER- 9. IF PRIME 14AS SUKONTRACTOR I OR SUPPLIER WHO IS A DISADVANTAPEUMINORITY, WOMEN-OM&D, SMALf', BUSINESS CONCERN OR SERVICE DISABLED VETERAN, PRIME IS TO COMPLETE THIS NEXT SECTION DBE MIWBE SUBCONTRACTOR OR SUPPLIER TYPE OFWORXOR ETHNICITY CODE SUB/SUPPLIER PERCENT OFCONTRACT VETERAN NAME SPECIALTY (see Below) DOLLAR AMOUNT DOLLARS TOTALS] 7 C. ISE Toll CTION TO BE COMPLETED BY PRIME VENDOR/CONTRAC NAME OF SUBMITTER DATE TrTLE OF SUBMITTER I R 10 1`1 il C, li 1� '- 2-1 eev EMAIL ADDRESS OF PRIME jSUBMinrTER) TELEPHONE Numi—ER FAX NUMBER L2 6 fj NOTE: This information is used to track and report anticipated DBE or m.st participation in federal! V-funde d contracts. The anticipated DBE or MBE amount Is voluntary and will not become pan of the contractual terms. This form must be submitted at time of response to a solicitation. if and when awarded a County contract, the prime will be asked to update the Information for the grant Compliance flies. Ty, 'CODE! black American BA Hispanic American KA Native American NA Subcont, Asian American SAA Asian-PicdiflcAmarjcan ^ APA Non•mmcrit'/ Women N NT-Al r—other: not of any other group listed 0 71A C FPacket Pg. 721 1A1(I131T 1.13 (ilZAN']' C'I:R'1'IF1("A'I'ION.`S AND ASSURANCH'S PID OPPORTUNITYLIST FOR COMMODITIES AND CONTRACTUAL SERVICES AND PROFESSIONAL CONSULTANT SERVICES tr is The Policy of Coiner county that disadvantaged businesses and min, or ry venc!ors, as defined in the We of Federal Regulations f cFR) or Fiorida stwtutes LP51, must have the opportunity to Lortkipate on contrwcrs ,v;th edernf wrrc�vcr staff? runt wssfstonca. Prime ContractortPrime Consultant: F/0 i0 rl E.V�I"" I r CORE] R�]-�L.C�.• _'J__�!d Aj7 i'I ,� (y� 1 t1-� �t �r�"+i/(� �l' � '=•-�` Address and Phone Number. �� 1y 1� 81. +� Procurement Number/Advertisement Number: The list below is intended to be a listing of firms that are, or attempting to, participate on the lvojett numbered above, The list must include the firm bidding or quoting as prime, as well as subs and suppliers quoting for participation. Prime contractors and consultants must provide information for Numixrs 1, 2, 3, and a and, should provide Any information they have for numbers 5; 6, 7, and B. 'this form must he submitted with the bid package. i. Federal Tax IDNumber: ,.�) �+ •(� •Gam• 6. tt11 DBE D.. A"" I Gross seca>pts d. Firm Name' / � �'i> j�'1 }" } (; i i,rl Non -DBE Less than $1 million 5. Phone Number. :2,�,e, 3 xj r. 4� Between ; 1-5 million a. Address Bet-ween $ 5-lo nttdlion .��rAR. ^tC_ >� 7. Subcontractor Between ;+ 10•15 miliiao it etv,ps El— 1 22) Subconsultant More than $ 15 mlHion 5. Year Firm Established: t2011 in bt'of1v`f.,�Ok)-,_401)-o i. Federal Tart ID Number. 6. DBE B. Annual G toss Receipts ?. Firm Naine: wan -DBE Less than j 1 Million 3. Phone Number: 8. Address S. Year FirmEstablished. Between 5 1-5 million Between $ 5.10 1110ion 11r���111 7, 1 , SuLcontrartor Bet.'+een $ 10-15 million hu—L 5ubconsurtant more than � 15 million 1. Federal Tax lD Number: 6. DBE a_ Annual Gross Receipts I Firm Name; ldcn-DBE Less than S 1 million 5. Phone Number: Between $ 1.3 m13lion .1. Address --_— Between ; 5-10 million :+. Subcontractor Between 5 113.15 million Subconsuitant More than $ 15 million 5. Year Finn Established: 1. Federal Tax it) Number: 6. DBE R. Annual Gross Receipts 3. Film Name' ® Not -DBE Less than S 1 million 5. Phone Number Setween $ 1-5 minion a. Address 5. Year Firm Established: 7. RSubcontractor subconsultant GCA - 17 Between s 5-10 million Between 5 W-15 million more than 1 .15 million to L O C d d Z U) O P- O a LL N O N Packet Pg. 722 Collier County Solicitation 18-7470S E:Xl lIBl"1' I.F3 C;ItAN'1' CF,R"1'lI ICA"t'IC)NS AND ASSURANCES COLLIER COUNTY Acknowledgement of Terms, Conditions, and Grant Clauses Flow Down of Terms and Conditions from the Grant Agreement Subcontracts: If the Contractor subcontracts any of the work required under this Agreement, a copy of the signed subcontract must be available to the County for review and approval. The Contractor agrees to include in the subcontract that (1) the subcontractor is bound by the terms of this Agreement, (ii) the subcontractor is bound by all applicable state and federal laws and regulations, and (iii) the subcontractor shall hold the County and the Grantor Agency harmless against all claims of whatever nature arising out of the subcontractor's performance of work under this Agreement, to the extent allowed and required by law. The County may document in the quarterly report the Contractor's progress in performing its work under this agreement. Certification On behalf of my firm, I acknowledge, and agree to perform all of the specifications and grant requirements identified in this solicitation document(s). Vendor/Contractor Name NF}'I'_M o �,i 1� THE' CLU,_ Date S15-lZt�2-/ Authorized Signature Address 3 Solicitation/Contract # IS 1430-S GCA-18 7/8/2021 1:08 PM 05/20 R4 p.50 - Packet Pg. 723 DATE(" 16•D.5.j A� o CERTIFICATE OF LIABILITY INSURANCE 11/11/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT CC Allred, AAI NAME: Purmort and Martin Insurance Agency LLC aCC Ext : (941) 366-7070 AIX No): (941) 953-490' 2301 Ringling Boulevard E-MAIL... Certificates@purmort.com INSURER(S) AFFORDING COVERAGE NAIC # Sarasota FL 34237 INSURERA: General Star Indemnity Company 37362 INSURED INSURER B: Ascendant Commercial Insurance 13683 Sunshine Health Care Services, LLC INSURER C : & Sunshine Health Care Services of Manatee County LLC INSURER D : 5600 Bee Ridge Rd; Suite B INSURER E : Sarasota 34233 INSURER F : COVERAGES CERTIFICATE NUMBER: CL216925119 REVISION NUMBER: 1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCEADDLSUBR INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 OCCUR CLAIMS -MADE M oNcE ante $ 50,000 IVIED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 A Y IJA399832 06/05/2021 06/05/2022 GEN-LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY ❑ PRO ❑ LOC JECT PRODUCTS - COMP/OP AGG $ Excluded *ea claim and agg Imt $ 25,000 X OTHER HIPPA *$1000 ded ea claim AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 500,000 BODILY INJURY (Per person) $ ANYAUTO A OWNED SCHEDULED AUTOS ONLY AUTOS IJA399832 06/05/2021 06/05/2022 BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY /� AUTOS ONLY Aggregate Limit $ 500,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LB DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA WC-75295-1 02/12/2021 02/12/2022 PER OTH- 'PER TATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ A Professional Liability ( claims -made) Sexual Misconduct Liab (claims -made) IJA399832 06/05/2021 06/05/2022 $ 1,000,000 $ 1,000,000 Aggregate per claim limit $300,000 /$1000 Deduct Ea Claim & Agg DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Collier County Board of County Commissioners, OR, Board of County Commissioners in Collier County, OR, Collier County Government, OR, Collier County included as an additional insured under the General Liability policy on a primary and non-contributory basis if and to the extend required by written contract for any and all work performed on behalf of Collier County. CERTIFICATE HOLDER CANCELLATION Collier County Board of Co Commissioners 3295 Tamiami Trail E Naples FL 34112 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Packet Pg. 724 Copy OD% Western SuretyCompany DISHONESTY BOND Bond No. 65700722 (FOR ANY TYPE OF BUSINESS) In consideration of the agreed premium, Western Surety Company, a South Dakota corporation (the "Surety"), hereby agrees to indemnify SUNSHINE HEALTHCARE SERVICES LLC/SUNSHINE HEALTHCARE SERVICES OF MANAT 5600 Bee Ridge Road Suite B, Sarasota, FL 34233 (the "Insured"), against any loss of money or other property which the Insured shall sustain or for which the Insured shall incur liability to any Customer or Subscriber of the Insured through any fraudulent or dishonest act or acts committed by any Employee or Employees of the Insured acting alone or in Collusion with others, the amount of indemnity on each of such Employees being Fifty Thousand and 00/100 DOLLARS ($50,000.00 ) THE FOREGOING AGREEMENT IS SUBJECT TO THE FOLLOWING CONDITIONS AND LIMITATIONS: TERM OF BOND: SECTION 1. The term of this bond begins with the 19th day of November 2021 standard time, at the address of the Insured above given, and ends at 12:00 o'clock night, standard time, on the effective date of the cancellation of this bond in its entirety. EXCLUSION: SECTION 2. This bond does not apply to loss, or to that part of any loss, as the case may be, the proof of which, either as to its factual existence or as to its amount, is dependent upon an inventory computation or a profit and loss computation. In addition, the policy does not apply to the defense of any legal proceedings brought against the Insured, or to fees, costs or expenses incurred or paid by the Insured in prosecuting or defending any legal proceedings whether or not such proceedings results or would result in a loss to the Insured covered by this policy. In addition, the Company shall not be liable for any costs, fees and other expenses incurred by the Insured in establishing the existence or the amount of loss covered under this policy. DISCOVERY PERIOD: SECTION 3. Loss is covered under this bond only (a) if sustained through any act or acts committed by any Employee of Insured while this bond is in force as to such Employee, and (b) if discovered prior to the expiration or sooner cancellation of this bond in its entirety as provided in Section 10, or from its cancellation or termination in its entirety in any other manner, whichever shall first happen. DEFINITION OF EMPLOYEE: SECTION 4. The word Employee or Employees, as used in this bond, shall be deemed to mean, respectively, one or more of the natural persons (except directors or trustees of the Insured, if a corporation, who are not also officers or employees thereof in some other capacity) while in the regular service of the Insured in the ordinary course of the Insured's business during the term of this bond, and whom the Insured compensates by salary or wages and has the right to govern and direct in the performance of such service, and who are engaged in such service within any of the States of the United States of America, or within the District of Columbia, Puerto Rico, the Virgin Islands, or elsewhere for a limited period, but not to mean brokers, factors, commission merchants, consignees, contractors, or other agents or representatives of the same general character. FRAUDULENT OR DISHONEST ACT: SECTION 5. A FRAUDULENT OR DISHONEST ACT OF AN EMPLOYEE OF THE INSURED SHALL MEAN AN ACT WHICH IS PUNISHABLE UNDER THE CRIMINAL CODE IN THE JURISDICTION WITHIN WHICH ACT OCCURRED, FOR WHICH SAID EMPLOYEE IS TRIED AND CONVICTED BY A COURT OF PROPER JURISDICTION. MERGER OR CONSOLIDATION: SECTION 6. If any natural persons shall be taken into the regular service of the Insured through merger or consolidation with some other concern, the Insured shall give the Surety written notice thereof and shall pay an additional premium on any increase in the number of Employees covered under this bond as a result of such merger or consolidation computed pro rata from the date of such merger or consolidation to the end of the current premium period. NON -ACCUMULATION OF LIABILITY: SECTION 7. Regardless of the number of years this bond shall continue in force and the number of premiums which shall be payable or paid, the liability of the Surety under this bond shall not be cumulative in amounts from year to year or from period to period. Form 1432-9-2019 Packet Pg. 725 Copy LIMIT OF LIABILITY UNDER THIS BOND AND PRIOR INSURANCE: SECTION 8. With respect to loss or losses caused by an Employee or which are chargeable to such Employee as provided in Section 5 and which occur partly under this bond and partly under other bonds or policies issued by the Surety to the Insured or to any predecessor in interest of the Insured and terminated or cancelled or allowed to expire and in which the period for discovery has not expired at the time any such loss or losses thereunder are discovered, the total liability of the Surety under this bond and under such other bonds or policies shall not exceed, in the aggregate, the amount carried under this bond on such loss or losses or the amount available to the Insured under such other bonds or policies, as limited by the terms and conditions thereof, for any such loss or losses, if the latter amount be the larger. SALVAGE: SECTION 9. If the Insured shall sustain any loss or losses covered by this bond which exceed the amount of coverage provided by this bond, the Insured shall be entitled to all recoveries, except from suretyship, insurance, reinsurance, security or indemnity taken by or for the benefit of the Surety, by whomsoever made, on account of such loss or losses under this bond until fully reimbursed, less the actual cost of effecting the same; and less the amount of the deductible carried on the Employee causing such loss or losses; and any remainder shall be applied to the reimbursement of the Surety. CANCELLATION AS TO ANY EMPLOYEE: SECTION 10. This bond shall be deemed cancelled as to any Employee: (a) immediately upon discovery by the Insured, or by any partner or officer thereof not in collusion with such Employee, of any fraudulent or dishonest act on the part of such Employee; or (b) at 12:00 o'clock night, standard time, upon the effective date specified in a written notice served upon the Insured or sent by mail. Such date, if the notice be served, shall be not less than ten days after such service, or, if sent by mail, not less than fifteen days after the date of mailing. The mailing by Surety of notice, as aforesaid, to the Insured at its principal office shall be sufficient proof of notice. CANCELLATION AS TO BOND IN ITS ENTIRETY: SECTION 11. This bond shall be deemed cancelled in its entirety at 12:00 o'clock night, standard time, upon the effective date specified in a written notice served by the Insured upon the Surety or by the Surety upon the Insured, or sent by mail. Such date, if served by the Surety, shall be not less than ten days after such service, or if sent by the Surety by mail, not less than fifteen days after the date of mailing. The mailing by the Surety of notice, as aforesaid, to the Insured at its principal office shall be sufficient proof of notice. The Surety shall refund to the Insured the unearned premium computed pro rata if this bond be cancelled at the instance of the Surety, or at short rates if cancelled or reduced at the instance of the Insured. PRIOR FRAUD, DISHONESTY OR CANCELLATION: SECTION 12. No Employee, to the best of the knowledge of the Insured, or of any partner or officer thereof not in collusion with such Employee, has committed any fraudulent or dishonest act in the service of the Insured or otherwise. If prior to the issuance of this bond, any fidelity insurance in favor of the Insured or any predecessor in interest of the Insured and covering one or more of the Insured's Employees shall have been cancelled as to any of such Employees by reason of (a) the discovery of any fraudulent or dishonest act on the part of such Employees, or (b) the giving of written notice of cancellation by the insurer issuing said fidelity insurance, whether the Surety or not, and if such Employees shall not have been reinstated under the coverage of said fidelity insurance or superseding fidelity insurance, the Surety shall not be liable under this bond on account of such Employees unless the Surety shall agree in writing to include such Employees within the coverage of this bond. LOSS —NOTICE —PROOF —LEGAL PROCEEDINGS: SECTION 13. At the earliest practical moment, and at all events not later than fifteen days after discovery of any fraudulent or dishonest act on the part of any Employee by the Insured, or by any partner or officer thereof not in collusion with such Employee, the Insured shall give the Surety written notice thereof and within four months after such discovery shall file with the Surety affirmative proof of loss, itemized and duly sworn to, and shall upon request of the Surety render every assistance, not pecuniary, to facilitate the investigation and adjustment of any loss. No suit to recover on account of loss under this bond shall be brought before the expiration of two months from the filing of proof as aforesaid on account of such loss, nor after the expiration of fifteen months from the discovery as aforesaid of the fraudulent or dishonest act causing such loss. If any limitation in this bond for giving notice, filing claim or bringing suit is prohibited or made void by any law controlling the construction of this bond, such limitation shall be deemed to be amended so as to be equal to the minimum period of limitation permitted by such law. PART-TIME OR TEMPORARY EMPLOYEES: SECTION 14. The named Insured shall not at any time while this bond is in force direct any temporary or part-time Employee(s) to any subscriber's premises unless such Employee(s) is accompanied by a foreman who is in the regular employ of the Insured. SIGNED, SEALED AND DATED November 18th 2021 Appointed Agent of Surety WESTER URETY COMPANY By G.-� PAUL T, 13RUFIXT, VICE PRESIDENT a Packet Pg. 726 --1 16. D.5.1 ncoR"W CERTIFICATE OF LIABILITY INSURANCE DATE( PRODUCER Warren Insurance Corporation 950 Peninsula Corporate Circle Suite 1012 Boca Raton FL 33487 INSURED Home Health Care Resources Corp 2475 Mercer Ave Ste 207 West Palm Beach FL 33401 COVERAGES 11 /15/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIOf ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATI HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND Of ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW INSURERS AFFORDING COVERAGE NAIC # INSURER A: Lloyd's of London INSURER B: Technology Insurance Company INSURER C: CNA Surety INSURER E: THE POLICIESOFINSURANCE LISTED BELOW HAVE BEEN ISSUEDTOTHE INSURED NAMEDABOVEFORTHE POLICY PERIOD INDICATED. NOTWITHSTANDIN( ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED Of MAY PERTAIN, THE INSURANCEAFFORDED BYTHEPOLICIES DESCRIBED HEREIN ISSUBJECTTOALLTHE TERMS, EXCLUSIONS AND CONDITIONS OFSUCI POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRADD' OF lNqt]RANrF POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIONTYPE TE D[YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED A X X COMMERCIALLIABILITY W25CF5210301 02/08/2021 02/08/2022 CLAIMS MADEERAL OCCUR MED EXP An one person)$ 5,000000 PERSONAL & ADV INJURY $ 1,000,000 X Professional Liability GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ Inc Professional Liab. $1 M/$3M X POLICY PRO- LOC A AUTOMOBILE LIABILITY ANY AUTO W25CF5210301 02/08/2021 02/08/2022 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS X BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F—ICLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE TWC3978777 06/18/2021 06/18/2022 X WC STATU- OTH- E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 OTHER C Crime/Dishonesty Bond 72238977 03/18/2021 03/18/2022 $50,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Collier County Board of County Commissioners, OR Board of County Commissioner in Collier County, or Collier County County Government, I Collier County included as an additional Insured under the Captioned Commercial Liability and Automobile Liability Policies on a primary and non-contributory basis if and to the extend required by written contract. Location #2: 866 Tamiami Trail Unit 4. Port Charlotte, FL 33953 Location #3: 7270 Harmony Square Dr. South. Saint Cloud, FL 3477 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATI( Collier County Board of County Commissioners DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTI 3295 Tamiami Trail East NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHA IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS Naples, FL 34112 REPRESENTATIVES. AUTHORIZED REPRESENTATIVLi-1 _ i <SS> L O C d 3 Iv Z N 0 ti ti 00 a LL N le 0 N ACORD 25 (2009/01) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Packet Pg. 727 I 16.D.5.1 I IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009/01) Packet Pg. 728 ,aco CERTIFICATE OF LIABILITY INSURANCE 16.D.5.m DATE (MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: William Mennitt Sena & Whitney LLC PHONE 561 391-4661 FAX A/C No Ext : ( ) A/C No): (561)338-6551 190 Glades Road Suite C E-MAIL ADDRESS: wmennitt@thesenagroup.com BOCA RATON, FL 33432 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: LLUTU, Ur LUIVLIUIV INSURED HEMO MEDIKA CARE LLC INSURERB: DBA HARMONIA THE CLUB INSURERC: 3425 10TH ST N UNITS 1,2,3 INSURERD: NAPLES, FL 34103 INSURER E, INSURER F : COVERAGES CERTIFICATE NUMBER: 00059194-109221 REVISION NUMBER: 6 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y W2A7D929210201 03/05/2021 03/05/2022 EACH OCCURRENCE $ 1,000,0( CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 50,0( MED EXP (Any one person) $ 5,0 PERSONAL & ADV INJURY $ 1,000,0 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3000,0( POLICY JE� LOC X PRODUCTS - COMP/OP AGG $ 1,000,0( $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY L $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N / A E.L. EACH ACCIDENT $ (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A PROFESSIONAL LIAB W2A7D929210201 03/05/2021 03/05/2022 EACH CLAIM 1,000,0( A PROFESSIONAL LIAB W2A7D929210201 03/05/2021 03/05/2022 AGGREGATE 3,000,0( DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS, OR BOARD OF COUNTY COMMISSIONERS IN COLLIER COUNTY, OR COLLIER COUNTY GOVERNMENT OR COLLIER COUNTY ARE INCLUDED AS ADDITIONAL INSURED UNDER GENERAL LIABILITY ON A PRIMARY AND NON-CONTRIBUTORY BASIS IF AND TO THE EXTENT REQUIRED BY WRITTEN CONTRACT AS REQUIRED BY WRITTEN CONTRACT. FOR ANY AND ALL WORK PERFORMED ON BEHALF OF COLLIER COUNTY. CERTIFICATE HOLDER CANCELLATION COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS 3295 TAMIAMI TRAIL E. NAPLES, FL 34112 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE i O c a� 3 Z O ti 00 r (L LL N O v d1 C� C 7 N C I O E 0) O It- ti 00 r c m E Q r © 1988-2015 ACORD CORPORATIOI ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by WIM on (WIM) Packet Pg. 729 116.D.5.m I AC"J? o CERTIFICATE OF LIABILITY INSURANCE I DATE (II 11 /22/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Ardent Insurance Group NAME: Ardent Insurance Group, Inc. pnH1CONE.. Ext : (239) 919-3916 IX No : (866) 347-8852 1004 Collier Center Way E-MAIL info@ardentinsurancegroup.com ADDRESS: #205 INSURER(S) AFFORDING COVERAGE NAIC # Naples FL 34110 INSURERA: Frank Winston Crum Insurance Company 11600 INSURED INSURER B : HEMO MEDIKA CARE LLC DBA Harmonia the Club INSURER C : 3425 10th Street N Suite 1 INSURER D : INSURER E : Naples FL 34103 I INSURER F : COVERAGES CERTIFICATE NUMBER: Master WC 21-22 Term REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCEADDLSUBR INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS -MADE OCCUR PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL &ADV INJURY $ GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑ PRO ❑ LOC JECT PRODUCTS -COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LAB DED I I RETENTION $ $ WORKERS COMPENSATION X AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE Y OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA FWFL0022420401 12/28/2021 12/28/2022 STATUTE ERH E.L. EACH ACCIDENT 1,000,000A $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Collier County Board of County Commissioners 3295 Tamiami Trail East Naples FL 34104 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE a+ Q @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Packet Pg. 730 CN? ■■ A Better Solution Home Care Cover Letter/Management Summary Our Mission Statement To consistently exceed the expectations of our clients, by delivering the highest standards of service with integrity, honesty and excellence. We strive to provide a sense of warmth, kindness and individual pride while maintaining discreet and personal care in each client's home. A Better Solution has been servicing elderly and disabled adults in the Gulf Coast since 1998. We are licensed home health agency servicing from Polk to Collier Counties. A Better Solution has been working with CCE and ADI programs in Manatee, Sarasota, Lee and Desoto counties for the past 3 years. Key Staff that will be involved: a. CEO: Barbara Cogswell i. Primary Office Location: 5600 Bee Ridge Rd. Suite B Sarasota, FL 34233 ii. Email: bcogswell@abs.care iii. Phone:941-906-1881 b. CFO: Daniel Dellapina i. Primary Office Location: 5600 Bee Ridge Rd. Suite B Sarasota, FL 34233 ii. Email: ddellapina@abs.care iii. Phone:941-906-1881 5600 BEE RIDGE ROAD SUITE B SARASOTA, FL 34233 OFFICE:941.906.1881 FAX 941.906.1190 WWW.ABS.CARE Collier County Solicitation 18-7470S Solicitation 18-7470S Services for Seniors Solicitation Designation: Public �q*ieir Cout Collier County 7/16/2021 2:56 PM P. 1 Collier County Solicitation 18-7470S Solicitation 18-7470S Services for Seniors Solicitation Number 18-74705 Solicitation Title Services for Seniors Solicitation Start Date Jul 7, 2021 3:18:53 PM EDT Solicitation End Date Aug 10, 2021 3:00:00 PM EDT Question & Answer End Aug 3, 2021 3:00:00 PM EDT Date Solicitation Contact Barbara Lance Procurement Strategist 239-252-8998 Barbara.Lance@colliercountyfl.gov Contract Duration 6 months Contract Renewal 3 annual renewals Prices Good for 180 days Pre -Solicitation Conference Jul 21, 2021 10:00:00AM EDT Attendance is optional Location: A Pre -Proposal conference shall be held at: Procurement Services Division 3295 Tamiami Trail East, Bldg C-2 Naples, FL 34112 Solicitation Comments The purpose of this solicitation is to secure vendors for the provision of home and community -based services, to be delivered to persons sixty years and older under Older American's Act (OAA), Community Care for the Elderly (CCE) and Health Care for the Elderly (HCE), and to qualified persons eighteen years or older under Alzheimer's Disease Initiative (ADI). This solicitation was prepared to supplement the services under Request for Proposal #18-7470. The term of the agreement for this solicitation will run concurrently with the existing term of Agreement #18-7470, Services for Seniors. Item Response Form Item 18-74705-01-01 -Services for Seniors Quantity 1 each Unit Price Delivery Location Collier County No Location Specified Qty 1 Expected Expenditure $1.00 7/16/2021 2:56 PM p. 2 Collier County Solicitation 18-7470S Description Please see Solicitation for specific evaluation criteria to include in your submission. 7/16/2021 2:56 PM p. 3 Collier County Solicitation 18-7470S Collier County Administrative Services Department Procurement Services Division COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS REQUEST FOR PROPOSAL (RFP) FOR SERVICES FOR SENIORS SOLICITATION NO. 18-7470S BARBARA LANCE, PROCUREMENT STRATEGIST PROCUREMENT SERVICES DIVISION 3295 TAMIAMI TRAIL EAST, BLDG C-2 NAPLES, FLORIDA 34112 TELEPHONE: (239) 252-8998 Barbara.Lance&colliercouniyfl. oovv (Email) This solicitation document is prepared in a Microsoft Word format (Rev 8/7/2017). Any alterations to this document made by the Vendor may be grounds for rejection of proposal, cancellation of any subsequent award, or any other legal remedies available to the Collier County Government. 7/16/2021 2:56 PM p. 4 Collier County Solicitation 18-7470S SOLICITATION PUBLIC NOTICE REQUEST FOR PROPOSAL (RFP) NUMBER: 18-7470S PROJECT TITLE: SERVICES FOR SENIORS PRE -PROPOSAL CONFERENCE: July 21, 2021 at 10:00 am LOCATION: PROCUREMENT SERVICES DIVISION, CONFERENCE ROOM A, 3295 TAMIAMI TRAIL EAST, BLDG C-2, NAPLES, FLORIDA 34112 DUE DATE: Au ust 10 2021 at 3:00 Pm PLACE OF RFP OPENING: PROCUREMENT SERVICES DIVISION 3295 TAMIAMI TRAIL EAST, BLDG C-2 NAPLES, FL 34112 All proposals shall be submitted online via the Collier County Procurement Services Division Online Bidding System: httDs://www.bidsvnc.com/bidsvnc-cas/ I INTRODUCTION I As requested by the Community and Human Services Division (hereinafter, the "Division or Department"), the Collier County Board of County Commissioners Procurement Services Division (hereinafter, "County") has issued this Request for Proposal (hereinafter, "RFP") with the intent of obtaining proposals from interested and qualified vendors in accordance with the terms, conditions and specifications stated or attached. The vendor, at a minimum, must achieve the requirements of the Specifications or Scope of Work stated. The results of this solicitation may be used by other County departments once awarded according to the Board of County Commissioners Procurement Ordinance. Historically, County departments have spent approximately $2,000,000 of grant program funds annually; however, this may not be indicative of future buying patterns. BACKGROUND The purpose of this solicitation is to secure vendors for the provision of home and community -based services, to be delivered to persons sixty years and older under Older American's Act (OAA), Community Care for the Elderly (CCE) and Health Care for the Elderly (HCE), and to qualified persons eighteen years or older under Alzheimer's Disease Initiative (ADI), within the geographic area of Collier County. Unless otherwise stated, minimum hours of availability are 7:00 a.m. to 5:00 p.m. Monday through Saturday, with the exception of federal and state holidays. Respite services and emergency services must be available 24 hours/day, 365 days/year if needed. Definitions, standards, and requirements of these services are included in the Department of Elder Affairs' Home and Community - Based Services Handbook (DOEA Handbook) link below: http://elderaffairs.state.fl.us/doea/nois.php TERM OF CONTRACT This solicitation was prepared to supplement the services under Request for Proposal #18-7470. The term of the agreement for this solicitation will run concurrently with the existing term of Agreement #18-7470, Services for Seniors. Prices shall remain firm for the initial term of this contract. Surcharges will not be accepted in conjunction with this contract, and such charges should be incorporated into the pricing structure. The County Manager, or designee, may, at his discretion, extend the Agreement under all of the terms and conditions contained in this Agreement for up to one hundred eighty (180) days. The County Manager, or designee, shall give the Contractor written notice of the County's intention to extend the Agreement term not less than ten (10) days prior to the end of the Agreement term then in effect. All Goods are FOB destination and must be suitably packed and prepared to secure the lowest transportation rates and to comply with all carrier regulations. Risk of loss of any goods sold hereunder shall transfer to the COUNTY at the time and place of delivery; provided that risk of loss prior to actual receipt of the Zoods by the COUNTY nonetheless remain with VENDOR. 7/16/2021 2:56 PM p. 5 Collier County DETAILED SCOPE OF WORK Solicitation 18-7470S Those interested in providing the services detailed below must adhere to all requirements in this RFP, in addition to maintaining adherence with the guidelines set forth by the current DOEA Handbook. Lack of knowledge of all requirements of a service listed in the proposal SHALL NOT relieve the provider of liability and obligations under the resultant agreement. Collier County Community & Human Services (CHS) shall lead all service authorization and coordination. In an effort to comply with the requirements of the OAA, ADI, CCE and HCE Programs, clients entering the service system will be assessed and prioritized by CHS. Upon determination of the service level to be provided, the CHS will offer the client a listing of service vendors for the specific service(s) outlined within their care plan. The client will be encouraged to pick a service provider of their choice and have the option of interviewing potential service providers. Should the client not have a preference, CHS will select a service provider from the centralized provider list, using a rotation basis (rotating to the next vendor on the list). In this manner, all service providers will be equally treated unless the client has a preference. CHS shall not endorse one service provider over another. Upon the determination of the service, the service levels, and the selected vendor, CHS will contact the vendor agency, and authorize the service, number of hours, and frequency. In keeping with the state policy of client choice of service providers, Collier County does not guarantee a minimum or maximum number of clients that will be referred, nor a minimum or maximum number of service hours that will be requested during the contract period. Should a client later indicate dissatisfaction with the chosen service provider, they will again be offered their choice of provider. CHS shall send the agreed -upon Service Authorization to the chosen provider. These "service authorizations" or "service orders" must contain necessary client information, such as street address, telephone number, and services or items needed, as well as the name and telephone number of the CHS case manager authorizing the service. In order to meet client needs, some services may be required outside of normal office hours (8:00 AM to 5:00 PM, Monday - Friday). CHS reserves the right to request adding additional service providers throughout the resultant agreement period. The County may do so through a competitive and publicly announced selection process, which shall be coordinated through the County's Procurement Department. Services shall be provided in the manner described in the most current DOEA manual and outlined herein. Should funding for additional Senior Services be identified the County reserves the right to add to the resultant agreements the services, descriptions, rates, etc. by way of a contract addendum. Services covered by this agreement include, but are not limited to: 1. Adult Day Care: A program of therapeutic social and health activities and services provided to adults who have functional impairments, in a protective environment that provides as non -institutional an environment as possible. 2. Chore: Performance of routine house or yard tasks including such jobs as seasonal cleaning, yard work, lifting and moving furniture, appliances, or heavy objects, household repairs which do not require a permit or specialist, and household maintenance. 3. Enhanced Chore: This service is beyond the scope of chore due to the level of service needed. The service includes a more intensified, thorough cleaning to address more demanding circumstances. 4. Homemaking: Specific home management duties including housekeeping, laundry, cleaning refrigerators, clothing repair, minor home repairs, assistance with budgeting and paying bills, client transportation, meal planning and preparation, shopping assistance, and routine house -hold activities by a trained homemaker. 5. Personal Care: Assistance with eating, dressing, personal hygiene and other activities of daily living. This service may include assistance with meal preparation, housekeeping chores such as bed making, dusting, and vacuuming incidental to the care furnished or essential to the health and welfare of the individual. Personal care can include accompanying the client to clinics, physician office visits, or trips for the purpose of health care provided that the client does not require special medical transportation. Personal care can also include shopping assistance to purchase food, clothing, and other items needed for the client's personal care needs. 6. In Home Respite: Relief or rest for a primary caregiver from the constant/continued supervision, companionship, therapeutic and/or personal care, of a functionally impaired older person for a specified period of time. 7. Skilled Nursing: Part-time or intermittent nursing care administered to an individual by a licensed practical nurse, registered nurse, or advanced registered nurse practitioner, in the client's place of residence, pursuant to a care plan approved by a licensed physician. 8. Emergency Alert Response Services: Emergency alert/response service is defined as a community based electronic surveillance 7/16/2021 2:56 PM p. 6 Collier County Solicitation 18-7470S service which monitors the frail homebound elder by means of an electronic communication link with a response center. 9. Specialized Medical Equipment, Services, and Supplies: Adaptive devices, controls, appliances, or services, which enable individuals to increase their ability to perform activities of daily living and repair of such services which may include: dentures, walkers, reaching devices, bedside commodes, telephone amplifiers, touch lamps, adaptive eating equipment, glasses, hearing aids, and other mechanical or non -mechanical, electronic, and non -electronic adaptive devices. Supplies may include such things as adult briefs, bed pads, oxygen or nutritional supplements. 10. Facility Respite: 24-hour care in a State of Florida Licensed Nursing home. 11. Establish protocols for contacting CHS Case Managers in emergency or unusual circumstances and include the documentation requirements (oral and written) in the Service Provider Application. 12. Provide disaster response protocols, plans and services: In the event of a natural disaster (hurricane, tropical storm, tornado, flood, heat wave, etc.), the provider will have staff available to serve those clients in critical need of services, as designated by the CHS Case Managers. 13. Establish a client grievance process: Each service provider agency must have a policy addressing client grievances and/or complaints. 14. Establish and provide staff training: All services provided with funding from DOEA require service delivery personnel to have general pre -service orientation and training specific to the service being provided. Lead Agencies are responsible for provision of the pre -service training (on program and billing requirements, in particular) for all paid staff, volunteer staff and assigned staff of service providers. Pre -service orientation must also include: • An overview of the aging process • An overview of the aging network • Communication techniques with the elderly • Observation of abuse, neglect, exploitation and incident reporting • Local agency service procedures and protocol • Client confidentiality NOTE: All "hands-on" service personnel must receive training emphasizing the necessity of Universal Precautions. Home Health Aides must have documentation of successful completion of 40 hours required training, and CNAs must have on file a copy of their State of Florida certification. In-service training hours and topics are to be provided at the discretion of the service provider agency and shall meet state requirements. 15. Compile and report program service delivery statistics and other data as identified by CHS. This may be required to be provided in an electronic format at the choosing of CHS. These are reported to the Area Agency on Aging and Department of Elder Affairs in accordance with the reporting requirements developed by the Department. Lead agencies are responsible for entry of data in the Client Information and Registration Tracking System (CIRTS), which generates payment to the service provider agency. Therefore, service provider agencies are required to provide Lead Agencies with correct and timely service data to comply with these requirements. Timely submission is no later than noon on Wednesday of the week following the week services are performed (service week defined as Monday through Sunday). 16. Maintain complete and accurate records: Service delivery logs, at a minimum, must be legible and contain the name of client, type(s) of services and date(s) and hour(s) of delivery. The client/caregiver must sign the log at the time of each service visit. The service worker must sign and date the log upon completion and submit it to the service provider agency. Provide complete, clear and accurate invoices: Weekly invoices, which may be required to be provided electronically in a system provided by CHS, must be submitted by noon on the Wednesday following the week that the service was provided and shall include service provided. The service week is defined as Monday through Sunday. Monthly reporting requirements for CIRTS dictate that all client and service data for the previous month to be entered into CIRTS by the 1 Oth day of the month. Collier County "Services for Seniors" will coordinate with vendors to determine due dates for invoices. This will ensure compliance with DOEA reporting requirements. Failure to record or report units of service will result in nonpayment (or delayed payment) for such services. Data required on weekly invoices and weekly timesheets include: • Vendor name • Vendor address • Vendor telephone number • Client name 4 7/16/2021 2:56 PM p. 7 Collier County Solicitation 18-7470S • Service Provider employee who delivered the service(s) • Services ordered and services delivered date • Number of service hours, cost per hour and total cost • Person preparing the report and the date it was prepared • Weekly timesheets signed and dated by the client and Service Provider employee • Additional information as determined by CHS 17. Prepare for annual on -site compliance audits by CHS or members of the Collier County staff as directed by the CHS or grant requirements. REQUEST FOR PROPOSAL (RFP) PROCESS 1.1 The Proposers will submit a qualifications proposal which will be scored based on the criteria in Evaluation Criteria for Development of Shortlist, which will be the basis for short -listing firms. The Proposers will need to meet the minimum requirements outlined herein in order for their proposal to be evaluated and scored by the COUNTY. The COUNTY will then score and rank the firms and enter into negotiations with the top ranked firm to establish cost for the services needed. The COUNTY reserves the right to issue an invitation for oral presentations to obtain additional information after scoring and before the final ranking. With successful negotiations, a contract will be developed with the selected firm, based on the negotiated price and scope of services and submitted for approval by the Board of County Commissioners. 1.2 The COUNTY will use a Selection Committee in the Request for Proposal selection process. 1.3 The intent of the scoring of the proposal is for respondents to indicate their interest, relevant experience, financial capability, staffing and organizational structure. 1.4 The intent of the oral presentations, if deemed necessary, is to provide the vendors with a venue where they can conduct discussions with the Selection Committee to clarify questions and concerns before providing a final rank. 1.5 Based upon a review of these proposals, the COUNTY will rank the Proposers based on the discussion and clarifying questions on their approach and related criteria, and then negotiate in good faith an Agreement with the top ranked Proposer. 1.6 If, in the sole judgment of the COUNTY, a contract cannot be successfully negotiated with the top -ranked firm, negotiations with that firm will be formally terminated and negotiations shall begin with the firm ranked second. If a contract cannot be successfully negotiated with the firm ranked second, negotiations with that firm will be formally terminated and negotiations shall begin with the third ranked firm, and so on. The COUNTY reserves the right to negotiate any element of the proposals in the best interest of the COUNTY. RESPONSE FORMAT AND EVALUATION CRITERIA FOR DEVELOPMENT OF SHORTLIST: 1.7 For the development of a shortlist, this evaluation criterion will be utilized by the COUNTY'S Selection Committee to score each proposal. Proposers are encouraged to keep their submittals concise and to include a minimum of marketing materials. Proposals must address the following criteria: Evaluation Criteria Maximum Points l . Cover Letter / Management Summary 5 Points 2. Organizational Capabilities and Experience 20 Points 3. Financial and Human Resources Capabilities 20 Points 4. General Service Delivery 25 Points 5. Acceptance of Cost 20 Points 6. Cost of Services to the County 10 Points TOTAL POSSIBLE POINTS 100 Points Tie Breaker: In the event of a tie at final ranking, award shall be made to the proposer with the lower volume of work previously awarded. Volume of work shall be calculated based upon total dollars paid to the proposer in the twenty-four (24) months prior to the RFP submittal deadline. Payment information will be retrieved from the County's financial system of record. The tie breaking procedure is only applied in the final ranking step of the selection process and is invoked by the Procurement Services Division Director or designee. In the event a tie still exists, selection will be determined based on random selection by the Procurement Services Director before at least three (3) witnesses. Each criterion and methodology for scoring is further described below. 7/16/2021 2:56 PM p. 8 Collier County Solicitation 18-7470S ***Proposals must be assembled, at minimum, in the order of the Evaluation Criteria listed or your proposal may be deemed non -responsive*** EVALUATION CRITERIA NO. 1: COVER LETTER/MANAGEMENT SUMMARY (5 Total Points) Provide a cover letter, signed by an authorized officer of the firm, indicating the underlying philosophy of the firm in providing the services stated herein. Include the name(s), telephone number(s) and email(s) of the authorized contact person(s) concerning proposal. Submission of a signed Proposal is Vendor's certification that the Vendor will accept any awards as a result of this RFP. Submit proposer's Agency for Health Card Administration (AHCA) Certification: If certification is not provided at time of proposal submission, the firm will be deemed non -responsive. Indicate by selecting any one, or multiple services which the proposer is interested in providing to the County (descriptive information is outlined in the above scope of work. Item Services Interested in Providing Service (Place X) Not Interested in Providing Service (Place X) 1 Adult Day Care x 2 Chore x 3 Chore (Enhanced) x 4 Homemaking x 5 Personal Care x 6 Respite (In -home) x 7 Skilled Nursing x 8 Emergency Alert Response Services EARS x 9 Specialized Medical Equipment, Services, and Supplies x 10 Respite (Facility Based) x EVALUATION CRITERIA NO.2: ORGANIZATIONAL CAPABILITIES AND EXPERIENCE (20 Total Points) Complete each of the items below in the format requested and submit evidence of documentations where indicated. Proposers who do not complete in the format indicated below may be deemed non -responsive. Yes/No 1. The proposer has received license from Agency for Health Care Administration (AHCA). Provide evidence of license. Yes 2. The proposer has by-laws which describe how business will be conducted. Yes 3. The proposer has the appropriate license for the services it intends to provide to Collier County. Provide license evidence. Yes 4. Board members are required to sign a conflict of interest statement. Yes 5. The proposer has a written business plan that is updated regularly. Yes 7/16/2021 2:56 PM P. 9 Collier County Solicitation 18-7470S 6. Organizational Chart: Proposer has to provide a copy of the organizational Yes chart indicating lines of authority and permanent and full-time positions. Provide evidence. 7. Total number of years that the proposer has been in business. 6+ 8. Proposer has supervisory staff on call 24 hours per day/ 365 days per year. Yes 9. oposer's Owner/Operator license has never been denied, suspended or NO evoked by Medicare, Medicaid, any Federal and/or any State Agency. If es, please attach a letter or explanation. The County requests that the vendor submits no fewer than three (3) and no more than ten (10) completed reference forms from clients during a period of the last 5 years whose services provided are of a similar nature to this solicitation as a part of their proposal. Provide information on the services completed by the Proposer that best represent services of similar size, scope and complexity of this scope of work using Form 5 — Reference Questionnaire. Proposers may include two (2) additional pages for each reference to illustrate aspects of the completed services that provides the information to assess the experience of the Proposer on relevant work. EVALUATION CRITERIA NO 3: FINANCIAL AND HUMAN RESOURCES CAPABILITIES (20 Total Points) Complete each of the items below in the format requested and submit evidence of documentations where indicated. Proposers who do not complete in the format indicated below may be deemed non -responsive. Yes/No I Proposer maintains daily, monthly and annual financial records of payroll, benefits, operating and capital equipment. Yes 2. Proposer prepares annual 1099 forms for all employees. Yes 3. Proposer has a certified public accountant or an independent accounting/auditing firm to prepare financial records. Yes 4. Proposer uses an accounting software product. Yes 5. Proposer has an accounting staff produce monthly financial statements. Yes 6. Proposer has annual audit completed. Provide copy recently completed. NO 7. Proposer has written recruitment policy. Yes 8. Proposer provides criminal background check for employees on this contract. Yes 9. Proposer conducts formal orientation for all new staff. Yes 10. Proposer distributes written personnel policies to staff. Yes 7 7/16/2021 2:56 PM P. 10 Collier County Solicitation 18-7470S 11. Proposer distributes written personnel policies. Yes 12. orkman's Compensation Policy information clearly posted for staff. Yes 13. Proposer maintains written, signed Job Descriptions. Yes 14. roposer's employees are evaluated at least annually in writing. Yes 15. Proposer has written hiring practices. Yes 16. Proposer has written retention policies. Yes 17. Proposer has formal progressive disciplinary procedures. Yes 18. Proposer has written policies regarding theft and falsification of time sheets Yes 19. Proposer has policy to prevent fraud and formalized methods to report suspected incidents. Yes 0. Agency has written disaster plan. Yes 1. Proposer agrees to utilize electronic means to submit documentation, as determined by CHS, to include invoices. Yes EVALUATION CRITERIA NO 4: GENERAL SERVICE DELIVERY (25 total points) Complete each of the items below in the format requested and submit evidence of documentations where indicated. Proposers who do not complete in the format indicated below may be deemed non -responsive. Yes/No I Proposer maintains a formal record of in -services, available for review. Yes 2. Proposer maintains copies of training schedule for last year, available for review. Yes 3. Proposer maintains sign in sheets for in-service training, available for review. Yes 4. Proposer maintains evidence of attendance and completion in employee files. Yes 5. Proposer has copies on file of training materials. Yes 7/16/2021 2:56 PM P. 11 Collier County Solicitation 18-7470S 6. Proposer has written Quality Assurance plan. Provide plan. Yes 7. Proposer surveys clients for satisfaction in writing at least once per year. Yes Provide sample. 8. Proposer analyzes surveys and uses reports for transmission to Yes dministration and to employees. 9. Proposer incorporates results of Quality Assurance activities to annual Yes plan. 10. Proposer has Quality Assurance Committee as standing subcommittee of Yes Board 11. Proposer has written policy for reporting incidents. Provide copy and a Yes ample of the incident report. 12. Proposer has formal training for staff regarding reporting of suspected Yes cases of abuse or neglect. 13. Proposer maintains anti -discrimination policies related to service Yes consumer. 14. Proposer has written policy regarding consumers rights. Yes 15. Proposer has written system for registering consumers' complaints. Yes 16. Proposer has written policy to follow up on consumers' complaints. Yes 17. Proposer has written description of how service is delivered from point of Yes equest through provision and termination. Provide copy. 18. Proposer has written procedures for assuring confidentiality of consumer Yes records. EVALUATION CRITERIA NO. 5: ACCEPTANCE OF COST (20 Total Points) In this criterion you will be provided a list of services needed by the County. Those services with rates, In -kind match and Cost already completed are standard rates in which you will be required to accept. Please sign as an acceptance to the rates if you deem these standard rates to be acceptable. Daniel Dellapina I accept the standard contract rates listed below. Cost Per Service In -kind 10% Reimbursement Unit (Cost your Match (Grant Rate Per Unit Item Services Grant Service Unit company charges for Amount your (Amount the County will the service) company will be reimburse your paying) company for a given service) 1. Skilled Nursing CCE, OAA Per Hour $40.00 $4.00 $36.00 9 7/16/2021 2:56 PM p. 12 Collier County Solicitation 18-7470S 2. Enhance Chore ADI, CCE, OAA Per Hour $40.00 $4.00 $36.00 3. Respite (In -Home) ADI, CCE, OAA Per Hour $24.11 $2.41 $21.70 4. Respite (Facility Based) ADI, CCE, OAA Daily Rate $225.00 0 $225.00 5. Personal Care ADI, CCE, OAA Per Hour $24.11 $2.41 $21.70 6. Chore ADI, CCE, OAA Per Hour $24.00 $2.40 $21.60 7. Homemaking ADI, CCE, OAA Per Hour $23.33 $2.33 $21.00 8. Adult Day Care ADI, CCE, OAA Per Hour $13.89 $1.39 $12.50 9. Emergency Alert Response ADI, CCE, OAA Per Day $1.09 $0.11 $0.98 EVALUATION CRITERIA NO. 6: COST OF SERVICES TO THE COUNTY (10 Total Points) In this tab, insert your cost for the services listed below. Reimbursement Cost Per Service In -kind 10% Rate Per Unit Unit (Cost your Match (Grant (Amount the Item Services Grant Service company charges Amount your County will Unit for the service) company will be reimburse your paying) company for a given service) Specialized Medical ADI, CCE, OAA Per Episode 10. Equipment, Services, and Supplies VENDOR CHECKLIST ***Vendor should check off each of the following items as the necessary action is completed (please see, Vendor Check List)*** 10 7/16/2021 2:56 PM p. 13 Collier County Solicitation 18-7470S COAT County Administrative Services Department Procurement Services Division Vendor Check List IMPORTANT: Please review carefully and submit with your Proposal/Bid All applicable documents shall be submitted electronically through BidSync. Vendor should checkoff each of the following items: XGeneral Bid Instructions has been acknowledged and accepted. XCollier County Purchase Order Terms and Conditions have been acknowledged and accepted. XForm 1: Vendor Declaration Statement XForm 2: Conflict of Interest Certification XProof of status from Division of Corporations - Florida Department of State (If work performed in the State) - http://dos.myflorida.com/sunbiz/ should be attached with your submittal. XVendor MUST be enrolled in the E-Verify - https://www.e-verify.gov/ at the time of submission of the proposal/bid. X Form 3: Immigration Affidavit Certification MUST be signed and attached with your submittal or you MAY be DEEMED NON -RESPONSIVE E-Verify Memorandum of Understanding or Company Profile page should be attached with your submittal. XForm 4: Certification for Claiming Status as a Local Business, if applicable, has been executed and retumed. Collier or Lee County Business Tax Receipt should be attachedwith yoursubmittal to be considered. Form 5: Reference Questionnaires form must be utilized for each requested reference and included with your submittal, id applicable to the solicitation. XForm 6: Grant Provisions and Assurances package in its entirety, if applicable, are executed and should be included with your submittal. All forms must be executed, or you MAY be DEEMED NON -RESPONSIVE. XVendor W-9 Form. Vendor acknowledges Insurance Requirements and is prepared to produce the required insurance certificate(s) within five (5) days of the County's issuance of a Notice of Recommend Award. X The Bid Schedule has been completed and attached with your submittal, applicable to bids. XCopies of all requested licenses and/or certifications to complete the requirements of the project. X All addenda have been signed and attached, or you MAY be DEEMED NON-RESPONS IVE. XCounty's IT Technical Architecture Requirements has been acknowledged and accepted, if applicable. XAny and all supplemental requirements and terms has been acknowledged and accepted, if applicable. 7/16/2021 2:56 PM p. 14 ***UPDATED JANUARY 2& 2020*** Collier County Solicitation 18-7470S (Z;ci Ter (Z;m 1ty Administrative Services Department Procurement Services Division Form 1: Vendor Declaration Statement BOARD OF COUNTY COMMISSIONERS Collier County Government Complex Naples, Florida 34112 Dear Commissioners: The undersigned, as Vendor declares that this response is made without connection or arrangement with any otherperson and th is proposal is in every respect fair and made in good faith, without collusion or fraud. The Vendor hereby declares the instructions, purchase order terms and conditions, requirements, and specifications/scope of work of this solicitation have been fully examined and accepted. The Vendor agrees, if this solicitation submittal is accepted by Collier County, to accept a Purchase Order as a form of a formal contract or to execute a Collier County formal contract for purposes of establishing a contractual relationship between the Vendor and Collier County, for the performance of all requirements to which this solicitation pertains. The Vendor states that the submitted is based upon the documents listed by the above referenced solicitation. The Vendor agrees to comply with the requirements in accordance with the terms, conditions and specifications denoted herein and according to the pricing submitted as a part of the Vendor's bids. Further, the Vendor agrees that if awarded a contract for these goods andmor services, the Vendor will not be eligible to compete, submit a proposal, be awarded, or perform as a sub -vendor for any future associated work that is a result of this awarded contract. INWITNESS WHEREOF, WE have hereunto sub scribed our names on this i�dayof AVG--)—c�,20c4iinthe County of the State of �o fZ ; . D A- Firm's Legal Name: Address: City, State, Zip Code: Florida Certificate of Authority Document Number Federal Tax Identification Number *CCR # or CAGE Code *Only if Grant Funded Telephone: Email: Signature by: (Typed and written) Title: 7/12/2021 6:14 AM Sunshine Health Care Services, LLC 5600 Bee Ridge Rd. Suite B Sarasota, FL 34233 L15000093278 !rm, Neil 941-906-1881 CFO County of Sarasota Sworn to (or affirm d) and subscribed Before me this day of u�05"C my el - Cyr elp °,s;pu,i Signature o ry, for S e , F rid.: � �' or Personally Knowq.Qr Pro uca MATTHEW CLEARY Commisslon # GG 255897 Expires September 19, 2022 0andad Tnm BuCpet Not+ry Servlcee P. 15 Collier County Additional Contact Information Solicitation 18-7470S Send payments to: A Better Solution (required if different from Company name used as payee above) Contact name: Daniel Dellapina Title: CFO Address: 5600 Bee Ridge Rd. Suite B City, State, ZIP Sarasota, FL 34233 Telephone: 941-906-1881 mil: ddellapinap_abs.care Office servicing Collier 10600 Chevrolet Way Suite 215 Estero, FL 33928 County to place orders (required if different from above) Contact name: Daniel Dellapina Title: CFO Address: 5600 Bee Ridge Rd. Suite B City, State, ZIP Sarasota, FL 34233 Telephone: 941-906-1881 Email; ddellapina(a)abs.care 7/12/2021 6:14 AM p. 16 Collier County Solicitation 18-7470S cone coy Administrative Services Department Procurement Serdces Division Form 2: Conflict of Interest Certification Affidavit The Vendor certifies that, to the best of its knowledge and belief, the past and current work on any Collier County project affiliated with this solicitation does not pose an organizational conflict as described by one of the three categories below: Biased ground rules —The firm has not set the "ground rules" for affiliated past or current Collier County project identified above (e.g., writing a procurement's statement of work, specifications, or performing systems engineering and technical direction for the procurement) which appears to skew the competition in favor of my firm. Impaired objectivity — The firm has not performed work on an affiliated past or current Collier County project identified above to evaluate proposals / past performance of itself or a competitor, which calls into question the contractor's ability to render impartial advice to the government. Unequal access to information —The firm has not had access to nonpublic information as part of its performance of a Collier County project identified above which may have provided the contractor (or an affiliate) with an unfair competitive advantage in current or future solicitations and contracts. In addition to this signed affidavit, the contractor/ vendor mist provide the following: 1. All documents produced as a result of the work completed in the past or currently being worked on for the above -mentioned project; and, 2. Indicate if the information produced was obtained as a matter of public record (in the "sunshine") or through non-public (not in the "sunshine") conversation (a), meeting(s), document(s) and/or other means. Failure to disclose all material or having an organizational conflict in one or more of the three categories above be identified, may result in the disqualification for future solicitations affiliated with the above referenced project(s). By the signature below, the fam (employees, officers and/or agents) certifies, and hereby discloses, that, to the best of their knowledge and belief; all relevant facts concerning past, present, or currently planned 'interest or activity (financial, contractual, organizational, or otherwise) which relates to the project identified above has been fully disclosed and does not pose an organizational conflict. S G14511"k? i s 1 / ( 4re S*rry c rt. ZCC Company Name Signature l%al1i1°l �1lVwg, CfD Print Name and Title State of 1b_11 County of 5^Ar The foregping instrument was acknowledged before me by means of -Jif$hysical presence or ❑ online notarization, this �J day of RU(.v tm1month), (year), by bPsr i A4DC L-L I) I •44', (name ofperson acknowledging). ruo,� MATTHEW CLEARY =",tr # Commleslon#GG255897 ws Expires September 19.2022 P ��FOF fI�p Banded itWu Budget Notary$arvins Personally Known OR Prod cad Iantification Type of Identification Produced (Print, Type, or (Signature ofNotary Public - Sta a ofFlorid Name of Notary Public) 7/12/2021 6:14 AM p. 17 Collier County Solicitation 18-7470S Co�ter County Administrative Services Department Procurement Services Division Form 3: Immigration Affidavit Certification This Affidavit is required and should be signed, by an authorized principal of the firm and submitted with formal solicitation submittals. Further, Vendors are required to be enrolled in the &Verify program (httgs://www.e-verify.gov/), at the time of the submission of the Vendor's proposal/bid. Acceptable evidence of your enrollment consists of a copy ofthe properly completed E- Verify Company Profile page or a copy of the fully executed &Verify Memorandum of Understanding for the company which will beproducedat the time ofthesubmtssion ofthe Vendor'sproposal/bid or within five (5) day ofthe County'sNotice ofRecommend Award. FAILURE TO ENECU111 THIS AFFIDAVIT CERTIFICATION AND SUBMIT WrM VENDOR'S PROPOSAUBM MAX DEEM THE VF MOWS AS NON -RESPONSIVE. Collier County will not intentionally award County contracts to any Vendor who knowingly employs unauthorized alien workers, constituting a violation of the employment provision contained in 8 U.S.C. Section 1324 a(e) Section 274A(e) of the Immigration and Nationality Act ("INA"). Collier County may consider the employment by any Vendor of unauthorized aliens a violation of Section 274A (e) of the INA. Such Violation by the recipient of the Employment Provisions contained in Section 274A (e) of the INA shall be grounds for unilateral termination of the contract by Collier County. Vendor attests that they are fully compliant with all applicable immigration laws (specifically to the 1986 Immigration Act and subsequent Amendment(s)) and agrees to comply with the provisions of the Memorandum of Understanding with E-Verify and to provide proof of enrollment in The Employment Eligibility Verification System (&Verify), operated by the Department of Homeland Security in partnership with the Social Security Administration at the time of submission of the Vendor's proposaYbid. Sunjliy,P Howlg 61,- Sc'ryli6,zz( Company Name T Signature L%uniz-� ��o�iha m and Print ame and Title State of 0 (-ova_ 0-9- County of The foregoing instrument was acknowledged before me by means of -J�—physical presence or ❑ online notarization, this L- day of &r &&i�ntDith), -I (year), by 'PA I)ti4C-luf A (name of person acknowledging). Personally Known OR Produced Identification f��Lvp-qf oa Z) Alt,4 - Type of Identification Produced (Signature o11'Notary Public - State of Florida) 2MMI (Print, Type, or Stamp Commissioned Name Y1�nv rea�� MATTHEW CLEARY "mo Commlaelon#GG266897 Explree September 18, 2022 o for rtP sanded Th,u Budget Notary Services Public) 7/12/2021 6:14 AM P. 18 Collier County Solicitation 18-7470S Administrative Services Department Procurement Services Division Form 4: Vendor Submittal —Local Vendor Preference Certification (Check Appropriate Bows Below) State of Florida (Select County if Vendor is described as a Local Business) ❑ Collier County ® Lee County Vendor affirm that it is a local business as defined by the Procurement Ordinance of the Collier County Board of County Commissioners and the Regulations Thereto. As defined in Section Fifteen of the Collier County Procurement Ordinance: Local business means the vendor has a current Business Tax Receipt issued by the Collier County Tax Collector prior to bid or proposal submission to do business within Collier County, and that identifies the business with a permanent physical business address located within the limits of Collier County fromwhich the vendor's staff operates and performs busines s in an area zoned for the conduct of such business. A Post Office Box or a facility that receives marl, or a non -permanent structure such as a construction trailer, storage shed, or other non -permanent structure shall not be used for the purpose of establishing said physical address. In addition to the foregoing, a vendor shallnot be considered a "local business" unless it contributes to the economic development and well-being of Collier County in a verifiable and measurable way. This may include, but not be limited to, the retention and expansion of employment opportunities, support and increase to the County's tax base, and residency of employees and principals of the business within Collier County. Vendors shall affirm in writing their compliance with the foregoing at the time of submitting their bid or proposal to be eligible for consideration as a "local business" under this section. A vendor who misrepresents the Local Preference status of its firm in a proposal or bid submitted to the County will lose the privilege to claim Local Preference status for a period of up to one year under this s ection. Vendor must complete the following information: Year Business Established in ❑ Collier County or 0 Lee County: 2015 Number of Employees (Including Owner(s) or Corporate Officers): 150+ Number of Employees Living in 0 Collier County or ❑ Lee (Including Owner(s) or Corporate Ofiicers):yarles If requested by the County, Vendor will be required to provide documentation substantiating the information given in this certification. Failure to do sowfll result inwridor's submission being deemed not applicable. $jgp and Date Certification: Under penaltiesofpetiuty IceniJythatthefnfarmationshown onthis form iscorrect tomyknowledge. company Name: Sunshine Health Care Services, LLC Date: Address in collier or Lee j County: 10600 Chevrolet Way Suite 215 Estero, FL 33928 Signature: tl� I' Title: CFO 7/12/2021 6:14 AM p. 20 Collier County Solicitation 18-7470S Cuyer County Administrative Services Departrnent Procurement Services Division Form 5 Reference Questionnaire (USE ONE FORM FOR EACH REQUIRED REFERENCE) Solicitation: Reference Questionnaire for: (Name of Company Requesting Reference Information) (Name of Individuals Requesting Reference Information) Name: Katie Alfs (Evaluator completing reference questionnaire) Email: kalfs(ab_friendshipcenters.org FAX: Company: Senior Friendship Centers (Evaluator's Company completing reference) Telephone: (941)924-8775 Collier County has implemented a process that collects reference infon-nation on firms and their key personnel to be used in the selection of firms to perform this project. The Name of the Company listed in the Subject above has listed you as a client for which they have previously performed work. Please complete the survey. Please rate each criteria to the best of your knowledge on a scale of 1 to 10, with 10 representing that you were very satisifed (and would hire the firm/individual again) and 1 representing that you were very unsatisfied (and would never hire the firni/indivdival again). If you do not have sufficient knowledge of past performance in a particular area, leave it blank and the item or form will be scored "0." Project Description: Project Budget: Completion Date: Project Number of Days: Item Criteria Score must be completed) 1 Ability to manage the project costs (minimize change orders to scope). 10 2 Ability to maintain project schedule (complete on -time or early). 8 3 Quality of work. 8 4 Quality of consultative advice provided on the project. 10 5 Professionalism and ability to manage personnel. 9 6 Project administration (completed documents, final invoice, final product turnover; invoices; manuals or going forward documentation, etc.) 9 7 Ability to verbally communicate and document information clearly and succinctly. 9 8 Abiltity to manage risks and unexpected project circumstances. 9 9 Ability to follow contract documents, policies, procedures, rules, regulations, etc. 10 10 Overall comfort level with hiring the company in the future (customer satisfaction). 9 TOTAL SCORE OF ALL ITEMS 91 7/12/2021 6:14 AM p. 21 * * * TJPDATED JANUARY 28. 2020** * 1\45\5054 @:J14 b'W * **nbDVJM 1vunVxr, sa' 3030** b• 51 ,LO.LYP 2CONE OL Yrr ILEM �i 10 OACL911 COUJL04 IGAGI Mrjp P!L!UR WC COUJb9ul lu jpG LnjnLG (Cn2 fOu-Tu 29ji2L9CjrOU)• 90 a yprl!ja to LolloM coujL9cjgocnwcuj2' bolrcrc2' bLoccgnLG2'LnIG2' LGRnl9jiou2' Gjc• 0 g ypgjljl, to uJ9u9PxG Lr2p suq nucxbccjcq bLOlccj cncnw2j9ucG2• 0 � r r a o AGL 9 A coulmnuresjc Su ocniJJGuj !u pumgou c GSL A Su 2ncclucj x `dP.1 � j A Il q q b I I q 1 runolcc2' LWUn912 OL PxOluPx LOUASLq gocnwcupgou' Gjc•) bLOIGCj SgLu!u12jL9jI0U (couJbjgGq gocnuJGuf2'LwsI ruAojcG' Liusl bLogncjjnwonGL' 2 bLOLG221ouslr2w 9uq 9pgg), to uju9RG bGL20UUGl• d 6nspjl, o{ cou2nljsjrAGsgAIcG bLOArgsq ou jpG bLolccj- 3 6nslrjA oLMoLr S ypil!j1, touJsrujsBJ bLolscj2cpsgnlG(couiblsjG ou-yuJG OLGSLIA)• I yprl!jl, to UJ9u9?G jpcbLOlccj co2j2(w!uwnsG cp9uRcoLgGL2 to2cobG)- Ijsw CLIjsLIS 2coLs urn2j pG cow sjs bLolGcj BnggGj: 1 �f eC'. t bLOlccj DG2CLlbj!Ou: bLOlccj 1/1nUJpGL OLD91,2: r1,1 J-- CouJblGjlou DsjG: ;fit' ,,. BJ s b94rcnl9L 9LGs' JG9AG It pl9ulc suq jpG rjGUJ OL LOUD Mill pG 2COLGq ,,O'„ MGLG AGil, nu2sg2LiGq (9uq MOnlq UGAGL pILG jpG Lruu\!uq!Agrn91 9Rsru)' IL),On qo uoj psAG 2nLLICrGuj lmotAlcgRG OLbs2j bGLLowzucc oL I j0 IQ' Mijp 10 LGbLG2GujruR jp9j ),Ofi MGLG AcLX 29jr2ILGq (suq MOnlq pILG jpG LILru\iUgiAignsl 9Pasru) 9uq I LGbwnuquJ� jp9j XOn jpGA psAG bLGAton21A bGLLoLuJGq MOL1c bIG92G comblcjG jpG 2nLAGa• blc92G LsjG G9Cp Ulful9 to jpG pc2j OLAOM IwoM1GgRG ou s 2csIG 2GIGcjrou oLLuim to bGLLoLw jpr2 kolccj• LpG ylsuiG oLjpG Cowbsu), 1!2jcq iu jpG 2nplGcj 9POAC ps2 p2jcq Aon 92 s CI!Guj LOLMprcp COIIrGL COnUj�, ps2 BJiblGwGujcq s bLocG22 jp9j COIIGCj2 LGLGLGUCG BJLOLUJsjIOU OU LMLU12 9Uq jpGIL rGA bGL20UUGl j0 pG n2Gq ru jpG (EA91n9jOL cOwblGqu?- LCLGLGUCG dnG2ji0UtJ9ILG) ( auis oL luq!Algnsl2 gcdnc2 jruR gGLGLGucG lutowisjrou) (yisuJG OL CouJbsul, gcdnc2 jiug gGLGLGucG IuLoumpou) V BG�gGL gGLGLGucG 6nc2jlouus'Lc LOL: 20pclj9jlOu-. pout:rf, 34 (EA9ln9jOL,2 Coiubsua cowblcjrug LcLucucc) COuJbsu),:�4i'y'r �CjCr?% rt Ir',rl t rAArrrc.l t1& WAE V.OKW V is EN CH \SE tli1SED K6 EKEV�GE b,OLM 2 IfGtGLsucs 6ns2jrouusrLs bi.ocnLGWGIJ( P.6VIc6E 4.,12:OU yquJ!u!?ILspas 2GrAICS2 DsbsLp ieuj COII!GL Conuja 201!C!jsf!ou 49-XIIA2 Collier County Solicitation 18-7470S Cuter Coxlnty Administrative Services Department Arocummerd Services Division Form 5 Reference Questionnaire (USE ONE FORM FOR EACH REQUIRED REFERENCE) Solicitation: Reference Questionnaire for: A Better Solution (Name of Company Requesting Reference Information) (Name of Individuals Requesting Reference Information) Name: Mary Wernentin - Supportive Aging Services Director (Evaluator completing reference questionnaire) Email: mwernentin@friendshipcenters.org FAX: Company: Senior Friendship Centers (Evaluator's Company completing reference) 239-322-9766 Collier County has implemented a process that collects reference information on firms and their key personnel to be used in the selection of firms to perform this project. The Name of the Company listed in the Subject above has listed you as a client for which they have previously performed work. Please complete the survey. Please rate each criteria to the best of your knowledge on a scale of 1 to 10, with 10 representing that you were very satisifed (and would hire the firm/individual again) and 1 representing that you were very unsatisfied (and would never hire the firm/indivdival again). If you do not have sufficient knowledge of past performance in a particular area, leave it blank and the item or form will be scored "0." Project Description: In home service provider Project Budget: Capacity up to State and Federal funding Completion Date: On Project Number of Days: 365 days a year Item Criteria Score must be completed) 1 Ability to manage the project costs (minimize change orders to scope). 2 Ability to maintain project schedule (complete on -time or early). 3 Quality of work. 9 4 Quality of consultative advice provided on the project. 5 Professionalism and ability to manage personnel. 10 6 Project administration (completed documents, final invoice, final product turnover; invoices; manuals or going forward documentation, etc.) 9 7 Ability to verbally communicate and document information clearly and succinctly. 10 8 Abiltity to manage risks and unexpected project circumstances. 9 9 Ability to follow contract documents, policies, procedures, rules, regulations, etc. 10 10 Overall comfort level with hiring the company in the future (customer satisfaction). 10 TOTAL SCORE OF ALL ITEMS NJ11804 141 ..2EW-1UVil p. 21 * * * UPDATED JANUARY 2& 2020** * Collier County Solicitation 18-7470S INSURANCE AND BONDING REOUIREMENTS Insurance / Bond Type Required Limits 1. ® Worker's Compensation Statutory Limits of Florida Statutes, Chapter 440 and all Federal Government Statutory Limits and Requirements Evidence of Workers' Compensation coverage or a Certificate of Exemption issued by the State of Florida is required. Entities that are formed as Sole Proprietorships shall not be required to provide a proof of exemption. An application for exemption can be obtained online at https://Nps.fldfs.com/bocexempt/ 2. ® Employer's Liability $1,000,000 single limit per occurrence 3. ® Commercial General Bodily Injury and Property Damage Liability (Occurrence Form) patterned after the current $1,000,000_single limit per occurrence, $2,000,000 aggregate for Bodily Injury ISO form Liability and Property Damage Liability. This shall include Premises and Operations; Independent Contractors; Products and Completed Operations and Contractual Liability. 4. ® Indemnification To the maximum extent permitted by Florida law, the Contractor/Vendor shall defend, indemnify and hold harmless Collier County, its officers and employees from any and all liabilities, damages, losses and costs, including, but not limited to, reasonable attorneys' fees and paralegals' fees, to the extent caused by the negligence, recklessness, or intentionally wrongful conduct of the Contractor/ Vendor or anyone employed or utilized by the Contractor/Vendor in the performance of this Agreement. 5. ® Automobile Liability $500,000 Each Occurrence; Bodily Injury & Property Damage, Owned/Non-owned/Hired; Automobile Included 6. ❑ Other insurance as noted: ❑ Watercraft $ Per Occurrence ❑ United States Longshoreman's and Harborworker's Act coverage shall be maintained where applicable to the completion of the work. $ Per Occurrence ❑ Maritime Coverage (Jones Act) shall be maintained where applicable to the completion of the work. $ Per Occurrence ❑ Aircraft Liability coverage shall be carried in limits of not less than $5,000,000 each occurrence if applicable to the completion of the Services under this Agreement. $ Per Occurrence ❑ Pollution $ Per Occurrence ® Professional Liability $ 1,000,000 Per claim & in the aggregate ❑ Project Professional Liability $ Per Occurrence ❑ Valuable Papers Insurance ❑ Cyber Liability ❑ Technology Errors & Omissions X Crime/Employee Dishonesty $ Per Occurrence $ Per Occurrence $ Per Occurrence $50,000 Per Occurrence 7. ❑ Bid bond Shall be submitted with proposal response in the form of certified funds, cashiers' check or an irrevocable letter of credit, a cash bond posted with the County Clerk, or proposal bond in a sum equal to 5% of the cost proposal. All checks shall be made payable to the Collier County Board of County Commissioners on a bank or trust company located in the State of Florida and insured by the Federal Deposit Insurance 7/12/2021 6:14 AM p. 24 Collier County Solicitation 18-7470S Corporation. 8. ❑ Performance and Payment For projects in excess of $200,000, bonds shall be submitted with the executed Bonds contract by Proposers receiving award, and written for 100% of the Contract award amount, the cost borne by the Proposer receiving an award. The Performance and Payment Bonds shall be underwritten by a surety authorized to do business in the State of Florida and otherwise acceptable to Owner; provided, however, the surety shall be rated as "A-" or better as to general policy holders rating and Class V or higher rating as to financial size category and the amount required shall not exceed 5% of the reported policy holders' surplus, all as reported in the most current Best Key Rating Guide, published by A.M. Best Company, Inc. of 75 Fulton Street, New York, New York 10038. ® Vendor shall ensure that all subcontractors comply with the same insurance requirements that he is required to meet. The same Vendor shall provide County with certificates of insurance meeting the required insurance provisions. 10. ® Collier County must be named as "ADDITIONAL INSURED" on the Insurance Certificate for Commercial General Liability where required. This insurance shall be primary and non-contributory with respect to any other insurance maintained by, or available for the benefit of, the Additional Insured and the Vendor's policy shall be endorsed accordingly. 11. ® The Certificate Holder shall be named as Collier County Board of County Commissioners, OR, Board of County Commissioners in Collier County, OR Collier County Government, OR Collier County. The Certificates of Insurance must state the Contract Number, or Project Number, or specific Project description, or must read: For any and all work performed on behalf of Collier County. 12. ® On all certificates, the Certificate Holder must read: Collier County Board of County Commissioners, 3295 Tamiami Trail East, Naples, FL 34112 13. ® Thirty (30) Days Cancellation Notice required. 14. Collier County shall procure and maintain Builders Risk Insurance on all construction projects where it is deemed necessary. Such coverage shall be endorsed to cover the interests of Collier County as well as the Contractor. Premiums shall be billed to the project and the Contractor shall not include Builders Risk premiums in its project proposal or project billings. All questions regarding Builder's Risk Insurance will be addressed by the Collier County Risk Management Division. GG — 6/29/2021 Vendor's Insurance Statement We understand the insurance requirements of these specifications and that the evidence of insurability may be required within five (5) days of the award of this solicitation. The insurance submitted must provide coverage for a minimum of six (6) months from the date of award. Name of Firm Sunshine Health Care Services, LLC Date 8/4/2021 Vendor Signature Print Name Insurance Agency Agent Name Daniel Dellapina Purmort and Martin Russ Bobbit Telephone Number 941-366-7070 7/12/2021 6:14 AM p. 25 Collier County Solicitation 18-7470S EXHIBIT LA FEDERAL CONTRACT PROVISIONS U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (ADMINISTRATION ON AGING) AND FLORIDA DEPARTMENT OF ELDER AFFAIRS CFDA 93.OXX (CSFA 65.010) The supplemental conditions contained in this section are intended to cooperate with, to supplement, and to modify the general conditions and other specifications. In cases of disagreement with any other section of this contract, the Supplemental Conditions shall govern. Contractor means an entity that receives a contract. The services performed by the awarded Contractor shall be in compliance with the provisions of Title 45 CFR Part 75; and/, 2 CFR Part 200; and/or Title 45 Chapter XIII Part 1321 and/or other applicable regulations. It shall be the awarded Contractor's responsibility to acquire and utilize the necessary manuals and guidelines that apply to the work required to complete this project. In general, 1) The contractor (including all subcontractors) must insert these contract provisions in each lower tier contracts (e.g. subcontract or sub -agreement); 2) The contractor (or subcontractor) must incorporate the applicable requirements of these contract provisions by reference for work done under any purchase orders, rental agreements and other agreements for supplies or services; 3) The prime contractor is responsible for compliance with these contract provisions by any subcontractor, lower -tier subcontractor or service provider. FEDERAL STATUTORY AUTHORITY Older Americans Act of 1965 (OAA), as amended (42 U.S.0 § 3001 et seq., as amended by Public Law 114-144; 106-501; Section 20.41) OLDER AMERICANS ACT PROGRAM FUNDS OAA Title III B - Supportive Services; OAA, Title III, Section 307(a)(10) Title 45 Public Welfare (45 CFR 1321) Chapter XIII Office of Human Development Services, Department of Health and Human Services Part 1321.65 Grants to State and Community Programs on Aging; Part 1321.67 Service Contributions FLORIDA STATUTORY AUTHORITY TITLE XXX (Social Welfare); Chapter 430 (Elder Affairs) CONTRACT COMPLIANCE OVERVIEW Under the Florida Department of Elder Affairs Older Americans Act, the contractor must comply with the contract documentation, conform to state and AAA policies, and comply with federal and state statutory and regulatory requirements. (Ref. - Department of Elder Affairs Programs and Services Handbook, Chapter 4, Page 22; July 2018: Older Americans Act.). The contractor will comply with the intent of Title III to provide for formula grants to State agencies on aging to stimulate the development or enhancement of comprehensive and coordinated community -based systems resulting in a continuum of services to older persons with special emphasis on older individuals with the greatest economic or social need, with particular attention to low-income minority individuals. (Ref. - Title 45 CFR 1321) FCP-1 7/16/2021 2:56 PM p. 26 Collier County Solicitation 18-7470S EXHIBIT LA FEDERAL CONTRACT PROVISIONS U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES FEDERAL CONTRACT PROVISIONS Administrative, Contractual, or Legal Remedies (Ref. 41 U.S.C. 1908, 2 CFR § 200 Appendix II (A) Unless otherwise provided in this contract, all claims, counter -claims, disputes and other matters in question between the local government and the contractor, arising out of or relating to this contract, or the breach of it, will be decided by arbitration, if the parties mutually agree, or in a Florida court of competent jurisdiction. Access to Records and Reports (Reference: 2 CFR § 200.333, 2 CFR § 200.336) The contractor/vendor agrees to maintain all books, records, accounts and reports required under this contract for a period of not less than three years after the date of termination or expiration of this contract, except in the event of litigation or settlement of claims arising from the performance of this contract, in which case the Contractor agrees to maintain same until the Purchaser, the Grantor Administrator, the Comptroller General, or any of their duly authorized representatives, have disposed of all such litigation, appeals, claims or exceptions related thereto. Furthermore, the County shall maintain written policies and procedures for computer system backup and recovery and shall have the same requirement of its Contractors. Byrd Anti -Lobbying Amendment (31 U.S.C. 1352) (Reference 2 CFR § 200 Appendix II (J) Vendors must certify it will not and has not used Federal appropriated funds have been paid or will be paid, by or to any person or organization for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. The certification includes any lobbying with non -Federal funds that takes place in connection with obtaining any Federal award. Civil Rights Compliance The contractor or a subcontractor who is the recipient of Federal funds (or assumes others with whom it arranges to provide services or benefits in connection with any of its programs and activities or assures others with whom it arranges to provide services or benefits to participants or employees) must comply with Title VI of the Civil Rights Act of 1964, which prohibits discrimination on the basis of race, color, or national origin (45 CFR 80), and Statutes and Regulations enforced by the Office of Civil Rights, U.S. Department of Health and Human Services, as follow: Section 504 of the Rehabilitation Act of 1973, as amended (29 USC § 794), prohibits discrimination against otherwise qualified individuals on the basis of disability in programs and activities receiving financial assistance from HHS 45 CFR 84 and/or programs or activities conducted by HHS 45 CFR 85 in the provision of benefits and under the ADA that does not: a. Exclude a person with a disability from a program or activity; b. Deny a person with a disability the benefits of a program or activity; c. Afford a person with a disability an opportunity to participate in or benefit from a benefit or service that is not equal to what is afforded others; d. Provide a benefit or service to a person with a disability that is not as effective as what is provided others; e. Provide different or separate benefits or services to a person with a disability unless necessary to provide benefits or services that are as effective as what is provided others; or, £ Apply eligibility criteria that tend to screen out persons with disabilities unless necessary for the provision of the service, program or activity. FCP-2 7/16/2021 2:56 PM p. 27 Collier County Solicitation 18-7470S EXHIBIT LA FEDERAL CONTRACT PROVISIONS Section 508 of the Rehabilitation Act of 1973, as amended, (29 USC § 794(d)) prohibits discrimination on the basis of disability in electronic and information technology as they relate to programs and activities conducted by HHS. The Age Discrimination Act of 1975, as amended (42 USC § 6101) prohibits discrimination on the basis of age in programs or activities receiving Federal financial assistance 45 CFR 90; and/or programs or services receiving HHS financial assistance 45 CFR 91; Title II of the Americans with Disabilities Act (28 CFR Part 35), relating to Nondiscrimination on the Basis of Disability in State and Local Government Services 2010 ADA Standards for Accessible Design; The Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §290 dd-3 and 290 ee 3), as amended, as relating to confidentiality of alcohol and drug abuse patient records; Section 1908 of the Public Health Service Act (42 USC § 300w-7) prohibits discrimination on the basis of age, race, color, national origin, disability, sex (gender), or religion in programs, services, and activities funded by Preventative Health and Health Services Block Grants. Federal Health Care Conscience Protection Statutes (42 USC § 300a-7; 42 USC § 300a-7; 42 USC § 238n and the Weldon Amendment (Continuing Appropriations Resolution, Pub. L. No. 113-164, Sec. 101(a) (Sept. 19, 2015); Regulation for the Enforcement of Federal Health Care Provider Conscience Protection Laws, which prohibit recipients of certain Federal funds from discriminating against certain health care providers who refuse to participate in certain health care services on religious or moral grounds. Section 1557 of the Affordable Care Act prohibits discrimination on the basis of disability by entities that operate a health program or activity. 45 CFR 80. The contractor must have on file an assurance that the program will be conducted in compliance with all nondiscriminatory provisions as required in 45 CFR 80. Debarment and Suspension (Reference 2 CFR § 200 Appendix II (I) Contract awards that exceed the small purchase threshold and certain other contract awards shall not be made to parties listed on the government wide Excluded Parties List System in the System for Award Management (SAM), in accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR Part 1986 Comp., p. 189) and 12689 (3 CFR Part 1989 Comp., p. 235), "Debarment and Suspension." The Excluded Parties List System in SAM contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549. The successful bidder, by administering each lower tier subcontract that exceeds $25,000 as a "covered transaction", must verify each lower tier participant of a "covered transaction" under the project is not presently debarred or otherwise disqualified from participation in this federally assisted project. The Contractor shall comply with these provisions before doing business or entering into subcontracts receiving federal funds pursuant to this contract. The Contractor shall complete and sign the Certifications and Assurances Attachment prior to the execution of this contract. Diversity (Reference 2 CFR § 200.321) The County is dedicated to fostering the continued development and economic growth of small, minority-, women-, and service -disabled veteran business enterprises. All contracting and subcontracting opportunities afforded by this solicitation/contract are strongly encouraged to contribute as both Contractors and Sub - Contractors. Firms may be required to submit documentation addressing diversity and describing the efforts being made to encourage the participation of small, minority-, women-, and service -disabled veteran business enterprises. Information on Certified Minority Business Enterprises (CMBE) and Certified Service -Disabled Veteran Business Enterprises (CSDVBE) is available from the Office of Supplier Diversity at: http://dms.Inyflorida.com/other programs/office of supplier diversity osd/ FCP-3 7/16/2021 2:56 PM p. 28 Collier County Solicitation 18-7470S EXHIBIT LA FEDERAL CONTRACT PROVISIONS Energy Policy and Conservation Act - (Reference 2 CFR § 200 Appendix II (H) The contractor shall comply with any mandatory standards and policies relating to energy efficiency which are contained in the F 1 o r i d a state energy conservation plan issued in compliance with the Energy Policy and Conservation Act (Pub. L. 94-163, 89 Stat. 871, 42 U.S.0 Section 6201) Equal Employment Opportunity (Appendix II, 2 CFR Part 200; Department of Labor 41 CFR Part 60; Dept. of Health and Human Services 45 CFR Part 92, if applicable). The Contractor shall not discriminate against any employee or applicant for employment because of race, age, creed, color, sex or national origin. The Agency will take affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to their race, age, creed, color, sex, or national origin. Such action shall include, but not be limited to, the following: Employment upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. Contractors must insert a similar provision in all subcontracts, except subcontracts for standard commercial supplies or raw materials. E-verify, Presidential Executive Order 12989; Florida Executive Order Number 11-116 Vendors/Contractors/Subcontracts: 1. Agree to utilize the U.S. Department of Homeland Security's E-verify system to verify the employment of all new employees hired by Contractor during the contract term; and 2. Contractor shall include in related subcontracts a requirement that Subcontractors performing work or providing services pursuant to the state contract utilize the E-verify system to verify employment eligibility of all new employees hired by the Subcontractor during the contract term. The HIPAA Privacy Rules, 4 CFR Part 160 and Subparts A and E of part 164 The Third Party subrecipient will comply with HIPAA requirements to appropriate safeguards to protect the privacy of personal health information, and sets limits and conditions on the uses and disclosures that may be made of such information without patient authorization. No Government Obligation to Third Parties - The Federal Government is not a party to this contract and is not subject to any obligations or liabilities to the non -Federal entity, contractor, or any other party pertaining to any matter resulting from the contract." Procurement of Recovered Materials (Reference 2 CFR § 200.323) Contractor and subcontractor agree to comply with Section 6002 of the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act, and the regulatory provisions of 40 CFR Part 247. (1) In the performance of this contract, the Contractor shall make maximum use of products containing recovered materials that are EPA designated items unless the product cannot be acquired (i) Competitively within a timeframe providing for compliance with the contract performance schedule; (ii) Meeting contract performance requirements; or (iii) At a reasonable price. (2) Information about this requirement is available at EPA's Comprehensive Procurement Guidelines web sitehttp://www.epa.gov/. The list of EPA -designate items is available at https://www.epa.gov/smm/comprehensive-procurement-guideline-cpg-program. Program Fraud and False or Fraudulent Statements of Related Acts The contractor acknowledges that 31 U.S.C. Chap. 38 (Administrative Remedies for False Claims and Statements) applies to the contractor's actions pertaining to this contract. Termination for Cause and Convenience See County's Standard Terms and Conditions. Trafficking in Persons The Contractor and subcontractors shall comply with Title 2 CFR Part 175 and 2 CFR § 175.15 provisions applicable to a private entity, as defined in 2 CFR 175.25. FCP-4 7/16/2021 2:56 PM p. 29 Collier County Solicitation 18-7470S EXHIBIT LA FEDERAL CONTRACT PROVISIONS Transparency Act Unless exempt under 2 CFR § 170.11 O(b), the Contractor shall comply with the reporting requirements of the Transparency Act as expressed in 2 CFR Part 170. Clean Air Act and Federal Water Pollution Control Act (Reference: 2 CFR § 200 Appendix II (G)) Contracts and subgrants of amounts in excess of $150,000 shall contain a provision that requires the Contractor or recipient to comply with all applicable standards, orders, or requirements issued pursuant to Section 306 of the Clean Air Act as amended (42 U.S.C. 7401-7671q.), Executive Order 11738, as amended, where applicable, the Federal Water Pollution Control Act as amended (33 U.S.C. 1251-1387), and Environmental Protection Agency regulations 2 CFR Part 1500. The Contractor shall report any violations of the above to the Federal awarding agency and the Regional Office of the Environmental Protection Agency (EPA). Unlawful Employment of Aliens (Reference Immigration and Nationality Act (8 U.S.C. § 1324a) and the Immigration Reform and Control Act of 1986 (8 U.C. § 1101) (a) Making Employment of Unauthorized Aliens Unlawful (1) In General It is unlawful for a person or other entity— (A) to hire, or to recruit or refer for a fee, for employment in the United States an alien knowing the alien is an unauthorized alien (as defined in subsection (h)(3)) with respect to such employment. (2) Continuing Employment It is unlawful for a person or other entity, after hiring an alien for employment in accordance with paragraph (1), to continue to employ the alien in the United States knowing the alien is (or has become) an unauthorized alien with respect to such employment. Such violation will be cause for unilateral cancellation of this contract by the Federal awarding Agency. Prohibition on Certain Telecommunications and Video Surveillance Services or Equipment (2 CFR § 200.216) The Federal awarding agency prohibits the County to enter into a contract to procure or obtain equipment, services or systems that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. As described in Public Law 115-232, section 889, covered telecommunications equipment is telecommunications equipment produced by Huawei Technologies Company or ZTE Corporation (or any subsidiary or affiliate of such entities). (i) For the purpose of public safety, security of government facilities, physical security surveillance of critical infrastructure, and other national security purposes, video surveillance and telecommunications equipment produced by Hytera Communications Corporation, Hangzhou Hikvision Digital Technology Company, or Dahua Technology Company (or any subsidiary or affiliate of such entities). (ii) Telecommunications or video surveillance services provided by such entities or using such equipment. (i)(iii) Telecommunications or video surveillance equipment or services produced or provided by an entity that the Secretary of Defense, in consultation with the Director of the National Intelligence or the Director of the Federal Bureau of Investigation, reasonably believes to be an entity owned or controlled by, or otherwise connected to, the government of a covered foreign country. (b) In implementing the prohibition under Public Law 115-232, section 889, subsection (f), paragraph (1), heads of executive agencies administering loan, grant, or subsidy programs shall prioritize available funding and technical support to assist affected businesses, institutions and organizations as is reasonably necessary for those affected entities to transition from covered communications equipment and services, to procure replacement equipment and services, and to ensure that communications service to users and customers is sustained. (c) See Public Law 115-232, section 889 for additional information. Domestic Preference for Procurements (2 CFR § 200.322) (a) As appropriate and to the extent consistent with law, the non -Federal entity should, to the greatest extent practicable under a Federal award, provide a preference for the purchase, acquisition, or use of goods, products, FCP-5 7/16/2021 2:56 PM p. 30 Collier County Solicitation 18-7470S EXHIBIT LA FEDERAL CONTRACT PROVISIONS or materials produced in the United States (including but not limited to iron, aluminum, steel, cement, and other manufactured products). The requirements of this section must be included in all subawards including all contracts and purchase orders for work or products under this award. (b) For purposes of this section: (1) "Produced in the United States" means, for iron and steel products, that all manufacturing processes, from the initial melting stage through the application of coatings, occurred in the United States. (2) "Manufactured products" means items and construction materials composed in whole or in part of non-ferrous metals such as aluminum; plastics and polymer based products such as polyvinyl chloride pipe; aggregates such as concrete; glass, including optical fiber; and lumber. STATE CONTRACT PROVISIONS Administrative Procedures Act, Section 120.57(2), F.S. Additional procedures for particular cases. In a matter initiated as a result of agency action proposing to determine the substantial interests of a party, the party's timely petition for hearing may challenge the proposed agency action based on a rule that is an invalid exercise of delegated legislative authority or based on an alleged unadopted rule. Data Integrity and Safeguarding Information, Uniform Electronic Transaction Act, Section 668.50, F.S.; Public Records Law, Chapter 119, Section 29, F.S The Contractor shall ensure an appropriate level of data security for the information the Contractor is collecting or using in the performance of this contract. An appropriate level of security includes approving and tracking all Contractor employees that request system or information access and ensuring that user access has been removed from all terminated employees. The Contractor, among other requirements, must anticipate and prepare for the loss of information processing capabilities. All data and software shall be routinely backed up to ensure recovery from losses or outages of the computer system. The security over the backed -up data is to be as stringent as the protection required of the primary systems. The Contractor shall ensure all Subcontractors maintain written procedures for computer system backup and recovery. The Contractor shall complete and sign the Certification Regarding Data Integrity Compliance for Agreements, Grants, Loans, and Cooperative Agreements prior to the execution of this contract. Discriminatory Vendors List, Section 287.134, F.S. In accordance with Section 287.134, Florida Statutes, an entity or affiliate who has been placed on the discriminatory vendor list may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to a public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity, and may not transact business with any public entity. Equal Employment Opportunity The Contractor shall not discriminate against any employee or applicant for employment because of race, age, creed, color, sex or national origin. The Agency will take affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to their race, age, creed, color, sex, or national origin. Such action shall include, but not be limited to, the following: Employment upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. Contractors must insert a similar provision in all subcontracts, except subcontracts for standard commercial supplies or raw materials. Interest of Members of Congress No member of or delegate to the Congress of the United States shall be admitted to any share or part of this contract or to any benefit arising therefrom. FCP-6 7/16/2021 2:56 PM p. 31 Collier County Solicitation 18-7470S EXHIBIT LA FEDERAL CONTRACT PROVISIONS Interest of Public Officials No member, officer, or employee of the public body or of a local public body during his tenure or for two years thereafter shall have any interest, direct or indirect, in this contract or the proceeds thereof. For purposes of this provision, public body shall include municipalities and other political subdivisions of States; and public corporations, boards, and commissions established under the laws of any State. No member, officer, or employee of the MPO or of a local public body during his tenure or for two years thereafter shall have any interest, direct or indirect, in this contract or the proceeds thereof. Inspections (Meals) The Contractor must agree to notify the Nutrition Provider within 24 hours of any sanitation inspection and provide a copy of the report. Inspector General Cooperation, Section 20.055(5), F.S. The Parties agree to comply with Section 20.055(5), Florida Statutes, for the inspector general to have access to any records, data and other information deemed necessary to carry out his or her duties and incorporate into all subcontracts the obligation to comply with Section 20.055(5), Florida Statutes. Lobbying No funds received pursuant to this Agreement may be expended for lobbying the Legislature, the judicial branch or a state agency. Computer Use and Social Media Policy The Florida Department of Elder Affairs has implemented a Social Media Policy, in addition to its Computer Use Policy, which applies to all employees, contracted employees, consultants, OPS and volunteers, including all personnel affiliated with third parties, such as, but not limited to, contractors and subcontractors. Any entity that uses the Department's computer resource systems must comply with the Department's policy regarding social media. Social Media includes, but is not limited to blogs, podcasts, discussion forums, Wikis, RSS feeds, video sharing, social networks like MySpace, Facebook and Twitter, as well as content sharing networks such as flickr and YouTube. This policy is available on the Department's website at: http://elderaffairs.state.fl.us/doea/financial.php. Public Entity Crime Pursuant to Section 287.133, F.S., a person or affiliate who has been placed on the Convicted Vendor List following a conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the construction or repair of a public building or public work; may not submit bids, proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a Contractor, Supplier, Subcontractor, or Consultant under a contract with any public entity; and may not transact business with any public entity in excess of the threshold amount 7.017, F.S., for CATEGORY TWO for a period of thirty six (36) months following the date of being placed on the Convicted Vendor List. FCP-7 7/16/2021 2:56 PM p. 32 Collier County Solicitation 18-7470S EXHIBIT 1.13 GRANT CERTIFICATIONS AND ASSURANCES GRANT CERTIFICATIONS AND ASSURANCES THE FOLLOWING DOCUMENTS NEED TO BE RETURNED WITH SOLICITATION DOCUMENTS BY DEADLINE TO BE CONSIDERED RESPONSIVE. Page Certification and Form GCA 2-6 Attachment III - Certifications and Assurances (A-J-) A. Debarment and Suspension Certification (29 CFR Part 95 and 45 CFR Part 75) B. Certification Regarding Lobbying (29 CFR Part 93 and 45 CFR Part 93) C. Nondiscrimination & Equal Opportunity Assurance (29 CFR Part 37 and 45 CFR Part 80) D. Certification Regarding Public Entity Crimes, section 287.133. F.S. E. Association of Community Organizations for Reform Now (ACORN) Funding Restrictions Assurances (Pub. L. I I1-117) F. Scrutinized Companies Lists and No Boycott of Israel Certification, section 287.135. F.S. G. Certification Regarding Data Integrity Compliance for Contracts, Agreements, Grants, Loans and Cooperative Agreements H. Verification of Employment Status Certification I. Records and Documentation J. Certification Regarding Inspection of Public Records GCA - 7-9 Attachment IV — Assurances Non -Construction Programs GCA -10-13 Attachment V — Civil Rights Compliance Checklist GCA - 14 Attachment VII — Background Screening Affidavit of Compliance - Employer GCA - 15 Conflict of Interest Certification GCA - 16 Anticipated DBE, MIWBE or VETERAN Participation Statement GCA - 17 Bid Opportunity List for Commodities and Contractual Services and Professional Consultant Services GCA - 18 Acknowledgement of Terms, Conditions, and Grant Clauses 7/16/2021 2:56 PM GCA- I p. 33 Collier County Solicitation 18-7470S ATTACHMENT III CERTIFICATIONS AND ASSURANCES Agency will not award this Contract unless Contractor completes this CERTIFICATIONS AND ASSURANCES. In performance of this contract, Contractor provides the following certifications and assurances: B. Certification Regarding Lobbying (29 CFR Part 93 and 45 CFR Part 931 C. Nondiscrimination & Equal OUportunity Assurance (29 CFR Part 37 and 45 CFR Part80) D. Certification Regarding Public Entity Crimes. section 287,133. F.S. F. Scrutinized Companies Lists and No Boycott of Israel Certification. section 287,135. F.S. G. Certification Regarding Data Integrity Compliance for Contracts. Agreements. Grants. Loans. and Cooperative Agreements H. Verification of Em llooyment Status Certification L Records and Documentation J. Certification Regarding Inspection of Public Records A. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS — PRIMARY COVERED TRANSACTION. The undersigned Contractor certifies, to the best of its knowledge and belief, that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by a Federal department or agency; 2. Have not within a three-year period preceding this Contract been convicted or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; 3. Are not presently indicted or otherwise criminally or civilly charged by a government entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph A.2. of this certification; and/or 4. Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State, or local) terminated for cause of default. The undersigned shall require that language of this certification be included in the documents for all subcontracts at all tiers (including subcontracts, sub -grants, and contracts under grants, loans, and cooperative agreements) and that all sub -recipients and contractors shall provide this certification accordingly. GCA-2 7/16/2021 2:56 PM p. 34 Collier County Solicitation 18-7470S EXH. LB GRANT ASSURANCES AND CERTIFICATIONS B. CERTIFICATION REGARDING LOBBYING — CERTIFICATION FOR CONTRACTS, GRANTS, LOANS, AND COOPERATIVE AGREEMENTS. The undersigned Contractor certifies, to the best of its knowledge and belief, that: No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of Congress or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or employee of a Member of Congress in connection with a Federal contract, grant, loan, or cooperative agreement, the undersigned shall also complete and submit Standard Form — LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. The undersigned shall require that language of this certification be included in the documents for all subcontracts at all tiers (including subcontracts, sub -grants, and contracts under grants, loans, and cooperative agreements) and that all sub -recipients and contractors shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this Contract was made or entered into. Submission of this certification is a prerequisite for making or entering into this Contract imposed by 31 U.S.C. 1352. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. C. NON- DISCRIMINATION & EQUAL OPPORTUNITY ASSURANCE (29 CFR PART 37 AND 45 CFR PART 80). - As a condition of the Contract, Contractor assures that it will comply fully with the nondiscrimination and equal opportunity provisions of the following laws: 1. Section 188 of the Workforce Investment Act of 1998 (WIA), (Pub. L. 105-220), which prohibits discrimination against all individuals in the United States on the basis of race, color, religion, sex, national origin, age, disability, political affiliation, or belief, and against beneficiaries on the basis of either citizenship/status as a lawfully admitted immigrant authorized to work in the United States or participation in any WIA Title I -financially assisted program or activity. 2. Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 80), to the end that, in accordance with Title VI of that Act and the Regulation, no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Agency. 3. Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-112), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 84), to the end that, in accordance with Section 504 of that Act and the Regulation, no otherwise qualified handicapped individual in the United States shall, solely by reason of his handicap, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Agency. GCA-3 7/16/2021 2:56 PM p. 35 Collier County Solicitation 18-7470S EXH. 1.13 GRANT ASSURANCES AND CERTIFICATIONS 4. The Age Discrimination Act of 1975 (Pub. L. 94-135), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 91), to the end that, in accordance with the Act and the Regulation, no person in the United States shall, on the basis of age, be denied the benefits of, be excluded from participation in, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Agency. 5. Title IX of the Education Amendments of 1972 (Pub. L. 92-318), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 86), to the end that, in accordance with Title IX and the Regulation, no person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any education program or activity for which the Applicant receives Federal financial assistance from the Agency. 6. The American with Disabilities Act of 1990 (Pub. L. 101-336), which prohibits discrimination in all employment practices, including job application procedures, hiring, firing, advancement, compensation, training, and other terms, conditions, and privileges of employment. It applies to recruitment, advertising, tenure, layoff, leave, fringe benefits, and all other employment -related activities. 7. Contractor also assures that it will comply with 29 CFR Part 37 and all other regulations implementing the laws listed above. This assurance applies to Contractor's operation of the WIA Title I — financially assisted program or activity, and to all contracts Contractor makes to carry out the WIA Title I — financially assisted program or activity. Contractor understands that the Agency and/or DOEA and the United States have the right to seek judicial enforcement of the assurance. The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all tiers (including subcontracts, sub -grants, and contracts under grants, loans, and cooperative agreements) and that all sub -recipients and contractors shall provide this assurance accordingly. D. CERTIFICATION REGARDING PUBLIC ENTITY CRIMES, SECTION 287.133, F.S. Contractor hereby certifies that neither it, nor any person or affiliate of Contractor, has been convicted of a Public Entity Crime as defined in section 287.133, F.S., nor placed on the convicted vendor list. Contractor understands and agrees that it is required to inform Agency immediately upon any change of circumstances regarding this status. E. ASSOCIATION OF COMMUNITY ORGANIZATIONS FOR REFORM NOW (ACORN) FUNDING RESTRICTIONS ASSURANCE (Pub. L. 111-117). As a condition of the Contract, Contractor assures that it will comply fully with the federal funding restrictions pertaining to ACORN and its subsidiaries per the Consolidated Appropriations Act, 2010, Division E, Section 511 (Pub. L. 111-117). The Continuing Appropriations Act, 2011, Sections 101 and 103 (Pub. L. 111-242), provides that appropriations made under Pub. L. I I 1-117 are available under the conditions provided by Pub. L. 111-117. The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all tiers (including subcontracts, sub -grants and contracts under grants, loans and cooperative agreements) and that all sub - recipients and contractors shall provide this assurance accordingly. F. SCRUTINIZED COMPANIES LISTS AND NO BOYCOTT OF ISRAEL CERTIFICATION, SECTION 287.135, F.S. In accordance with section 287.135, F.S., Contractor hereby certifies that it has not been placed on the Scrutinized Companies that Boycott Israel List and that it is not participating in a boycott of Israel. GCA-4 7/16/2021 2:56 PM p. 36 Collier County Solicitation 18-7470S EXH. LB GRANT ASSURANCES AND CERTIFICATIONS If this Contract is in the amount of $1 million or more, in accordance with the requirements of section 287.135, F.S., Contractor hereby certifies that it is not listed on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List and that it does not have business operations in Cuba or Syria. Contractor understands that pursuant to section 287.135, F.S., the submission of a false certification may result in the Agency terminating this contract and the submission of a false certification may subject Contractor to civil penalties and attorney fees and costs, including any costs for investigations that led to the finding of false certification. If Contractor is unable to certify any of the statements in this certification, Contractor shall attach an explanation to this Contract. G. CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR CONTRACTS, AGREEMENTS, GRANTS, LOANS, AND COOPERATIVE AGREEMENTS 1. The Contractor and any Subcontractors of services under this contract have financial management systems capable of providing certain information, including: (1) accurate, current, and complete disclosure of the financial results of each grant -funded project or program in accordance with the prescribed reporting requirements; (2) the source and application of funds for all contract supported activities; and (3) the comparison of outlays with budgeted amounts for each award. The inability to process information in accordance with these requirements could result in a return of grant funds that have not been accounted for properly. 2. Management Information Systems used by the Contractor, Subcontractors, or any outside entity on which the Contractor is dependent for data that is to be reported, transmitted, or calculated have been assessed and verified to be capable of processing data accurately, including year -date dependent data. For those systems identified to be non -compliant, Contractors will take immediate action to assure data integrity. 3. If this contract includes the provision of hardware, software, firmware, microcode, or imbedded chiptechnology, the undersigned warrants that these products are capable of processing year -date dependent data accurately. All versions of these products offered by the Contractor (represented by the undersigned) and purchased by the state will be verified for accuracy and integrity of data prior to transfer. 4. In the event of any decrease in functionality related to time and date related codes and internal subroutines that impede the hardware or software programs from operating properly, the Contractor agrees to immediatelymake required corrections to restore hardware and software programs to the same level of functionality as warranted herein, at no charge to the state, and without interruption to the ongoing business of the state, time being of the essence. 5. The Contractor and any Subcontractors of services under this contract warrant that their policies and procedures include a disaster plan to provide for service delivery to continue in case of an emergency, including emergencies arising from data integrity compliance issues. H. VERIFICATION OF EMPLOYMENT STATUS CERTIFICATION As a condition of contracting with the Agency, Contractor certifies the use of the U.S. Department of Homeland Security's E-verify system to verify the employment eligibility of all new employees hired by Contractor during the contract term to perform employment duties pursuant to this contract, and that any subcontracts include an express requirement that Subcontractors performing work or providing services pursuant to this Contract utilize the E-verify system to verify the employment eligibility of all new employees hired by the Subcontractor during the entire contract term. GCA-5 7/16/2021 2:56 PM p. 37 Collier County Solicitation 18-7470S I:0Z4-Hill: eI;7:,1.Yr:VY.Y81:7:1►[a14=3: 193mi The Contractor shall require that the language of this certification be included in all sub -agreements, sub -grants, and other agreements/contracts and that all Subcontractors shall certify compliance accordingly. This certification is a material representation of fact upon which reliance was placed when this Contract was made or entered into. Submission of this certification is a prerequisite for making or entering into this Contract imposed by Circulars A-102 and 2 CFR Part 200 and 215 (formerly OMB Circular A-110). I. RECORDS AND DOCUMENTATION The Contractor agrees to make available to Agency staff and/or any party designated by the Agency any and all contract related records and documentation. The Contractor shall ensure the collection and maintenance of all program related information and documentation on any such system designated by the Agency. Maintenance includes valid exports and backups of all data and systems according to Agency standards. J. CERTIFICATION REGARDING INSPECTION OF PUBLIC RECORDS In addition to the requirements of sections 10.1 and 10.2 of the Standard Contract, sections 119.0701(3) and (4) F.S., and any other applicable law, if a civil action is commenced as contemplated by section 119.0701(4), F.S., and the Agency is named in the civil action, Contractor agrees to indemnify and hold harmless the Agency for any costs incurred by the Agency and any attorneys' fees assessed or awarded against the Agency from a Public Records Request made pursuant to Chapter 119, F.S., concerning this contract or services performed thereunder. a. Notwithstanding section 119.0701, F.S., or other Florida law, this section is not applicable to contracts executed between the Agency and state agencies or subdivisions defined in section 768.28(2), F.S. 2. Section 119.01(3), F.S., states if public funds are expended by an agency in payment of dues or membership contributions for any person, corporation, foundation, trust, association, group, or other organization, all the financial, business, and membership records of such an entity which pertain to the public agency (Area Agency on Aging for Southwest Florida, Inc.) are public records. Section 119.07, F.S, states that every person who has custody of such a public record shall permit the record to be inspected and copied by any person desiring to do so, under reasonable circumstances. Additionally, I certify this organization does does notXprovide for institutional memberships. Contractor's signature below attests that records pertaining to the dues or membership application by the Agency are available for inspection if applicable, as stated above. By execution of this contract, Contractor must include these provisions (A-J) in all related subcontract agreements (if applicable). By signing below, Contractor certifies that the representations outlined in parts A through J above are true and correct. Davie.(. D CFO 5600 Bee Ridge Rd. Suite B Signature and Title of Authorized Representative Street Address A Better Solution 8/4/2021 Sarasota, FL 34233 Contractor Date City, State, Zip code GCA-6 7/16/2021 2:56 PM p. 38 I�:N:U:3MI�w:3 Collier County Solicitation 18-7470S 10911'd11I[y11:41M111[�1:741M100► =11121RX.,V3Y81:7:V141Q.61 ATTACHMENT IV ASSURANCES--NON-CONSTRUCTION PROGRAMS Public reporting burden for this collection of information is estimated to average forty-five (45) minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget. Paperwork Reduction Project (0348-0043), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET, SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. Note: Certain of these assurances may not be applicable to your project or program. If you have questions please contact the awarding agency. Further, certain federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. 1. Has the legal authority to apply for federal assistance, and the institutional, managerial and financial capability (including funds sufficient to pay the non-federal share of project cost) to ensure proper planning, management, and completion of the project described in this application. 2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the state, throughany authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives. 3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain. 4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency. 5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. §4728-4763) relating to prescribed standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F). Will comply with all federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. §6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title V11I of the Civil Rights Act of 1968 (42 U.S.C. §3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for federal assistance is being made; and 0) the requirements of any other nondiscrimination statute(s) which may apply to the application. GCA-7 7/16/2021 2:56 PM p. 39 Collier County Solicitation 18-7470S we) :1:\21I[y11:141111[�1:rI111000 1112Ml7.'V331:7:V141Q.61 7. Will comply, or has already complied, with the requirements of Titles I1 and III of the uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of federal or federally assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of federal participation inpurchases. 8. Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C. §1501-1508 and 7324-7328), which limit the political activities of employees whose principal employment activities are funded in whole or in part with federal funds. 9. Will comply, as applicable, with the provisions of the Davis -Bacon Act (40 U.S.C. §276a to 276a-7), the Copeland Act (40 U.S.C. 276c and 18 U.S.C. §874) and the Contract Work Hours and Safety Standards Act (40 U.S.C. §327-333), regarding labor standards for federally assisted construction sub -contracts. 10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000.00 or more. 11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. §1451 et seq.); (f) conformity of federal actions to State (Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. §7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-523); and (h) protection of endangered species under the Endangered Species Act of 1973, as amended, (P.L. 93-205). 12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. §1721 et seq.) related to protecting components or potential components of the national wild and scenic rivers system. 13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. §470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. §469a-1 et seq.). 14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and related activities supported by this award of assistance. 15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. §2131 et seq.) pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities supported by this award of assistance. 16. Will comply with the Lead -Based Paint Poisoning Prevention Act (42 U.S.C. §4801 et seq.), which prohibits the use of lead- based paint in construction or rehabilitation of residence structures. GCA-8 7/16/2021 2:56 PM p. 40 Collier County Solicitation 18-7470S Cep:7:��M1[�1�1:71YIYI[���II.`1_\�IY7_`.XYYl7_�[�.y 17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and 2 CFR Part 200. 18. Will comply with all applicable requirements of all other federal laws, executive orders, regulations and policies governing this program. SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE Dav�,i,el. D CFO APPLICANT ORGANIZATION DATE SUBMITTED 8/4/2021 A Better Solution GCA-9 7/16/2021 2:56 PM p. 41 EXHIBIT 1.B /ATTACHMENT V Collier County Solicitation 18-7470S STATE OF FLORIDA DEPARTMENT OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE CHECKLIST Program/Facility Name: County: AAA/Contractor A Better Solution Collier Address: Completed By: 5600 Bee Ridge Rd. Suite B Barbara Cogswell City, State, Zip Code: Sarasota, FL 34233 Date: 8/3/2021 Telephone: 941-906-1881 PART I: READ THE ATTACHED INSTRUCTIONS FOR ILLUSTRATIVE INFORMATION WHICH WILL HELP YOU COMPLETE THIS FORM. 1. Briefly describe the geographic area served by the program/facility and the type of service provided: Polk, Manatee, Sarasota, Charlotte, Lee, Collier Counties For questions 2-5, please indicate the following: Total # White Black Hispanic Other Female Disabled Over 40 2.Population of area served Source of data 433,742 82.8 4.7 9.6 2.9 52.4 8.4 3.Staff currently employed Source of data 150 29 58 9 4 88 1 4.Clients currently enrolled/registered Source of data 5.Advisory/Governing Board if applicable Source of data PART II: USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE. 1. Is an Assurance of Compliance on file with DOEA? N/A ❑ YES N NO ❑ 2. Compare the staff composition to the population. Is staff representative of the population? N/A ❑ YES X NO ❑ 3. Are eligibility requirements for services applied to clients and applicants without regard to race, color, national origin, sex, age, religion or disability? N/A ❑ YES YMN NO ❑ 4. Are all benefits, services and facilities available to applicants and participants in an equally effective manner regardless of race, sex, color, age, national origin, religion or disability? N/A ❑ YES NO ❑ 5. For in -patient services, are room assignments made without regard to race, color, national origin or disability? N/A YES ❑ NO ❑ 6. Is the program/facility accessible to non-English speaking clients? N/A ❑ YES NO ❑ 7. Are employees, applicants and participants informed of their protection against discrimination? If YES, how? Verbal X Written X Posterx N/❑A YES N❑O 8. Give the number and current status of any discrimination complaints regarding services or employment filed against the program/facility. N/A NUMBER 0 1 7/16/2021 2:56 PM p. 42 GCA -10 EXHIBIT LB/ATTACHMENT V Collier County Solicitation 18-7470S 9. Is the program/facility physically accessible to mobility, hearing, and sight -impaired individuals? N/A X YES NO ❑ ❑ PART III: THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15 OR MORE EMPLOYEES. IF NO EXPLAIN 10. Has a self -evaluation been conducted to identify any barriers to serving disabled individuals, and to make any necessary modifications? YES NO X ❑ 11. Is there an established grievance procedure that incorporates due process in the resolution of complaints? YES X NO ❑ 12. Has a person been designated to coordinate Section 504 compliance activities? YES ,rs.xL NO El 13. Do recruitment and notification materials advise applicants, employees and participants of nondiscrimination on the basis of disability? YES X NO ❑ 14. Are auxiliary aids available to assure accessibility of services to hearing and sight -impaired individuals? YES NO PART IV: FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF $50,000.00 MORE. 15. Do you have a written affirmative action plan? If NO, explain. YES X❑ OR NO e text here DOEA USE ONLY Reviewed By In Compliance: YES ❑ NO* ❑ Program Office *Notice of Corrective Action Sent Date Telephone Response Due / / On -Site ❑ Desk Review ❑ Response Received / /_ Revised August 2010, Page 2 of 2 GCA - 11 2 7/16/2021 2:56 PM p. 43 EXHIBIT 1.13 / ATTACHMENT V Collier County INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST Solicitation 18-7470S Describe the geographic service area such as a district, county, city or other locality. If the program/facility serves a specific target population such as adolescents, describe the target population. Also, define the type of service provided. 2. Enter the percent of the population served by race and sex. The population served includes persons in the geographical area for which services are provided such as a city, county or other regional area. Population statistics can be obtained from local chambers of commerce, libraries, or any publication from the 1980 Census containing Florida population statistics. Include the source of your population statistics. ("Other" races include Asian/Pacific Islanders and American Indian/Alaskan Natives.) Enter the total number of full-time staff and their percent by race, sex and disability. Include the effective date of your summary. 4. Enter the total number of clients who are enrolled, registered or currently served by the program or facility, and list their percent by race, sex and disability. Include the date that enrollment was counted. 5. Enter the total number of advisory board members and their percent by race, sex, and disability. If there is no advisory or governing board, leave this section blank. 6. Each recipient of federal financial assistance must have on file an assurance that the program will be conducted in compliance with all nondiscriminatory provisions as required in 45 CFR 80. This is usually a standard part of the contract language for DOEA recipients and their sub -grantees, 45 CFR 80.4 (a). 7. Is the race, sex, and national origin of the staff reflective of the general population? For example, if 10% of the population is Hispanic, is there a comparable percentage of Hispanic staff? 8. Where there is a significant variation between the race, sex or ethnic composition of the clients and their availability in the population, the program/facility has the responsibility to determine the reasons for such variation and take whatever action may be necessary to correct any discrimination. Some legitimate disparities may exist when programs are sanctioned to serve target populations such as elderly or disabled persons, 45 CFR 80.3 (b) (6). 9. Do eligibility requirements unlawfully exclude persons in protected groups from the provision of services or employment? Evidence of such may be indicated in staff and client representation (Questions 3 and 4) and also through on -site record analysis of persons who applied but were denied services or employment, 45 CFR 80.3 (a) and 45 CFR 80.1 (b) (2). 10. Participants or clients must be provided services such as medical, nursing and dental care, laboratory services, physical and recreational therapies, counseling and social services without regard to race, sex, color, national origin, religion, age or disability. Courtesy titles, appointment scheduling and accuracy of record keeping must be applied uniformly and without regard to race, sex, color, national origin, religion, age or disability. Entrances, waiting rooms, reception areas, restrooms and other facilities must also be equally available to all clients, 45 CFR 80.3 (b). 11. For in -patient services, residents must be assigned to rooms, wards, etc., without regard to race, color, national origin or disability. Also, residents must not be asked whether they are willing to share accommodations with persons of a different race, color, national origin, or disability, 45 CFR 80.3 (a). 12. The program/facility and all services must be accessible to participants and applicants, including those persons who may not speak English. In geographic areas where a significant population of non-English speaking people live, program accessibility may include the employment of bilingual staff. In other areas, it is sufficient to have a policy or plan for service, such as a current list of names and telephone numbers of bilingual individuals who will assist in the provision of services, 45 CFR 80.3 (a). GCA - 12 7/16/2021 2:56 PM p. 44 EXHIBIT LB /ATTACHMENT V Collier County Solicitation 18-7470S 13. Programs/facilities must make information regarding the nondiscriminatory provisions of Title VI available to their participants, beneficiaries or any other interested parties. This should include information on their right to file a complaint of discrimination with either the Florida Department of Elder Affairs or the U.S. Department of HHS. The information may be supplied verbally or in writing to every individual, or may be supplied through the use of an equal opportunity policy poster displayed in a public area of the facility, 45 CFR 80.6 (d). 14. Report number of discrimination complaints filed against the program/facility. Indicate the basis, e.g., race, color, creed, sex, age, national origin, disability, retaliation; the issues involved, e.g., services or employment, placement, termination, etc. Indicate the civil rights law or policy alleged to have been violated along with the name and address of the local, state or federal agency with whom the complaint has been filed. Indicate the current status, e.g., settled, no reasonable cause found, failure to conciliate, failure to cooperate, under review, etc. 15. The program/facility must be physically accessible to disabled individuals. Physical accessibility includes designated parking areas, curb cuts or level approaches, ramps and adequate widths to entrances. The lobby, public telephone, restroom facilities, water fountains, information and admissions offices should be accessible. Door widths and traffic areas of administrative offices, cafeterias, restrooms, recreation areas, counters and serving lines should be observed for accessibility. Elevators should be observed for door width, and Braille or raised numbers. Switches and controls for light, heat, ventilation, fire alarms, and other essentials should be installed at an appropriate height for mobility impaired individuals. 16. Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance conduct a self - evaluation to identify any accessibility barriers. Self -evaluation is a four step process: a. With the assistance of a disabled individual/organization, evaluate current practices and policies which do not comply with Section 504. b. Modify policies and practices that do not meet Section 504 requirements. c. Take remedial steps to eliminate any discrimination that has been identified. d. Maintain self -evaluation on file. (This checklist may be used to satisfy this requirement if these four steps have been followed.), 45 CFR 84.6. 17. Programs or facilities that employ 15 or more persons must adopt grievance procedures that incorporate appropriate due process standards and provide for the prompt and equitable resolution of complaints alleging any action prohibited by Section 504.45 CFR 84.7 (b). 18. Programs or facilities that employ 15 or more persons must designate at least one person to coordinate efforts to comply with Section 504.45 CFR 84.7 (a). 19. Continuing steps must be taken to notify employees and the public of the program/facility's policy of nondiscrimination on the basis of disability. This includes recruitment material, notices for hearings, newspaper ads, and other appropriate written communication, 45 CFR 84.8 (a). 20. Programs/facilities that employ 15 or more persons must provide appropriate auxiliary aids to persons with impaired sensory, manual or speaking skills where necessary. Auxiliary aids may include, but are not limited to, interpreters for hearing impaired individuals, taped or Braille materials, or any alternative resources that can be used to provide equally effective services, 45 CFR 84.52 (d). 21. Programs/facilities with 50 or more employees and $50,000.00 in federal contracts must develop, implement and maintain a written affirmative action compliance program in accordance with Executive Order 11246, 41 CFR 60 and Title VI of the Civil Rights Act of 1964, as amended. DOEA Form 101-B, Revised August 2010 GCA - 13 7/16/2021 2:56 PM p. 45 BAtLD111.15/AllAl.l]LY1ClV1 Vll Collier County Solicitation 18-7470S DEPARThfENT OF BACKGROUND SCREENING ELDER, AFFAIRSI, Affidavit of Compliance - Employer ST4rE. or rwRIDA AUTHORITY: This form is required annually of all employers to comply with the attestation requirements set forth In section 435.05(3), Florida Statutes. The term "employer" means any person or entity required by law to conduct background screening, including but not limited to, Area Agencies on Aging, Aging Resource Centers, Aging and Disability Resource Centers, Lead Agencies, Long -Term Care Ombudsman Program, Serving Health Insurance Needs of Elders Program, Service Providers, Diversion Providers, and any other person or entity which hires employees or has volunteers in service who meet the definition of a direct service provider. See §§ 435.02, 430.0402, Fla. Stat. A A direct service provider is "a person 18 years of age or older who, pursuant to a program to provide services to the elderly, has direct, face-to-face contact with a client while providing services to the client and has access to the client's living area, funds, personal property, or personal identification information as defined in s. 817.568. The term includes coordinators, managers, and supervisors of residential facilities; and volunteers." § 430.0402(1)(b), Fla. Start. ATTESTATION: As the duly authorized representative of A Better Solution Employer Name located at 5600 Bee Ridge Rd. Suite B Street Address State ZIP code 1 Daniel Dellapina do hereby affirm under penalty of perjury Name of Representative that the above named employer is in compliance with the provisions of Chapter 435 and section 430.0402, Florida Statutes, regarding level 2 background screening. KA/Z2021 Signature of Reoresentative Date STATE OF FLORIDA, COUNTY OFtfz Sworn to (or affirmed) and subscribed before me this 7 day of AUG('�— 20!�L by k"I 4_c— -6 G, LL vA- -PI " Pc (Name of Representative) who is personally known to me or produced %Lc C)-*. I) as proof of identification. �v nuuq MATTHEW CLEARY commisslan800255897 uuyy .,e@' - as September 19, 2022 Print, Type, or stamp commissione,T,v4 frA towdk k lg,Nourys-Nlm Notary Public DDEA Form 235, Affidavit of Compliance - Employer, Effective April 2012 Section 435.05(3), F.S. Form available at: htto://eldemffairs state fl us/english/backeroundscreenina oho 7/16/2021 2:56 PM M Collier County Solicitation 18-7470S EXHIBIT 1.13 18-7470S Collier County Solicitation No. GRANT CERTIFICATIONS AND ASSURANCES COLLIER COUNTY Conflict of Interest Certification I, Daniel Dellapina , hereby certify that to the best of my knowledge, neither I nor my spouse, dependent child, general partner, or any organization for which I am serving as an officer, director, trustee, general partner or employee, or any person or organization with whom I am negotiating or have an arrangement concerning prospective employment has a financial interest in this matter. I further certify to the best of my knowledge that this matter will not affect the financial interests of any member of my household. Also, to the best of my knowledge, no member of my household; no relative with whom I have a close relationship; no one with whom my spouse, parent or dependent child has or seeks employment; and no organization with which I am seeking a business relationship nor which I now serve actively or have served within the last year are parties or represent a party to the matter. I also acknowledge my responsibility to disclose the acquisition of any financial or personal interest as described above that would be affected by the matter, and to disclose any interest I, or anyone noted above, has in any person or organization that does become involved in, or is affected at a later date by, the conduct of this matter. Daniel Dellapina Pa'v� D Name Signature CFO 8/4/2021 Position Date Privacy Act Statement Title I of the Ethics in Government Act of 1978 (5 U.S.C. App.), Executive Order 12674 and 5 CFR Part 2634, Subpart I require the reporting of this information. The primary use of the information on this form is for review by officials of The Justice Department to determine compliance with applicable federal conflict of interest laws and regulations. Additional disclosures of the information on this report may be made: (1) to a federal, state or local law enforcement agency if the Justice Department becomes aware of a violation or potential violation of law or regulations; (2) to a court or party in a court or federal administrative proceeding if the government is a party or in order to comply with a judge -issued subpoena; (3) to a source when necessary to obtain information relevant to a conflict of interest investigation or decision; (4) to the National Archives and Records Administration or the General Services Administration in records management inspections; (5) to the Office of Management and Budget during legislative coordination on private relief legislation; and (6) in response to a request for discovery or for the appearance of a witness in a judicial or administrative proceeding, if the information is relevant to the subject matter. This confidential certification will not be disclosed to any requesting person unless authorized by law. See also the OGE/GOVT-2 executive branch -wide Privacy Act system of records. GCA - 15 7/16/2021 2:56 PM p. 47 Collier County Solicitation 18-7470S EXHIBIT 1.13 GRANT CERTIFICATIONS AND ASSURANCES COLLIER � OIIJNTY ANTICIPATED DISADVANTAGED, MINORITY, WOMEN OR VETERAN PARTICIPATIOI4 STATEMENT status will be verified. Unveri?auest=5es v,.Il regwre M__ PR ME Eo either pro.-ade a reY--d statement or provide source documentation that validates a S-atus. A. PRIME VENDORICO NTRACTOR INFORMATION P11ME NAME FAIF.ME FE D NUMBER CONTRAC'T DOLLL.R AMOUNT Sunshine Health Care Service, LLC 474121839 �5THE PRIME A H-OR;DA-CEATrFIED INSADYANTAGEE7, 'qY-ERAN y N S TbiE ACTIVITV OF THIS cONTRA-CT._ !f INORIFFYOR WONkEN €IU5MESSENTERPRISE? DBET V N CONSTRLFCTION 7 Y N .'9WM6�f 0rEI OR HAVE ASMALLDISADVAhTAGE11 t1U5ME55 CER71F"TI0NFROM THE SMALL BUSINESS MBE' W N CON5ULTATtON? Y N ADMINISTRATION? A5E;I'0CEDISABLED VETERAN.' *BE? 0 N OTHER? Y❑ N SDS SAy N ;S-r,9'-S'CBrt;SSO'tAREVISI,DN'I Y N I F S'_S. REV 5ION NUMBER B. IF MIME HAS 5U6CONTRACTOR OR SUPPLIER WHO IS A 0ISADV,ANTAGED MINORITY, WOMEN -OWNED, SMALL BUSINESS CONCERN OR SERVICE DISABLED VETERAN, PRIME IS TO COMPLETE THIS NEXT SECTION DBE M/100$E S UGC ONTRACTOR OR SUPPLIER TYPE OF WORK OR ET31 NK ITY CIDDE SU B f5UPPLIER YERC,EN'T OF CQNTRACT VEFERA..k NAME SPECMI-Tv See BebowI DOLLAR AMOUNT DOLLARS -L LS C. SECTION To BE COMPLETEO BY PRJME VENDOR/CONTRACTOR NAME OF SUISMFTTER GATE -MLE OFSUBMf7TEA Barbara Cogswell 8/25/2021 CEO/President EMAIL ADDRESS OF PRIME(5UEIMnTER) TELEPHONE NUMMM FUNUMBER BCogswell@abs.care 941-906-1881 941-906-1190 NOTE: This information is used to Luck and report anWpated DBE ar MBE participation in federally-fumled contracts- The antiapated a6E or MBE amount is val uMary and v.ill not become partof the contractual terms- This farm mast be submitted at time of response to a solicitation .f and w hen awarded a County contract, the prime will be asked to update the Information for the grant camptiance ides. ETFtNKTFY eme BIackAmetican 9A Hispanic American HA KativekmenLan RIA, 5ubcont.:alan American SAA Asian-PaCiFicAmerican APA Non-Vinarit.,Women NIAW other: nut oFany after group listed o D. SECTION TO BE COMPLETED BY COLLIER COUNTY DEPARTMENT tiAME COW EF CONTF.-CT e I IF6 `R? P o. PO:'REO'. GPA- iT PP OG PAK1.'CON'TP.AC- ALCEPTED BY_ DATE GCA-16 7/16/2021 2:56 PM p. 48 Collier County Solicitation 18-7470S EXHIBIT 1.13 GRANT CERTIFICATIONS AND ASSURANCES tioLlJE2"WNT, GP.sYr470WLFANCE FORM �Ia OPPORTUNITY LIST FOR CDWAODITIES AND CCWFRALTLIAL SERVICES AND PROFESSIONAL CONSULTANT SiERVKES ft fs tlSepofiryof afW umontyvenda-h usdeff.Aedin t.SeCodeoj Federu0Aegufa6on5 fC AJ or Fforrdo-%cruts F.Smusthawethe o un' tb ortk ateonconbructswth delnfand/orstate rantassitanee_ Prm-ECarltractor/PrimeCurnuktant: Sunshine Health Care Services, LLC Address and Phone Number. 5600 Bee Ridge Rd., Suite B, Sarasota, FL. 34233 941-906-1881 Procurement Number,AiJvertlsement Number: 18-4740S The list below is intended to be it IlAM offimtsthat are: or attempting M, parflripat,e vn the pYojea numbered abwe. The list must hdLtde the firm biddingor quoting as prirw_. a€well as subs and suppliers gtr3ting For participation. prime tantratmrsarid tonsuhtants must provide information for Numbers it 2, 3, and 3, and, siwuld provide airy inform tian they h3•: a For Numbers 5, 6, 7, and'8. 71ris fbrm musk besubmitted with the bid package- 1. FederaF Tax IDPvurrber: 474121839 6. oe€ s. ,annual Gross Receipt, 2. Farm Name: Sunshine Health Care Services, LLC Nart-DBE Less than $ i mftion 3. Phone plumber: 941-906-1881 Between $ 1-5 million a_ Address 5600 Bee Ridge Rd Between S 5-113 aMian Suite B 7. 5ubcontraaw Between S 10-15 million Sarasota FL 34233 5ubccnsuftent hiarethan $ 15mZk3n 5. Year Fum Established: 2015 1. Federal Tax IUHllmber. 6. OB€ 8. Annual Gross ReceipL I. Firm Name: Non -DBE Less than S i mUmn 3. Phone plumber: Between $1-5mWiorr S. Address BetWeen$-5-i4 mdion 7. oDrdractw Between $ 1&15 million aSui SuboorasultanL More than S 15mdli3rL 5. Year Firm Established 1. Federal Tax IDAFumber: 6. f�6€ S. Annual Grass Receipts 2_ Ftm Name'. Noctf3BE Less than $ 1 mifion 3. Phone Riarnber. Bet-meen $1-5 nvlliao 4_ Adctress Between $ 5-14 million 7. Between $ itF15 million aSubcontractor 5ubccrewtent -more than $.5million 5. YeaF Firm Established: 1. Federal Tax Iar4;L1mbET. 6. OE€ a. Annual Gross Receipts x_ Finn Name: a NCR -DBE Less than 5 1 million 3. Phan Number.. Between $ 2-5 million 4_ Ad.dresE Between $ 5-ID million 7. Subxntractor Between $ I -25 million Sub 3rsultant More than $ 13 mil lion 5. Year Firm Establlshed GCA - 17 7/16/2021 2:56 PM p. 49 Collier County Solicitation 18-7470S EXHIBIT 1.13 GRANT CERTIFICATIONS AND ASSURANCES COLLIER COUNTY Acknowledgement of Terms, Conditions, and Grant Clauses Flow Down of Terms and Conditions from the Grant Agreement Subcontracts: If the Contractor subcontracts any of the work required under this Agreement, a copy of the signed subcontract must be available to the County for review and approval. The Contractor agrees to include in the subcontract that (1) the subcontractor is bound by the terms of this Agreement, (ii) the subcontractor is bound by all applicable state and federal laws and regulations, and (iii) the subcontractor shall hold the County and the Grantor Agency harmless against all claims of whatever nature arising out of the subcontractor's performance of work under this Agreement, to the extent allowed and required by law. The County may document in the quarterly report the Contractor's progress in performing its work under this agreement. Certification On behalf of my firm, I acknowledge, and agree to perform all of the specifications and grant requirements identified in this solicitation document(s). Vendor/Contractor Name A Better Solution Authorized Signature Address 5600 Bee Ridge Rd. Suite B Sarasota, FL 34233 Solicitation/Contract # 18-7470S Date 8/4/2021 05/20 R4 GCA - 18 7/16/2021 2:56 PM p. 50 Collier County Solicitation 18-7470S REQUEST FOR PROPOSAL (RFP) INSTRUCTIONS 1. QUESTIONS 1.1 Direct questions related to this Request for Proposal (RFP) to the Collier County Procurement Services Division Online Bidding Systemwebsite: https://www.bidsync.com/bidsync-cas/. 1.2 Proposer/Vendor/Firm must clearly understand that the only official answer or position of the County will be the one stated on the Collier County Procurement Services Division Online Bidding Systemwebsite. For general questions, please call the referenced Procurement Strategist noted on the cover page. 2. PRE -PROPOSAL CONFERENCE (if applicable) 2.1 The purpose of the pre -proposal conference is to allow an open forum for discussion and questioning with County staff regarding the RFP with all prospective vendors having an equal opportunity to hear and participate. Oral questions will receive oral responses, neither of which will be official, nor become part of the RFP. Only written responses to written questions will be considered official, and will be included as part of the RFP as an addendum. 2.2 All prospective vendors are strongly encouraged to attend, as, this will usually be the only pre -proposal conference for this solicitation. If this pre -proposal conference is denoted as "mandatory", prospective Vendors must be present in order to submit a proposal response. 3. COMPLIANCE WITH THE RFP Proposals must be in strict compliance with this RFP. Failure to comply with all provisions of the RFP may result in disqualification. 4. AMBIGUITY, CONFLICT, OR OTHER ERRORS IN THE RFP It is the sole responsibility of the vendor if they discover any ambiguity, conflict, discrepancy, omission or other error in the RFP, to immediately notify the Procurement Professional, noted herein, of such error in writing and request modification or clarification of the document prior to submitting the proposal. The Procurement Professional will make modifications by issuing a written revision and will give written notice to all parties who have received this RFP fromthe Procurement Services Division. 5. ADDENDA The County reserves the right to formally amend and/or clarify the requirements of the solicitation where it deems necessary. Any such addendum/clarification shall be in writing and notifications shall be distributed electronically to all parties who received the original RFP prior to the deadline for submission of proposals. All changes to this RFP will be conveyed electronically through a notice of addendum or questions and answers to all Vendors registered under the applicable commodity code(s) at the time when the original RFP was released, as well as those Vendors who downloaded the RFP document. All addendums are posted on the Collier County Procurement Services Division Online Bidding System website: https://www.bidsync.com/bidsync-cas/. Before submitting a proposal, please make sure that you have read all documents provided, understood clearly and complied completely with any changes stated in the addenda as failure to do so may deeming your submittal non -responsive. 6. PROPOSALS, PRESENTATIONS, AND PROTEST COSTS The County will not be liable in any way for any costs incurred by any Vendor in the preparation of its proposal in response to this RFP, nor for the presentation of its proposal and/or participation in any discussions, negotiations, or, if applicable, any protest procedures. 7. DELIVERY OF PROPOSALS 7.1 All proposals are to be submitted by the due date and Naples local time, on the Collier County Procurement Services Division Online Bidding Systemwebsite: https://www.bidsync.com/bidsync-cas/. 7.2 The County does not bear the responsibility for proposals delivered to the Procurement Services Division past the stated date and/or time indicated. 8. VALIDITY OF PROPOSALS No proposal can be withdrawn after it is opened unless the vendor makes their request in writing to the County. All proposals shall be valid for a period of one hundred eighty (180) days fromthe submission date to accommodate evaluation and selection process. 9. METHOD OF SOURCE SELECTION 9.1 The County is using the Competitive Sealed Proposals methodology of source selection for this procurement, as authorized by Ordinance Number 2017-08, as amended, establishing and adopting the Collier County Procurement Ordinance. 9.2 If the County receives proposals from less than three (3) firms, the Procurement Director shall review all the facts and determine if it is in the best interest of the County to solicit additional proposals or request that the Selection Committee 7/16/2021 2:56 PM ***Updated on022820**p• 51 Collier County rank order the received proposals. 10. EVALUATION OF PROPOSALS Solicitation 18-7470S 10.1 The County's procedure for selection is as follows: 10.1.1 The Procurement Services Director shall appoint a selection committee to review all proposals submitted. 10.1.2 The Request for Proposal is issued. 10.1.3 Subsequent to the closing date of the solicitation, the Procurement Professional will review the proposals received and verify each proposal to determine if it minimally responds to the requirements of the published RFP. 10.1.4 Selection committee meetings will be open to the public and publicly noticed by the Procurement Services Division. 10.1.5 In an initial organization meeting, the selection committee members will receive instructions, the submitted proposals, and establish the next selection committee meeting date and time. After the first meeting, the Procurement professional will publicly announce all subsequent committee meeting dates and times. The subsequent meeting dates and times will be publicly posted with at least seventy-two hours advanced notice. 10.1.6 Selection committee members will independently review and score each proposal based on the evaluation criteria stated in the request for proposal using the Individual Selection Committee Score sheet and prepare comments for discussion at the neat meeting. The Individual Selection Committee Scoresheet is merely a tool to assist the selection committee member in their review of the proposals. 10.1.7 At the publicly noticed selection committee meeting, the members will present their independent findings / conclusions / comrents based on their reading and interpretation of the materials presented to each other, and may ask questions of one another. Time will be allowed for public comment. 10.1.8 Collier County selection committee members may consider all the material submitted by the Proposer and other information Collier County may obtain to determine whether the Proposer is capable of and has a history of successfully completing projects of this type, including, without limitation, additional information Collier County may request, clarification of proposer information, and/or additional credit information. 10.1.9 Once the individual scoring has been completed, the Procurement professional will read the results publicly. The committee will make a determination if oral presentations are needed and which firms will be invited to give oral presentations by short listing the proposals submitted. The selection committee may ask for additional information, present materials, interview, ask questions, etc. The members may consider any and all information obtained through this method in formulating their final ranking. 10.1.10 The selection committee's overall rank of firms in order of preference (from highest score or beginning with a rank of one (1) if presentations were held) will be discussed and reviewed by the Procurement Professional. By final tabulation, and having used all information presented (proposal, presentation, references, etc.), the selection committee members will vote and thus create a final ranking and staff will subsequently enter into negotiations. 10.2 The County reserves the right to withdraw this RFP at any time and for any reason, and to issue such clarifications, modifications, addendums, and/or amendments as it may deem appropriate, including, but not limited, to requesting supplemental proposal information. 10.3 Receipt of a proposal by the County offers no rights upon the proposer nor obligates the County in any manner. 10.4 Acceptance of the proposal does not guarantee issuance of any other governmental approvals. 11. REFERENCES The County reserves the right to contact any and all references submitted as a result of this solicitation. 12. RESERVED RIGHTS Collier County reserves the right in any solicitation to accept or reject any or all bids, proposals or offers; to waive minor irregularities and technicalities; or to request resubmission. Also, Collier County reserves the right to accept all or any p art of any bid, proposal, or offer, and to increase or decrease quantities to meet additional or reduced requirements of Collier County. Collier County reserves the right to cancel, extend, or modify any or all bids, proposals or offers and to negotiate with any responsible providers to secure the best terms and conditions when it is deemed to be in the best of the County. County reserves its right to reject any sole response. 13. INSURANCE AND BONDING REOUIREMENTS 13.1 The Vendor shall at its own expense, carry and maintain insurance coverage fromresponsible companies duly authorized to do business in the State of Florida as set forth in the Insurance and Bonding attachment of this solicitation. The Vendor shall be required to provide the Certificate of Insurance(s) with the limits set forth in the solicitation within five (5) days upon notification of selection for award. If the Vendor cannot provide the document within the referenced timeframe, the County reserves the right to award to another Vendor. The Vendor shall procure and maintain property 7/16/2021 2:56 PM ***Updated on 022820**p. 52 Collier County Solicitation 18-7470S insurance upon the entire project, if required, to the full insurable value of the scope of work. 13.2 The County and the Vendor waive against each other and the County's separate Vendors, Contractors, Design Vendor, Subcontractors agents and employees of each and all of them, all damages covered by property insurance provided herein, except such rights as they may have to the proceeds of such insurance. The Vendor and County shall, where appropriate, require similar waivers of subrogation from the County's separate Vendors, Design Vendors and Subcontractors and shall require each of them to include similar waivers in their contracts. 13.3 Collier County shall be responsible for purchasing and maintaining, its own liability insurance. 13.4 Certificates issued as a result of the award of this solicitation must identify "For any and all work performed on behalf of Collier County." 13.5 The General Liability Policy provided by Vendor to meet the requirements of this solicitation shall name Collier County, Florida, as an additional insured as to the operations of Vendor under this solicitation and shall contain a severability of interests provisions. 13.6 Collier County Board of County Commissioners shall be named as the Certificate Holder. The Certificates of Insurance must state the Contract Number, or Project Number, or specific Project description, or must read: For any and all work performed on behalf of Collier County. The "Certificate Holder" should read as follows: Collier County Board of County Commissioners Naples, Florida 13.7 The amounts and types of insurance coverage shall conform to the minimum requirements set forth in Insurance and Bonding attachment, with the use of Insurance Services Office (ISO) forins and endorsements or their equivalents. If Vendor has any self -insured retentions or deductibles under any of the below listed minimumrequired coverage, Vendor must identify on the Certificate of Insurance the nature and amount of such self- insured retentions or deductibles and provide satisfactory evidence of financial responsibility for such obligations. All self -insured retentions or deductibles will be Vendor's sole responsibility. 13.8 Coverage(s) shall be maintained without interruption from the date of commencement of the Work until the date of completion and acceptance of the scope ofworkby the County or as specified in this solicitation, whichever is longer. 13.9 The Vendor and/or its insurance carrier shall provide 30 days written notice to the County of policy cancellation or non - renewal on the part of the insurance carrier or the Vendor. The Vendor shall also notify the County, in a like manner, within twenty-four (24) hours after receipt, of any notices of expiration, cancellation, non -renewal or material change in coverage or limits received by Vendor from its insurer and nothing contained herein shall relieve Vendor of this requirement to provide notice. In the event of a reduction in the aggregate limit of any policy to be provided by Vendor hereunder, Vendor shall immediately take steps to have the aggregate limit reinstated to the full extent permitted under such policy. 13.10 Should at any time the Vendor not maintain the insurance coverage(s) required herein, the County may terminate the Agreement or at its sole discretion shall be authorized to purchase such coverage(s) and charge the Vendor for such coverage(s) purchased. If Vendor fails to reimburse the County for such costs within thirty (30) days after demand, the County has the right to offset these costs from any amount due Vendor under this Agreement or any other agreement between the County and Vendor. The County shall be under no obligation to purchase such insurance, nor shall it be responsible for the coverage(s) purchased or the insurance company or companies used. The decision of the County to purchase such insurance coverage(s) shall in no way be construed to be a waiver of any of its rights under the Contract Documents. 13.11 If the initial or any subsequently issued Certificate of Insurance expires prior to the completion of the scope of work, the Vendor shall furnish to the County renewal or replacement Certificate(s) of Insurance not later than ten (10) calendar days after the expiration date on the certificate. Failure of the Vendor to provide the County with such renewal certificate(s) shall be considered justification for the County to terminate any and all contracts. 14. ADDITIONAL ITEMS AND/OR SERVICES Additional items and / or services may be added to the resultant contract, or purchase order, in compliance with the Procurement Ordinance. 15. COLNTY'S RIGHT TO INSPECT The County or its authorized Agent shall have the right to inspect the Vendor's facilities/project site during and after each work assignment the Vendor is performing. The County reserves the right to take into consideration a vendor's past performance under a prior or current County contract when it is considering the granting of a new contract, the assignment of a work order, or any additional work. Past poor performance may result in the County deeming the vendor non -responsible and therefore refraining from awarding such work. 7/16/2021 2:56 PM ***Updated on022820**P. 53 Collier County 16. VENDOR PERFORMANCE EVALUATION Solicitation 18-7470S The County has implemented a Vendor Performance Evaluation System for all contracts awarded in excess of $25,000. To this end, vendors will be evaluated on their performance upon completion/termination of this Agreement. The County reserves the right to take into consideration a Vendor's past performance under a prior or current County contract when it is considering the granting of a new contract, the assignment of a work order, or any additional work. Past poor performance may result in the County deeming the vendor non -responsible and therefore refraining from awarding such work. 17. ADDITIONAL TERMS AND CONDITIONS OF CONTRACT 17.1 The selected Vendor shall be required to sign a standard Collier County contract or accept the County's Purchase Order terms and conditions to serve as a formal contact. 17.2 The resultant contract(s) may include purchase or work orders issued by the County's Project Manager (a/k/a Contract Administrative Agent). 17.3 The County reserves the right to include in any contract document such terms and conditions, as it deems necessary for the proper protection of the rights of Collier County. A sample copy of this contract is available upon request. The County will not be obligated to sign any contracts, maintenance and/or service agreements, other documents or agree to any exceptions to the County's terms and conditions provided by the Vendor. 17.4 The County's Project Manager shall coordinate with the Vendor / Contractor the return of any surplus assets, including materials, supplies, and equipment associated with the scope or work. 18. PUBLIC RECORDS COMPLIANCE 18.1 Florida Public Records Law Chapter 119, including specifically those contractual requirements in 119.0701(2)(a)-(b) as follows: IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT: Communication and Customer Relations Division 3299 Tamiami Trail East Suite 102 Naples, FL 34112-5746 Telephone: (239) 252-8999 18.2 The Contractor must specifically comply with the Florida Public Records Law to: 18.2.1 Keep and maintain public records required by the public agency to perform the service. 18.2.2 Upon request from the public agency's custodian of public records, provide the public agency with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law. 18.2.3Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law for the duration of the contract term and following completion of the contract if the Contractor does not transfer the records to the public agency. 18.2.4 Upon completion of the contract, transfer, at no cost, to the public agency all public records in possession of the Contractor or keep and maintain public records required by the public agency to perform the service. If the Contractor transfers all public records to the public agency upon completion of the contract, the Contractor shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the Contractor keeps and maintains public records upon completion of the contract, the Contractor shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to the public agency, upon request from the public agency's custodian of public records, in a format that is compatible with the information technology systems of the public agency. 19. PAYMENT METHOD 19.1 Payments are made in accordance with the Local Goverment Prompt Payment Act, Chapter 218, Florida Statutes. Vendor's invoices must include: 7/16/2021 2:56 PM ***Updated on022820**P. 54 Collier County 19.1.1 Purchase Order Number Solicitation 18-7470S 19.1.2 Description and quantities of the goods or services provided per instructions on the County's purchase order or contract. Invoices shall be sent to: Board of County Commissioners Clerk's Finance Department ATTN: Accounts Payable 3299 Tamiami Trail East, Suite 700 Naples FL 34112 Or Emailed to: bccapclerkncollierclerk.com 19.2 Payments will be made for articles and/or services furnished, delivered, and accepted, upon receipt and approval of invoices submitted on the date of services or within six (6) months after completion of contract. Any untimely submission of invoices beyond the specified deadline period is subject to non-payment under the legal doctrine of "laches" as untimely submitted. Time shall be deemed of the essence with respect to the timely submission of invoices under this agreement. 19.3 In instances where the successful Vendor may owe debts (including, but not limited to taxes or other fees) to Collier County and the contractor has not satisfied nor made arrangement to satisfy these debts, the County reserves the right to off -set the amount owed to the County by applying the amount owed to the vendor or contractor for services performed of for materials delivered in association with a contract. 19.4 Invoices shall not reflect sales tax After review and approval, the invoice will be transmitted to the Finance Division for payment. Payment will be made upon receipt of proper invoice and in compliance with Chapter 218 Florida Statutes, otherwise known as the "Local Government Prompt Payment Act." Collier County reserves the right to withhold and/or reduce an appropriate amount of any payment for work not performed or for unsatisfactory performance of Contractual requirements. 20. ENVIRONMENTAL HEALTH AND SAFETY 20.1 All Vendors and Sub Vendors performing service for Collier County are required and shall comply with all Occupational Safety and Health Administration (OSHA), State and County Safety and Occupational Health Standards and any other applicable rules and regulations. Vendors and Sub Vendors shall be responsible for the safety of their employees and any unsafe acts or conditions that may cause injury or damage to any persons or property within and around the work site. All firewall penetrations must be protected in order to meet Fire Codes. 20.2 Collier County Government has authorized OSHA representatives to enter any Collier County facility, property and/or right-of-way for the purpose of inspection of any Vendor's work operations. This provision is non-negotiable by any department and/or Vendor. 20.3 All new electrical installations shall incorporate NFPA 70E Short Circuit Protective Device Coordination and Arc Flash Studies where relevant as determined by the engineer. 20.4 All electrical installations shall be labeled with appropriate NFPA 70E arch flash boundary and PPE Protective labels. 21. POLLUTION PREVENTION The vendor is required to implement industry relevant pollution prevention and best management practices. Should pollution incidents occur, Collier County Pollution Control must be notified immediately. 22. LICENSES 22.1 The Vendor is required to possess the correct Business Tax Receipt, professional license, and any other authorizations necessary to carry out and perform the work required by the project pursuant to all applicable Federal, State and Local Law, Statute, Ordinances, and rules and regulations of any kind. Additionally, copies of the required licenses must be submitted with the proposal response indicating that the entity proposing, as well as the team assigned to the County account, is properly licensed to perform the activities or work included in the contract documents. Failure on the part of any Vendor to submit the required documentation may be grounds to DEEM VENDOR NON -RESPONSIVE. A Vendor, with an office within Collier County is also required to have an occupational license. 22.2 All State Certified contractors who may need to pull Collier County permits or call in inspections must complete a Collier County Contractor License registration form and submit the required fee. After registering the license/registration will need to be renewed thereafter to remain "active" in Collier County. 22.3 If you have questions regarding professional licenses contact the Contractor Licensing, Community Development and Environmental Services at (239) 252-2431, 252-2432 or 252-2909. Questions regarding required occupational licenses, please contact the TaxCollector's Office at (239) 252-2477. 23. SURVIVABILITY The Vendor agrees that any Purchase Order/Work Order/Solicitation Documents that extends beyond the expiration date of the 7/16/2021 2:56 PM ***Updated on 022820**p. 55 Collier County Solicitation 18-7470S original Solicitation will survive and remain subject to the terms and conditions of that Agreement until the completion or termination. 24. PRINCIPAL/COLLUSION By submission of this Proposal the undersigned, as Vendor, does declare that the only person or persons interested in this Proposal as principal or principals is/are named therein and that no person other than therein mentioned has any interest in this Proposal or in the contract to be entered into; that this Proposal is made without connection with any person, company or parties making a Proposal, and that it is in all respects fair and in good faith without collusion or fraud. 25. RELATION OF COUNTY It is the intent of the parties hereto that the Vendor shall be legally considered an independent Vendor, and that neither the Vend or nor their employees shall, under any circumstances, be considered employees or agents of the County, and that the County shall be at no time legally responsible for any negligence on the part of said Vendor, their employees or agents, resulting in eitherbodily orpersonal injury orproperty damage to any individual, firm, or corporation. 26. TERMINATION Should the Vendor be found to have failed to perform services in a manner satisfactory to the County, the County may terminate this Agreement immediately for cause; further the County may terminate this Agreement for convenience with a thirty (30) day written notice. The County shall be sole judge of nonperfomrance. In the event that the award of this solicitation is made by the Procurement Services Director, the award and any resultant purchase orders may be terminated at any time by the County upon thirty (30) days written notice to the awarded vendor(s) pursuant to the Board's Procurement Ordinance. 27. LOBBYING After the issuance of any solicitation, no current or prospective vendor or any person acting on their behalf, shall contact, communicate with or discuss any matter relating to the solicitation with any Collier County employee or elected or appointed official, other than the Procurement Services Director or his/her designees. This prohibition ends upon execution of the final contract or upon cancellation of the solicitation. Any current or prospective vendor that lobbies any Collier County employe e or elected or appointed official while a solicitation is open or being recommended for award (i) may be deemed ineligible for award of that solicitation by the Procurement Services Director, and (ii) will be subject to Suspension and Debarment outlined in section Twenty -Eight of County Procurement Ordinance 2017-08, as amended. 28. CERTIFICATE OF AUTHORITY TO CONDUCT BUSINESS IN TBE STATE OF FLORIDA (FL Statute 607.1501) In order to be considered for award, firms must be registered with the Florida Department of State Divisions of Corporations in accordance with the requirements of Florida Statute 607.1501 and provide a certificate of authority (www.sunbiz.org/search.html) prior to execution of a contract. A copy of the document should be submitted with the solicitation response and the document number should be identified. Firms who do not provide the certificate of authority at the time of response shall be required to provide same within five (5) days upon notification of selection for award. If the firm cannot provide the document within the referenced timeframe, the County reserves the right to award to another firm. 29. SINGLE PROPOSAL Each Vendor must submit, with their proposal, the required forms included in this RFP. Only one proposal from a legal entity as a primary will be considered. A legal entity that submits a proposal as a primary or as part of a partnership or joint venture submitting as primary may not then act as a sub -vendor to any other firm submitting under the same RFP. If a legal entity is not submitting as a primary or as part of a partnership or joint venture as a primary, that legal entity may act as a sub -vendor to any other firm or firms submitting under the same RFP. All submittals in violation of this requirement will be deemed non- responsive and rejected from further consideration. 30. PROTEST PROCEDURES 30.1 Any Vendor who alleges to be aggrieved in connection with the solicitation or award of a contract, may protest to the Procurement Services Director, who shall serve as the sole receipt of the any and all notices of intent to protest and all formal protests. 30.2 With respect to a protest of the terms, conditions and specifications contained in a solicitation, including any provisions governing the methods for evaluation of bids, proposals or replies, awarding contracts, reserving rights for further negotiation or modifying or amending any contract, the protesting party shall file a notice of intent to protest within three (3) days, excluding weekends and County holidays, after the first publication, whether by posting or formal advertisement of the solicitation. The formal written protest shall be filed within five (5) days of the date the notice of intent is filed. Fomral protests of the terms, conditions and specifications shall contain all of the information required for the Procurement Services Director, to render a decision on the formal protest and determine whether postponement of the bid opening or proposal/response closing time is appropriate. The Procurement Services Director's decision shall be considered final and conclusive unless the protesting party files an appeal of the Procurement Services Director's decision. 30.3 Any actual proposer orrespondent to who desires to protest a recorm- fended contract award shall submit a notice of intent 7/16/2021 2:56 PM ***Updated on 022820**p. 56 Collier County Solicitation 18-7470S to protest to the Procurement Services Director within three (3) calendar days, excluding weekends and County holidays, from the date of the initial posting of the recommended award. 30.4 All formal protests with respect to a recommended contract award shall be submitted in writing to the Procurement Services Director for a decision. Said protests shall be submitted within five (5) calendar days, excluding weekends and County holidays, from the date that the notice of intent to protest is received by the Procurement Services Director, and accompanied by the required fee. 30.5 Complete instructions for formal protest are set forth in Section 23 of Collier County Procurement Ordinance 2017-08, as amended. The protesting party must have standing as defined by established Florida case law to maintain a protest. 31. PUBLIC ENTITY CRPUE A person or affiliate who has been placed on the convicted Vendor list following a conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the construction or repair of a public building or public work; may not submit bids, proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or vendor under a contract with any public entity; and may not transact business with any public entity in excess of the threshold amount provided in s. 287.017 for CATEGORY TWO for a period of 36 months following the date of being placed on the convicted Vendor list. 32. SECURITY AND BACKGROUND CHECKS 32.1 The Contractor is required to comply with County Ordinance 2004-52, as amended. Background checks are valid for five (5) years and the Contractor shall be responsible for all associated costs. If required, Contractor shall be responsible forthe costs of providing background checks by the Collier County Facilities Management Division for all employees that shall provide services to the County under this Agreement. This may include, but not be limited to, checking federal, state and local law enforcement records, including a state and FBI fingerprint check, credit reports, education, residence and employment verifications and other related records. Contractor shall be required to maintain records on each employee and make them available to the County for at least four (4) years. 32.2 All of Contractor's employees and subcontractors must wear Collier County Government Identification badges at all times while performing services on County facilities and properties. Contractor ID badges are valid for one (1) year from the date of issuance and can be renewed each year at no cost to the Contractor during the time period in which their background check is valid, as discussed below. All technicians shall have on their shirts the name of the contractor's business. 32.3 The Contractor shall ininiediately notify the Collier County Facilities Management Division via e-mail (DL, FMOPS@colliergov.net) whenever an employee assigned to Collier County separates from their employment. This notification is critical to ensure the continued security of Collier County facilities and systems. Failure to notify within four (4) hours of separation may result in a deduction of $500 per incident. 32.4 CCSO requires separate fingerprinting prior to work being performed in any of their locations. This will be coordinated upon award of the contract. If there are additional fees for this process, the vendor is responsible for allcosts. 33. CONFLICT OF INTEREST Vendor shall complete the Conflict of Interest Affidavit included as an attachment to this RFP document. Disclosure of any potential or actual conflict of interest is subject to County staff review and does not in and of itself disqualify a firm from consideration. These disclosures are intended to identify and or preclude conflict of interest situations during contract selection and execution. 34. PROHBITION OF GIFTS TO COUNTY EMPLOYEES No organization or individual shall offer or give, either directly or indirectly, any favor, gift, loan, fee, service or other item of value to any County employee, as set forth in Chapter 112, Part III, Florida Statutes, the current Collier County Ethics Ordinance and County Administrative Procedure 5311. Violation of this provision may result in one or more of the following consequences: a. Prohibition by the individual, firm, and/or any employee of the firm from contact with County staff for a specified period of time; b. Prohibition by the individual and/or firm from doing business with the County for a specified period of time, including but not limited to: submitting bids, RFP, and/or quotes; and, c. immediate termination of any contract held by the individual and/or firm for cause. 35. P4MIGRATION LAW AFFIDAVIT CERTIFICATION 35.1 Statutes and executive orders require employers to abide by the immigration laws of the United States and to employ only individuals who are eligible to work in the United States. 35.2 The Employment Eligibility Verification System (E-Verify) operated by the Department of Homeland Security (DHS) in partnership with the Social Security Administration (SSA), provides an Internet -based means of verifying employment eligibility of workers in the United States; it is not a substitute for any other employment eligibility verification requirements. The program will be used for Collier County formal Invitations to Bid (ITB) and Request for Proposals 7/16/2021 2:56 PM ***Updated on022820**p• 57 Collier County Solicitation 18-7470S (RFP) including Request for Professional Services (RFP) and construction services. 35.3 Exceptions to the program: 35.3.1 Commodity based procurement where no services are provided. 35.3.2 Where the requirement for the affidavit is waived by the Board of County Commissioners 35.4 Vendors are required to be enrolled in the E-Verify program at the time of submission of the bid. Acceptable evidence of your enrollment consists of a copy of the properly completed E-Verify Company Profile page or a copy of the fully executed E-Verify Memorandum of Understanding for the company which will be produced at the time of the submission of the Vendor's proposal/bid or within five (5) day of the County's Notice of Recommend Award. FAILURE TO EXECUTE THIS AFFIDAVIT CERTIFICATION AND SUBMIT WITH VENDOR'S PROPOSAL/BID MAY DEEM THE VENDOR'S AS NON -RESPONSIVE. 35.5 Additionally, Vendors shall require all subcontracted Vendors to use the E-Verify system for all purchases not covered under the "Exceptions to the program" clause above. All vendors shall familiarize themselves with the statutory requirements set fort in the Florida Statutes §448.095 pertaining to the responsibilities of Public Employers, Contractors and Subcontractors. 35.6 For additional information regarding the Employment Eligibility Verification System (E-Verify) program visit the following website: http://www.dhs.gov/E-Verify. It shall be the Vendor's responsibility to familiarize themselves with all rules and regulations governing this program 35.7 Vendor acknowledges, and without exception or stipulation, any firms) receiving an award shall be fully responsible for complying with the provisions of the Immigration Reform and Control Act of 1986 as located at 8 U.S.C. 1324, et seq. and regulations relating thereto, as either may be amended and with the provisions contained within this affidavit. Failure by the awarded fmn(s) to comply with the laws referenced herein or the provisions of this affidavit shall constitute a breach of the award agreement and the County shall have the discretion to unilaterally terminate said agreement immediately. 36. COLLIER COUNTY INFORMATION TECHNOLOGY REQUIREMENTS All vendor access will be done via VPN access only. All access must comply with current published County Manager Agency (CMA) policies. Current policies that apply are CMAs 5402, 5403 and 5405. These policies will be available upon request from the Information Technology Department. All vendors will be required to adhere to IT policies for access to the County network. Vendors are required to notify the County in writing twenty-four (24) hours in advance as to when access to the network is planned. Included in this request must be a detailed work plan with actions that will be taken at the time of acce ss. The County IT Department has developed a Technical Architecture Requirements Document. 37. GRANT COMPLIANCE The purchase of any goods and/or services that are funded through Federal Grant Appropriations, the State of Florida, or any other public or private foundations shall be subject to the compliance and reporting requirements of the granting agency. The Vendor agrees include with the bid submission all the completed and fully executed Grant documents provided as an attachment to the solicitation, or you may BE DEEMED NON-RESPONS IVE. 38. LOCAL VENDOR PREFERENCE (LVP) Any Vendor claiming local vendor preference must complete the required form and submit a Collier or Lee Business Tax receipt with their submission. 39. OFFER EXTENDED TO OTHER GOVERNMENTAL ENTITIES Collier County encourages and agrees to the successful vendor extending the pricing, terms and conditions of this solicitation or resultant contract to other governmental entities at the discretion of the successful vendor. Certification: The Vendor hereby agrees to comply with the instructions above, by submission of a bid/proposal. 7/16/2021 2:56 PM ***Updated on022820**P. 58 Collier County Solicitation 18-7470S J Collier County Purchase Order Terms and Conditions 1. Offer This offer is subject to cancellation by the COUNTY without notice if not accepted by VENDOR within fourteen (14) days of issuance. 2. Acceptance and Confirmation This Purchase Order (including all documents attached to or referenced herein) constitutes the entire agreement between the parties, unless otherwise specifically noted by the COUNTY on the face of this Purchase Order. Each delivery of goods and/or services received by the COUNTY from VENDOR shall be deemed to be upon the terms and conditions contained in this Purchase Order. No additional terms may be added and Purchase Order may not be changed except by written instrument executed by the COUNTY. VENDOR is deemed to be on notice that the COUNTY objects to any additional or different terms and conditions contained in any acknowledgment, invoice or other communication from VENDOR, notwithstanding the COUNTY'S acceptance or payment for any delivery of goods and/or services, or any similar act by VENDOR. 3. Inspection All goods and/or services delivered hereunder shall be received subject to the COUNTY'S inspection and approval and payment therefore shall not constitute acceptance. All payments are subject to adjustment for shortage or rejection. All defective or nonconforming goods will be returned pursuant to VENDOR'S instruction at VENDOR'S expense. To the extent that a purchase order requires a series of performances by VENDOR, the COUNTY prospectively reserves the right to cancel the entire remainder of the Purchase Order if goods and/or services provided early in the term of the Purchase Order are non -conforming or otherwise rejected by the COUNTY. 4. Shipping and Invoices a) All goods are FOB destination and must be suitably packed and prepared to secure the lowest transportation rates and to comply with all carrier regulations. Risk of loss of any goods sold hereunder shall transfer to the COUNTY at the time and place of delivery; provided that risk of loss prior to actual receipt of the goods by the COUNTY nonetheless remain with VENDOR. b) No charges will be paid by the COUNTY for packing, crating or cartage unless otherwise specifically stated in this Purchase Order. Unless otherwise provided in Purchase Order, no invoices shall be issued nor payments made prior to delivery. Unless freight and other charges are itemized, any discount will be taken on the full amount of invoice. c) All shipments of goods scheduled on the same day via the same route must be consolidated. Each shipping container must be consecutively numbered and marked to show this Purchase Order number. The container and Purchase Order numbers must be indicated on bill of lading. Packing slips must show Purchase Order number and must be included on each package of less than container load (LCL) shipments and/or with each car load of equipment. The COUNTY reserves the right to refuse or return any shipment or equipment at VENDOR'S expense that is not marked with Purchase Order numbers. VENDOR agrees to declare to the carrier the value of any shipment made under this Purchase Order and the full invoice value of such shipment. d) All invoices must contain the Purchase Order number and any other specific information as identified on the Purchase Order. Discounts of prompt payment will be computed from the date of receipt of goods or from date of receipt of invoices, whichever is later. Payment will be made upon receipt of a proper invoice and in compliance with Chapter 218, Fla. Stats., otherwise known as the "Local Government Prompt Payment Act," and, pursuant to the Board of County Commissioners Purchasing Policy. 5. Time Is Of the Essence Time for delivery of goods or performance of services under this Purchase Order is of the essence. Failure of VENDOR to meet delivery schedules or deliver within a reasonable time, as interpreted by the COUNTY alone, shall entitle the COUNTY to seek all remedies available to it at law or in equity. VENDOR agrees to reimburse the COUNTY for any expenses incurred in enforcing its rights. VENDOR further agrees that undiscovered delivery of nonconforming goods and/or services is not a waiver of the COUNTY'S right to insist upon further compliance with all specifications. 7/16/2021 2:56 PM G/ Operations/Document Approved by Attorney Reviewed 12/18/13; 5/5/10p' 59 Collier County Solicitation 18-7470S 6. Changes The COUNTY may at any time and by written notice make changes to drawings and specifications, shipping instructions, quantities and delivery schedules within the general scope of this Purchase Order. Should any such change increase or decrease the cost of, or the time required for performance of the Purchase Order, an equitable adjustment in the price and/or delivery schedule will be negotiated by the COUNTY and VENDOR. Notwithstanding the foregoing, VENDOR has an affirmative obligation to give notice if the changes will decrease costs. Any claims for adjustment by VENDOR must be made within thirty (30) days from the date the change is ordered or within such additional period of time as may be agreed upon by the parties. 7. Warranties VENDOR expressly warrants that the goods and/or services covered by this Purchase Order will conform to the specifications, drawings, samples or other descriptions furnished or specified by the COUNTY, and will be of satisfactory material and quality production, free from defects and sufficient for the purpose intended. Goods shall be delivered free from any security interest or other lien, encumbrance or claim of any third party. These warranties shall survive inspection, acceptance, passage of title and payment by the COUNTY. 8. Statutory Conformity Goods and services provided pursuant to this Purchase Order, and their production and transportation shall conform to all applicable laws, including but not limited to the Occupational Health and Safety Act, the Federal Transportation Act and the Fair Labor Standards Act, as well as any law or regulation noted on the face of the Purchase Order. 9. Advertising No VENDOR providing goods and services to the COUNTY shall advertise the fact that it has contracted with the COUNTY for goods and/or services, or appropriate or make use of the COUNTY'S name or other identifying marks or property without the prior written consent of the COUNTY'S Purchasing Department. 10. Indemnification VENDOR shall indemnify and hold harmless the COUNTY from any and all claims, including claims of negligence, costs and expenses, including but not limited to attorneys' fees, arising from, caused by or related to the injury or death of any person (including but not limited to employees and agents of VENDOR in the performance of their duties or otherwise), or damage to property (including property of the COUNTY or other persons), which arise out of or are incident to the goods and/or services to be provided hereunder. 11. Warranty of Non -Infringement a) VENDOR represents and warrants that all goods sold or services performed under this Purchase Order are: a) in compliance with applicable laws; b) do not infringe any patent, trademark, copyright or trade secret; and c) do not constitute unfair competition. b) VENDOR shall indemnify and hold harmless the COUNTY from and against any and all claims, including claims of negligence, costs and expense, including but not limited to attorneys' fees, which arise from any claim, suit or proceeding alleging that the COUNTY'S use of the goods and/or services provided under this Purchase Order are inconsistent with VENDOR'S representations and warranties in section 11 (a). c) If any claim which arises from VENDOR'S breach of section 11 (a) has occurred, or is likely to occur, VENDOR may, at the COUNTY'S option, procure for the COUNTY the right to continue using the goods or services, or replace or modify the goods or services so that they become non -infringing, (without any material degradation in performance, quality, functionality or additional cost to the COUNTY). 12. Insurance Requirements The VENDOR, at its sole expense, shall provide commercial insurance of such type and with such terms and limits as may be reasonably associated with the Purchase Order. Providing and maintaining adequate insurance coverage is a material obligation of the VENDOR. All insurance policies shall be executed through insurers authorized or eligible to write policies in the State of Florida. 13. Compliance with Laws In fulfilling the terms of this Purchase Order, VENDOR agrees that it will comply with all federal, state, and local laws, rules, codes, and ordinances that are applicable to the conduct of its business. By way of non -exhaustive example, this shall include the American with Disabilities Act and all prohibitions against discrimination on the basis of race, religion, sex creed, national origin, handicap, marital status, or veterans status. Further, VENDOR acknowledges and without exception or stipulation shall be fully responsible for complying with the provisions of the Immigration Reform and Control Act of 1986 as located at 8 U.S.C. 1324, et sea. and regulations relating thereto, as either may be amended. Failure by the awarded firm(s) to comply with the laws referenced herein shall constitute a breach of the award agreement and the County shall have the discretion to unilaterally terminate said 7/16/2021 2:56 PM G/ Operations/Document Approved by Attorney Reviewed 12/18/13; 5/5/10p' 60 Collier County Solicitation 18-7470S agreement immediately. Any breach of this provision may be regarded by the COUNTY as a material and substantial breach of the contract arising from this Purchase Order. 14. Force Majeure Neither the COUNTY nor VENDOR shall be responsible for any delay or failure in performance resulting from any cause beyond their control, including, but without limitation to war, strikes, civil disturbances and acts of nature. When VENDOR has knowledge of any actual or potential force majeure or other conditions which will delay or threatens to delay timely performance of this Purchase Order, VENDOR shall immediately give notice thereof, including all relevant information with respects to what steps VENDOR is taking to complete delivery of the goods and/or services to the COUNTY. 15. Assignment VENDOR may not assign this Purchase Order, nor any money due or to become due without the prior written consent of the COUNTY. Any assignment made without such consent shall be deemed void. 16. Taxes Goods and services procured subject to this Purchase Order are exempt from Florida sales and use tax on real property, transient rental property rented, tangible personal purchased or rented, or services purchased (Florida Statutes, Chapter 212), and from federal excise tax. 17. Annual Appropriations The COUNTY'S performance and obligation to pay under this Purchase Order shall be contingent upon an annual appropriation of funds. 18. Termination This Purchase Order may be terminated at any time by the COUNTY upon 30 days prior written notice to the VENDOR. This Purchase Order may be terminated immediately by the COUNTY for breach by VENDOR of the terms and conditions of this Purchase Order, provided that COUNTY has provided VENDOR with notice of such breach and VENDOR has failed to cure within 10 days of receipt of such notice. 19. General a) This Purchase Order shall be governed by the laws of the State of Florida. The venue for any action brought to specifically enforce any of the terms and conditions of this Purchase Order shall be the Twentieth Judicial Circuit in and for Collier County, Florida b) Failure of the COUNTY to act immediately in response to a breach of this Purchase Order by VENDOR shall not constitute a waiver of breach. Waiver of the COUNTY by any default by VENDOR hereunder shall not be deemed a waiver of any subsequent default by VENDOR. c) All notices under this Purchase Order shall be sent to the respective addresses on the face page by certified mail, return receipt requested, by overnight courier service, or by personal delivery and will be deemed effective upon receipt. Postage, delivery and other charges shall be paid by the sender. A party may change its address for notice by written notice complying with the requirements of this section. d) The Vendor agrees to reimbursement of any travel expenses that may be associated with this Purchase Order in accordance with Florida Statute Chapter 112.061, Per Diem and Travel Expenses for Public Officers, employees and authorized persons. e) In the event of any conflict between or among the terms of any Contract Documents related to this Purchase Order, the terms of the Contract Documents shall take precedence over the terms of the Purchase Order. To the extent any terms and /or conditions of this Purchase Order duplicate or overlap the Terms and Conditions of the Contract Documents, the provisions of the Terms and/or Conditions that are most favorable to the County and/or provide the greatest protection to the County shall govern. 7/16/2021 2:56 PM G/ Operations/Document Approved by Attorney Reviewed 12/18/13; 5/5/10p' 61 Collier County Solicitation 18-7470S Question and Answers for Solicitation #18-7470S - Services for Seniors Question 1 We are a provider of Specialized Medical Equipment, Services, and Supplies. The RFP asks for a cost per service unit, In -kind match and reimbursement rate per unit. It is not possible to provide a cost as these episodes are priced based upon products provided. Please provide guidance in order to respond. Thank you! (Submitted: JuI 8, 2021 11:49:08 AM EDT) Answer - You would have to supply us with a supply list and pricing. (Answered: JuI 8, 20213:05:10 PM EDT) Question 2 Hello good morning. My question is about Facility Respite care. Do you need someone to go inside a facility to meet the needs of the resident that needs care for or do you need a facility to house the seniors in? (Submitted: Jul 9, 2021 10:48:15 AM EDT) Answer - We are looking for a Facility to house (Assisted Living Facility or Rehab Center) and to provide short term Respite stay to give the home Care giver (family member) a break or if they are unable to provide the care due to illness or travel, etc. A 1 to 2 week stay maximum. (Answered: Jul 9, 2021 2:49:42 PM EDT) Question 3 Is there a list of products that we can review and present a price list? (submitted: JuI 9, 2021 11:11:30 AM EDT) Answer - Not all Supplies are required but a list of what might be ordered for clients, is up to the vendor to determine what supplies they want to provide pricing on the entire list of an abridged version (Answered: JuI 12, 2021 8:13:19AM EDT) Question 4 Hello good evening I was contacting you to get more clarification for Chore, Chore (Enhanced) Respite (In - Home) and how many needs for personal care (submitted: JuI 11, 20213:23:41 PM EDT) Answer - Chore: Usually a one time occurrence for a certain # of hours in order to make the home sanitary or clutter free in order to provide service to the client safely for both client and caregiver. Enhanced Chore: May require additional outside vendor. Carpet Cleaners, Pest Control, Home Maintenance etc - last resort not used often. In Home Respite: All items of care that are covered in Personal Care and Homemaking. Personal Care duties can include: (from 4 to 20 hours a week per client) Bathing Wash Hair Dressing Bathroom Assistance 7/16/2021 2:56 PM p. 62 Collier County Solicitation 18-7470S Shaving Oral Hygiene Mobility Feeding Soak Feet Nails Change -Make Bed Take out Trash Clean Bathroom/Bedroom Prepare meals Laundry Homemaking duties can include: (from 4 to 20 hours a week per client) Vacuum/Sweep Dusting General Housekeeping Moppingfloors Washing dishes Grocery Shop/Errands Respite duties: (from 12 to 20 or more a week) Can be any and all of Personal Care and Homemaking duties to give the Home Caregiver (usually a family member) a break and help with the authorized client. (Answered:Jul 12, 2021 2:06:35 PM EDT) Question 5 Hello Please confirm that Collier County will consider offers received from Nurse Registries, for the Services for Seniors - Solicitation 18-74705 bid. Thank you (Submitted: Jul 16, 2021 4:24:15 PM EDT) Answer - We do not have enough work for Nurse Registries and at this time we are not considering them. (Answered:Jul 16, 20214:55:04 PM EDT) Question Deadline: Aug 3, 2021 3:00:00 PM EDT 7/16/2021 2:56 PM p. 63 View current license information at: Floridahealthfinder.gov State of Florida AGENCY FOR HEALTH CARE ADMINISTRATION DIVISION OF HEALTH QUALITY ASSURANCE Home Health Agency LICENSED LICENSE #: 299994589 CERTIFICATE #: 52730 This is to confirm that SUNSHINE HEALTH CARE SERVICES LLC has complied with rules and regulations adopted by the State of Florida, Agency for Health Care Administration, authorized in Chapter 400, Part III, Florida Statutes, and Chapter 59A-8 of the Florida Administrative Code and is authorized to operate the following: A BETTER SOLUTION OF SARASOTA Service Area: Charlotte, Collier, Desoto, Glades, Hendry, Lee, Sarasota Skilled Services: Other Services: Home Health Aide, Homemaker/Companion EFFECTIVE DATE: 11/27/2020 EXPIRATION DATE: 11/26/2022 5600 Bee Ridge Rd Ste B Sarasota, FL 34233 c ��n WF Secreta , Agency for Health Care Administration DON Organizational Chart CEO COO, CFO Director of Marketing Billing Manager / Supervisor I I Marketing Team Standby Caregiver Standby Caregiver Early Shift Late Shift Standby Caregiver Standby Caregiver Overnight Shift Weekend Shift Scheduler 1 Scheduler 2 Scheduler 3 Scheduler 4 Caregivers Receptionist Client Liaison Recruiter 6.6 QUALITY IMPROVEMENT INITIATIVES The Agency seeks to provide the highest quality of care and customer satisfaction. We will effectively implement a quality improvement program that systematically measures, assesses and improves the performance of the quality of care and services provided by the agency. The design emphasizes the importance of the Agency affecting its best efforts to create appropriate processes and functions required to achieve improved client health outcomes and customer satisfactions. It ensures the provision of uniform quality care and services throughout the Agency as reflected in the Agency's mission, goals and vision and within the dimensions of quality performance which are defined as follows: Doing the right thing with efficiency and appropriateness relating to the degree to which care and services will achieve the desired or projected outcomes and relevant needs of the client. 2. Doing the right thing with regard to the: a. availability to meet the client's needs. b. timeliness of the provision of services at the necessary or most beneficial time for the client. c. effectiveness to correctly provide care and services to achieve the desired outcomes for the client. d. continuity of services provided with respect to service coordination with clinicians, providers and over time. e. safety to clients and others with respect to reduce risk of interventions and environment to the client and others including staff. efficiency of service with regard to results of care/service resources used to deliver care and services. respect and caring which allows the client or designee to be involved in the care/service decisions and services to be provided with sensitivity and respect for the client's needs, expectations and individual differences. Quality Improvement Program Page 8 Copyright 2016© 21st Century HHC CLIENT SATISFACTION SURVEY Client Name -------------------------------------- Date -------------------- We were privileged to participate in the care of the above client. We are interested rendering quality care to our clients and would appreciate your input by answering the following questions. Your evaluation will allow us to be more responsive to future client/family needs. 1. What services(s) did you receive from the Agency? (circle all that apply) Home Health Aide Homemaking/Chore Service Medical Social Worker 1. Were you satisfied with the care you received? _____ Yes ______ No If not, why? --------------------------------------------------------------------- 1. Did you participate in your plan of care? YesNo 1. Did you receive and understand your "Bill of Rights" including the toll free "Hotline" number that you could call if any problems were not resolved by the Agency or if you were dissatisfied with the services provided? YesNo 1. Did the staff visit as frequently as they stated they would? YesNo 1. Did you feel comfortable asking staff questions regarding your health? YesNo 1. Did the staff person visit at a mutually agreeable time? YesNo 1. Did you feel that you were discharged appropriately? YesNo 1. Would you use the services of the Agency in the future? _____ Yes______ No If not, why? Suggestions for improvement: ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- Incident Report PART 1: Patient, Incident & Witness General Information Client name: Address: Phone: Location of incident (kitchen, bathroom, etc) Date on which the incident occurred: Time at which incident occurred or was discovered: Witness name Tel: Witness name Tel: Patient condition prior to occurrence (select all that apply) ❑Alert/oriented ❑Disoriented/confused ❑Sedated/medicated ❑Weak/dizzy ❑Combative/assaultive ❑Confused dementia/Alzheimer's ❑Unconscious ❑Visually impaired ❑Hearing impaired ❑Walked w/device ❑Walked independently ❑Walked w/person(s) ❑Bed only ❑Chair only ❑Other (describe) PART 2: Incident Details Provide a brief narrative description of incident (factual information only) Severity of incident ❑ No apparent injury ❑ Minor (first aid) ❑ Moderate (fracture, sutures) ❑ Severe (hospitalization) ❑ Death Description of injury (if any): Response to incident (select all that apply) ❑First aid ❑Patient refused treatment ❑Called 911 ❑Admitted to hospital ❑No intervention ❑Unknown If you feel it will be helpful, provide further description of the action you took in response to this incident: Individuals Notified (select all that apply) [ 1 Supervisor / manager Name of individual notified:_ Date/ Time notified: [ ] Physician Name of individual notified:_ Date notified Time notified: [ ] Family Name of individual notified Date notified Time notified: PART 3: Type of Occurrence (select all that apply) Fall Occurrence ❑Observed ❑Not Observed ❑Found on floor ❑From toilet ❑While ambulating ❑During transfer ❑Out of bed ❑Eased to floor ❑Out of chair ❑Slip/trip ❑Out of wheelchair ❑Other (describe): Miscellaneous Occurrence ❑Observed ❑Not Observed ❑Fire ❑Client refuses treatment ❑Burn ❑Unplanned absence of caregiver ❑Abuse ❑Caregiver/Client issues ❑Complaints of theft ❑Home care staff/patient disagreement ❑Damage to personal property ❑Safety issue(s) ❑Other (describe) Equipment Occurrence ❑Observed ❑Not Observed Related to: ❑Fire ❑Client refuses treatment ❑Equipment malfunction ❑Catheter ❑Life -sustaining equipment ❑Implanted device ❑Infusion pump ❑Disposable device ❑IV ❑Other (describe) Medication Occurrence ❑Observed ❑Not Observed Related to: ❑Client error ❑Caregiver error ❑Employee error ❑Pharmacy error Type of medication intake: ❑Oral medication ❑IM medication ❑IV medication ❑Other (describe) Type of medication incident: ❑Adverse/allergic reaction ❑Wrong medication ❑Extra dose ❑Wrong time ❑Wrong dose ❑Wrong route ❑Missed dose ❑Late delivery ❑Mislabeled ❑Other (describe) PART 4: Signature of Person Completing this Form Signature: Print name: Date: Comments: 3.4 Admission Policy A Better Solution has a process in place to ensure all clients understand the services provided and are appropriate candidates with regard to the scope of practice. The organization shall make available and provide services to all persons without regard to race, color, creed, sex, national origin, handicap, sexual orientation, age, and marital status, status with regard to public assistance or veteran status, in compliance with all applying federal and state regulations. All services are available without distinction to all program participants, regardless of diagnosis. Agency shall not deny admission to people with contagious disease, including but not limited to HIV/AIDS, MRSA, and Hepatitis. All persons and organizations that either refer persons for services or recommend the agency's services shall also be advised of the same. To provide guidelines for accepting clients for home services to be provided in the client's place of residence that are clear to the home care staff, the medical and lay community, and that abide by state/federal guidelines. Criteria for Client Admission: 1. A direct request or "referral" for services shall be made to the agency. 2. The client must live in the geographic area served by the agency. 3. There must be reasonable expectation that the client's needs maybe adequately met in the client's home. 3.5 Client Admission Process A Better Solution will assess the client's needs and in consultation with the client/representative determine service requirements prior to implementation. 1. Admission criteria are standards by which a client can be deemed appropriate for admission. These standards include: a. The client has an acceptance of home care services b. The client and/or family will be contacted and consulted about a time to assess the client, within 48 hours of the referral. c. The home environment is suitable or adaptable for proper home care services. d. The client's needs may safely and adequately be met at home. This includes the ongoing availability of personnel and equipment. e. Home services provided in the client's place of residence are within the geographical area served by the agency. f. The agency is capable of providing the needed care or service at the level of intensity the client requires. g. Intake Forms shall be completed. Data collected to include: i. Client information ii. Emergency Contact iii. Physician/Pharmacist iv. Pertinent diagnosis v. Reason for service vi. Known allergies vii. Advanced directives viii. List of disciplines involved h. Safety assessment shall be performed at the time of assessment. i. Provide the client/POA with a copy of their privacy rights, Bill of Rights, and Agency grievance procedure. j. The client will also be provided with a description of the client's expectations/goals, and obtain input when possible, at this time a care plan will devised and a copy will be given to the client. k. Advise the client of the charges and billing procedures and, to the extent possible, the anticipated insurance coverage, the client financial liability, and other methods of payment. If third party payment applies — this step will be skipped. I. Obtain the client's signature on the Service Agreement m. Should the client be unable to sign their full name, the client will make their mark (i.e. X), which will be witnessed. n. Develop an Emergency Plan with the client and/or family/POA. 2. Upon acceptance and admission of a client, the supervisor will assign the individual home service worker. All efforts will be made to provide continuity and limit the number of individuals providing care/services. The supervisor will discuss the plan of care/services with the direct employee prior to the initiation of care/services. Dctail by Officer/Registered Agcnt Namc http://search. sunbiz. org/Inquiry/CorporationSearch/SearchRcsultDctail?... Detail by Officer/Registered Agent Name Florida Limited Liability Company SUNSHINE HEALTH CARE SERVICES, LLC Filing Information Document Number L15000093278 FEI/EIN Number 47-4121839 Date Filed 05/28/2015 Effective Date 06/01 /2015 State FL Status ACTIVE Principal Address 5600 Bee Ridge Road Suite B SARASOTA, FL 34233 Changed: 01 /07/2020 Mailing Address 5600 Bee Ridge Road Suite B SARASOTA, FL 34233 Changed: 01 /07/2020 Registered Agent Name & Address COGSWELL, BARBARA 5600 Bee Ridge Road Suite B SARASOTA, FL 34233 Address Changed: 01/07/2020 Authorized Persons) Detail Name & Address 2 of 3 7/29/2021, 11:51 AM Detail by Officer/Registered Agent Name http://search.sunbiz. org/Inquiry/CorporationSearch/SearchResultDetail?... SARASOTA, FL 34233 Annual Reports Report Year Filed Date 2019 02/04/2019 2020 01 /07/2020 2021 01 /13/2021 Document Images 01/13/2021 --ANNUAL REPORT View image in PDF format 01/07/2020 -- ANNUAL REPORT View image in PDF format 02/04/2019 -- ANNUAL REPORT View image in PDF format 01/15/2018 --ANNUAL REPORT View image in PDF format 01/29/2017 -- ANNUAL REPORT View image in PDF format 06/09/2016 -- AMENDED ANNUAL REPORT View image in PDF format 04/28/2016 -- ANNUAL REPORT View image in PDF format 05/28/2015 -- Florida Limited Liability View image in PDF format Florida Department of State, Division of Corporations 3 of 3 7/29/2021, 11:51 AM 8/3/2021 My Corporate I E-Verify ® An official website of the United States government Here's how you know �ri Menu My Company My Corporate Account Company Information Company Name Sunshine Health Care Services, LLC. Doing Business As (DBA) A Better Solution Company ID 1722683 Enrollment Date DUNS Number 090169112 Edit Company Information Company Addresses Physical Address Mailing Address Same as Physical Address https://everify.uscis.gov/account/corporate/profile 1 /2 8/3/2021 My Corporate I E-Verify 5600 Bee Ridge Road Ste B Sarasota, FL 34233 Edit Company Addresses Company Access My Company is Configured to: Manage Child Companies U.S. Department of Homeland Security_ U.S. Citizenship and Immigration Services Accessibility_ Plug -ins J � 2 � �' �US� IIQIII �E�ANn SE�� https://everify.uscis.gov/account/corporate/profile 2/2 W=9 Request for Taxpayer Give Form to the Form (Rev. October2018) Identification Number and Certification requester. Do not Department of the Treasury send to the IRS. Internal Revenue Service ► Go to www.irs.gov/FormW9 for instructions and the latest information. 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. Sunshine Health Care Services, LLC 2 Business name/disregarded entity name, if different from above A Better Solution to a� 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to Ca following seven boxes. certain entities, not individuals; see a instructions on page 3): c ❑ Individual/sole proprietor or ❑ C Corporation ❑ S Corporation ❑ Partnership ❑ Trust/estate ai c single -member LLC Exempt payee code (if any) T 't ❑✓ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ► o 2 Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check Exemption from FATCA reporting n - = LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is code ( if any) a _g another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner. d El Other (ee instructions)► (Applies to accounts maintained outside the U.S.) W 5 Address (number, street, and apt. or suite no.) See instructions. Requester's name and address (optional) 5600 Bee Ridc qe Rd. Suite B 6 City, state, and ZIP code Sarasota, FL 34233 7 List account number(s) here (optional) Oftil Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid social security number backup withholding. For individuals, this is generally your social security number (SHowever, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. or Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Employer identification number Number To Give the Requester for guidelines on whose number to enter. 4 F7- 4 1 2 1 8 3 9 Certification Under penalties of perjury, I certify that 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part 11, later. Sign Signature of " � `� 8/4/2021 Here U.S. person ► Za4.&a,4.a,, Date ► General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/F6rmW9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099-INT (interest earned or paid) • Form 1099-DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231X Form W-9 (Rev. 10-2018) Collier County Solicitation 18-7470S Solicitation 18-7470S Services for Seniors Solicitation Designation: Public Coit CCoUnty Collier County 7/7/2021 1:18 PM P. 1 Collier County Solicitation 18-7470S Solicitation 18-747OS Services for Seniors Solicitation Number 18-74705 Solicitation Title Services for Seniors Solicitation Start Date Jul 7, 20213:18:53 PM EDT Solicitation End Date Aug 10, 2021 3:00:00 PM EDT Question &Answer End Aug 3, 2021 3:00:00 PM EDT Date Solicitation Contact Barbara Lance Procurement Strategist 239-252-8998 Barbara.Lance@colIiercountyfl.gov Contract Duration 6 months Contract Renewal 3 annual renewals Prices Good for 180 days Pre -Solicitation Conference Jul 21, 2021 10:00:OOAM EDT Attendance is optional Location: A Pre -Proposal conference shall be held at: Procurement Services Division 3295 Tamiami Trail East, Bldg C-2 Naples, FL 34112 Solicitation Comments The purpose of this solicitation is to secure vendors for the provision of home and community -based services, to be delivered to persons sixty years and older under Older American's Act (OAA), Community Care for the Elderly (CCE) and Health Care for the Elderly (HCE), and to qualified persons eighteen years or older underAlzheimer's Disease Initiative (ADI). This solicitation was prepared to supplement the services under Request for Proposal #18-7470. The tens of the agreement for this solicitation will run concurrently with the existing term of Agreement#18-7470, Services for Seniors. Item Response Form Item 18-74705-01-01 -Services for Seniors Quantity 1 each Unit Price Delivery Location Collier County No Location Specified Qty 1 Expected Expenditure $1.00 777/2021 1:18 PM P 2 Collier County Solicitation 18-7470S Description Please see Solicitation for specific evaluation criteria to include in your submission. 7/7/2021 1:18 PM P_ 3 Collier County Solicitation 18-7470S Collier Cousaty Administrative Services Department Procurement Services Division COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS REQUEST FOR PROPOSAL (RFP) FOR SERVICES FOR SENIORS SOLICITATION NO. 18-7470S BARBARA LANCE, PROCUREMENT STRATEGIST PROCUREMENT SERVICES DIVISION 3295 TAMIA H TRAIL EAST, BLDG C-2 NAPLES, FLORIDA 34112 TELEPHONE: (239) 252-8998 Barbara.Lance(iDcolliercountyfl.Rv (Email) This solicitation document is prepared in a Microsoft Word format (Rev 8/7/2017). Any alterations to this document made by the Vendor maybe grounds for rejection of proposal, cancellation of any subsequent award, or any other legal remedies available to the Collier County Government. 7/7/2021 1:18 PM p. 4 Collier County Solicitation 18-7470S SOLICITATION PUBLIC NOTICE REQUEST FOR PROPOSAL (RFP) NUMBER: 18-7470S PROJECT TITLE: SERVICES FOR SENIORS PRE -PROPOSAL CONFERENCE: July 21, 2021 at 10:00 am LOCATION: PROCUREMENT SERVICES DIVISION CONFERENCE ROOM 3295 TAMIAMI TRAIL EAST, BLDG C-2, NAPLES. FLORIDA 34112 DUE DATE: August 10 2021 at 3,00 gin PLACE OF REP OPENING: PROCUREMENT SERVICES DIVISION 3295 TAMIAMI TRAIL EAST, BLDG C-2 NAPLES, FL 34112 All proposals shall be submitted online via the Collier County Procurement Services Division Online Bidding System: httus://www.b idsvnc.com/bidsvnc-cas/ INTRODUCTION As requested by the Community and Human Services Division (hereinafter, the "Division or Department"), the Collier County Board of County Commissioners Procurement Services Division (hereinafter, "County") has issued this Request for Proposal (hereinafter, "RFP") with the intent of obtaining proposals from interested and qualified vendors in accordance with the terms, conditions and specifications stated or attached. The vendor, at a minimum, must achieve the requirements of the Specifications or Scope of Work stated. The results of this solicitation may be used by other County departments once awarded according to the Board of County Commissioners Procurement Ordinance. Historically, County departments have spent approximately $2,000,000 of grant program funds annually; however, this may not be indicative of future buying patterns. BACKGROUND The purpose of this solicitation is to secure vendors for the provision of home and community -based services, to be delivered to persons sixty years and older under Older American's Act (OAA), Community Care for the Elderly (CCE) and Health Care for the Elderly (HCE), and to qualified persons eighteen years or older under Alzheimer's Disease Initiative (ADI), within the geographic area of Collier County. Unless otherwise stated, minimum hours of availability are 7:00 a.m. to 5:00 p.m. Monday through Saturday, with the exception of federal and state holidays. Respite services and emergency services must be available 24 hours/day, 365 days/year if needed. Definitions, standards, and requirements of these services are included in the Department of Elder Affairs' Home and Community - Based Services Handbook (DOEA Handbook) link below: httn://elderaffai rs. state. fl. a s/doea/noi s.nhn TERM OF CONTRACT This solicitation was prepared to supplement the services under Request for Proposal #18-7470. The term of the agreement for this solicitation will run concurrently with the existing term of Agreement #18-7470, Services for Seniors. Prices shall remain firm for the initial term of this contract. Surcharges will not be accepted in conjunction with this contract, and such charges should be incorporated into the pricing structure. The County Manager, or designee, may, at his discretion, extend the Agreement under all of the terms and conditions contained in this Agreement for up to one hundred eighty (180) days. The County Manager, or designee, shall give the Contractor written notice of the County's intention to extend the Agreement term not less than ten (10) days prior to the end of the Agreement term then in effect. 7/7/2021 1:18 PM P. 5 Collier County Solicitation 15-7470S DETAILED SCOPE OF WORK Those interested in providing the services detailed below must adhere to all requirements in this RFP, in addition to maintaining adherence with the guidelines set forth by the current DOEA Handbook. Lack of knowledge of all requirements of a service listed in the proposal SHALL NOT relieve the provider of liability and obligations under the resultant agreement. Collier County Community & Human Services (CHS) shall lead all service authorization and coordination. In an effort to comply with the requirements of the OAA, ADI, CCE and HCE Programs, clients entering the service system will be assessed and prioritized by CHS. Upon determination of the service level to be provided, the CHS will offer the client a listing of service vendors for the specific service(s) outlined within their care plan. The client will be encouraged to pick a service provider of their choice and have the option of interviewing potential service providers. Should the client not have a preference, CHS will select a service provider from the centralized provider list, using a rotation basis (rotating to the next vendor on the list). In this manner, all service providers will be equally treated unless the client has a preference. CHS shall not endorse one service provider over another. Upon the determination of the service, the service levels, and the selected vendor, CHS will contact the vendor agency, and authorize the service, number of hours, and frequency. In keeping with the state policy of client choice of service providers, Collier County does not guarantee a minimum or maximum number of clients that will be referred, nor a minimum or maximum number of service hours that will be requested during the contract period. Should a client later indicate dissatisfaction with the chosen service provider, they will again be offered their choice of provider. CHS shall send the agreed -upon Service Authorization to the chosen provider. These "service authorizations" or "service orders" must contain necessary client information, such as street address, telephone number, and services or items needed, as well as the name and telephone number of the CHS case manager authorizing the service. In order to meet client needs, some services maybe required outside of normal office hours (8:00 AM to 5:00 PM, Monday - Friday). CHS reserves the right to request adding additional service providers throughout the resultant agreement period. The County may do so through a competitive and publicly announced selection process, which shall be coordinated through the County's Procurement Department. Services shall be provided in the manner described in the most current DOEA manual and outlined herein. Should funding for additional Senior Services be identified the County reserves the right to add to the resultant agreements the services, descriptions, rates, etc. by way of a contract addendum. Services covered by this agreement include, but are not limited to 1. Adult Day Care: A program of therapeutic social and health activities and services provided to adults who have functional impairments, in a protective environment that provides as non -institutional an environment as possible. 2. Chore: Performance of routine house or yard tasks including such jobs as seasonal cleaning, yard work, lifting and moving furniture, appliances, or heavy objects, household repairs which do not require a permit or specialist, and household maintenance. 3. Enhanced Chore: This service is beyond the scope of chore due to the level of service needed. The service includes a more intensified, thorough cleaning to address more demanding circumstances. 4. Homemaking: Specific home management duties including housekeeping, laundry, cleaning refrigerators, clothing repair, minor home repairs, assistance with budgeting and paying bills, client transportation, meal planning and preparation, shopping assistance, and routine house -hold activities by a trained homemaker. 5. Personal Care: Assistance with eating, dressing, personal hygiene and other activities of daily living. This service may include assistance with meal preparation, housekeeping chores such as bed making, dusting, and vacuuming incidental to the care famished or essential to the health and welfare of the individual. Personal care can include accompanying the client to clinics, physician office visits, or trips for the purpose of health care provided that the client does not require special medical transportation. Personal care can also include shopping assistance to purchase food, clothing, and other items needed for the client's personal care needs. 6. In Home Respite: Relief or rest for a primary caregiver from the constant/continued supervision, companionship, therapeutic and/or personal care, of a functionally impaired older person for a specified period of time. 7. Skilled Nursing: Part-time or intermittent nursing care administered to an individual by a licensed practical nurse, registered nurse, or advanced registered nurse practitioner, in the client's place of residence, pursuant to a care plan approved by a licensed physician. 8. Emergency Alert Response Services: Emergency alert/response service is defined as a community based electronic surveillance 3 7/7/2021 1:18 PM P. 6 Collier County Solicitation 18-7470S service which monitors the frail homebound elder by means of an electronic communication link with a response center. 9. Specialized Medical Equipment, Services, and Supplies: Adaptive devices, controls, appliances, or services, which enable individuals to increase their ability to perform activities of daily living and repair of such services which may include: dentures, walkers, reaching devices, bedside commodes, telephone amplifiers, touch lamps, adaptive eating equipment, glasses, hearing aids, and other mechanical or non -mechanical, electronic, and non -electronic adaptive devices. Supplies may include such things as adult briefs, bed pads, oxygen or nutritional supplements. 10. Facility Respite: 24-hour care in a State of Florida Licensed Nursing home 11. Establish protocols for contacting CHS Case Managers in emergency or unusual circumstances and include the documentation requirements (oral and written) in the Service Provider Application. 12. Provide disaster response protocols, plans and services: In the event of a natural disaster (hurricane, tropical storm, tornado, flood, heat wave, etc.), the provider will have staff available to serve those clients in critical need of services, as designated by the CHS Case Managers. 13. Establish a client grievance process: Each service provider agency must have a policy addressing client grievances and/or complaints. 14. Establish and provide staff training: All services provided with funding from DOEA require service delivery personnel to have general pre -service orientation and training specific to the service being provided. Lead Agencies are responsible for provision of the pre -service training (on program and billing requirements, in particular) for all paid staff, volunteer staff and assigned staff of service providers. Pre -service orientation must also include: • An overview of the aging process • An overview of the aging network • Communication techniques with the elderly • Observation of abuse, neglect, exploitation and incident reporting • Local agency service procedures and protocol • Client confidentiality NOTE: All "hands-on" service personnel must receive training emphasizing the necessity of Universal Precautions. Home Health Aides must have documentation of successful completion of 40 hours required training, and CNAs must have on file a copy of their State of Florida certification. In-service training hours and topics are to be provided at the discretion of the service provider agency and shall meet state requirements. 15. Compile and report program service delivery statistics and other data as identified by CHS. This may be required to be provided in an electronic format at the choosing of CHS. These are reported to the Area Agency on Aging and Department of Elder Affairs in accordance with the reporting requirements developed by the Department. Lead agencies are responsible for entry of data in the Client Information and Registration Tracking System (CIRTS), which generates payment to the service provider agency. Therefore, service provider agencies are required to provide Lead Agencies with correct and timely service data to comply with these requirements. Timely submission is no later than noon on Wednesday of the week following the week services are performed (service week defined as Monday through Sunday). 16. Maintain complete and accurate records: Service delivery logs, at a minimum, must be legible and contain the name of client, type(s) of services and date(s) and hour(s) of delivery. The client/caregiver must sign the log at the time of each service visit. The service worker must sign and date the log upon completion and submit it to the service provider agency. Provide complete, clear and accurate invoices: Weekly invoices, which may be required to be provided electronically in a system provided by CHS, must be submitted by noon on the Wednesday following the week that the service was provided and shall include service provided. The service week is defined as Monday through Sunday. Monthly reporting requirements for CIRTS dictate that all client and service data for the previous month to be entered into CIRTS by the 10th day of the month. Collier County "Services for Seniors" will coordinate with vendors to determine due dates for invoices. This will ensure compliance with DOEA reporting requirements. Failure to record or report units of service will result in nonpayment (or delayed payment) for such services. Data required on weekly invoices and weekly timesheets include: • Vendor name • Vendor address • Vendor telephone number • Client name 7/7/2021 1:18 PM p. 7 Collier County Solicitation 18-7470S • Service Provider employee who delivered the service(s) • Services ordered and services delivered date • Number of service hours, cost per hour and total cost • Person preparing the report and the date it was prepared • Weekly timesheets signed and dated by the client and Service Provider employee • Additional information as determined by CHS 17. Prepare for annual ou-site compliance audits by CHS or members of the Collier County staff as directed by the CHS or grant requirements. REQUEST FOR PROPOSAL (RFP) PROCESS 1.1 The Proposers will submit a qualifications proposal which will be scored based on the criteria in Evaluation Criteria for Development of Shortlist, which will be the basis for short -listing firms. The Proposers will need to meet the minimum requirements outlined herein in order for their proposal to be evaluated and scored by the COUNTY. The COUNTY will then score and rank the firms and enter into negotiations with the top ranked firm to establish cost for the services needed. The COUNTY reserves the right to issue an invitation for oral presentations to obtain additional information after scoring and before the final ranking. With successful negotiations, a contract will be developed with the selected firm, based on the negotiated price and scope of services and submitted for approval by the Board of County Commissioners. 1.2 The COUNTY will use a Selection Committee in the Request for Proposal selection process. 1.3 The intent of the scoring of the proposal is for respondents to indicate their interest, relevant experience, financial capability, staffing and organizational structure. 1.4 The intent of the oral presentations, if deemed necessary, is to provide the vendors with a venue where they can conduct discussions with the Selection Committee to clarify questions and concerns before providing a final rank. 1.5 Based upon a review of these proposals, the COUNTY will rank the Proposers based on the discussion and clarifying questions on their approach and related criteria, and then negotiate in good faith an Agreement with the top ranked Proposer. 1.6 If, in the sole judgment of the COUNTY, a contract cannot be successfully negotiated with the top -ranked firm, negotiations with that firm will be formally terminated and negotiations shall begin with the firm tanked second. If a contract cannot be successfully negotiated with the firm ranked second, negotiations with that firm will be formally terminated and negotiations shall begin with the third ranked firm, and so on. The COUNTY reserves the right to negotiate any element of the proposals in the best interest of the COUNTY. RESPONSE FORMAT AND EVALUATION CRITERIA FOR DEVELOPMENT OF SHORTLIST 1.7 For the development of a shordist, this evaluation criterion will be utilized by the COUNTY'S Selection Committee to score each proposal. Proposers are encouraged to keep their submittals concise and to include a minimum of marketing materials. Proposals must address the following criteria: Evaluation Criteria Maximum Points 1. Cover Letter / Management Summary 5 Points 2. Organizational Capabilities and Experience 20 Points 3. Financial and Human Resources Capabilities 20 Points 4. General Service Delivery 25 Points 5. Acceptance of Cost 20 Points 6. Cost of Services to the County 10 Points TOTAL POSSIBLE POINTS 100 Points Tie Breaker: In the event of a tie at final ranking, award shall be made to the proposer with the lower volume of work previously awarded. Volume of work shall be calculated based upon total dollars paid to the proposer in the twenty-four (24) months prior to the RFP submittal deadline. Payment information will be retrieved from the County's financial system of record. The tie breaking procedure is only applied in the final ranking step of the selection process and is invoked by the Procurement Services Division Director or designee. In the event a tie still exists, selection will be determined based on random selection by the Procurement Services Director before at least three (3) witnesses. Each criterion and methodology for scoring is further described below. 5 7/7/2021 1:18 PM P. 8 Collier County Solicitation 18-7470S ***Proposals must be assembled, at minimum, in the order of the Evaluation Criteria listed or your proposal may be deemed non -responsive*** EVALUATION CRITERIA NO.1: COVER LETTER/MANAGEMENT SUMMARY (5 Total Points) Provide a cover letter, signed by an authorized officer of the firm, indicating the underlying philosophy of the fum in providing the services stated herein. Include the name(s), telephone number(s) and email(s) of the authorized contact person(s) concerning proposal. Submission of a signed Proposal is Vendor's certification that the Vendor will accept any awards as a result of this REP. Submit proposer's Agency for Health Card Administration (AHCA) Certification: If certification is not provided at time of proposal submission, the firm will be deemed non -responsive. Indicate by selecting any one, or multiple services which the proposer is interested in providing to the County (descriptive information is outlined in the above scope of work. Item Services Interested in Providing Service (Place X) Not Interested in Providing Service (Place X) 1 Adult Day Care X 2 Chore x 3 Chore (Enhanced) 4 Homemaking X 5 Personal Care X 6 Respite (In -home) X 7 Skilled Nursing X 8 Emergency Alert Response Services EARS 9 Specialized Medical Equipment, Services, and Supplies X 10 Respite (Facility Based) x EVALUATION CRITERIA NO.2: ORGANIZATIONAL CAPABILITIES AND EXPERIENCE (20 Total Points) Complete each of the items below in the format requested and submit evidence of documentations where indicated. Proposers who do not complete in the format indicated below may be deemed non -responsive. Yes/No 1. The proposer has received license from Agency for Health Care Administration (AHCA). Provide evidence of license. i1�S J The proposer has by-laws which describe how business will be conducted. Vies The proposer has the appropriate license for the services it intends to rovide to Collier County. Provide license evidence. J es 4. Board members are required to sign a conflict of interest statement. 5. e proposer has a written business plan that is updated regularly. )AP 6 7/7/2021 1:18 PM P. 9 Collier County Solicitation 18-7470S 6. Organizational Chart: Proposer has to provide a copy of the organizational chart indicating lines of authority and permanent and full-time positions. es Provide evidence. Total number of years that the proposer has been in business. 8. Proposer has supervisory staff on call 24 hours per day/ 365 days per year. oz,s roposer's Owner/Operator license has never been denied, suspended or by evoked Medicare, Medicaid, any Federal and/or any State Agency. If i V es, please attach a letter or explanation. The County requests that the vendor submits no fewer than three (3) and no more than ten (10) completed reference forms from clients during a period of the last 5 years whose services provided are of a similar nature to this solicitation as a part of their proposal. Provide information on the services completed by the Proposer that best represent services of similar size, scope and complexity of this scope of work using Form 5 — Reference Questionnaire. Proposers may include two (2) additional pages for each reference to illustrate aspects of the completed services that provides the information to assess the experience of the Proposer on relevant work. EVALUATION CRITERIA NO 3: FINANCIAL AND HUMAN RESOURCES CAPABILITIES (20 Total Points) Complete each of the items below in the format requested and submit evidence of documentations where indicated. Proposers who do not complete in the format indicated below may be deemed non -responsive. Yes/No 1. roposer maintains daily, monthly and annual financial records of payroll, enefits, operating and capital equipment. J 2. roposer prepares annual 1099 forms for all employees. roposer has a certified public accountant or an independent ccounting/auditing firm to prepare financial records. Proposer uses an accounting software product. Proposer has an accounting staff produce monthly financial statements.�� 6. roposer has annual audit completed. Provide copy recently completed. oposer has written recruitment policy. 8. oposer provides criminal background check for employees on this contract. 9. Proposer conducts formal orientation for all new staff. , t 107 Proposer distributes written personnel policies to staff. V 5 777/2021 1:18 PM P. 10 Collier County Solicitation 18-7470S 11. oposer distributes written personnel policies. 12. orkman's Compensation Policy information clearly posted for staff. c, 13. roposer maintains written, signed Job Descriptions. 14. roposer's employees are evaluated at least annually in writing. J 15. Proposer has written hiring practices. ✓ 16. roposer has written retention policies. CC �J 17. roposer has formal progressive disciplinary procedures. 18. roposer has written policies regarding theft and falsification of time sheets 19. oposer has policy to prevent fraud and formalized methods to report uspected incidents. (` e5 Sf 0. gency has written disaster plan. 1. roposer agrees to utilize electronic means to submit documentation, as determined by CHS, to include invoices.; EVALUATION CRITERIA NO 4: GENERAL SERVICE DELIVERY (25 total points) Complete each of the items below in the format requested and submit evidence of documentations where indicated. Proposers who do not complete in the format indicated below may be deemed non -responsive. Yes/No 1. roposer maintains a formal record of in -services, available for review. �5 2. roposer maintains copies of training schedule for last year, available for eview.3. Proposer maintains sign in sheets for in-service training, available for ev"w. 4. intains evidence of attendance and completion in employee p,,ps,, copies on file of training materials. t C 8 7/7/2021 1:18 PM P. 11 Collier County Solicitation 18-7470S 6. roposer has written Quality Assurance plan. Provide plan. \� roposer surveys clients for satisfaction in writing at least once per year. Provide sample. 8. roposer analyzes surveys and uses reports for transmission to administration and to employees. {4 e_% J 9. roposer incorporates results of Quality Assurance activities to annual Ian. 10. roposer has Quality Assurance Committee as standing subcommittee of card � 05 11. roposer has written policy for reporting incidents. Provide copy and a sample of the incident report. `[ je S J 12. roposer has formal training for staff regarding reporting of suspected ases of abuse or neglect. `/1 c...✓ 13. roposer maintains anti -discrimination policies related to service consumer. J C� 14. Proposer has written policy regarding consumers rights. 15. Proposer has written system for registering consumers' complaints. 16. roposer has written policy to follow up on consumers' compla nts. 17. roposer has written description of how service is delivered from point of equest through provision and termination. Provide copy. Cam. 18. roposer has written procedures for assuring confidentiality of consumer ecords. EVALUATION CRITERIA NO. 5: ACCEPTANCE OF COST (20 Total Points) In this criterion you will be provided a list of services needed by the County. Those services with rates, In -kind match and Cost already completed are standard rates in which you will be required to accept. Pie e�eyy sign as an accep ance to the rates if you deem these standard rates to be acceptable. I accept the standard contract rates listed below. Cost Per Service In -kind 10% Reimbursement Unit (Cost your Match (Grant Rate Per Unit Item Services Grant Service Unit company charges for Amount, your (Amount the the service) company will be County will paying) reimburse your company for a given service) 1. Skilled Nursing CCE, OAA Be, Hour $40.00 $4.00 $36.00 9 7/7/2021 1:18 PM p. 12 Collier County Solicitation 18-7470S 2. Enhance Chore ADI, CCE, OAA Per Hour $40.00 $4.00 $36.00 3. Respite (In -Home) ADI, CCE, OAA Per Hour $24.11 $2.41 $21.70 4. Respite (Facility Based) ADI, CCE, OAA Daily Rate $225.00 0 $225.00 5. Personal Care ADI, CCE, OAA Per Hour $24.11 $2.41 $21.70 6. Chore ADI, CCE, OAA Per Hour S24.00 $2.40 $21.60 7. Homemaking ADI, CCE, OAA Per Hour $23.33 $2.33 $21.00 8. Adult Day Care ADI, CCE, OAA Per Hour $13.89 $1.39 $12.50 9. Emergency Alert Response ADI, CCE, OAA Per Day $1.09 $0.11 $0.98 EVALUATION CRITERIA NO. 6: COST OF SERVICES TO THE COUNTY (10 Total Points) In this tab, insert your cost for the services listed below. Cost Per Service In -kind 10% Reimbursement Rate Per Unit Item Services Grant Service Unit (Cost your company charges Match (Grant Amount your (Amount the Unit for the service) company will be County will reimburse your paying) company for a given service) Specialized Medical ADI, CCE, OAA Per Episode 10. Equipment, Services, and Supplies VENDOR CHECKLIST ***Vendor should check off each of the following items as the necessary action is completed (please see, Vendor Check List)*** 10 7/7/2021 1:18 PM p. 13 Collier County Collier County Administrative Services Department Procurement Services Division Vendor Check List Solicitation 18-7470S IMPORTANT: Please review carefully and submit with your Proposal/Bid All applicable documents shall be submitted electronically through BidSync. Vendor should checkoff each of the following items: V/ General Bid Instructions has been acknowledged and accepted. ITK Collier County Purchase Order Terms and Conditions havebeen acknowledged and accepted. rl" ,Form 1: Vendor Declaration Statement fi! / Form 2: Conflict of Interest Certification L✓! Proof of status from Division of Corporations - Florida Department of State (If work performed in the State) - httpJ/dos.myflorida.com/sunbi7Jshouldbeattached with your submittal. 4d'/Vendor MUST be enrolled in the F Venfy - https://www.e-veiify.gov/ at the time of submission of theproposal/bid. W Form 3: Irrmoigration Affidavit Certification MUST be signed and attachedwith your submittal or you MAY be DEEMED NON -RESPONSIVE &Verify Memorandum ofUnderstandingorCompany Profile page should be attached with your submittal. ❑ I1 Form 4: Certification for Claiming Status as a Local Business, if applicable, has been executed and returned. Collier or L ee Business Tax Receipt should be attached with your submittal to be considered. 2. Reference Questionnaires fomr must be utilized for each requested reference and included with your submittal, id applicable to the solicitation. Form 6: Crant Provisions and Assurances package in its entirety, if applicable, are executed and should be included with your submittal. All forms most be executed, or you MAY be DEEMED NON -RESPONSIVE. Veydor W-9 Form U.r Vendor acknowledges Insurance Requirements and is prepared to produce the required insurance certificate(s) within five (5) days of the County's issuance of a Notice of Recommend Award. The Bid Schedule has been completed and attached with your submittal, applicable to bids. 01 Copies of all requested licenses and/or certifications to complete therequirements of the project. All addenda have been s igned and attached, or you MAY be DEEMED NON -RESPONSIVE. �.T County's IT Technical Architecture Requirements has been acknowledged and accepted, if applicable. ❑ N Any and all supplemental requirements and terms has been acknowledged and accepted, if applicable. 7/7/2021 1:y25 PM f p. 14 ** *UPDATED JANUARY 2 & 2020" Collier County Solicitation 18-7470S 001(er County Administrative Services Departrnent Procurement Services Derision Form 1: Vendor Declaration Statement BOARD OF COUNTY COMMISSIO Collier County Government Complex Naples, Florida 34112 Dear Commissioners: The undersigned, as Vendor declares that this response is made without connection or arrangement with any otherperson and this proposal is in every respect fair and made in good faith, without collusion or fraud. The Vendor hereby declares the instructions, purchase order temis and conditions, requirements, and specifications/scope of work of this solicitation have been fully examined and accepted. The Vendor agrees, if this solicitation submittal is accepted by Collier County, to accept a Purchase Order as a form of a fomtal contract or to execute a Collier County formal contract for purposes of establishing a contractual relationship between the Vendor and Collier County, for the performance of all requirements to which this solicitation pertains. The Vendor states that the submitted is based upon the documents listed by the above referenced solicitation. The Vendor agrees to comply with the requirements in accordance with the terms, conditions and specifications denoted herein and according to the pricing submitted as a part of the Vendor's bids. Further, the Vendor agrees that if awarded a contract for these goods and/or services, the Vendor will not be eligible to compete, submit a proposal, be awarded, or perform as a sub -vendor for any future associated work that is a result of this awarded contract. IN WITNESS WHEREOF, WE have hereunosubscribed out names onthis bCi dayof ,20�tin the County of GO4�ief httheStateof }t7 t Firm's Legal Name: Address: City, State, Zip Code: Florida Certificate of Authority Document Number Federal Tax Identification Number *CCR # or CAGE Code *Only if Grant Funded Telephone: Email: Signature by: (Typed and written) Title: t arl();ctrn � Tru:1 5a,A-e.. Li 7/7/2021 1-:18 PM P. 15 ***UPDATM JANUARY 28, 2020*** Collier County Solicitation 18-7470S Additional Contact Information Send payments to: (required if different from above) Contact name: Title: Address: City, State, ZIP Telephone: qI N I - Email: Office servicing Collier County to place orders (required if different from above) Contact name: Title: Address: City, State, ZIP Telephone: Email: 7/7/2021 1:18 PM p. 16 * * *UPDAUD JANUARY 28; 2020*** '�CCo[�llier County Solicitation 18-7470S �iofner CiOH14ty Administrative Sernces Deparlinerr Procurement Sers4�s Dnislcn Form 2: Conflict of Interest Certification Affidavit The Vendor certifies that, to the best of its knowledge and belief, the past and current work on any Collier County project affiliated with this solicitation does not pose an organizational conflict as described by one of the three categories below: Biased ground rules —The firm has not set the "ground rules" for affiliated past or current Collier County project identified above (e.g., writing a procurement's statement of work, specifications, or performing systems engineering and technical direction for the procurement) which appears to skew the competition in favor of my firm Impaired objectivity — The firm has not performed work on an affiliated past or current Collier County project identified above to evaluate proposals / past performance of itself ora competitor, which calls into question the contractor's ability to renderimpanial advice to the govem men I. Unequal access to information — The firm has not had access to nonpublic information as part of its performance of a Collier County project identified above which may have provided the contractor (or an affiliate) with an unfair competitive advantage in current or future solicitations and contracts. In addition to this signed affidavit, the contractor/ vendor must provide the following: 1. All documents produced as a result of the wot$ completed in the past or currently being worked on for the above -mentioned project; and, 2. Indicate if the information produced was obtained as a matter of public record (in the "sunshine") orthrough non-public (not in the "sunshine") conversation (s), meeting(s), document(s) and/or other means. Failure to disclose all material or having an organizational conflict in one or more of the three categories above be identified, may result in the disqualification for future solicitations affiliated with the above referenced project(s). By the signature below, the firm (employees, officers and/or agents) certifies, and hereby discloses, that, to the best of their knowledge and belief, all relevant facts concerning past, present, or currently planned interest or activity (financial, contractual, organizational, or otherwise) which relates to the project identified above has been fully disclosed and does not pose an organizational conflict. Print Name and Title State of kt+ J\ A County of 1 The foregoing instrument was acknowledged before me by means of physical p e ence or ❑ online notarization, this )02 day of �(,(� �J e',J (month), �. (year), by �J �.��,� h11#ill{ 640. (name ofperson acknowledging). ot�av naa` AMANDAPERTUCH _ �.•.�� c Commission#NH 099776 ` Expires March 2, 21125 (Signature of Notary Public -State of Florida) M�9�FOFF1.�Qo� Bondednw Bud9UNotaryServivs (Print, Type, or Stamp Connnissioned Name ofNotary Public) Personally Known OR Produced Identification Type of Identification Produced 7/7/2021 1:18 PM p. 17 `**UPDATED JANUARY 28. 2020"* Collier County Solicitation 18-7470S 001fer C 01414ty Administrative Services Department Procurement Services Division Form 3: hnmigration Affidavit Certification This Affidavit is required and should be signed, by an authorized principal of the firm and submitted with formal solicitation submittals. Further, Vendors are required to be enrolled in the E-Verify program (httns://ivww e-verify eov/). at the time of the submission of the Vendor'sproposal/bid. Acceptable evidence of your enrollinent consists of a copy ofthe properly completed E- Verify Company Profile page or a copy of the fully executed E-Verify Memorandum of Understanding for the company which will be produced at the time ofthe submission ofthe Vendor's proposal/bid or within five (5) day ofthe County's Notice of Recommend Award. FAILURE TO EXECUTE THIS AFFIDAVIT CERTMCATION AND SUBMIT WITH VEMOR'S PROPOSAIJBM MAY DEEM TIM VENDOR'S AS NON -RESPONSIVE. Collier County will not intentionally award County contracts to any Vendor who knowingly employs unauthorized alien workers, constituting a violation of the employment provision contained in 8 U.S.C. Section 1324 a(e) Section 274A(e) of the Immigration and Nationality Act ("INA"). Collier County may consider the employment by any Vendor of unauthorized ahens a violation of Section 274A (e) of the INA. Such Violation by the recipient of the Employment Provisions contained in Section 274A (e) of the INA shall be grounds for unilateral termination of the contract by Collier County. Vendor attests that they are fully compliant with all applicable immigration laws (specifically to the 1986 Immigration Act and subsequent Amendment(s)) and agrees to comply with the provisions of the Memorandum of Understanding with E-Verify and to provide proof of enrollment in The Employment Eligibility Verification System (E-Verify), operated by the Department of Homeland Security in partnership with the Social Security Administration at the time of submission ofthe Vendor's proposat/bid. �e.Svur[eSCorP- // Xbnivany Name Print Name State of ntw,iAn County of The foregoing instrument was acknowledged before me by means of Erphysical resence or ❑ online notarization, this day of ��! (month), .rim (yeaz), by 1 i��\1 Mtlgsr }' V\e all (name ofperson acknowledging). ,j"!Pik AM DAPERTUCti ao ° Commission#HH0WT75 * * Expires March 2, 2025 (Signature of Notary Public -State of Florida) aI9 OF F�pe Bended7NU B*etNONcyWli' (Print, Type, or Stamp Commissioned Name of Notary Public) Personally Known OR Produced Identification Type of Identification Produced 7/7/2021 1:18 PM P. 18 ***UPDATED JANUARY 28, 2020*** Collier County Solicitation 18-7470S 7/7/2021 1:18 PM P. 19 ***UPDATED JANUARY28, 2020*** p s .nyl.<m: Poye w - E-vedry wokcmc Vserw Y ONF CASiE- pROfiLE- `�mpanY Sulymeralicce ifmna Heet9r Cere Rsaur Corp SppID39 RETORii- RES611RCEY- L OG OUi 4 r QUICK LINKS p;h L USIt the v+a�Ray E eri a message Center lipow ••a m �. to get the latest a �{ j E-Verify News and Information za. w>�: mna tiaras �. i,:;jr, �'�,-zscj,,�Nrh Core Jul 13, 2021 To: Collier County Senior Services Program This is Sullymar Alicea, Administrator of Home Health Care Resources Corp, Port Charlotte office. I would like to inform you that we are a Private Duty Agency contracted with the LongTerm Medicaid Program and Charlotte County Senior Services Program. Our State license allows us to provide care in Region 8 including counties of Charlotte, De Soto, Sarasota, Lee, Collier and Hendry. At the moment we are servicing LTC's clients and VA's clients in Collier county since 2018. 1 did notice that the Solicitacion package on pag. 20 addresed that a physical business location needed to be present in Lee or Collier Counties, our office is located in Port Charlotte, Florida, Charlotte County, but we do provide care for clients in Collier County and we have our RN that provides supervisory visits to the staff in the field. If you please take our agency into consideration as we are actively contributing and providing care to the senior population in Collier County. We are looking forward to continuing providing excellent care to Collier County Seniors for the wellbeing of our senior community. Best Regards, Sullymar Alicea Administrator 866 Tamiami Suite 4 Port Charlotte, FI 33953 941-883-4282 CoIrw Cotnty Soral tion i$-7470S IC..O 7Ci" county Adm'uevaSatviresf Pimrtdaefa0lvisml Form 4: Vendor Submittal —Local. Vendor Preference Certdcsdoa Sfsm 8 �(Selma if Vendor is described as a Local Business) Q Lee County Vendor of O s that it is a local busims as defied by the Procurement Oulmance of the Collier County Board of County Commssiouecs arrdtbe Reguffitiorts Thexeus, As defuted in Section Fdteen ofthe Copier County Procurement Osdangce: local business means the vendor has a count Business Tax Receipt issued by the CoI&rCounty TaxColleetorprlorto bid of proposal submission to do business wi'thm Collier County, and that identifies the business with a permanent physical business address Exeatecl withal the Smas of Carper County fromwhieh the vendor's staffopetates and perfoms busmes s in an area arced for the conduct of such business. A Post Office Box or a facifity that receives Maal, or a non-pemmncut stmelme such as a construction ftwle4 storage shed, or othernon-Pemmment structure shall not be used for the purpose of estabiaidug said physical address, In addition to the foregoing, a vendor shalnot be considered a "local business" unless it c ures to the eeaaorac development and we0-bang of CoDer County in a veri6abk and m,asutable way. This may include, but not befnitedto,theretontionandexpansionofemploymentopportanities,supportand increasetothe County's tmbsse, and residency of employees and principals of the business widr$t Collier County. Vendors shall afi>mrin writing their eompTaoee with the foregoing at the time of submitting their bid or proposal to be eligible ibroonsideratiou as a "boat business* under Ill's section. A vendor who misrepresents the local Preference status of its turn in a proposal or bid submitted to the County win lose the privilege to claim local Preference status for a period ofup to one year under this section. Vendorvast convicts themawmg wfamiatlon. Near BusiaessEmablished in MCoTwr Conuty orO Lee County: V ( O f il) S +pal &r Cc�r e— Number ofTmnployees (including Owner(s) orCosporate OfEeers). i S t y- l = —I iX � n 4 Din mbff ofEapbYces Living in ETCaDier county orM lee (Including owners) orcorporsts O$cert If mlttestcd by the Crrmnty, Vendor WM be requited to provide documentation substantiating the information given in this seatbicsga0n. FxUwe 14 da sovM result in vendor's submission being deemed not applicable. a P,- � _.. _pus ♦.l _ I �1. f .. . Title: C " p.20 ***aPIDAM,TAWwmt as aszv** Collier County Solicitation 18-7470S Questionnaire for. Collier County Administrative Services Department Procurement Services Division Form 5 Reference Questionnaire (USE ONE FORM FOR EACH REQUIRED REFERENCE) Information) (Name oflndivduals JRequesting Reference Information) Name: �Clcta'(i^Jo CCwct C' Company: f ..... �V— GXAI cckna? (Evaluator completing referent estionnaire) (Evaluator's Company completing reference) Email:.ea� L�� �2HlAFCAr2.COrn 11��11 !t1 a ,( Ck G )Y1r)�ria FAX: 1 1 — -7`^ `' 913 Telephone: 1410(0 '9,54 Collier County has implemented a process that collects reference information on firms and their key personnel to be used in the selection of firms to perform this project. The Name of the Company listed in the Subject above has listed you as a client for which they have previously performed work Please complete the survey. Please rate each criteria to the best of your knowledge on a scale of 1 to 10, with 10 representing that you were very satisifed (and would hire the fnrn/individual again) and I representing that you were very unsatisfied (and would never hire the fir✓indivdival again). If you do not have sufficient knowledge ofpast performance in a particular area, leave it blank and the item or foam will be scored "0." Project Description: Project Budget: Completion Date: Project Number of Days: Item 1 Criteria Ability to manage the project costs (minimize change orders to scope). Score (must be completed) 2 Ability to maintain project schedule (complete on - time or early). 3 Quality of work. 4 Quality of consultative advice provided on the project. 5 Professionalism and ability to manage personnel. 6 Project administration (completed documents, final invoice, final producttumover, invoices; manuals or going forward docummntation, etc.) 7 Ability to verbally communicate and document information clearly and succinctly. 8 Abiltity to manage risks and unexpected project circumstances. 9 Ability to follow contract documents, policies, procedures, rules, regulations, etc. 10 Overall comfort level with hiring the company in the future (customer satisfaction). TOTAL SCORE OF ALL ITEMS 7/7/2021 1:18 PM p. 21 ***IIPDATM JANUARY 2K 2020*** Collier County Solicitation 18-7470S Collier County Administrative Services Department Procurement Services Division Form 5 Reference Questionnaire (USE ONE FORM FOR EACH REOUdRED REFERENCE) Reference Questionnaire for: �+ G.a <eSouaes C(}vr (Name Company RequestgReferenceInformation) U it (Name of Ind duals Requesting Reference Information) Name: VA� MSIt•�e0Y" Company: 9LAO-Ctl1nit (Evaluator completing referencr,e\qu nnaire) (Evaluator's Company completing reference) Email: _� Collier County has implemented a process that collects reference information on firms and their key personnel to be used in the selection of firms to performthis project. The Name of the Company listed in the Subject above has listed you as a client forwhich they have previously performed work. Please complete the survey. Please rate each criteria to the best of your knowledge on a scale of I to 10, with 10 representing that you were very satisifed (and would hire the fmmyindividual again) and 1 representing that you were very unsatisfied (and would never hire the fimn/indivdival again). If you do not have sufficient knowledge ofpast performance in a particular area, leave it blank and the item or form will be scored "0.- Project Description: Project Budget: Completion Date: Project Number of Days: Item 1 Criteria Ability to manage theproject costs (minimize changeorders to scope). Score (must be completed) 2 Ability to maintain project schedule (complete on -time or early). 3 Quality of work- 4 Quality of consultative advice provided on the project. 5 Professionalism andabihty to managepersonnel 6 Project administration (completed docmnents,final invoice, final producttumover; invoices; manuals or going forward documentation, etc.) 7 Ability to verbally convnunicate and document information cleazly and succinctly. 8 Abiltity to manage risks and unexpected project circumstances. 9 Ability to follow contract docnments,policies, procedures, rules, regulations, etc. 10 Overall comfort level with hiring the company in the future (customer satisfaction). TOTAL SCORE OF ALL ITEMS 717l2021 1:18 PM p. 21 * *UPDA'D JANUARY 28, 2020-1 Collier County Solicitation 18-7470S for. co ler county Administrative Services Department Procurement Services Division Form 5 Reference Questionnaire (USE ONE FORM FOR EACH REQUIRED REFERENCE) Information) (Name of Indio duals Requesting Reference Information) ference Infoation) Name: A0%2(}Vne- A@4p plllAisz- RGj' ej--Company: W �llC�zrP, (Evaluator completin reference questionnaire) (Evaluator's Company completing refree�Frice) fi Sq. p9CYa2-H' ill i'(.j .c D% (QM V),J-'J�r%� Email:,�OXGnY12. .4h6 10dlCQVC, FAX: !)��J-�'I`%�'o�%�-+W Telenhone• oa4-.:)1)4--`'7,L(7 Collier County has irwlemented a process that collects reference information on firms and their key personnel to be used in the selection of firms to perform this project. The Name of the Company listed in the Subject above has listed you as a client for which they have previously performed work. Please complete the survey. Please rate each criteria to the best of your knowledge on a scale of I to 10, with 10 representing that you were very satisifed (and would hire the frmyindividual again) and 1 representing that you were very unsatisfied (and would never hire the firrdindivdival again). If you do not have sufficient knowledge of past perfbmmnce in a particular area, leave it blank and the item or form will be scored "0.- Project Description: Project Budget: Completion Date: Project Number of Item I Criteria Ability to manage the project costs (minimize change orders to scope). Score (must be complete(o 2 Ability to maintain project schedule (complete on early). or early). 3 Quality of work. 4 Quality of consultative advice provided on the project. 5 Professionalism and ability tomanage personnel. 6 Project administration (completed documents,final invoice, final productmmover, invoices; manuals or going forward documentation, etc.) 7 Ability to verbally communicate and document information clearly and succinctly. 8 Abiltity to manage risks and unexpected project circumstances. 9 Ability to follow contract documents, policies, procedures, rules, regulations ,etc. 10 Overall comfort level with hiring the congmany in the future (customer satisfaction). TOTAL SCORE OF ALL 1TENN 7/7/2021 1:18 PM p. 21 ***UPDA'ffD JANU.ARY 28, 2020*** Collier County Solicitation 18-7470S Collier County Administatve Services Depar med Procurement Services Mnsion Form 5 Reference Questionnaire (USE ONE FORM FOR EACH REOUIRED REFERENCEI Questionnaire for: (Name of Endiv duals Requesting Nam: btzlx-a ,boo li (Evaluator completing reference Information) FAX: CorrpanY,3hCi/1tJCiN. p Kvmao SAY Vausp �i'jii (Evaluator's Company completing reference) AAU 1+F Fl.` ol/ 51 Collier County has implemented a process that collects reference information on firms and their key personnel to be used in the selection of Hums to perform this project. The Nam of the Company listed in the Subject above has listed you as a client forwhich they have previously performed work Please complete the survey. Please rate each criteria to the best of your knowledge on a scale of 1 to 10, with 10 representing that you were very satisifed (and would hire the firm/individual again) and I representing that you were very unsatisfied (and would never hire the fnxn/indivdival again). If you do not have sufficient knowledge of past performance in a particular area, leave it blank and the item or form will be scored "0." Project Description: Project Budget: Completion Date: Project Number of Days: Item Criteria Score (must be completed) 1 Ability to manage theproject costs (minimize changeorders to scope). 2 Ability to maintain project schedule (complete on -time or early). 3 Quality of work 4 Quality of consultative advice provided on the project. 5 Professionalism and ability to manage personnel. 6 Project administration (completed documents, final invoice, final product turnover; invoices; manuals or going forward documentation, etc.) 7 Ability to verbally communicate and document information clearly and succinctly. 8 Ablltity to manage risks and unexpected project circumstances. 9 Ability to follow contract documents, policies, procedures, rules, regulations, etc. 10 Overall comfort level with hiring the company in the future (customer satisfaction). TOTAL SCORE OF ALL ITEMS 7/7/2021 1:18 PM p. 21 ***UPDATED JANUARY 28, 2020*** Collier County Solicitation 18-74705 for: Collier County Administrative Services Department Procurement Services Division Form 5 Reference Questionnaire (USE ONE FORM FOR EACH REOUIRED REFERENCE) Information) (Name of Indiv duals RequestingReference Information) Name: C�n��t `'ZIi�, �) rnS Company: 4 LA yy) an a (Evaluator completing reference questionnaire) (Evaluator's Company completing reference) 'gti®—X(VqTelephone: P--'-tjCI— Collier County has implemented a process that collects reference information on fimrs and their key personnel to be used in the selection of funs to perform this project. The Name of the Company listed in the Subject above has listed you as a client for which they have previously performed work Please complete the survey. Please rate each criteria to the best of your knowledge on a scale of 1 to 10, with 10 representing that you were very satisifed (and would hire the firm/individual again) and I representing that you were very unsatisfied (and would never hire the fimr/indivdival again). If you do not have sufficient knowledge of past performance in a particular area, leave it blank and the item or form will be scored "0." Project Description: Project Budget: Completion Date: Project Number of Item 1 Criteria Ability to manage theproject costs (rnm min change orders to scope). Score (must be completed) 2 Ability to maintain project schedule (complete on -time or early). 3 Quality of work. 4 Quality of consultative advice provided on the project. 5 Profes sion alism and ability to manage pens onnel. 6 Project administration (completed documents, final invoice, final product turnover, invoices; manuals or going forward documentation, etc.) 7 Ability to verbally communicate and document information clearly and succinctly. 8 Abiltity to manage risks and unexpected project circumstances. 9 Ability to follow contract documents, policies, procedures, rules, regulations, etc. 10 Overall comfort level with hiring the company in the future (customer satisfaction). TOTAL SCORE OF ALL rMMS 7/7/2021 1:18 PM p. 21 ** •UPDAMM JANUARY 2& 2020--' Collier County Solicitation 18-7470S FORM 6 IF APPLICABLE T PROVISIONS AND ASSURANCES FORM E PROVIDED IN SEPARATE PACKAGE AN. MUST BE COMPLETED AND EXECUTED IN ITS ENTIRTY AND RETURNED WITH THE SUBMISSION OF THE BID/PROPOSAL. FAILURE TO DO SO MAY DEEM YOU NON- RESPONSIVE. 7/7/2021 1:18 PM p. 22 ***UPDATED JANUARY 28, 2020*** Collier County Solicitation 18-74703 CONFIlZM ALL REQUIRED LICENSES AND FORMS ARE COMPLETED AND EXECUTED IN ITS ENTIRTY AND RETURNED WITH THE SUBMISSION OF THE BID/PROPOSAL. FAILURE TO DO SO MAY DEEM YOU NON- RESPONSIVE. 7/7/2021 1:18 PM p. 23 ***UPDXIM JANUARY 28, 2020*** �1 AcoR1J" CERTIFICATE OF LIABILITY INSURANCE F DATE(MMIDDITYYY) 07/12/2021 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Warren Insurance Corporation ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 950 Peninsula Corporate Circle ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 1012 Boca Raton FL 33487 INSURERS AFFORDING COVERAGE NAIC # INSURED Home Health Care Resources Corp INSURER A: Lloyd's of London 2475 Mercer Ave Ste 207 INSURERS. Technology Insurance Company West Palm Beach FL 33401 INSURPP o CNA Surety COVERAGES THEPOLICIES OF INSURANCE LISTED BELOW HAVEBEEN ISSU EDTOTHE INSURED NAMEDABOVEFORTH EPOLICYPERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAYPERTAIN, THE INSURANCEAFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR D' POLICYNUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS A X GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY W25CF5210301 02108/2021 02/08/2022 EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED $50,000 MED EXP (Any one erron) $ 5,000 CLAIMS MADE � OCCUR PERSONAL &ADV INJURY S 1,000,000 X Professional Liability GENERAL AGGREGATE S 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO sInc X POLICY PRO- LOC Professional Liab. $1M/$3M A AUTOMOBILE LIABILITY ANYAUTO W25CF5210301 1 02/0812021 02/08/2022 COMBINED SINGLE LIMIT (Ea accident) S1,000,000 BODILY INJURY (Per person) S ALL OWNED AUTOS SCHEDULED AUTOS X BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS X PROPERTY DAMAGE (Per acmdenl) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC IS ANY AUTO S AUTO ONLY: AGG EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE S OCCUR '� CLAIMS MADE 5 $ DEDUCTIBLE S RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOPIPARTNER/EXECUTIV �YI�N OFFICER/MEME EXCLUDED? ITN TWC3978777 10611812021 06/18/2022 X WCSTATU- OTH- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) Ifyes, describe under E.L. DISEASE - POLICY LIMIT I $1,000,000 SPECIAL PROVISIONS below OTHER C Surety Bond 72238977 03/18/2021 03/18/2022 $50,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Location #2: 866 Tamiami Trail Unit 4. Port Charlotte, FL 33953 Location #3: 7270 Harmony Square Dr. South. Saint Cloud, FL 34773 Collier County Board of County Commissioners 3295 Tamiami Trail East Naples, FL 34112 25 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ©1 reserved. The ACORD name and logo are registered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s)- If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. .,wrtv ca tcwn�u it iT fa z Q F+ cn F E-+ CY x � x W Q Op PZ z W F O m 6 x O 4+ N O w v N 77 � _ U F d Ca 5 Q 4J VI U 'U � h 2020/ 2021 CHARLOTTE COUNTY LOCAL BUSINESS TAX RECEIPT ACCOUNT 30196 MUST BE DISPLAYED IN A CONSPICUOUS PLACE EXPIRES SEPTEMBER 30, 2021 TYPE OF 621610 Home Health Care Services BUSINESS BUSINESS 866 TAMIAMI TR UNIT #4 ADDRESS PORT CHARLOTTE, FL 33953 BUSINESS HOME HEALTH CARE RESOURCES CORP RENEWAL NAME AMOUNT 35.00 OWNER PEREIRA CARLOS PENALTY 0.00 29994481 ACHA TOTAL 35.00 MAILING 866 TAMIAMI TR UNIT #4 ADDRESS PORT CHARLOTTE, FL 33953 THIS FORM BECOMES A RECEIPT ONLY WHEN VALIDATED Paid 08/18/2020 Receipt #INT-000411894 35.00 2020 / 2021 CHARLOTTE COUNTY LOCAL BUSINESS TAX RECEIPT ACCOUNT 30196 MUST BE DISPLAYED IN A CONSPICUOUS PLACE EXPIRES SEPTEMBER 30,2021 TYPE OF 621610 Home Health Care Services BUSINESS RENEWAL BUSINESS 866 TAMIAMI TR UNIT #4 ADDRESS PORT CHARLOTTE, FL 33953 BUSINESS HOME HEALTH CARE RESOURCES CORP NAME AMOUNT 35.00 OWNER PEREIRA CARLOS PENALTY 0.00 MAILING 866 TAMIAMI TR UNIT #4 29994481 ACHA TOTAL 35.00 ADDRESS PORT CHARLOTTE, FL 33953 THIS FORM BECOMES A RECEIPT ONLY WHEN VALIDATED Paid 08/18/2020 Receipt #INT-001340894 35.00 Dear Business Owner Your 2020 - 2021 Charlotte County Local Business Tax Receipt is attached above. Please detach the receipt and display it in a place that is visible to the public and available for inspection. The Charlotte County Local Business Tax Receipt is in addition to any other license or certificate that may be required by law and does not signify compliance with zoning, health, or regulatory requirements. The Charlotte County Local Business Tax Receipt is non -regulatory and is not an endorsement of work quality. Your 2020 - 2021 Local Business Tax Receipt is valid from October 01, 2020 through September 30, 2021 . Annual account notices are mailed in June to the address of record at that time. Any Changes to your Local Business Tax Account due to change of Business Name, Ownership, Physical Address or you are Closing your Business please Contact our office at 941-743-1350 . VICKIE L. POTTS Charlotte County Tax Collector Home Health Care Resources Corp. ORGANIZATIONAL CHART R .0 & ARO OF DIRE�iORS PROFI $$ZONAL ADVISORY CO14 M'fTEk, DISASTER COORDINATOR A)IISTRATOR /- DIRECTOR OF PATIENT SER`UICES (DON) AUXELARY SERVICES PHYSICAL THERAPIST OCCUPATIONAL THERAPIST SPEECH THERAPIST 4kIEDIAL SOCIAL WORKER CI ERICAL LICENSED PRACTICALNURSE PATIENT AT.1'1�RNATE" bISAST'ER COORDINATOR:. ALTERNATE ADMINISTRATOR:' ALTERNATE'DON REGISTERED NURSE Request for Taxpayer Give Form to the FormW-9 (feu Omober2d18) Identification Number and Certification requester. Do not rlepaKmeM o£the Treasury -foe send to the IRS. ktemal tieu Serves ► Go to wwwars gov/PormWefor instructions and the latest information. 1 Name (as shown on your Income tax return). Name Is required on this fine; do not leave this line blank. Home Health Care Resources Corp 2 Business nameldisregarded entity name, If different from above m 3 Check appropriate box for federal tax classification of the pe ion whose name is entered on lime 1. Check only one of the 4 Exemptions (codes apply only to a following seven boxes certain entities, not individuals; see a Cp ❑ in&WduaVsole proprietor a ❑ CComoraton Z SCorporation ❑ Partnership ❑ Troduestate instructions on page 3): ai single- member LLC Exempt Payee code Cif any) 0 0 'ifi, fanned liability company. Pstzr the tax classification {C=C corporation, 5=S corporation, P=Partiership) ► `p Note Check the appropriate box In the line above for the tax chwifcation of the single -member owner. Do not check Exemption from FATCA reporting ffi e LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is LLC that isnot disregarded from federal tax code ff any) 3s another the owner for US. purposes. Dihewtse, a single -member LLC that Is disregarded from the ovmer should check the appropriate box for the tax classification of its owner. ❑ Other (see Instructions) ► ,,,JPPPM%l2 o' W S Address (number, seeet, and apt. or suite no. See instructions. P� ) Requester's name and address o t on 9' (Pi a9 N 2475 Mercer Ave, Suite 207 6 City, state, and ZIP code West Palm Beach, FL 33401 7 Listacccum numbers) here (optionatti IMM Taxpayer identification Number (TIN) Enter your TIN in the app, Wriate box. The TIN provided must match the name given on line 1 to avoid I social security number backup when, oftg. For individuate, this is general(, your social realty number (Sant. However, fora � — m _LAW resident alien, sole proprietor, or disregarded amity, see the av';iruciions for Part 1, later. For other entitles, it is your employer identification number (EIN). if you do not have a number, see How to get a TIN, later. or Note: If the amount is in more than one name, see the instructions for line 1. Also see What Adatm and I Employer Identification number Number To Give the Requester for guidelines on whose number to enter. Tl 1 ©MMKI r LINM yaIM Under penalties of perjury, I certify that: t. The number shown on this form is my correct taxpayer Identification number for I am waiting for a number to be issued to me), and 2.1 am not subject to backup withholding because: (a) I am exempt from backup wfbholding, or (b) i have not been notified by the Internal Revenue Serer ORS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3.1 am a U.S, citizen or other U.S. person (defined belrnnj; and 4. The FATCA codes) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instruction. You muss crass out item 2 above fi you have been notifred by the IRS that you are currently subject to backup withholding because you have failed to report all Interest and dvidends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement ORA), and generally, payments other than interest and dividends, you arepot requri Ign certification, but you mast provide your cored TK See the instructions for Par, 11, Iater. signature of U.S. Person ► Section references are to the Internet Revenue Code unless otherwise noted. Future developments. For, the latest information about developments related to Form W-S and its instructions, such as legislation enacted after they were published, go to www.frs.gov1FomrVVR Purpose of Form An,, individual or entity (Form W-9 requester) who is required to file an information retUm with the IRS must obtain your correct taxpayer Identification number (TIN) which may be your social security number (SSN), individual taxpayer Identification number (ITIM, adoption taxpayer identification number (ATIM, or employer identification number (EIM, to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099-INT (nrterest earned or paid) Date► 1 f oZ I o�.0aI • Form 1099-DN (dividends, Including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-8 (stock or mutual fund sales and cerialn other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student Joan interest), 1098-T pultion) • Form I M9-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Forth W-9 wry if you are a U.S. person (including a resident alien), to provide your correct TIN. if you do not return Form W-9 to fhe requester with a 77N, you might be subject to backup withholding. See What is backup withholding, 1"-. Cat No. 10231X Forth W-9 (Rev. 10-2018) of 12 7/9/2021 Detail by Entity Name DIVSStON Or CORPORATIONS _.�Su/�� rYel eyi?,'fi!L _irSNv eti ���ivf;Eff; SC±Sur S+e X eoartment of State / Division of Corporations / Search Records / Search by Entity Name / Detail by Entity Name Florida Profit Corporation HOME HEALTH CARE RESOURCES, CORP Filing Information Document Number FEI/EIN Number Date Filed State Status Last Event Event Date Filed Event Effective Date Principal Address 2475 Mercer Ave Suite 207 W PALM BEACH, FL 33401 Changed: 02/24/2016 Mailina Address 2475 Mercer Ave Suite 207 W PALM BEACH, FL 33401 P09000019711 26-4384590 03/03/2009 FL ACTIVE AMENDMENT 08/14/2009 NONE Changed: 02/24/2016 Registered Agent Name & Address PEREIRA, CARLOS M 2475 Mercer Ave Suite 207 WEST PALM BEACH, FL 33401 Address Changed: 02/24/2016 Officer/Director Detail Name & Address Title P PEREIRA, CARLOS M 2475 Mercer Ave Suite 207 WEST PALM BEACH, FL 33401 search.su nbiz.org/Inquiry/CorporationSearch/SearchResultDetai I?inquirytype=EntityName&directionType=l nitial&seamhNameOrder--HOMEHEAL- 7/9/2021 Detail by Entity Name Annual Reports Report Year Filed Date 2019 03/07/2019 2020 02/03/2020 2021 02/23/2021 Document Images 02/23/2021 - ANNUAL REPORT View image in PDF format 02/03/2020 - ANNUAL REPORT View image in PDF format 03/07/2019 - ANNUAL REPORT View image in PDF format 01/27/2018 - ANNUAL REPORT View image in PDF format 01/25/2017 -ANNUAL REPORT View image in PDF format j M24/2016 - ANNUAL REPORT View image in PDF format _ 03/05/2015 -ANNUAL REPORT View image in PDF format 03f0=014 -ANNUAL REPORT View image in PDF forma 04/03/2013 - ANNUAL REPORT View image in PDF format 05/03/2012 -ANNUAL REPORT View image in PDF format 03/21/2011 -- ANNUAL REPORT View image in PDF format 03/31/2010 - ANNUAL REPORT View image in PDF format 08/14/2009 --Amendment View image in PDF format 03/03/2009 - Domestic Profit View image in PDF format search.su nbiz.org/Inquiry/CorporationSearch/SeamhResu[tDetail?inqu i rytype=EntityName&directionType=ln itial&searchNameOrder-HOMEHEALTHC... 2/2 2021 FLORIDA PROFIT CORPORATION ANNUAL REPORT DOCUMENT# P09000019711 Entity Name: HOME HEALTH CARE RESOURCES, CORP Current Principal Place of Business: 2475 MERCER AVE SUITE 207 W PALM BEACH, FL 33401 Current Mailing Address: 2475 MERCER AVE SUITE 207 W PALM BEACH, FL 33401 US FEI Number: 26-4384590 Name and Address of Current Registered Agent: PEREIRA, CARLOS M 2475 MERCER AVE SUITE 207 WEST PALM BEACH, FL 33401 US FILED Feb 23, 2021 Secretary of State 4271530972CC Certificate of Status Desired: No The above named entity submits this statement for the purpose of changing its registered office or registered agent, or both, in the State ofFlodda. SIGNATURE: Electronic Signature of Registered Agent Officer/Director Detail Title P Name PEREIRA, CARLOS M Address 2475 MERCER AVE SUITE 207 City -State -Zip: WEST PALM BEACH FL 33401 I hereby.diy Mat Me information indicatedon thisreportorsupplememalreport is true and accurate and Mat my electronicmgnatam shall have the same legaleffectasifm aii antler oath; Mat I am an efear o, direct., of Me corporation or Me receiver or trustee empowered w execute cas report es required by Greeter 607. Florida Statures; and Mat my name appears above, or on an attachment wJM.Il oMe, like empowered. SIGNATURE: PEREIRA, CARLOS M Electronic Signature of Signing Officer/Director Detail PRESIDENT 02/23/2021 Date 1.36 INCIDENT REPORT PART 1: Patient, Incident & Witness General Information Patient name: Phone: Address: Location of incident: Date on which the incident occurred: Time at which incident occurred or was discovered: Witness name/Tel: Patient condition prior to occurrence: _ Witness name/Tel: (select all that apply)'i oAlerUoriented ❑Disoriented/confused d ated/medicated oWeak/dizzy ❑Combative/assaultive `.flenile dementia/Alzheimer's r ❑Unconscious ❑Visually impaired oHearing impaired ❑Walked w/device ❑Walked independently :;,., ❑Walked w/person(s) ❑Bed only ❑Chair only ❑Other (describe) 0-<, %.k'` " . Administrative Policies Page 78 Copyright 2018© 21st Century HCC PART 2: Incident Details Provide a brief narrative description of incident (factual information only) Severity of incident: ❑No apparent injury ❑Minor (first aid) ❑Moderate (fracture, sutures) ❑Severe (hospitalization) ❑Death Description of injury (if any): Response to incident (select all that apply) ❑First aid ❑Patient refused treatment oAdmitted to hospital ❑No intervention If you feel it will be helpful, provide further to this incident: Individuals Notified (select all that apply) [ ] Supervisor / Manager Name of individual notified`:', Date/Time [ ] Physician Name Rf1, n ividual notified: notified: [ ] Family Name of individual notified: Date notified/Time notified: action you took in response Administrative Policies Page 79 Copyright 2018© 21st Century HCC PART 3: Type of Occurrence (select all that apply) Fall Occurrence ❑Observed ❑Not Observed ❑Found on floor ❑From toilet ❑While ambulating ❑During transfer ❑Out of bed ❑Eased to floor ❑Out of chair ❑Slip/trip ❑Out of wheelchair ❑Other (describe): Miscellaneous Occurrence ❑Observed ❑Not Observed ❑Fire ❑Patient refuses treatment ❑Burn ❑Abuse []Complaints of theft ❑Damage to personal ❑Other (describe) ❑unplanned absence of caregiver ❑Care iv / f t' g er pa en Issues ❑Home care staff/patient disagreem',grit property ❑Safety issue(s) 41, Equipment Occurrence ❑Observed ❑Not observed Related to: ❑Fire ❑Patieefuses treatment ❑Equipment malfunction ❑Catheter ,,-t i-i%4ustaining equipment ❑Implanted device ❑Infusion pump '-': oDt`sposable device ❑IV ❑Other (describe) Medication Occurrence ❑Observed - ❑Not Observed Related to: ❑Patient error ❑Caregiv error Li Employee error ❑Pharmacy error Type of medication intake:.,. ,wz.. ❑Oral medication ❑IM medication ❑IV medication ❑Other-':! escribe) Type of medicati ❑Adverse/allergic reaction ❑Extra dose '"oW'rong time ❑Wrong dose ❑Missed dose,.,, `"'•oLate delivery ❑Mislabeled '°s PAR �-.- Signature of Person Completing this Form Sig1lature: Print name: Date: ❑Wrong medication ❑Wrong route ❑Other (describe Administrative Policies Page 80 Copyright 2018© 21st Century HCC PART l : Patient, Incident & Wimew General Information I'atieat name: �••`�'. more: t.ion oP`mciile Date on which the meideat OwwfecL Time at which bc;identoccurred c rwas disoovereei wimess nameifeh wuoes �mef!`e1: pantet condition prior to oeenrmnee (see& AV. Drat w1y) i Akrtdwiaateei. J3Disoriez#d/CDufisedCSSedWdlmedicated1Z1WWk/di=Y❑CamhnisveJa�aetlm�e Memle demerdidAlzhemrer`s ElUnconscious CrJL am ly impaired Meaeiog impaired pay AUmd w/device IIWalked mdepe u&utly OWdod w/gi-easan(s) OBe d oulj' r3Chair only i3Dther (desn Phe) PART 2: Incident Details provide a brief oarratr,e dawrip aus of b1cideut (facraal it nation 0*) Severity of meideut 0 No appMnt mjory II Mianr(firstaid) 0 Modecate (fxaduee. sutures) Severe finoapimlizuinn) 0 Death iiescriptiou of injnrg (if Response to iaesdeut (s ket ad thO apply) OFa-t aid ❑t?adent refused irealmo t MCalled 911 C.'lAdrnittedto hoViW E3No iateaveatim ERhd sown If you feel R wrrl be helpful; psrodde Air Cher descrip ou of1he ac#on you took is reVeme to this 'tucident: Indh ideals Notified (select all thatrWy) j j Supervisor I manager Name of individrxal aoll'6ed- 1 Physician. Name of individual Dare neasad rune f j Family Name ofladividaal Datenotiffed Time PART 3. Tyree of Occurrence (sadec2 a amadiff*) Fail Occurrence 00Yaerved MNiot Observed EPomrd on floor Wrom Wilet UVSA& amnia ing Mining transfar t3oot of bed OEwed to floor C7oat of chair mip/€rip 00ut ss whaelchsa- 00thm (describe). Mmeeliapeous Ocurrrence DObserved UrIet Observed OFire UPatientrefiuses wrnmant i)B= Maplanned absence ofcaregiva-Mkbose 0Csrefflw/patient sissm s ElCompiaint, of$eft ❑Home care sta ftWea Maarage w personal laoparty OSafery issue(s) ❑Other (dweibe) Equipment Occurrence UObserved C1Ns# Observed Mate it tv. 0Fire UPauentrefttses treatmers 0Ega m mt malftmction Oicathcter lit&-sastwomig egmpmmt Olmplained. device 01af idon pump Misposable devise DIV i OUT rdessazw Medication Occurrence 00bserved LIElrot Observed Related ter LSPatieut error MCargg v%w error i3EarCrioyee error EMpharmaey cricr Type of mediesfioa vatake: ❑Oral medication QM medicamm C HV mesirmaim Cloches (describe} Type of medication meldeut: adverse/allergic reaction i7V•rmng medication ❑Extra dose C Wimig time 13W]rang dose Myopg route E M seed dose i7T delivery 0hoslabeied i_i off w describe} PART 4: Signature of Person Comtplettg This Form Signature: Prira name: Home Hedth Core Y'ResourcesCorp, �ht,'d 'ng sfp"n= L 14fi C�� Cl: ^nifaq'v4P 0 "4"T Inciaent Kepon corm Date and Time of Incident: Name of Person Involved: Last First Description of Incident & Where it took place: Reported to Whom and When: Witnesses Medical Attention Required? Able to Return to Work? If so, when? Person Completing Form: Print Sign 866 Tamiami Trail Suite 4 Port Charlotte FI 33953 www.homehealthcrc.com Home Health Care Resources Corp. Providing Home Health Care, One Patten, of aTime Incident Report Form Date and Time of Incident: Name of Person Involved: Last First Description of Incident & Where it took place: Reported to Whom and When: Witnesses Medical Attention Required? Able to Return to Work? If so, when? Person Completing Form: Print Sign 2475 Mercer Ave, #207 West Palm Beach, FL 33401 561-304-1311 Office 561-304-1315 Fax www.homehealthcrc.com N 2.1 POLICIES GOVERNING THE PROVISION OF SERVICES Home Health Care Resources Corp. shall provide every patient or his designated representative the name of the Agency worker responsible for supervising the patient's home care and the manner in which that worker may be contacted. 2. The agency will designate a Registered Nurse as a Director of Nursing who is responsible for direction, coordination, and overall supervision of all services that are provided by theAeiacy, either directly or by contract. This person, or a qualified alternate, will be available atti .II ftrxies during business hours and participates in all activities relevant to the profess ionalseruices rendered. :t}• w 3. Administrative and supervisory functions are provided by direct agency staff. These functions are not delegated to an outside agency or organization. �}{ 4. All Agency workers employed either directly by the Agency or by contract who provide services to patients in their place of residence shall be readily identifiable',by`name tag, to the patient, his family or other responsible party. 5. To the extent possible, services are provided by the same wo.Fkers to the same patient. 6. Services are available 24 hours a day, seven daysIa>'week 7. The Agency provides assistance to the patient nobtaining other services needed, but not provided by the Agency. 8. If appropriate to the patient's condition;hr0hab'ilitative and maintenance services shall be provided. 9. The character, scope of advice, Ad"Jeatment provided by the Agency shall be consistent with accepted standards of praclio&-for the disciplines involved. 10. The Agency will follow f}lisped nursing procedures . r. ti\ '{4 Patient Care Policies Page 1 Copyright 2018© 21 st Century HCC 2.2 ETHICAL ISSUES 1. The Agency recognizes that issues of an ethical nature related to the patient, Agency and the provision of services may develop. Such issues may include but are not limited to: a. Informed Consent b. Decision making C. High technology and medical experimentation d. Patient safety e. Accepting or refusing care f. Standards of care g. Advance Directives h. Confidentiality i. Care for persons with inadequate reimbursement €or`services j. Right to freedom of choice, dignity and r;wement 2. It is the policy of the Agency to: .. r a. Provide care within an ethical framework established by the professional disciplines provided by the Agency, e tablid,a in Agency policy and procedure, and as established by law and sta;ndarrds of care. b. Allow the patient 01�b1s'�Ner representative the right to participate in any discussion concerning ethic.611'sues and to document such involvement. c. Have Agency sf And the patient's Physician, PA or ARNP participate in the considers 4oapd resolution of ethical issues. d. Furnish staff with education regarding ethics and the mechanisms available to assist theaM*-With consideration and resolution of ethical issues. .1 3. Patie t�Eftitca[ Issues a.; Ethical issues for patients including but are not limited to the following: i. The patient has a Do Not Resuscitate or Do Not Intubate order but there is conflict among the family members. ii. The patient and/or family is participating in and/or conducting rituals, religious healing activities or other behaviors that are disturbing to the employee and/or causing the employee to be concerned for the patient's well-being. Patient Care Policies Page 2 Copyright 2018© 21st Century HCC iii. The family and Physician, PA or ARNP are concealing from the patient true information about his condition. iv. The Physician, PA or ARNP does not respond to requests for care that the nurse believes is necessary, i.e. an increase or decrease in pain medication, testing for TB, to be seen by the Physician, etc. v. The patient refuses to accept assistance the employee feels is necessary4 e;. bathing, food stamps, companion, homemaker, ACLF placement, etc..; vi. The patient refuses part of the ordered care (i.e., nursing) but chooso o a ept another part of the ordered care (i.e., pharmacy). ` yA t> vii. There is obvious drug use or other unusual or illegal activity"6-:the patient's home which jeopardizes the employee's safety. { b. The Agency will convene an Ad Hoc Committee to discuss�a0p(,�Ittempt to resolve ethical issues that arise. This committee will meet if ethical`i;ssues arise. The Agency employees involved in the patienr&,'care'will be included in the Ethics Committee. c. The patient's Physician, PA or ARNP and, 4e Ageency employees involved in the patient's care will be included in the Ethic I"Committee. a,. d. The Agency's Quality Improvement 66i amittee or other designated individual(s) or group may serve as a resource tc'=as�ist in the consideration of ethical issues. e. The Governing Body will re' c61 ' z.. a minutes of the Ethics Committee meetings and may be called upon to takact+on on issues as required. f. Anyone may initiate,.�nsideration by notifying the Administrator and/or DON of a potential or actuaconcern. The Administrator or DON shall present the issues at a meeting of the c�orx m:ittee as soon as possible. Minutes shall be kept of the meeting, and as appropr>ae; staff, the patient and the patient's Physician, PA or ARNP shall be advised ditfle,r suits of the meeting in a manner appropriate to the individual situation. ."t, 4. Ethical Issues for:;.Employees a. ThQ'jency recognizes that from time to time staff members' personal values and "ljelfs enter into their ability to provide care. Such issues include, but are not limited to: i. Working or traveling on certain religious holidays ii. Right to life issues iii. Administering blood transfusions iv. Respecting an individual decision not to seek medical care because of their religious beliefs V. Ethnic and sexual orientation issues for care Patient Care Policies Page 3 Copyright 2018© 21 st Century HCC vi. Termination of life support systems and participation in certain advanced directive decisions vii. Conflicting ethical, cultural or religious beliefs b. It is the Agency policy that: i. Refusal of an individual staff member to participate in certain aspects of care „e based upon personal values and beliefs will not disrupt the patient's care`. ',,,,, ii. When a situation arises for care that is in conflict with individual staft.values and beliefs there is an alternative method of care.'`' iii. Individual performance evaluations will appropriately reflect,lf,je, manager's consideration of motives related to refusal to participate basedlupon cultural values or religious beliefs. s Patient Care Policies Page 4 Copyright 2018© 21st Century HCC 2.3 PRIVATE DUTY (PD) SERVICES PROVIDED 1. The Agency is dedicated to providing the most qualified personnel to the patient in his/her own home in order to maximize and fulfill his/her goals as a member of the community. 2. Services are available 24 hours a day, seven days a week using an answering service and on - call procedures after normal working hours, weekends, and holidays. As needed, staff rpAy be assigned to make patient visits after normal business hours. a > 3. All non -Medicare services provided to clients in their place of residence or designatec1eervice site, are provided on a per visit or hourly basis. Services can be provided byfce ed professionals or paraprofessionals and are reimbursed by private insurance, prime pay, third party payers, grants or state Medicaid funds. PD SERVICE CLASSIFICATIONS: PD Services includes 2 a. Skilled: services provided by licensed professionals ari assistants and certified home health aides under direction/supervision of licen d professionals. b. Paraprofessional: non -skilled services provided"' V,n'on-skilled staff. PD SERVICE TYPES: PD Services include 4 types of:,'rviees: a. Nursing Services b. Certified Home Health Aide SerJC.es.CNA) c. Basic Personal Care Se( i,cese ome health aide (HHA) d. Home/Environmental Sbppq,t Services (companions, homemaker) 1. Registered Nurses/Licensetl;Piactical Nurses: �y .sib a. Registered N,use's., (RNs) provide quality nursing care. The highly trained professionals follow the;;Pskci'an, PA or ARNP's orders, monitor and instruct the patient regarding their carre> Specialized therapies as IV antibiotics, chemotherapy, and total parenteral and enteral nutrition are also provided by the RN. b. Thj6ensed Practical Nurse (LPN) provides assigned nursing care under the direction ` °f ah RN. "r ,c. All nurses are licensed in the state of Florida and follow all regulations and standards of practice required by the state practice act. d. Our Agency does not provide psycho -active treatments. Patient Care Policies Page 5 Copyright 2018© 21st Century HCC 2. Certified Home Health Aide (Certified Nursing Assistant) - CNA A person who has completed a state approved training program for certified nursing assistants and who has received additional home care training and has been competency tested. CNA service is provided through visits or hourly care to clients with complex care needs and is under the direct supervision of a registered nurse. Services include assistance with personal care, activities of daily living and additional duties as delegated by the RN according to the plan of care. Each CNA is oriented to each new patient assignment by a nurse or therapist during,"' e visit. Thus, the applications of their skills are individualized to meet the needs of a:^ particular patient. Coordination of total patient care is the responsibility of the coo rdinatng nurse. Certified CNA staff are required to have at least 12 hours of in-service training peryear. 3. Basic Personal Care Services: Home Health Aide (HHA) a. A person who carries out health care tasks under the supervis A',o., a RN or licensed therapist and who may also provide assistance with personal caqei:>housekeeping and other related supportive tasks to a patient with health care needs,•sin hi0her home. HHAs successfully completed a basic training program of not lesk,,than 40 hours in HHA services and possess written evidence of such completion and competency testing. b. Each worker is oriented to each new patient ;a sign.Ment by a nurse or therapist during a home visit. Thus, the applications of their skill @r€ Individualized to meet the needs of a particular patient. Coordination of total patient care is the responsibility of the coordinating nurse. = z k � HHA without prior home care experience will be supervised in the home every two weeks for the eight weeks after hire and are.-regb#"'* to have at least 12 hours of in -services yearly. 4. Home/Environmental Support.,Services: Companion/Homemaker Trained and competency�(ested support personnel, who provide support services through visits or hourly service. Services include,,,hniaet;raking, housekeeping, and other activities inside and outside the home which support client; independence. These support services are assistive in scope and DO NOT require persoral care activities. WHEN PR Vfr1DED IN CONJUNCTION WITH SKILLED OR BASIC PERSONAL CARE SERVIS services are under the direct or indirect supervision of a registered nurse when supportervices are provided in conjunction with skilled or basic personal care services WI EN PROVIDING SUPPORT SERVICE ONLY, services are under the direct supervision of a qualified supervisor (LPN), registered dietitian, social worker). Companions and Homemakers are required to have at least 4 hours of in -services yearly. Patient Care Policies Page 6 Copyright 2018© 21st Century HCC To the extent that appropriate professional staff are either hired or contracted for the additional services listed below will also be available: Physical Therapy, Occupational Therapy, Speech Therapy, Medical Social Workers Services. 1. If the agency provides these services, they will be provided as ordered by the Physician, PA or ARNP to enable the patient to receive restorative therapy and social work and nutritional intervention as needed. They are provided through contract or directly. ."'' t 1�. 2.b'% >k., If the agency chooses to provide these services in the future, they will be proviidecf assorderec by the physician. This therapy will be provided either through contract or directly. Policies will be developed to address standards of care, standard procedures, and clinicafcon petency. rn This agency does not have medical delegation. Professional License Verification The Florida State Board website will be utilized for license verification of license employees at the time of hire and per expiration dates. ww2.doh.state.f1 'tom' Physician, PA and ARNP License Verification Physician, PA and ARNP verification/credentlaJjng i.s conducted at the time of the first patient referral and upon expiration thereafter. This is conducted on-line through the State Medical Board. ww2.doh.stateX "' Reporting of Staff and Locati--' "ancies 1. Address changes n us De reported to the AHCA Home Care Unit 21 to 120 calendar days in advance of the char�gWin your location. There is a $500 fine for failure to report address changes timely::;,'. 2. Personnel�changes for Administrator or Alternate Administrator must be reported to AHCA Home,,,C re Unit within 21 days of the change. 3.,,DF[edtof of Nursing changes must be reported to the AHCA Home Care Unit within 10 businesE ':'A* ys of the DON termination of employment. There is a $1,000 fine for failure to notify the `' AHCA Home Care Unit of the resignation of a Director and a $2,000 fine for operating for 30 or more days without a Director of Nursing if your agency provides skilled services. Patient Care Policies Page 7 Copyright 2018© 21st Century HCC 1.37 PATIENT RIGHTS AND RESPONSIBILITIES Purpose: To provide a delineated list of patient rights and responsibilities. Policy: Patients will be advised at the time of admission and at every re -certification, about their rights and responsibilities regarding the receipt of home care services. - Procedure: 1. During the initial visit and every re -certification, the patieht>is advised of the individual's rights and responsibilities (Bill of Riglttsr& Responsibilities) in the receipt of home care services. 2. The patient is provided with an understanda.'le'mitten explanation of individual rights and responsibilities regardsn the receipt of home care services. 3. The Bill of Rights & Responsibilitles:vuill"be provided to the patient's legal representative if the patient is unable to comprehend them. 4. Interpreters will be employdas' necessary. 5. The patient is given an gpportunity to read the written explanation and to ask questions with respect to the Bill of Rights & Responsibilities. 6. The date, signature; and other relevant information with respect to disclosure qd sc 1ssion and receipt of the patient's Bill of Rights & Responsibilities will be noted on the Authorization for Services form. 7. Co`i tradis with providers and payers contain a section whereby the p.l',oviders acknowledge and agree to abide by the Patient's Bill of Rights & ponsibilities. .'`'•$."' The patient who feels his rights have been denied or who desires further clarification of his rights or who desires to lodge a complaint about any aspect of service or care should contact the Administrator or supervising nurse, verbally or in writing. The Agency's grievance procedure shall be followed in handling grievances or complaints. 9. At the time of admission, the patient shall be given in writing the number of the state's toll -free "hot line" and its hours of operation, and the name, address and phone number of the Administrator and supervising Nurse. Administrative Policies Page 81 Copyright 2018© 21st Century HCC 1.38 PATIENT BILL OF RIGHTS Patient Rights and Responsibilities Statement of Purpose: It is anticipated that observance of these rights and responsibilities will contribute to more effective care and greater satisfaction for the patient as well as the staff. The,.,, rights will be respected by all personnel and integrated into all Home Care progn�6s 'A copy of these rights will be given to patients and their families or designated > •'"ry; representative. If the patient or his/her designated representative is unable'`tq read the Bill of Rights and Responsibilities, it will be read to them. If the patient o'r� her representative does not speak English, a copy of these rights will be provided in a language that is understood. The patient or his/her designated rep,resen-, has the right to exercise these rights. In the case of a patient adjudged;jncompetent, the rights of the patient are exercised by the person appointed by law to_,adt,, n the patient's behalf. In the case of a patient who has not been adjudged incompetent, any legal representative may exercise the patient's rights to the extb9t permitted by law. The Patient has the right: 1. To be fully informed and knowledgeable df all `rights and responsibilities before 11 providing pre -planned care and to understand that these rights can be exercised at any time. 2. To receive appropriate and,,prcf0sional care without discrimination in accordance with physician~grd�rs, if applicable. 3. To choose a healtFt care provider, including choosing an attending physician or other licensed indeperiddnt practitioner with prescriptive authority. 4. To request serv''ices from the Home Care Agency of their choice and to request full inform ti6h'fr6m their agency before care is given concerning services provided, alternatives available, licensure and accreditation requirements, and organizdti.on ownership and control. '. 5. TokbeJhformed in advance about care to be furnished and of any changes in the to be furnished before the change is made. 1i4� n. . �fo be informed of the disciplines that will furnish care and the frequency of visits proposed to be furnished and to know that all staff providing care is properly trained and competent to perform their duties. 7. To information necessary to give informed consent prior to the start of any procedure or treatment and any changes to be made. 8. To participate in the development and periodic revision of the plan of care and to make changes to the plan of care. Administrative Policies Page 82 Copyright 2018© 21 st Century HCC 9. To access to their record and to expect confidentiality and privacy of all information contained in the patient record and of Protected Health Information (PHI). 10. To refuse care or treatment after the consequences of refusing care or treatment are fully presented. 11. To treatment with utmost dignity and respect by all agency representatives, regardless of the patient's chosen lifestyle, marital status, cultural mores„, political, religious, ethical beliefs, having or not having executed an aduan,ce' , directive and source of payment without regard to race, creed, color; s`e.'age or handicap. { ` 12. To have his/her property and person treated with respect, cogsidbration and recognition of patient and individuality. 13.To receive and access services consistently and in a,t 4jelymanner from the agency to his/her request for service. n4ky4� ti� 14. To receive information about the scope of servi'641hat the agency will provide and specific limitations on those services,., 15. To be admitted for service only if the agency has the ability to provide safe professional care at the level of inte"iiy agency's limitations. needed and to be informed of the 14 16.To reasonable continuity of care;-' 17. To an individualized plrr of care and teaching plan developed by the entire health team includingjh'e, patient and/or family. 18.To be advised on`t,e agency's policies and procedures regarding the disclosure of patient records:% 4 19.To be informed of patient rights under HIPAA, Federal, State and Accreditation regulations to formulate advanced care directives without fear of reprisal whether or.nit`n advance directive is prepared and to know that the agency will follow t#11;patient's requests regarding the advance directive in providing care. ifinformed of anticipated outcomes of service/care and of any barriers in ' outcome achievement. 21.To be informed within a reasonable time of anticipated termination of service of plans for transfer to another health care facility/provider and the reason for termination/transfer from service. 22. To be informed verbally and in writing and before care is initiated of the organization's billing policies and payment procedures and the extent to which: Administrative Policies Page 83 Copyright 2018© 21 st Century HCC a. Payment may be expected from Medicaid, or any other federally funded or aided program known to the organization b. Charges for services that will not be covered by payer c. Charges that the individual may have to pay 23. To be able to identify visiting staff members through proper photo identification. 24. To be informed orally and in writing of any changes in payment information a soon as possible, but no later than 30 days from the date that the or a- nation >x becomes aware of the change. 25.To honest, accurate, forthright information, regarding the home careIndustry in general and his/her chosen agency in particular, including cost -per visit, employee qualifications, names and titles of personnel, etc:`';" 26.To access necessary professional services 24 hours a days s a week. l Y, Y 27. To be referred to another agency if he/she is dissafsfled with the agency or the agency cannot meet the patient's needs. 28.To receive disclosure information regardrg`any beneficial relationship the organization has that may result in profit::#or-the referring organization. 29.To education, instruction and a list-ef;r quirements for continuity of care when the services of the agency are t�Y•Onated. .,, ..� 30. To be free from mistreatme7tt,,;neglect, or verbal, mental, sexual, and physical abuse, including injuriep of unknown source, and misappropriation of patient property of any kind., 'including from agency employees, volunteers or contractors. 31. To privacy to maint'aa"n his/her personal dignity and respect. 32. To know t" t the agency has liability insurance sufficient for the needs of the agency. 33. To,f,;&d)Ased that the agency complies with Subpart 1 of 42 CFR 489 and receive a copy of the organization's written policies and procedures regarding „avence directives, including a description of an individual's right under applicable state law and to know that the Agency will honor the patient's advance "• directives in providing care. 34. To voice grievances/complaints regarding treatment or care that is (or fails to be) furnished, or regarding the lack of respect of property or recommend changes in policy, staff, or service/care without restraint, interference, coercion, discrimination, or reprisal and to know that grievances will be investigated and resolved, and the patient notified of the resolution within 30 days. Administrative Policies Page 84 Copyright 20180 21st Century HCC To be advised of contact information for the Agency's Administrator. Administrator: Sullymar Alicea Agency: Home Health Care Resources Corp. Address: 866 Tamiarni Trail, Suite #4 Port Charlotte, FL 33953 Phone: 941-883-4282 35. To receive advance directives information prior to or at the time of il�e'rst'home visit, as long as the information is furnished before care is providerd and'to know that the Hotline number 1-888-419-3456 may be used to lodge cornplAints regarding the implementation of the Advance Directive requirem., ent. 36. To be advised of the toll -free home health agency hot-linerft)ifhe State of Florida and the purpose of the hotline to receive complaints o.ruestions about the organization. To report a complaint regarding the serv't `s you receive please call toll free the State of Florida Home Health Hotline N6 -i-ber 1-888-419-3456. The number is operated 8AM to 5PM daily to receiVb,cornplaints or questions about local Home Health Agencies. You may also,fegisfer complaints in writing to: Director of Health Facility Licensure and::(,eitification Division Florida Department of Human Services P. O. Box 149030, Mail Code Y98.1 Tallahassee, Florida 78714-903, `-," You may also lodge complaints with ACHC Phone number(855)^9 1,�252; By Fax: (919) 785-3011; By E-mail: achc.org/contract/complaint; By Mail: 139 Weston Oaks Court, Cary N.C. 27513 37. To be taf,,orm6d of the 2417 toll -free abuse hot-line. To report known or suspected child,An.'flnerable adult abuse, neglect, or abandonment, please call toll -free 1- 80..6962-2873. 3T.o*report suspected Medicaid Fraud, please call the Attorney General toll -free at 1-866-966-7226. Find out if you are eligible for a reward. Callers may request to remain anonymous. a. Medicaid fraud means an intentional deception or misrepresentation made by a health care provider with the knowledge that the deception could result in some unauthorized benefit to him or herself or some other person. It includes any act that constitutes fraud under federal or state law related to Medicaid. Administrative Policies Page 85 Copyright 20180 21 st Century HCC The Patient has the responsibility: To provide, to the best of his/her knowledge, accurate and complete information about: a. Past and present medical histories. b. Unexpected changes in his/her condition. c. Whether he/she understands a course of action selected. :i. 2. To follow the treatment recommended by the particular handling;. the'case. 3. For his/her actions if he/she refused treatment or does not follow the physician's orders. 4. For accruing that the financial obligations of his/her health care are fulfilled as promptly as possible. 5. To respect the rights of all staff providing seraice' �x 6. To notifythe agency g enc y promptly in advancappointment or visit you must cancel. 7. To become independent in care to`'t'e extent possible, utilizing self, family and th o er sources. 8. To pay for care or services not covered by 3rd party payers. 9. To comply with the4 ul s'and regulations established by the agency and any changes subsequ. h. the rules z; Signature of Ptient Date of Signature Signature Date of Signature PATIENT NAME (Last, First) 7ED"CALCORD # Administrative Policies Page 86 Copyright 2018© 21 st Century HCC 2.17 DISCHARGE/TRANSFER POLICY The Agency will maintain a process for the ongoing assessment of each patient's continuing care and discharge planning needs. This is required to ensure that patient discharges are adequately planned to terminate services when the patient no longer has a need or desire for care, and to ensure that the patient's continuing care needs are met and that the patient participates in the discharge planning process. The reason for discharge is discussed and charted. 2. Patients may be discharged for various reasons including the patient expires, top patient's" condition improves and therefore the patient no longer needs the care provided, tie Physician, PA or ARNP discontinues the order for home care services, or the patient refuses`the care and requests discontinuation of services. 3. Discharge planning shall begin at the time of admission with patients,,b%eing a"dvised as to the expected duration of treatment. Re-evaluation by the RN and addi#ional`planning with the patient shall occur throughout the course of care and shall inclu.le,documentation of specific plans and the expected date of discharge. 4. Discharge plans will be coordinated with other care/servrce`providers, as applicable. 5. All discharged patients will have required documentatiop to ensure appropriate communication is provided to the physician, as requested. 6. Patients may require transfer from the agency:, Reasons for transfer include the patient moves out of the agency geographic area, the p46§16t4equires care/service not provided by the agency or the agency is not a preferre&prbvided by the patient's insurance company. 7. All transferred patients will have 'required documentation to ensure appropriate communication is provided to the receiving agency: MEDICAID PATIENT DISCMA_ RGE PROCEDURE MEDICAW-PATEINT DISCHARGE: At Two (2) days before discharge, Medicaid patients will be req-u'red to sign the Notice of Medicare/Medicaid Non -Coverage (NOMNC). He/she also with e given instructions of their 'Right to Appeal' the decision to discharge. I.a(y of the following reasons are present, the Notice of Non -Coverage form should not be used: — • Because the Medicaid benefit is exhausted; • For denial of Medicaid admission; • For denial of non -Medicaid covered services; or • Due to a reduction or termination of Medicaid services that do not end the skilled Medicaid services. In these cases, the patient must receive the CMS form 1003-Notice of Denial of Medical Coverage (NDMC). Patient Care Policies Page 47 Copyright 2018© 21st Century HCC Discharge/Transfer Procedure: 1. At the visit before the discharge, the patient and the Physician, PA or ARNP will be notified of discharge. If the agency terminates services for a patient needing continuing home care, as determined by the patient's Physician, PA or ARNP, for patients receiving care under orders from one of these disciplines, or as k ., F' determined by the client or caregiver, for clients receiving care without orders ;fro a Physician, PA or ARNP, a plan will be developed and a referral made pby,tle' agency to another agency or service provider prior to termination.. 2. When the patient is transferred to another organization or facility, the•patient is informed in a timely manner of the need for transfer and/or level of;carl and of the alternatives. The patient and family have input into these degisions They are notified of any financial benefit to the referring home care. RR81ievant information regarding the patient's condition and care requirements:will"die provided verbally and in writing to the receiving agency or facility within 4l3a ours of the Agency becoming aware of the transfer. The transfer summary must include: a. date, patient identifying information antl emergency contact; b. destination of patient transferredi, c. status of patient at the time of frnsfer d. contact person receiving report and date and time report given; e. patient's Physician, PA'- ot fRNP and phone number; f. diagnosis related to 1hp,transfer; g. significant healf:.rIh{story; h. transfer ordeOs:and instructions; i. a brief desel3pt4on of services/care provided and ongoing needs that cannot be met„..,, j. Patient{ -progress toward desired goals; k. Instructions and referrals provided to the patient. 3. All paAbpts will receive discharge instructions regarding his/her ongoing care nedq prior to the final visit. `% i •�Y'?J'•h 1 Prior to discharging the patient, the attending Physician, PA or ARNP shall be `h notified. A written discharge summary, which shall be prepared within 30 days of discharge, will be made available to the Physician, PA or ARNP with a copy maintained in the clinical record. The discharge summary will include: a. Patient identifying information b. Patient's physician and phone number c. The reason for discharge Patient Care Policies Page 48 Copyright 2018© 21st Century HCC d. The date of discharge e. The patient's physical and psychosocial status at the time of discharge f. The patient's diagnosis g. A summary of the care and services provided h. Patient progress toward desired goals i. Instructions and referrals provided to the patient K , 5. Agency staff will be responsible for assisting the patient/family to identi#y and provide for anticipated care needs after discharge from the Agency. .x, 6. Patient/family will be informed of the anticipated discharge prior to st'visit and will participate in the discharge planning process. 7. Patients are discharged from the Agency for the following reasons a. The treatment goals are attained or are no longer attainable. b. A change in the patient's condition requires careeor-services other than those that can be safely provided by the Agency,.=` c. Another person (i.e., family member) is able acid willing to provide the required service. d. The patient refuses to obtain need d>pmedical supervision. e. The patient and/or family consistently refuse to cooperate in attaining treatment goals. f. The home setting is not sU liable. g. The patient moves o4t ofr'fhe geographic area served by the Agency. h. The patient is, receiving the same services from another Agency. i. The Physician ry'F 'or ARNP consistently fails to sign the plan of treatment in the rerid; time period or does not renew the Plan of Care at the 2 month,ior gives orders that are not consistent with the stated cy is closing out a particular service or all of its services; in such appropriate referral will be made. ,% The patient is institutionalized. k "I. The patient expires. 4:. ':••' m. The patient, family, Physician, PA or ARNP requests discharge. n. Payment sources are exhausted, and the Agency is fiscally unable to provide free or reduced -fee care. In such instance appropriate referral will be made with the patient's participation in the discharge/transfer process. o. The patient is non -compliant or continuously abusive to staff and all interventions have failed; appropriate referral will be made. p. The situation is unsafe for the staff. Patient Care Policies Page 49 Copyright 2018© 21st Century HCC POST ADMISSION PATIENT SATISF Patient Name We are privileged to participate in your care. We are interested rendering quality care to our clients and would appreciate your input by answering the following questions. Your evaluation will allow us to be more responsive to future client/family needs. Feel free to use back of form to expand on anything. 1. Were you notified that you were to receive an initial home visit in a timely manner? YES NO 2. Did your admitting professional give you the telephone number and contact person at the agency in case you had any questions or concerns, including after hour's information? YES NO 3. Did you participate in your plan of care? YES NO 4. Did you receive information on your Bill of Rights including the State Hotline number to call if you have any complaints? YES NO 5. Did the agency admitting nurse present a professional appearance? YES NO 6. Did the nurse wear a name tag and introduce himself/herself as a representative of the agency and explain his/her role? YES 1 NO 7. Did the nurse leave a folder with information about your care in your home? YES NO 8. Do you understand the services that your doctor ordered? N/A _ YES NO 9. Did the staff tell you the date of your next visit and the frequency of visits? YES _ NO _ 10. Did the nurse take your temperature, pulse, respirations and blood pressure? YES NO 11. Did the nurse wash her hands before and after caring for you? YES NO 12. Did the nurse teach/talk to you about: Your medications? YES NO Signs and Symptoms to report to the doctor? YES NO Your diet? YES NO Wound Care (if applicable)? YES NO Plans for discharge (if applicable)? YES NO 13. Did you feel the nurse answered your questions appropriately? YES NO COMMENTS: Copyright 2015© 21 st Century HCC j� , Home Health Care Resources Corp, Pr 'trng Home Health Care. one patient of a Time Supervisory Visit Report Patient/Client Name: Employee/Caregiver Name: Aide/Nurse (circle one) Present / Not Present Type of Services the Caregiver Performs: Are you satisfied? o Personal Service Yes/No/NA o Assistance with Bathing, Dressing, Skin/Nail/Hair/Oral Care, Grooming o Homemaking Service Yes/No/NA o Light Housekeeping, Meal Prep, Laundry o Companion Service Yes/No/NA o Skilled Nursing Service Yes/No/NA 1. Does the caregiver complete the tasks on the Aide Care Plan? Yes / No 2. Does your caregiver dress neat and clean? Yes / No 3. Is your caregiver friendly? Yes / No 4. Is your caregiver helpful? Yes / No S. Are you notified when your caregiver will be late/or not coming? Yes / No 6. Do you know how to contact Home Health Care Resource Corp? Yes / No 7. How would you rate your caregiver on a scale of 1-10? *1 being low and 10 being high 8. Are you ever asked by the caregiver to sign time sheets when work has not been performed or the IN/Out time is not filled in? Yes / No 9. Has the caregiver every brought family or friends with them when they work? Yes / No 10. Has the caregiver ever asked to borrow money or have you ever given money to the caregiver? If so, please explain. Yes / No Observations or Comments: Date: RN Supervisor Signature 8.6 QUALITY ASSESSMENT AND PERFORMANCE IMPROVEMENT INITIATIVES As an Agency seeking to provide the highest quality of care and customer satisfaction, we must effectively design a quality improvement program that systematically measures, assesses and improves the performance of the quality of care and services provided by the agency. The design emphasizes the importance of the Agency affecting its best efforts to create appropriate processes and functions required to achieve improved patient health outcomes and customer satisfactions. It ensures the provision of uniform quality cared services throughout the Agency as reflected in the Agency's mission, goals and vi> for -and within the dimensions of quality performance which are defined as follows: 1. Doing the right thing with efficiency and appropriateness relating to th'a degree to which care and services will achieve the desired or projected outcomes and relevant clinical needs of the patient. 2. Doing the right thing with regard to the: a. availability to meet the patient's needs. b. timeliness of the provision of services atgthe necessary or most beneficial time for the patient. c. effectiveness to correctly provide.,care:'and services to achieve the desired outcomes for the patient. d. continuity of services proved '-A it respect to service coordination with clinicians, providers an'::,,, 'rtime. e. safety to patientstand others with respect to reduce risk of interventions and environment tot0e.:patient and others including staff. f. efficiency:pt s rvice with regard to results of care resources used to deliver care. %:.> g. respect and caring which allows the patient or designee to be involved in the decisions and services to be provided with sensitivity and respect for the ;<patient's needs, expectations and individual differences. QAPI Program Policies Page 9 Copyright 2018© 21 st Century HCC 8.7 QUALITY ASSESSMENT AND PERFORMANCE IMPROVEMENT PHILOSOPHY The organizational management has developed through its Quality Assessment Performance Improvement Program the following care concepts: 1. Management individually and collectively plays a key role in enabling the Agency to systematically assess and improve performance. 2. The realization that most problems and opportunities for improvement are delved from process weakness, not individual incompetence. 3. Careful coordination of work and collaboration is needed among departments and professional groups. 4. The importance of seeking judgments about quality from patiehYs=and others and using such judgment to identify areas for improvement. 5. The need for both systematically improving the perfornanee of functions and maintaining the stability of these functions. M QAPI Program Policies Page 10 Copyright 2018© 21st Century HCC 8.8 RESOLUTION OF IDENTIFIED PROBLEMS Communication of problems, plans for resolutions, and re-evaluation of results will be the responsibility of the Director of Nursing. The staff will have the responsibility to communicate findings and if necessary recommend corrective action. 4 QAPI Program Policies Page 11 Copyright 2018© 21st Century HCC 8.9 ACTIONS FOR PROBLEM RESOLUTION AND IMPROVEMENT OF CARE Actions may involve the following but are not limited to: 1. In-service Education. 2. Change in Personnel. 3. Policy or procedural changes with approval of Professional Advisory,.0ommittee. N 'k QAPI Program Policies Page 12 Copyright 2018@ 21st Century HCC 8.10 CONFIDENTIALITY All persons participating in any aspect of the QAPI process will adhere to the Agency's confidentiality policies. All studies are performed in a manner that assures confidentiality for patients and caregivers and Agency staff. To assure confidentiality 1. Codes will be utilized to identify individuals. 2. Protection of data will be the responsibility of the Director of Nursing or his/her designee. 3. QAPI committee members, along with all staff having access to..•records/information will be informed of the Agency confidentiality policy. 4. Identifiable patient information is maintained by the Dire .cfor'of Nursing in secure files. 4 QAPI Program Policies Page 13 Copyright 2018© 21st Century HCC 8.15 ACTION PLAN 1. Once the situation is assessed, the Agency is ready to take action. In order to be effective, any actions to be taken are communicated to the appropriate staff and management. They include: a. What action is to be taken based on the problems identified and their causes, scope and severity. b. Who is responsible for making changes. c. The time table for implementing the actions, and d. The time table for evaluating the results of the actions to be taken:. 2. Types of actions that may need to be taken: a. Actions for systems problems may include: i. Changes in communication channels. ii. Changes in organizational struct4 ...and processes. iii. Adjustments to staffing and changes in equipment, facility design or chart forms. b. For problems involving understanding, the actions taken may include: i. Continuing education`. ii. In-serviceooation. iii. Attendinq'seminars. iv. Consilfation with peers. c. Behavior problems may require the following: i Counseling employees. ii. Changes in individual assignments or disciplinary action against one or more employees. iii. Required corrective actions to be recorded in the individual's personnel file. QAPI Program Policies Page 20 Copyright 20180 21st Century HCC Systematic Approach to Implementation For each process assessed, it will be determined whether opportunities to improve performance exist. When multiple opportunities exist, improvement opportunities will be prioritized. A systematic approach will be used, including the following: 1. Potential improvement expected. 2. Strategies for implementing the improvement changes. 3. Implementing the improvement system wide. 4. Assessing the improvement that occurred. 5. Redesign of strategies as necessary. Additionally, the basis for the priorities chosen is those that best -.assist in: 1. Achieving the goals of the Agency's strategic plan,.,anfnission statement. 2. Resolving problems related to the needs of high volume, high risk or problem prone patients. 3. Meeting the stated purposes of the functions and indicators being studied. Meeting the needs of employees and the Agency; •t,4`"" z a' QAPI Program Policies Page 21 Copyright 2018© 21st Century HCC Design of Improvement Approach 1. The design of the improvement approach will consider the following: a. The dimensions of performance that will be most affected by the change. b. Whether there is an interaction between dimensions that are being considered c. Identification of what performance is expected from the improved process. d. Identification of who needs to be involved in the improvement activity. 2. The person(s) responsible for implementing the actions is to determine the_;apl5r I iate actions to take. Action is taken and the results are forwarded to the Administrator. 4, 3. The actions are to be directed toward the identified root causes with an eye toward overall improvement in quality of patient services provided. 4. If the data are of significant import and the findings are negative `the Administrator must prioritize the overall QAPI activities and decide if the •situation warrants more intense investigation, given overall priorities. A more intensive review may include: a. Collecting additional information. b. Peer review. c. Use of additional statistical techniques,,,to examine the data from other aspects. 5. The goal of these activities is to understand the reasons why some of the data are significantly outside the expected norm: Steps are taken to bring all cases in the function or process being monitored"to the desired range. 6. Written Plan: The action plan will be•d Un'eated in writing specifying the actions, date of completion and person responsibly' 7. Problem solving'f6reach problem will include: 1. Recgrmended actions and responsible person for each. .4T 2.me frame for implementation. 3,1,:Expected outcome. 4. Monitoring activities: i. Need for ongoing monitoring. ii. Documentation of problem solving activity. QAPI Program Policies Page 22 Copyright 2018© 21st Century HCC 8.16 ASSESSING EFFECTIVENESS The Committee and Administrator evaluate the effectiveness of actions taken. Assessing the effectiveness of the actions taken can include: 1. Continuing to monitor the indicator for additional monitoring periods. 2. Using additional monitoring techniques. 3. Initiating special or ongoing monitoring rather than sampling, Changes may be piloted on a small scale before they are implemented Agency -wide QAPI Program Policies Page 23 Copyright 2018@ 21st Century HCC 8.17 REPORTING OF INFORMATION The Director of Nursing or other designated staff will document committee minutes and maintain all records provided by the committee for established studies. He/she is responsible for communicating the conclusions, recommendations, actions and follow-up to appropriate individuals and management. The mechanism for communicating relevant information is delineated in writing and includes: 1. Who will receive the information? 2. Type of information to be shared? 3. How information will be shared? 4. Frequency of information sharing? The committee will meet quarterly. Minutes of the meetingswill be given to the Administrator on a quarterly basis. The Professional Advisory Board Wip receive reports at each meeting. A„ QAPI Program Policies Page 24 Copyright 20180 21st Century HCC 8.18 QUALITY CONTROL Information regarding the results of all quality control activities will be reported to the Administrator who will review the results and use the findings and conclusions of the review to take appropriate action when necessary. Quality control activities apply to monitoring equipment used in providing care. The Registered Nurse assesses the condition of equipment used during routine supervisory visits. The Director of Nursing teaches staff', tto report equipment problems to him/her as they occur. Problems are immediately repot o the entity that provided the equipment and are documented in the Hazardous Medcal`Device log as well as in the patient's record. Examples of data collection can be documented in management meeting,minutes, committee reports, patient records, and quality control collection documents.``` QAPI Program Policies Page 25 Copyright 20180 21st Century HCC 8.19 IMPROVEMENT SCHEDULE/TIMETABLE In order to successfully administer the QAPI program, a schedule of QAPI activities is developed. Scheduling allows measurement/evaluation activities, meetings and the production of reports to be staggered. Staggering allows the distribution of these activities over time so that no one month is unduly busy due to QAPI activities. Using this timetable the Director of Nursing, along with the Administrator, produces.a `t schedule for when: 1. Each of the indicators selected will be measured, tabulated, and summarized monthly. 2. Chart audits from active and closed patient records are completed at least every two months. 3. Needed meetings will occur, quarterly and as needed. 4. Reports will be prepared quarterly. 5. The plan will be reviewed/revised once yearly and as" needed. 6. Any other activities are to occur. QAPI Program Policies Page 26 Copyright 2018© 21 st Century HCC 8.20 CASE CONFERENCES The purpose of case conferences is to: 1. Determine the adequacy of the plan of treatment and appropriateness of continuation of care. 2. Assure coordination of services in patient -goal directed activity on the part of each home care staff member. I Evaluate patient progress and plans for future care. 4. Provide assistance to team members having difficulty planning care for specific problem cases. 5. Refer cases which require further study to the clinical record roViO. ':committee. Case conferences shall be held regularly to review problem treatment for appropriateness and feasibility of continued se be documented separately or in the clinical record and silo the date the plan of treatment is due for the review (eve[y QI discharge. However, if a problem arises, a case-spe.eificcor ases, and to review the plan of ✓ices. Such conferences shall i be held for each patient prior to days or more often) and prior to E)rence would be indicated. All professional disciplines participating in the,, patient's care should have input at this conference. For personnel participating in the pat.ient's care but unable to attend the conference, a telephone conference could be established. Documentation of the conference shall be the responsibility of the prim�lry hurse or supervisor, or other professional as instructed by the supervisor. The documentation shall include a summary of progress, assessment of the need for cor time i care, plans, and discharge tools. For patients receiving equipment, the appropriateness and operation of the equipment will be considered in the revie y as.J,ndicated. All staff del ivering,:patient care services is encouraged to have at least weekly contact with their supervisor" This contact can be in the form of individual conferences held within the conferences or group case conferences. Any conference related to an office, telephor6. individual patient may be documented as a case conference. QAPI Program Policies Page 27 Copyright 2018© 21st Century HCC 8.21 CONTINUING REVIEW A periodic review of patient progress is a method of continuous audit services rendered to the patient. A summary regarding the patient's progress is prepared by all professional disciplines participating in the patient's care and is submitted to the physician at least every 60 days. The review will usually occur in conjunction with a recertification process. A copy of the summary is maintained in the clinical record. The continuing review of patient progress and case conferences assists the Agency in,. . meeting patient care objectives by: 1. Evaluating the patient's eligibility for home health care. 2. Reviewing the performance of patient care as ordered by the physician`" 3. Assessing the appropriate use of personnel and the therapeutic services provided. 4. Planning and/or evaluating the involvement of family merrtbers in the patient care plan. 5. Assessing the effect that the services have had up planning, on tle'patient, including discharge 6. Planning and/or evaluating the future plans foi the patient. 7. Determining the appropriateness of continuation of care. 8. Reviewing the written progress ,rep�,rt hat is sent to the patient's physician. 9. Providing learning experiences=#o..r staff development. 10. Identifying, evaluating and updating information for program development. QAPI Program Policies Page 28 Copyright 2018© 21st Century HCC 8.22 CLINICAL RECORD REVIEW Clinical record review is a method of systematic evaluation of the documentation in the clinical record. Its purpose is to ensure that: 1. Service is provided according to the treatment plan, care plan or service plan. 2. Professional and patient care policies are followed in giving care. 3. Needs of the patient are being met both quantitatively and qualitatively. 4. Continuity of care is provided within the Agency, among agencies and with physicians. 5. Components of services that are not available within the Agency and/or corn. or munity are identified. 6. Services are provided economically and effectively to promote, achieve and maintain the individual's optimum state of health and function. 7. All clinical records will be reviewed continuously for each certification period that the patients receive services. The clinical record review committee is appointed by the Agency`administration with approval of the Governing Body and the Advisory Committee. The Director of Nursing shall function as the chairperson and shall report to the Agency administration and the Advisory Committee the findings and recommendations. The committee is interdisciplinary and composed of members including the professional disciplines represented by the Agency. The committee shall meet at least every two;;mbnths and review a sampling of active and closed cases to assure that established policies are followed in providing services. The objective of the sampling is to obtain a valif>picture of all Agency services. The size of the sample will vary depending on the nuI. mber of patients serviced, but must constitute a minimum of 10% of active/closed;patient records for each category of private duty services for a maximum of 60 patient records per year. The records shall be selected':by random sample from the active and inactive files and will include representation'of ahl:disciplines providing care, diagnostic categories, lengths of stay and discharge. Problem cases are presented to the committee as needed. Audited records;,shall carry some notation that they have been audited and the date. These records will not be, selected for audit in the subsequent quarter unless specifically requested by committee members. The frequency of the clinical record review committee meetings may increase from every two months -to more often if the volume of records to be reviewed increases. The Director of Nursing will review, record the proceedings and prepare a summary of findings to be used by the Agency and reviewed by the Advisory Committee. QAPI Program Policies Page 29 Copyright 20180 21st Century HCC 8.23 RECORD REVIEW PROCEDURES Each committee member will review the records assigned to him/her by the chairman and will review the records using the Agency's standard review form. A committee member cannot review his/her own records. Following the individual record review, a summary of the findings will be presented to the committee by the reviewer. The chairperson shall prepare a report of the committee findings and recommendations. The chairman of the committee presents the committee report with findings and,.,'.'.:.. recommendations to the Director of Quality Assurance and the Advisory Co,,m tiee. The Agency is responsible for utilizing the findings and recommendations, of *the committee in order to take appropriate action in Agency planning and staff developmentto improve the quality of service and enhance home health services in the community` The clinical record review committee reports are utilized in the Agency's annual evaluation process. QAPI Program Policies Page 30 Copyright 2018© 21 st Century HCC 8.24 PEER REVIEW An Agency participating in peer review shall, in addition to quarterly record review, conduct a clinical record audit in accordance with Agency procedures on each record requested by peer review for patients discharged from a hospital and admitted to the Agency and subsequently re -admitted to the hospital within 30 days. All professional disciplines must comply with their respective professional practice acts or title acts relation reporting and peer review. coordinator will present the findings and recommendations to the Director of Nursing or:.the Quality Assurance Manager. All professional disciplines must comply with their spective professional practice acts or title acts relating to reporting and peer review. Peer review records may also be reviewed by the clinical record reviewvcommittee. The results and recommendations will be presented to the ProfessionalAdvsory Committee for their review and action. QAPI Program Policies Page 31 Copyright 20180 21st Century HCC 8.25 PATIENT EDUCATION GUIDELINES Education is considered an integral part of skilled nursing care. All patients receiving care will be assessed for knowledge deficits and education in the appropriate areas. The following is a partial list of target areas: 1. The disease process. 2. Medication regimen. 3. Therapeutic diet. 4. Treatments. 5. Safety activities. 6. Use/troubleshooting of equipment. 7. Plans for discharge include goals to be achieved, projected"length of service, alternate providers and support organizations. The ability of the patient/caregiver to understand and retain instruction will be assessed during the admission visit. Factors affecting this ability may include: 1. Educational level_ 2. Conduciveness of environment. 3. Psychological disorders:'.:;"' 4. Financial concerns. 5. Cultural/religious'factors. Instruction shoitd`include verbal lecture, written material, and return demonstrations of procedures with appropriate documentation. Instruction may be continued on a topic so long as consistent progress toward retention application is occurring and are documented. QAPI Program Policies Page 32 Copyright 2018© 21 st Century HCC 8.26 THIRD PARTY PAYER REQUESTS FOR INFORMATION/DENIAL NOTIFICATION Third party payer requests for information and denial notification shall be documented and responded to immediately. The supervising nurse or designee shall oversee the timely response to requests. Denials of coverage will be documented in writing and reviewed by the supervIsing,'n I urse or designee to determine: 1. Appropriateness of the denial. 2. Potential for reversal of the decision on appeal. 3. Implications for education of staff or revisions in Agency policies and procedures. QAPI Program Policies Page 33 Copyright 20180 21st Century HCC 8.27 ROLE OF THE QUALITY IMPROVEMENT TEAM IN INFECTION CONTROL The Quality Improvement Committee will provide oversight and guidance for infectious control activities within the Agency. In this role, the Quality Improvement Team will: 1. Support the implementation of infection control policies and procedures within the Agency. 2. Support surveillance activities. 3. Review and analyze surveillance data at least quarterly..: 4. Identify, implement and support additional surveillance activities as appropriate for the population served. 5. Promptly notify proper authorities of reportable control and -.medical device instruments. 6. Support annual mandatory infection control/medical dguice reporting education. 7. Identify and provide at least one additional artnutdl infection control continuing education program based upon the needs of the Agency, staff and patient population served. 8. Identify and support at least one focused, project per year for the reduction of risk of infection in patients and Agency<staffF Policies and procedures for infection control will be developed and approved at the corporate level. Any issues and areas needin4>policy and/or procedure development or revision should be brought to the attention of th corporate Governing Body. The Director of Nursing is`re�sponsible for assuring that local infection control policies and procedures are in compliance with local or state regulations and laws. QAPI Program Policies Page 34 Copyright 2018© 21st Century HCC 8.28 RISK MANAGEMENT Risk management is designed to identify areas of Agency operations which pose a potential risk to the Agency, its employees and patients. Management systems are in place to support, coordinate and implement risk management and infection control functions. The staff member assigned to oversee risk management shall seek to identify the occurrence of any event which could pose a risk. Potential risks shall signal the need for revisions to company policies, procedures and:w operating practices and for education, training and supervision of staff. The steps to-:' , ? evaluating a risk include: 1. Identification. 2. Investigation of the casual factors and review of company policies;'procedures, operating practices and professional standards of practice. 3. Development and implementation of corrective actions. 4. Evaluation and monitoring the response and effect corrective action. Areas of potential risk include but are not limited to: a. Deviations from company policies and,iprodedures. b. Deviation of clinical/professional practice standards. c. Accidents/incidents/unusual occurrences_ d. Safety violations e. Equipment failun f. Occupational ex1 g. Consumer h. Emolovee resolution. (i.e., breaks in bag technique, hand washing, etc.) j. Infusion therapy. k. ,,.Personnel management. `:Other data as required by local, state, Federal regulatory bodies and/or funding sources. Information management and leadership functions support the requirements of the risk management and infection control functions for aggregation, comparison of knowledge based data, knowledge of staff to interpret findings, and establish a plan for monitoring and evaluating the effect of the corrective action taken to reduce risk. The responsibility of management is to assure these activities occur. QAPI Program Policies Page 35 Copyright 2018© 21 st Century HCC 8.29 ANNUAL PROGRAM EVALUATION The Agency, through the Governing Body, Advisory Committee and Agency staff, shall annually evaluate the extent to which the Agency's program is appropriate, adequate, effective and efficient. The Agency may also contract with a qualified organization to perform the evaluation. The scope of the review shall encompass the following patient care information including: 1. Policies and procedures. 2. Organizational structure and system. 3. Achievement of goals. 4. Demographics of patients serviced. 5. Measurable patient outcomes. 6. Programs, including utilization and quality of services and products, appropriateness and adequacy. 7. Effectiveness and efficiency of all programs „inoludin"services under contract as well as information about referrals not accepted 8. Human resources. 9. Safety practices. 10. Risk management. 11. Financial resources and'bjllipg practices. 12.Information systems 13. Performance improvement findings. 14. Number of' patients not accepted, with reasons. 15. Total, staff tdays for each service offered. 16./Aetiue number of patients. 17.Average number of visits per discharged patient 18. Clinical record review and quality improvement review findings. 19. Results of questionnaires to active and discharged patients and physicians. 20. Review of personnel records, by category. 21. Review of conformance with personnel policies. QAPI Program Policies Page 36 Copyright 2018© 21st Century HCC 22. Personnel qualifications. 23.Turnover of personnel, by category. 24. Participation in both in-service and continuing education programs. 25. Review of administrative and financial activities including: a. Administrative policies and procedures. b. Budget. c. Billing reports and financial statements. ti The review committee shall use available instruments and criteria to evaluate the performance of the Agency in meeting its mission and goals. The written evaluation will be prepared and presented to the entire Advisory Committee which 'will review the committee's findings and prepare recommendations. The written recommendations shall be submitted to the Governing Body which shall take action on all recommmendations submitted by the Advisory Committee. The Administrator shall be responsible for implementing the recommendations of the Governing Body and shall periodically report tD,the Governing Body and the Advisory Committee regarding this process. Statistics gathered as a result of the ar_qual review may serve as planning tools for the Agency administrative staff to determine growth patterns, staffing needs, and patient care needs within the Agency. Annual.e.valuation reports are retained for five (5) years or according to state requirements'whichever is longer. QAPI Program Policies Page 37 Copyright 20180 21st Century HCC Collier County Florida's 16th most populous county with 1.8%of Florida's population Population Real Gross Domestic Product Real GDP Census Population Collier County Florida (The.ap.da of Chained 2012 Dollar.) Collier County Florida 1980 Census 85,971 9,746,961 2015 GOP 14,306,165 M2,269,369 1990 Census 152,099 12,938,071 Percera of m. $Me 17% %ehange 1980-90 76.9% 323% 2016GOP 14,907,455 8]0.963.202 2000 Cenws 2513Tr 15,982,824 P.-nt of Slate 1,7% %Grange 1990-00 653% 23.5% 2017GDP 15.159,917 90L903,549 2010 Census 321,520 18801,332 percent of the Slate 1.]% %range 2000-10 27.9% 17.6% 2018 GOP 15,760,820 936,580274 Age Percentof me Sste 1.7% % Under 18 years of age 19.5% 21.3% 2019 GOP 16,351,]]2 963,255,865 % 65 years of age and over 26A% 17.3% P.-ot ofthe sell 1.7% Rate &all %Irhga alone $33% 75.0% Housing % sNKK or Afriran Ameroan alone 6.6% 16.0% %I-Hp.re.,teano(ofanyri 25.9% 22s% Housing Counts Colliereoonry Florida OucuPis tl 102,9]3 6,33],929 Estimates and Prelate.. Owneroccupis l F],825 4,441.]99 2019 Estinete 3]6.]08 21,208,589 ReMer-oodi 25,148 1,8%130 %change 2010-19 172% 12.8% Vecent 41,533 965,018 2020 Estimate 387A50 21,596,068 I s,,9 arils, 2010 Census 19],2g6 81989,580 %orange 2019-20 2.9% 1.8% Occupied 133,179 7,420,802 Based on 2020 Eslimete Ovmendooupiea 96.159 4,998,079 2025 a23o. 23,138,553 Renter orou,sed a7'.o 2a2L82S 2030 452,806 24,419.127 Weer, e4,119 1.568,]]8 2035 477,Tli 25,461,863 20m 499]29 26,356,415 Units Permitted 2045 518,956 27,149,835 1990 5.846 126,384 2020 Wiled Age 49.1 41.8 200 ],9]0 155269 2010 1,259 38.679 Density 2011 1220 42,360 Personspersguu.rrik 2012 1,812 64,810 2010 160.9 296A 2014 8$]52 2020 160.3 2014 3.610 3,060 09,W5 2020 t94A 407A 40]A 2015 4,080 109,924 2016 3.829 i 240 Population Characteristics ton 4fN i22]19 Collier County Florida 2016 4,386 144,427 201. 3,991 150.302 language spoken at home olherthan English 2020 persons aged 5 and over 33 ]% 29A% o493 IK074 Place of birth Foreign Fom 2hA% 20.7% Veteran status ClAlien population 18 anti over 83% 8.6% Households and Family Households Residence 1 Year AS Households Collier County Florida Person. aged t and ever Collier County Florida 7oW households, 2000 Census 102W3 6.ns.075 Sane house 83.6% 84.5% Family hauseh01ds, 2000 Carrel 71,264 4.210.760 Different house in the US. 14.9% 14A% %udm om children under 16 32.8% 42.3% Same county in Florida 8A% 8.5% moral hoveenolds, 2010 Cones 133,172 7,420,802 Diners. mmnyin Flodda 22% 3.1% Family household, 201. Census 89,276 4,835,a75 ORferent wumy in anoNersRte 4.2% 2.8% % vith e- takren under l8 33.0% 40.0% Abmaa 1.4% 1.1% Average Household Sias 2010 Crocus 2.38 2.48 Average Family Size, 2010 Cones 2 e4 3.01 e.mawsw.•u'"nm.nMom+r.amxmnlivirtuw.wsmerenmiaalwimmMn:..v.manmw�onnewxuimreev®gew.N.lmno�.m. neviiwre..wrtlmnam.n.am.nwre Collier County Pa9a 2 Employment and Labor Force Establishments Seablishini 2020 pre llmmem, Collier County Florida %.fAI[eatables, 2020 Drell rdim, Collier County Forida M industries 161034 763,4r Ai ndecon. 16,034 763,4]] Wtural Reecourw&Mnin9 107 51511 DNWreI Resources &Mining 0.7% 0.]% Cons0uaion 2,293 )],530 Construction 14.3% 1U% Manufachuring 342 21,812 Mordaramin9 2.1% 29% Trade, Tra e,snalion and Wldies 2,494 145.824 Trade, Transponecon and AAtias 15.6% 19.1% Infornla0on 201 13,452 Information 1.3% 1.8% Financial Activ6les 2,216 83,894 Firetail Activy. a 13.8% 11.0% Professional& Business Services 4,084 187,325 Proncerional& Business Services 25.5% 245% Edsomen&IbaIIM1 Services 1,444 8],]35 Edmonton &I-aM Servics 9.0% 11.5% Lesure and lbapifality 1,229 60,878 Leisure and Ficspils4ry 7.7% 8.0% other Services 1.390 56,376 Other Services 8.7% 7.4% Government 82 5,894 Govemment 0.5% 0.8% Average Mnusl Employment Average Annual Wage % of At lndustrie; 2020 preliminary Collier County Florida 2020 preliminary Collier County Florida At industries 144,067 8,452,413 Allnduetsbe $51,829 $55.845 l4eturel Resource& Wring 2.0% 0.8% Naturel Resource&Mning 534.701 $37j11 ConsWttlon 11.7% 8]% Construction $53,50 $558m Manufacturing 3.3% 4.6% Manufacturing $601634 $66,740 Trade, Transportation and Where 18.7% 20.6% Trade, Treracomofim and WiOes M,529 549,378 Iwc,mcaGdn 0.8% 1.5% Information $]],149 $93,32] Financial Actomes 1.7% 6.9% F-.]AclNOaa $107,866 $81,238 PrOfcoo..I& 9usineas Services 11.3% 18.1% Professorial& Business Services $64,257 $68,201 Education & Heattb Services 15.5% 15.3% Education It Ifeadh Services $62.558 $55,093 Leisure and Ibspifaliy 17.5% 11.9% Laiamre ace Xcapitaflry $33.379 $f5,092 Other Services 42% 3.0% Cast Services $39j13 $41146 Government 9.0% 125% Government $59,447 556.795 ineue.a„wv.eemm:,cola.:xonneawoy..e.meNis Labor Force as Percent of Population Aged IS and Older Collier County Florida Unemployment Rate Collier County Florida 1990 60.7% 64.5% 1990 5.6% 62% 2000 58.2% 64294 2000 3.8% 3.8% 2010 58.1% 6L8% 2010 11.6% 108% 2020 56,4% 50.8% 2020 6.9% 3.3% Income and Financial Health Personal Inc..($009s) Collier County Florida Par Capin Personal Income Collier County Florida 1990 S4,151199 $257,91,430 1990 $26,857 $19.763 2000 810.859.890 $4]2,238,563 2000 $42,753 $38.475 2011 $20,182,863 $725,074,023 2011 $62,567 $40,131 2011 $21240..21 3764.633.664.5% 201t $66,.6% $d0.31 %cM1an9a 20i0-11 S30 %rlange 2010-11 4,3% 2012 ,163 $23,895,153 $1'93,423.8% 2012 ,923 $10.9% �25% %change 20t142 t2.5Ye 3.8% %cM1ange 2011-12 2013 $23,522,984 $795425004 2013 $69,392 $40,696 %change 2012-13 -1.6% 0.3% is change 2012-13 J5% -1.0% 2014 $26,888324 $856,161,P3 2014 $]],435 $43,140 %Mange 2013-14 14.3% ].a% %change 2013-14 116% 6.0% 2015 $29,60],63] $914,928,403 2015 $83,169 $4512)3 %Mange 2014t5 10.1% 6.9% %cre,r201415 7A% 4. 2016 $31,162,883 $949,717.988 2016 $55,274 446,0]3 %change2015-16 53% 3.8% %Mange 2015-16 2.5% 1.8% 2017 $33,39c573 $1016,818,999 2017 589,607 5481504 %change 2016-17 72% 7.1% is change 2016-17 5.1% 53% 2018 W7,178,408 $1052,]02,18] 2018 $98,303 $50.964 %change 2017-18 11.3% 6.5% is change 2017-18 9.7% 5.1% 2019 1138,252,405 $1,125,9e4,012 2019 $99,382 $5ZQ6 %Mange2018-19 2.9% 4.0% %chnnge2018-19 1.1% 2.9% Earnings by Place of Work ($000e) Marlon Income 1990 $1,950,623 $161p35,722 Mad an Ibumnold Income $65,660 2000 $4.880,690 g300,]51,]6] Metllan Fairly Income hgor3 $d82,092 $67,414 2011 $7,751,61S079 $438,99f,235 20fl $]]St,0% $950,502.6% 3019 %cM1an9a 201041 26% At WastinPoverty, Alleges in poverty g4% 12.T°% 2012 ,765 $],918]65 5488,414.0% UndeRelic age 10'm poverty 14.0% 162% %Mange 2011-12 22% 4.0% Relafetl children age 5-P in (amines in poverty 13.1% 169N. 2013 $8,128,.6% S482,900,4063.1% %Mange 2012-13 3.1% Filing Rate Poreoform 2014 ,019 $6,088,08% $512,386.1 ,00 Population) 1,000 000nrod Collier Ce1.15 Florida %Mange 201}i4 i1828 8.1% 2-Mon Ending) Period Ending March 30,2020 ids 20.5 20te $9,625,.1% $SM,426.34 12-Maori t2-hats Period Ending March 30, 2021 0.39 1.50 %Mange 201415 8.1% fi.3% $tile Rank 39 Bt4 2016 $t0,430,98t $568,848,341 rvoneur'ecsccexr>&ehaprerf3 e%chan9e20i5A6 62% 4.5% 2017 S1g804,103 $602,210,803 %change2015-5] 36% 59% Worken Aged 16 and Over collier County FbrMa 2018 $11.610.068 $639,710.580 Plam of Work, in Florida %chance 201118 7.5% 62% Worked 0c.s. county of reeiderre IJ.t% 182% 2019 $14269.267 $672,454,824 Travel Time to WOM %change 2018-19 53% 5.1% Meso lrovel lime fa mrk(fanutee) 247 27.8 Collier County Fee.3 Reported County Government Revenues and Expenditures Revenue 2016.19 Collier County Florida' IXpendiWres 2018-19 Coiner Count, Florida' Total - Al Revenue Account Cotles Toeel- Al Eyendilure Aaddart Codes ($OOOs) $1.430,0822 $48,723,763.0 ($000s) $1,132,Stt29 $441233142k.T6 Per Capita$ $3,79623 $2.407.55 Far Caddo 53,006.35 $2.185.67 a of Toad 100.0% 100.0% %ofTatsl 100.0% 1000% Taxes General Govemment Se,raas" ($0005) $471,1272 $16114,ll ($000.) $236,324.75 $7p629W.96 Per (apila $ 31,250.65 $79626 Per Capile el all $368.76 %of Total 32.9% 33.1% %of Total 20.9% 169% PenNte. Fee, al Specal assessments Public Safely ($000s) $85,63M1d $2.274.184.8 ($OOOa) $264,554.44 $10,847,40929 Per Castel SZ7.32 $112.37 Far Capita$ $20228 $53599 %of Total 6.0% 4.7% %of Total 23A% 245% Inter9ovemenertal Revenues PhilEnviranmenl ($0005) $151,458.7 $5,241,885.1 ($OOos) $182.712.20 $5,315.683.90 Per Capita$ SA02.06 $26901 Per Capes$ $485.03 $28281 %of Total 10.6% 10.8% %of Total 16.1% 120% Charges for Sal Transportation ($0005) 3369.018.5 $14.324,9191 ($OOoa) $86,957.90 $5,298,301.b'2 Per CaPIM3 sell $707.83 Far Capra $230.84 $261R0 %of Told 25.8% 29A% %ofTatal 7.7% 120% .Ndgmena, Fines, and Fmleas Eoonons.BF no,da l ($000s) $2,491.3 $196,198S ($000s) $8,60335 $1,655,038.51 Far Codes $6.61 $9.69 Per Codes $22S7 $81.78 %of Total 02% OA% %of Total 0.0% 3.7% Miscellaneous Revar.a. Human Sarvlces ($000s) $S.305.3 $1]13370.3 tsove) $17,147.40 $3,755,466.15 Fall Capita$ $144.16 584.66 Far Capita$ $4A52 $18547 %o1To41 39% 3.5% %of Total t5% 8.5% other So.- Culture / Formal ($Ool $296.04>.3 58,858,J22.0 (Noah $90,21232 $1,814,9T8A8 Per Capea$ $785.S8 $432.73 Per Capita$ S260.71 ads. %of Total 20.7% 18.2% %of Total 8]% 4.1% Other Uwe and I'or-0penw, ($WOa) $226,609.62 57,163,78358 - an County Caamments Except 0uwl-The corediaateeCle, of l dddeMlle/ Ourel County figures as Far cached $601.56 $353.98 Included in mwicilal tote@ raeertnan county goremmee had. el of Total 20.0% 162% Ceuri-Felared Elcendrares (Not Coud,undwer) ($000e) $it A89.32 Per Cal $30.50 545.30 %of Total 1.0% 2.1% Quality of Life Health Insurance Status Crime Celli -Col Florida Percent Insured deans Group Doltier County Florida Cnma.. 2.20 (index eftea per 100,000 populsl 1,208A 2.152.3 Udder 65 year3 78.7% 83.6% admissions to prison FY 2019-20 192 21,276 under 19 are 88.0% 92A% admaddosto prison per 100,000 fetd(FI'lrs >5.2% 80.6% soul FY2at9-20 490 98.5 State Infrastructure State and Local Taxation Tnihoporelion Collier Count, Florida 2020 ad Valorem Mill Ronald Collier county State H9hxay Conn1,l hat County-wde' Centerline Mlee 206.2 12,128.1 County 3U5&M 0.5974 Lane Miss 700.7 45,030.3 sel 5.0160 Stale Sedges Munidpal 05106 Number 215 7,044 Bpecal Mehriehe 02543 09174 'mSTl inrlutlm in xo[Counry-Witle"Lo�nry'rzt¢gory Slate FadlRiea BuiidNgisil lNes (mio. 30. Square Feet) Education Number 75 9,630 PublId Eal...Oon Schools Call County Square Feel 431.213 65,989245 Traditional seeing(2020-21) school Dial Florida Total (stele total ireluma specal darrom 63 3.744 Conservation land (land acres only) Elementary 32 1,883 Stata-Ovmed(incWds, porally-owned) a5,502 5,303,024 Head it 573 % of Toal Cordervation Lord(CL) 28.1% 51.6% Senior Hgb 9 715 % of Total area Land 192% 15.7% Core inesed 11 on %of Florida Brale-0vmetl CL 4.6% leduwOonalallainrtwnt Slate -Managed 213,697 5,496.474 Persona aged 25 and older Co..., County Florida V. of Total conservation Lend(CL) 24.4% 52,6% %Iig greduefe or higher 871% 882% % of Total Area land i6.7% 16.0% % bedhelofs degree or higher 36.4% 29.9% %of Florida Stela-IManagedCL 3.9% argaretl GS: A dem oadalel,.... m gr6areo„o,m 1a1 w.m,d Frddeutee7d 6 ILA..... FL all Vedd 71 Ifisol oar-vwz nrmb/mrm4aur dl/jrn tunez9n 2020 Collier County, Florida Health Profile Data foryear ending 2018, unless otherwise noted Demora'ruplues County Area 8* Florida Total 367,471 20.8% 1,768,648 8.4% 20,957,705 Male 180,815 49.2% 866,214 49.0% 10,244,293 48.9% Female 186,656 50.8% 902,434 51.0% 10,713,412 51.1% Ages 0-18 63,532 17.3% 293,575 16.6% 4,193,969 20.0% Ages 18-64 188,259 51.2% 921,602 52.1% 12,566,405 60.0% Ages 65+ 115,680 31.5% 553,471 31.3% 4,197,331 20.0% White 328,252 89.3% 1,567,884 88.6% 16,219,736 77.4% Black 27,216 7.4% 134,407 7.6% 3,549,464 16.9% Other 12,003 3.3% 66,357 3.8% 1,188,505 5.7% Hispanic 102,032 27.8% 340,473 19.3% 5,393,117 25.7% *Area 8 includes Charlotte, Collier, Desoto, Hendry, Glades, Lee, & Sarasota counties 80.0% 0 m 60.0% 3 0 a 40.0% m F° 20.0% 0 X 0.0% SOCioeeOROmies ■ County ■ Area 8 ■ Florida Ages 0-18 Ages 18-64 Ages 65+ County Per Capita Income $92,686 Median Household Income $65,675 Persons<100% of FPL 10.6% V j` Children under 18 years <100% of FPL 18.5% High School Graduate or Higher* 86.4% Bachelor's Degree or Higher* 36.2% Labor Force as % of Population Age 18+ 59.5% 1i1{ Unemployment Rate 3.4% Severe Housing Cost Burden** 16.0% % of Civilian Noninstitutionalized Population with a Disability"** 1.4% Florida $50,070 $53,267 13.7% $100,000 - $80,000 .._..............._ 20.0% $60,000 ................. 88.0% $40,000 ■County 29.2% $20,000 61.6% $0 ■ Florida 3.6% Per Capita Median 17.0% Income Household Income 13.4% FPL: Federal Poverty Level *age 25 and over **2020 *** 5 year estimates 80 "'Orkroly '. 60 Top IndusMes (% of all workers) County Florida Professional & Business Services 4 0 23.7% 23.4% Trade, Transportation & Utilities 16.2% 20.0% 20 r1LICE Data Households by Income, 2016 Construction 14.7% 10.3% 0 I�- Financial Activities 13.4% 10.6% voverty ?LICE A6°va.^L ICE Other Services 9.0% 8.0% Threshold Education & Health Services 8.8% 10.6% ALICE households are consisdered financially struggling 2020Collier Counly, Florida Health Profile Crone 3-year rate per 100,000, 2016-2018 County Trend Florida County Quartile Larceny 959.3 Positive `! 1,906.0 2 Burglary 207.1 Positive 422.2 1 Total Domestic Violence Offenses 441.1 Inconsistent 514.3 2 Aggravated Assault 196.6 Inconsistent 280.4 '1 Forcible Sex Offenses 39.7 Negative 54.4 2 Age -Adjusted Suicide Death Rate 12.0 Inconsistent 15.3 1 Alcohol -suspected Motor Vehicle Traffic Crash Deaths* 2.5 Positive 4.1 ,1 Murder 2.4 Negative " 5.3 t1 *?mc vnaoa...,. Healthcare Utilization & Resout ces Licensed Health Protessionah Rate per 100,000 County Florida Rate per 100,000t County Florida Total Hospital Beds 286;0 308.2 Physicians 331.0 310.0 Acute Care Beds 222.6 248.9 OB/GYNs 12.2 9.3 Specialty Beds 63.4 59.2 Pediatricians 15.9 22.0 Nursing Home Beds 201.9 399.8 Dentists 1.:75.7 56.7 County Health Dept FTE* 44.7 42.9 *Number oflicensed providers does not necessarily equal the number of practicing County Health Dept Expenditures** $31.40 $33.60 providers, tfiscalyearending2019 *fiscalyear ending 2019, FTE: full-time employees **Dollars ($) expended per person, fiscal year ending 2019 Collier County Florida Percentage of Percentage of Civilian Civilian Noninstitutionalized Noninstitutionalized Healthcare Access* Population Population Trend With Health Insurance Coverage 83.5% 86.5% Positive No Health Insurance Coverage 16.S% 13.5% *5 year estimates Health Insurance Coverage civilian noninstitutionalized population 19 to 64 years 80.0% 70.0% L 60.0% m 0 50.0% 0 a 40.0% m 0 30.0% F 0 20.0% 10.0% 0.0% e insured ■ uninsured Employed Unemployed Not in labor force School -Aged Children Population with a Disability Percentages County Florida Immunization at Yindergarten 92.8% 93.8% Third Grade Language Arts Proficiency* 61.0% 58.0% 1 �Of 11.4% of Collier County's High School Graduation Rate ** 91.9% 86.9% population has a disability compared to FL's 23.4% Middle School Students Eligible for Free/Reduced Lunch* 62.3% 55.4% *2019 data **2018-2019 School Year 2020 Collier County, Florida Health Profile 'Mortality R I.eatlinn Causes of Death Age -Adjusted Rate per 100,000, 2018 County Age -Adjusted Rate / 100,000 Trend Florida Age -Adjusted Rate / 100,000 County Quartile All Causes 457.3 Inconsistent 679.4 sl. Cancer 107.6 Inconsistent 146.2 1 Heart Disease 89.3 Positive 147.7 1 Stroke 41.4 Negative 41.0 3 Unintentional Injury 46.5 Inconsistent 53.8 '1 , Chronic Lower Respiratory Disease 15.3 Positive 38.4 1 Alzheimer's Diseases 12.5 _ _Positive 20.0"1 Diabetes 20.3 Inconsistent 20.4 `.1 Chronic Liver Disease and Cirrhosis 12.3 Inconsistent 12.0 2 Suicide 12.0 Inconsistent 15.3 1 County health Rankings 2020 County Florida Poor Mental Health Days 3.9 4.0 County Health Rankings by the Robert Wood Adult Smoking 14% 16°/o Johnson Foundation ranks all counties in a state Adult Obesity 21% 27% based on health data. Collier County was rank Physical Inactivity 23% 26% 2nd out of the 67 counties in Florida for Access to Exercise Opportunities 91% 89% Health Outcomes and 6th out of 67 for Health Factors. The data to the left are some of Food Insecurity 10% 13% the factors tracked by County Health Rankings. Drug Overdose Deaths (rate per 100,000) 16 23.0 Most of the data included in the 2020 rankings Disconnected Youth 7% 7% is from 2018. Maternal and Infant Healtli County 2016-2018 County Trend Florida Quartile Total Births (3 yr annual avg) 3,234 Teen (15-19) Birth Rate* 17.9 Positive - 18.2 �1 Neonatal Death Rate (0-27 Days)* 4.1 Inconsistent 4.1 2 Infant Death Rate (0-364 Days)* 5.2 Inconsistent_ 6.1 1 Low Birthweight <2500 Grams (% of Live Births) 7.2% Negative 8.7% 1 • of Live Births with Late or No Prenatal Care 7.3% inconsistent 6.7% 3 • of Births with 1st Trimester Prenatal Care 71.7%.Positive �. 77.4% 3 *per 1,000 births Conlntnn/eable Diseases County 3-year rate per 100,000, 2016-2018 County Trend Florida Quartile Infectious Syphilis Cases 4.5 Steady 12.4 1 Gonorrhea Cases 41.7 Negative 149.9 1 Chlamydia 320.4 Negative 485.5 1 AIDS Cases 6.6 Negative 9.8 3 Tuberculosis Cases 3.4 Inconsistent 2.9 3 2020 Collier County, Florida Health Profile Collier County INSURANCE AND BONDING REQUIREMENTS Solicitation 18-7470S Insurance / Bond Type Required Limits 1. E Worker's Compensation Statutory Limits of Florida Statutes, Chapter 440 and all Federal Government Statutory Limits and Requirements Evidence of Workers' Compensation coverage or a Certificate of Exemption issued by the State of Florida is required. Entities that are formed as Sole Proprietorships shall not be required to provide a proof of exemption. An application for exemption can be obtained online at https://aT)ps.fldfs.com/bocexeml)t/ 2. ® Employer's Liability $1,000,000 single limit per occurrence 3. ® Commercial General Bodily Injury and Property Damage Liability (Occurrence Form) patterned after the current $1,000,000_single limit per occurrence, $2,000,000 aggregate for Bodily Injury ISO form Liability and Property Damage Liability. This shall include Premises and Operations; Independent Contractors; Products and Completed Operations and Contractual Liability. 4. ® Indemnification To the maximum extent permitted by Florida law, the Contractor/Vendor shall defend, indemnify and hold harmless Collier County, its officers and employees from any and all liabilities, damages, losses and costs, including, but not limited to, reasonable attorneys' fees and paralegals' fees, to the extent caused by the negligence, recklessness, or intentionally wrongful conduct of the Contractor/ Vendor or anyone employed or utilized by the ContractorNendor in the performance of this Agreement. 5. ® Automobile Liability $500,000 Each Occurrence; Bodily Injury & Property Damage. Owned/Non-owned/Hired; Automobile Included 6. ❑ Other insurance as noted: ❑ Watercraft $ Per Occurrence ❑ United States Longshoreman's and Harborworker's Act coverage shall be maintained where applicable to the completion of the work. $ Per Occurrence ❑ Maritime Coverage (Jones Act) shall be maintained where applicable to the completion of the work S Per Occurrence ❑ Aircraft Liability coverage shall be carried in limits of not less than $5,000,000 each occurrence if applicable to the completion of the Services under this Agreement. $ Per Occurrence ❑ Pollution $ Per Occurrence ® Professional Liability $1,000,000 Per claim & in the aggregate ❑ Project Professional Liability $ Per Occurrence ❑ Valuable Papers Insurance $ Per Occurrence ❑ Cyber Liability $ Per Occurrence ❑ Technology Errors & Omissions $ Per Occurrence X Crime/Employee Dishonesty $50,000 Per Occurrence 7. ❑ Bid bond Shall be submitted with proposal response in the form of certified funds, cashiers' check or an irrevocable letter of credit, a cash bond posted with the County Clerk, or proposal bond in a sum equal to 5% of the cost proposal. All checks shall be made payable to the Collier County Board of County Commissioners on a bank or trust company located in the State of Florida and insured by the Federal Deposit Insurance 7/7/2021 1:18 PM p 24 Collier County Solicitation 18-7470S Corporation. 8. ❑ Performance and Payment For projects in excess of $200,000, bonds shall be submitted with the executed Bonds contract by Proposers receiving award, and written for 100% of the Contract award amount, the cost borne by the Proposer receiving an award. The Performance and Payment Bonds shall be underwritten by a surety authorized to do business in the State of Florida and otherwise acceptable to Owner; provided, however, the surety shall be rated as "A-" or better as to general policy holders rating and Class V or higher rating as to financial size category and the amount required shall not exceed 5% of the reported policy holders' surplus, all as reported in the most current Best Key Rating Guide, published by A.M. Best Company, Inc. of 75 Fulton Street, New York, New York 10038. 9. ® Vendor shall ensure that all subcontractors comply with the same insurance requirements that he is required to meet. The same Vendor shall provide County with certificates of insurance meeting the required insurance provisions. 10. ® Collier County must be named as "ADDITIONAL INSURED" on the Insurance Certificate for Commercial General Liability where required. This insurance shall be primary and non-contributory with respect to any other insurance maintained by, or available for the benefit of, the Additional Insured and the Vendor's policy shall be endorsed accordingly. 11. M The Certificate Holder shall be named as Collier County Board of County Commissioners, OR, Board of County Commissioners in Collier County, OR Collier County Government, OR Collier County. The Certificates of Insurance must state the Contract Number, or Project Number, or specific Project description, or must read: For any and all work performed on behalf of Collier County. 12. ® On all certificates, the Certificate Holder must read: Collier County Board of County Commissioners, 3295 Tamiami Trail East, Naples, FL 34112 13. ® Thirty (30) Days Cancellation Notice required. 14. Collier County shall procure and maintain Builders Risk Insurance on all construction projects where it is deemed necessary. Such coverage shall be endorsed to cover the interests of Collier County as well as the Contractor. Premiums shall be billed to the project and the Contractor shall not include Builders Risk premiums in its project proposal or project billings. All questions regarding Builder's Risk Insurance will be addressed by the Collier County Risk Management Division. GG — 6/29/2021 Vendor's Insurance Statement We understand the insurance requirements of these specifications and that the evidence of insurability may be required within five (5) days of the award of this solicitation. The insurance submitted must provide coverage for a minimum of six (6) months from the date of award. Name of Firm QQ WJ1 GiR, h Q SO IA rUS Date b7 IQ e1 I'd Vendor Signature i f - Print Name t � %l 11 t A W 16 d' F 1L Ca C- Insurance Agency Name t04 Si ;Y' II --Agent o R n Telephone Number Jep l' .JtPJa ' iCi ®v'� 7/7/2021 1:18 PM p. 25 Collier County Solicitation 18-7470S EXHIBIT LA FEDERAL CONTRACT PROVISIONS U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (ADMINISTRATION ON AGING) AND FLORIDA DEPARTMENT OF ELDER AFFAIRS CFDA 93.OXX (CSFA 65.010) The supplemental conditions contained in this section are intended to cooperate with, to supplement, and to modify the general conditions and other specifications. In cases of disagreement with any other section of this contract, the Supplemental Conditions shall govern. Contractor means an entity that receives a contract. The services performed by the awarded Contractor shall be in compliance with the provisions of Title 45 CFR Part 75; and/, 2 CFR Part 200; and/or Title 45 Chapter XIII Part 1321 and/or other applicable regulations. It shall be the awarded Contractor's responsibility to acquire and utilize the necessary manuals and guidelines that apply to the work required to complete this project. In general, 1) The contractor (including all subcontractors) must insert these contract provisions in each lower tier contracts (e.g. subcontract or sub -agreement); 2) The contractor (or subcontractor) must incorporate the applicable requirements of these contract provisions by reference for work done under any purchase orders, rental agreements and other agreements for supplies or services; 3) The prime contractor is responsible for compliance with these contract provisions by any subcontractor, lower -tier subcontractor or service provider. FEDERAL STATUTORY AUTHORITY Older Americans Act of 1965 (OAA), as amended (42 U.S.0 § 3001 et seq., as amended by Public Law 114-144; 106-501; Section20.41) OLDER AMERICANS ACT PROGRAM FUNDS OAA Title III B - Supportive Services; OAA, Title III, Section 307(a)(10) Title 45 Public Welfare (45 CFR 1121) Chapter XIII Office of Human Development Services, Department of Health and Human Services Part 1321.65 Grants to State and Community Programs on Aging; Part 1321.67 Service Contributions FLORIDA STATUTORY AUTHORITY TITLE XXX (Social Welfare); Chapter 430 (Elder Affairs) CONTRACT COMPLIANCE OVERVIEW Under the Florida Department of Elder Affairs Older Americans Act, the contractor must comply with the contract documentation, conform to state and AAA policies, and comply with federal and state statutory and regulatory requirements. (Ref. - Department of Elder Affairs Programs and Services Handbook, Chapter 4, Page 22; July 2018: Older Americans Act.). The contractor will comply with the intent of Title III to provide for formula grants to State agencies on aging to stimulate the development or enhancement of comprehensive and coordinated community -based systems resulting in a continuum of services to older persons with special emphasis on older individuals with the greatest economic or social need, with particular attention to low-income minority individuals. (Ref. - Title 45 CFR 1321) FCP-1 7/7/2021 1:18 PM p, 26 Collier County Solicitation 18-7470S EXHIBIT LA FEDERAL CONTRACT PROVISIONS U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES FEDERAL CONTRACT PROVISIONS Administrative, Contractual, or Legal Remedies (Ref. 41 U.S.C. 1908,2 CFR § 200 Appendix 11(A) Unless otherwise provided in this contract, all claims, counter -claims, disputes and other matters in question between the local government and the contractor, arising out of or relating to this contract, or the breach of it, will be decided by arbitration, if the parties mutually agree, or in a Florida court of competent jurisdiction. Access to Records and Reports (Reference: 2 CFR § 200.333, 2 CFR § 200.336) The contractor/vendor agrees to maintain all books, records, accounts and reports required under this contract for a period of not less than three years after the date of termination or expiration of this contract, except in the event of litigation or settlement of claims arising from the performance of this contract, in which case the Contractor agrees to maintain same until the Purchaser, the Grantor Administrator, the Comptroller General, or any of their duly authorized representatives, have disposed of all such litigation, appeals, claims or exceptions related thereto. Furthermore, the County shall maintain written policies and procedures for computer system backup and recovery and shall have the same requirement of its Contractors. Byrd Anti -Lobbying Amendment (31 U.S.C. 1352) (Reference 2 CFR § 200 Appendix 11(.1) Vendors must certify it will not and has not used Federal appropriated funds have been paid or will be paid, by or to any person or organization for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. The certification includes any lobbying with non -Federal funds that takes place in connection with obtaining any Federal award. Civil Rights Compliance The contractor or a subcontractor who is the recipient of Federal funds (or assumes others with whom it arranges to provide services or benefits in connection with any of its programs and activities or assures others with whom it arranges to provide services or benefits to participants or employees) must comply with Title VI of the Civil Rights Act of 1964, which prohibits discrimination on the basis of race, color, or national origin (45 CFR 80), and Statutes and Regulations enforced by the Office of Civil Rights, U.S. Department of Health and Human Services, as follow: Section 504 of the Rehabilitation Act of 1973, as amended (29 USC § 794), prohibits discrimination against otherwise qualified individuals on the basis of disability in programs and activities receiving financial assistance from HITS 45 CFR 84 and/or programs or activities conducted by HHS 45 CFR 85 in the provision of benefits and under the ADA that does not: a. Exclude a person with a disability from a program or activity; b. Deny a person with a disability the benefits of a program or activity; c. Afford a person with a disability an opportunity to participate in or benefit from a benefit or service that is not equal to what is afforded others; d. Provide a benefit or service to a person with a disability that is not as effective as what is provided others; e. Provide different or separate benefits or services to a person with a disability unless necessary to provide benefits or services that are as effective as what is provided others; or, f. Apply eligibility criteria that tend to screen out persons with disabilities unless necessary for the provision of the service, program or activity. FCP-2 7/7/2021 1:18 PM p 27 Collier County Solicitation 18-7470S EXHIBIT LA FEDERAL CONTRACT PROVISIONS Section 508 of the Rehabilitation Act of 1973, as amended, (29 USC § 794(d)) prohibits discrimination on the basis of disability in electronic and information technology as they relate to programs and activities conducted by HHS. The Age Discrimination Act of 1975, as amended (42 USC § 6101) prohibits discrimination on the basis of age in programs or activities receiving Federal financial assistance 45 CFR 90; and/or programs or services receiving HHS financial assistance 45 CFR 91; Title I1 of the Americans with Disabilities Act (28 CFR Part 35), relating to Nondiscrimination on the Basis of Disability in State and Local Government Services 2010 ADA Standards for Accessible Design; The Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §290 dd-3 and 290 ee 3), as amended, as relating to confidentiality of alcohol and drug abuse patient records; Section 1908 of the Public Health Service Act (42 USC § 300w-7) prohibits discrimination on the basis of age, race, color, national origin, disability, sex (gender), or religion in programs, services, and activities funded by Preventative Health and Health Services Block Grants. Federal Health Care Conscience Protection Statutes (42 USC § 300a-7; 42 USC § 300a-7; 42 USC § 238n and the Weldon Amendment (Continuing Appropriations Resolution, Pub. L. No. 113-164, Sec. 101(a) (Sept. 19, 2015); Regulation for the Enforcement of Federal Health Care Provider Conscience Protection Laws, which prohibit recipients of certain Federal funds from discriminating against certain health care providers who refuse to participate in certain health care services on religious or moral grounds. Section 1557 of the Affordable Care Act prohibits discrimination on the basis of disability by entities that operate a health program or activity. 45 CFR 80. The contractor must have on file an assurance that the program will be conducted in compliance with all nondiscriminatory provisions as required in 45 CFR 80. Debarment and Suspension (Reference 2 CFR § 200 Appendix II (1) Contract awards that exceed the small purchase threshold and certain other contract awards shall not be made to parties listed on the government wide Excluded Parties List System in the System for Award Management (SAM), in accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR Part 1986 Comp., p. 189) and 12689 (3 CFR Part 1989 Comp., p. 235), "Debarment and Suspension." The Excluded Parties List System in SAM contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549. The successful bidder, by administering each lower tier subcontract that exceeds $25,000 as a "covered transaction", must verify each lower tier participant of a "covered transaction" under the project is not presently debarred or otherwise disqualified from participation in this federally assisted project. The Contractor shall comply with these provisions before doing business or entering into subcontracts receiving federal funds pursuant to this contract. The Contractor shall complete and sign the Certifications and Assurances Attachment prior to the execution of this contract. Diversity (Reference 2 CFR § 200.321) The County is dedicated to fostering the continued development and economic growth of small, minority-, women-, and service -disabled veteran business enterprises. All contracting and subcontracting opportunities afforded by this solicitation/contract are strongly encouraged to contribute as both Contractors and Sub - Contractors. Firms may be required to submit documentation addressing diversity and describing the efforts being made to encourage the participation of small, minority-, women-, and service -disabled veteran business enterprises. Information on Certified Minority Business Enterprises (CMBE) and Certified Service -Disabled Veteran Business Enterprises (CSDVBE) is available from the Office of Supplier Diversity at: http://dms.myflorida.com/other programs/office of supplier diversity osd/ FCP-3 7/7/2021 1:18 PM p. 28 Collier County Solicitation 18-7470S EXHIBIT LA FEDERAL CONTRACT PROVISIONS Energy Policy and Conservation Act - (Reference 2 CFR § 200 Appendix H (H) The contractor shall comply with any mandatory standards and policies relating to energy efficiency which are contained in the F 1 o r i d a state energy conservation plan issued in compliance with the Energy Policy and Conservation Act (Pub. L. 94-163, 89 Star. 871, 42 U.S.0 Section 6201) Equal Employment Opportunity (Appendix II, 2 CFR Part 200; Department of Labor 41 CFR Part 60; Dept. of Health and Human Services 45 CFR Part 92, if applicable). The Contractor shall not discriminate against any employee or applicant for employment because of race, age, creed, color, sex or national origin. The Agency will take affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to their race, age, creed, color, sex, or national origin. Such action shall include, but not be limited to, the following: Employment upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. Contractors must insert a similar provision in all subcontracts, except subcontracts for standard commercial supplies or raw materials. E-verify, Presidential Executive Order 12989; Florida Executive Order Number 11-116 Vendors/Contractors/Subcontracts: 1. Agree to utilize the U.S. Department of Homeland Security's E-verify system to verify the employment of all new employees hired by Contractor during the contract term; and 2. Contractor shall include in related subcontracts a requirement that Subcontractors performing work or providing services pursuant to the state contract utilize the E-verify system to verify employment eligibility of all new employees hired by the Subcontractor during the contract term - The HIPAA Privacy Rules, 4 CFR Part 160 and Subparts A and E of part 164 The Third Parry subrecipient will comply with HIPAA requirements to appropriate safeguards to protect the privacy of personal health information, and sets limits and conditions on the uses and disclosures that may be made of such information without patient authorization. No Government Obligation to Third Parties - The Federal Government is not a parry to this contract and is not subject to any obligations or liabilities to the non -Federal entity, contractor, or any other party pertaining to any matter resulting from the contract." Procurement of Recovered Materials (Reference 2 CFR § 200.323) Contractor and subcontractor agree to comply with Section 6002 of the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act, and the regulatory provisions of 40 CFR Part 247. (1) In the performance of this contract, the Contractor shall make maximum use of products containing recovered materials that are EPA designated items unless the product cannot be acquired (i) Competitively within a timeframe providing for compliance with the contract performance schedule; (ii) Meeting contract performance requirements; or (iii) At a reasonable price. (2) Information about this requirement is available at EPA's Comprehensive Procurement Guidelines web site—http://www.epa.gov/. The list of EPA -designate items is available at https://www.epa.gov/smm/comprehensive-procurement-guideline-cpg-program. Program Fraud and False or Fraudulent Statements of Related Acts The contractor acknowledges that 31 U.S.C. Chap. 38 (Administrative Remedies for False Claims and Statements) applies to the contractor's actions pertaining to this contract. Termination for Cause and Convenience See County's Standard Terms and Conditions. Trafficking in Persons The Contractor and subcontractors shall comply with Title 2 CFR Part 175 and 2 CFR §175.15 provisions applicable to a private entity, as defined in 2 CFR 175.25. FCP4 7/7/2021 1:18 PM p. 29 Collier County Solicitation 18-7470S EXHIBIT LA FEDERAL CONTRACT PROVISIONS Transparency Act Unless exempt under 2 CFR § 170.11 O(b), the Contractor shall comply with the reporting requirements of the Transparency Act as expressed in 2 CFR Part 170. Clean Air Act and Federal Water Pollution Control Act (Reference: 2 CFR § 200 Appendix H (G)) Contracts and subgrants of amounts in excess of $150,000 shall contain a provision that requires the Contractor or recipient to comply with all applicable standards, orders, or requirements issued pursuant to Section 306 of the Clean Air Act as amended (42 U.S.C. 7401-7671q.), Executive Order 11738, as amended, where applicable, the Federal Water Pollution Control Act as amended (33 U.S.C. 1251-1387), and Environmental Protection Agency regulations 2 CFR Part 1500. The Contractor shall report any violations of the above to the Federal awarding agency and the Regional Office of the Environmental Protection Agency (EPA). Unlawful Employment of Aliens (Reference Immigration and Nationality Act (8 U.S.C. § 1324a) and the Immigration Reform and Control Act of 1986 (8 U.C. § 1101) (a) Making Employment of Unauthorized Aliens Unlawful (1) In General It is unlawful for a person or other entity— (A) to hire, or to recruit or refer for a fee, for employment in the United States an alien knowing the alien is an unauthorized alien (as defined in subsection (h)(3)) with respect to such employment. (2) Continuing Employment It is unlawful for a person or other entity, after hiring an alien for employment in accordance with paragraph (1), to continue to employ the alien in the United States knowing the alien is (or has become) an unauthorized alien with respect to such employment. Such violation will be cause for unilateral cancellation of this contract by the Federal awarding Agency. Prohibition on Certain Telecommunications and Video Surveillance Services or Equipment (2 CFR § 200.216) The Federal awarding agency prohibits the County to enter into a contract to procure or obtain equipment, services or systems that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. As described in Public Law 115-232, section 889, covered telecommunications equipment is telecommunications equipment produced by Huawei Technologies Company or ZTE Corporation (or any subsidiary or affiliate of such entities). (i) For the purpose of public safety, security of government facilities, physical security surveillance of critical infrastructure, and other national security purposes, video surveillance and telecommunications equipment produced by Hytera Communications Corporation, Hangzhou Hikvision Digital Technology Company, or Dalian Technology Company (or any subsidiary or affiliate of such entities). (ii) Telecommunications or video surveillance services provided by such entities or using such equipment. (i)(iii) Telecommunications or video surveillance equipment or services produced or provided by an entity that the Secretary of Defense, in consultation with the Director of the National Intelligence or the Director of the Federal Bureau of Investigation, reasonably believes to be an entity owned or controlled by, or otherwise connected to, the government of a covered foreign country. (b) In implementing the prohibition under Public Law 115-232, section 889, subsection (t), paragraph (1), heads of executive agencies administering loan, grant, or subsidy programs shall prioritize available funding and technical support to assist affected businesses, institutions and organizations as is reasonably necessary for those affected entities to transition from covered communications equipment and services, to procure replacement equipment and services, and to ensure that communications service to users and customers is sustained- (c) See Public Law 115-232, section 889 for additional information. Domestic Preference for Procurements (2 CFR § 200.322) (a) As appropriate and to the extent consistent with law, the non -Federal entity should, to the greatest extent practicable under a Federal award, provide a preference for the purchase, acquisition, or use of goods, products, FCP-5 7/7/2021 1:18 PM p. 30 Collier County Solicitation 18-7470S EXHIBIT LA FEDERAL CONTRACT PROVISIONS or materials produced in the United States (including but not limited to iron, aluminum, steel, cement, and other manufactured products). The requirements of this section must be included in all subawards including all contracts and purchase orders for work or products under this award. (b) For purposes of this section: (1) "Produced in the United States" means, for iron and steel products, that all manufacturing processes, from the initial melting stage through the application of coatings, occurred in the United States. (2) "Manufactured products" means items and construction materials composed in whole or in part of non-ferrous metals such as aluminum; plastics and polymer based products such as polyvinyl chloride pipe; aggregates such as concrete; glass, including optical fiber; and lumber. STATE CONTRACT PROVISIONS Administrative Procedures Act, Section 120.57(2), F.S. Additional procedures for particular cases. In a matter initiated as a result of agency action proposing to determine the substantial interests of a party, the parry's timely petition for hearing may challenge the proposed agency action based on a rule that is an invalid exercise of delegated legislative authority or based on an alleged unadopted rule. Data Integrity and Safeguarding Information, Uniform Electronic Transaction Act, Section 668.50, F.S.; Public Records Law, Chapter 119, Section 29, F.S The Contractor shall ensure an appropriate level of data security for the information the Contractor is collecting or using in the performance of this contract. An appropriate level of security includes approving and tracking all Contractor employees that request system or information access and ensuring that user access has been removed from all tenninated employees. The Contractor, among other requirements, must anticipate and prepare for the loss of information processing capabilities. All data and software shall be routinely backed up to ensure recovery from losses or outages of the computer system. The security over the backed -up data is to be as stringent as the protection required of the primary systems. The Contractor shall ensure all Subcontractors maintain written procedures for computer system backup and recovery. The Contractor shall complete and sign the Certification kegarding Data Integrity Compliance for Agreements, Grants, Loans, and Cooperative Agreements prior to the execution of this contract. Discriminatory Vendors List, Section 287.134, F.S. In accordance with Section 287.134, Florida Statutes, an entity or affiliate who has been placed on the discriminatory vendor list may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to a public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity, and may not transact business with any public entity. Equal Employment Opportunity The Contractor shall not discriminate against any employee or applicant for employment because of race, age, creed, color, sex or national origin. The Agency will take affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to their race, age, creed, color, sex, or national origin. Such action shall include, but not be limited to, the following: Employment upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation, and selection for training, including apprenticeship. Contractors must insert a similar provision in all subcontracts, except subcontracts for standard commercial supplies or raw materials. Interest of Members of Congress No member of or delegate to the Congress of the United States shall be admitted to any share or part of this contract or to any benefit arising therefrom. FCP-6 7/7/2021 1:18 PM p. 31 Collier County Solicitation 18-7470S EXHIBIT LA FEDERAL CONTRACT PROVISIONS Interest of Public Officials No member, officer, or employee of the public body or of a local public body during his tenure or for two years thereafter shall have any interest, direct or indirect, in this contract or the proceeds thereof. For purposes of this provision, public body shall include municipalities and other political subdivisions of States; and public corporations, boards, and commissions established under the laws of any State. No member, officer, or employee of the MPO or of a local public body during his tenure or for two years thereafter shall have any interest, direct or indirect, in this contract or the proceeds thereof. Inspections (Meals) The Contractor must agree to notify the Nutrition Provider within 24 hours of any sanitation inspection and provide a copy of the report. Inspector General Cooperation, Section 20.055(5), F.S. The Parties agree to comply with Section 20.055(5), Florida Statutes, for the inspector general to have access to any records, data and other information deemed necessary to carry out his or her duties and incorporate into all subcontracts the obligation to comply with Section 20.055(5), Florida Statutes. Lobbying No funds received pursuant to this Agreement may be expended for lobbying the Legislature, the judicial branch or a state agency. Computer Use and Social Media Policy The Florida Department of Elder Affairs has implemented a Social Media Policy, in addition to its Computer Use Policy, which applies to all employees, contracted employees, consultants, OPS and volunteers, including all personnel affiliated with third parties, such as, but not limited to, contractors and subcontractors. Any entity that uses the Department's computer resource systems must comply with the Department's policy regarding social media. Social Media includes, but is not limited to blogs, podcasts, discussion forums, Wikis, RSS feeds, video sharing, social networks like MySpace, Facebook and Twitter, as well as content sharing networks such as flickr and YouTube. This policy is available on the Department's website at: http://elderaffairs.state.fl.us/doea/financial.pht). Public Entity Crime Pursuant to Section 287.133, F.S., a person or affiliate who has been placed on the Convicted Vendor List following a conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the construction or repair of a public building or public work; may not submit bids, proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a Contractor, Supplier, Subcontractor, or Consultant under a contract with any public entity; and may not transact business with any public entity in excess of the threshold amount 7.017, F.S., for CATEGORY TWO for a period of thirty six (36) months following the date of being placed on the Convicted Vendor List. FCP-7 7/7/2021 1:18 PM p. 32 Collier County Solicitation 18-7470S EXHIBIT LB GRANT CERTIFICATIONS AND ASSURANCES GRANT CERTIFICATIONS AND ASSURANCES THE FOLLOWING DOCUMENTS NEED TO BE RETURNED WITH SOLICITATION DOCUMENTS BY DEADLINE TO BE CONSIDERED RESPONSIVE. Page Certification and Form GCA 2-6 Attachment III - Certifications and Assurances (A-,n A. Debarment and Suspension Certification (29 CFR Part 95 and 45 CFR Part 75) B. Certification Regarding Lobbying (29 CFR Part 93 and 45 CFR Part 93) C. Nondiscrimination & Equal Opportunity Assurance (29 CFR Part 37 and 45 CFR Part 80) D. Certification Regarding Public Entity Crimes, section 287.133. F.S. E. Association of Community Organizations for Reform Now (ACORN) Funding Restrictions Assurances (Pub. L. I I1-117) F. Scrutinized Companies Lists and No Boycott of Israel Certification, section 287.135. F.S. G. Certification Regarding Data Integrity Compliance for Contracts, Agreements, Grants, Loans and Cooperative Agreements H. Verification of Employment Status Certification I. Records and Documentation J. Certification Regarding Inspection of Public Records GCA - 7-9 Attachment IV —Assurances Non -Construction Programs GCA -10-13 Attachment V — Civil Rights Comnliance Checklist GCA -14 Attachment VII — Background Screening Affidavit of Compliance - Emplover GCA -15 Conflict of Interest Certification GCA -16 Anticipated DBE, M/WBE or VETERAN Participation Statement GCA -17 Bid Opportunitv List for Commodities and Contractual Services and Professional Consultant Services GCA- 1S Acknowledgement of Terms, Conditions, and Grant Clauses 7/7/2021 1:18 PM GCA -1 p. 33 Collier County Solicitation 18-7470S EXH. LB GRANT ASSURANCES AND CERTIFICATIONS ATTACHMENT III CERTIFICATIONS AND ASSURANCES Agency will not award this Contract unless Contractor completes this CERTIFICATIONS AND ASSURANCES. In performance of this contract, Contractor provides the following certifications and assurances: A. Debarment and Suspension Certification (29 CFR Part 95 and 45 CFR Part 75) B. Certification Regarding Lobbying (29 CFR Part 93 and 45 CFR Par 93) C. Nondiscrimination & Eaual Opportunity Assurance (29 CFR Part 37 and 45 CFR Part 80) D. Certification Regarding Public Entity Crimes. section 287133 F.S. E. Association of Community Organizations for Reform Now (ACORN) Funding Restrictions Assurance (Pub. L. 111-1171 F. Scrutinized Companies Lists and No Boycott of Israel Certificationsection 287.135, F.S. G. Certification Regarding Data Integrity Comnliance for Contracts Agreements Grants Loans and Cooperative Agreements H. Verification of EmplaMent Status Certification I. Records and Documentation J. Certification Regarding Inspection of Public Records A. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS — PRIMARY COVERED TRANSACTION. The undersigned Contractor certifies, to the best of its knowledge and belief, that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by a Federal department or agency; 2. Have not within a three-year period preceding this Contract been convicted or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; 3. Are not presently indicted or otherwise criminally or civilly charged by a government entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph A.2. of this certification; and/or 4. Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State, or local) terminated for cause of default. The undersigned shall require that language of this certification be included in the documents for all subcontracts atall tiers (including subcontracts, sub -grants, and contracts under grants, loans, and cooperative agreements) and that all sub -recipients and contractors shall provide this certification accordingly. GCA-2 7/7/2021 1:18 PM P 34 Collier County Solicitation 18-7470S EXH. 1.B GRANT ASSURANCES AND CERTIFICATIONS B. CERTIFICATION REGARDING LOBBYING — CERTIFICATION FOR CONTRACTS, GRANTS, LOANS, AND COOPERATIVE AGREEMENTS. The undersigned Contractor certifies, to the best of its knowledge and belief, that: No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of Congress or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or employee of a Member of Congress in connection with a Federal contract, grant, loan, or cooperative agreement, the undersigned shall also complete and submit Standard Form — LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. The undersigned shall require that language of this certification be included in the documents for all subcontracts at all tiers (including subcontracts, sub -grants, and contracts under grants, loans, and cooperative agreements) and that all sub -recipients and contractors shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this Contract was made or entered into. Submission of this certification is a prerequisite for making or entering into this Contract imposed by 31 U.S.C. 1352. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. C. NON- DISCRIMINATION & EQUAL OPPORTUNITY ASSURANCE (29 CFR PART 37 AND 45 CFR PART 80). - As a condition of the Contract, Contractor assures that it will comply fully with the nondiscrimination and equal opportunity provisions of the following laws: 1. Section 188 of the Workforce Investment Act of 1998 (WIA), (Pub. L. 105-220), which prohibits discrimination against all individuals in the United States on the basis of race, color, religion, sex, national origin, age, disability, political affiliation, or belief, and against beneficiaries on the basis of either citizenship/status as a lawfully admitted immigrant authorized to work in the United States or participation in any WIA Title I -financially assisted program or activity. 2. Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 80), to the end that, in accordance with Title VI of that Act and the Regulation, no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Agency. 3. Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-112), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 84), to the end that, in accordance with Section 504 of that Act and the Regulation, no otherwise qualified handicapped individual in the United States shall, solely by reason of his handicap, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Agency. GCA-3 W712021 1:18 PM p. 35 Collier County Solicitation 18-7470S EXH. LB GRANT ASSURANCES AND CERTIFICATIONS 4. The Age Discrimination Act of 1975 (Pub. L. 94-135), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 91), to the end that, in accordance with the Act and the Regulation, no person in the United States shall, on the basis of age, be denied the benefits of, be excluded from participation in, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Agency. 5. Title IX of the Education Amendments of 1972 (Pub. L. 92-318), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 86), to the end that, in accordance with Title IX and the Regulation, no person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any education program or activity for which the Applicant receives Federal financial assistance from the Agency. 6. The American with Disabilities Act of 1990 (Pub. L. 101-336), which prohibits discrimination in all employment practices, including job application procedures, hiring, firing, advancement, compensation, training, and other terms, conditions, and privileges of employment. It applies to recruitment, advertising, tenure, layoff, leave, fringe benefits, and all other employment -related activities. 7. Contractor also assures that it will comply with 29 CFR Part 37 and all other regulations implementing the laws listed above. This assurance applies to Contractor's operation of the WIA Title I — financially assisted program or activity, and to all contracts Contractor makes to carry out the WIA Title I — financially assisted program or activity. Contractor understands that the Agency and/or DOEA and the United States have the right to seek judicial enforcement of the assurance. The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all tiers (including subcontracts, sub -grants, and contracts under grants, loans, and cooperative agreements) and that all sub -recipients and contractors shall provide this assurance accordingly. D. CERTIFICATION REGARDING PUBLIC ENTITY CRIMES, SECTION 287.133, F.S. Contractor hereby certifies that neither it, nor any person or affiliate of Contractor, has been convicted of a Public Entity Crime as defined in section 287.133, F.S., nor placed on the convicted vendor list. Contractor understands and agrees that it is required to inform Agency immediately upon any change of circumstances regarding this status. E. ASSOCIATION OF COMMUNITY ORGANIZATIONS FOR REFORM NOW (ACORN) FUNDING RESTRICTIONS ASSURANCE (Pub. L. 111-117). As a condition of the Contract, Contractor assures that it will comply fully with the federal funding restrictions pertaining to ACORN and its subsidiaries per the Consolidated Appropriations Act, 2010, Division E, Section 511 (Pub. L. 111-117). The Continuing Appropriations Act, 2011, Sections 101 and 103 (Pub. L. 111-242), provides that appropriations made under Pub. L. 111-117 are available under the conditions provided by Pub. L. I I1-117. The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all tiers (including subcontracts, sub -grants and contracts under grants, loans and cooperative agreements) and that all sub - recipients and contractors shall provide this assurance accordingly. F. SCRUTINIZED COMPANIES LISTS AND NO BOYCOTT OF ISRAEL CERTIFICATION, SECTION 287.135, F.S. In accordance with section 287.135, F.S., Contractor hereby certifies that it has not been placed on the Scrutinized Companies that Boycott Israel List and that it is not participating in a boycott of Israel. GCA-4 7/7/2021 1:18 PM p. 36 Collier County Solicitation 18-7470S EXH. 1.13 GRANT ASSURANCES AND CERTIFICATIONS If this Contract is in the amount of $1 million or more, in accordance with the requirements of section 287.135, F.S., Contractor hereby certifies that it is not listed on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List and that it does not have business operations in Cuba or Syria. Contractor understands that pursuant to section 287.135, F.S., the submission of a false certification may result in the Agency terminating this contract and the submission of a false certification may subject Contractor to civil penalties and attorney fees and costs, including any costs for investigations that led to the finding of false certification. If Contractor is unable to certify any of the statements in this certification, Contractor shall attach an explanation to this Contract. G. CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR CONTRACTS, AGREEMENTS, GRANTS, LOANS, AND COOPERATIVE AGREEMENTS 1. The Contractor and any Subcontractors of services under this contract have financial management systems capable of providingcertain information, including: (1) accurate, current, and complete disclosure of the financial results of each grant -funded project or program in accordance with the prescribed reporting requirements; (2) the source and application of funds for all contract supported activities; and (3) the comparison of outlays with budgeted amounts for each award. The inability to process information in accordance with these requirements could result in a return of grant funds that have not been accounted for properly. 2. Management Information Systems used by the Contractor, Subcontractors, or any outside entity on which the Contractor is dependent for data that is to be reported, transmitted, or calculated have been assessed and verified to be capable of processing data accurately, including year -date dependent data. For those systems identified to be non -compliant, Contractors will take immediate action to assure data integrity. 3. If this contract includes the provision of hardware, software, firmware, microcode, or imbedded chip technology, the undersigned warrants that these products are capable of processing year -date dependent data accurately. All versions of these products offered by the Contractor (represented by the undersigned) and purchased by the state will be verified for accuracy and integrity of data prior to transfer. 4. In the event of any decrease in functionality related to time and date related codes and internal subroutines that impede the hardware or software programs from operating properly, the Contractor agrees to immediatelymake required corrections to restore hardware and software programs to the same level of functionality as warranted herein, at no charge to the state, and without interruption to the ongoing business of the state, time being of the essence. 5. The Contractor and any Subcontractors of services under this contract warrant that their policies and procedures include a disaster plan to provide for service delivery to continue in case of an emergency, including emergencies arising from data integrity compliance issues. H. VERIFICATION OF EMPLOYMENT STATUS CERTIFICATION As a condition of contracting with the Agency, Contractor certifies the use of the U.S. Department of Homeland Security's E-verify system to verify the employment eligibility of all new employees hired by Contractor during the contract term to perform employment duties pursuant to this contract, and that any subcontracts include an express requirement that Subcontractors performing work or providing services pursuant to this Contract utilize the E-verify system to verify the employment eligibility of all new employees hired by the Subcontractor during the entire contract term. GCA-5 7/7/2021 1:18 PM P 37 Collier County Solicitation 18-7470S EXH. LB GRANT ASSURANCES AND CERTIFICATIONS The Contractor shall require that the language of this certification be included in all sub -agreements, sub -grants, and other agreements/contracts and that all Subcontractors shall certify compliance accordingly. This certification is a material representation of fact upon which reliance was placed when this Contract was made or entered into. Submission of this certification is a prerequisite for making or entering into this Contract imposed by Circulars A-102 and 2 CFR Part 200 and 215 (formerly OMB Circular A-110). I. RECORDS AND DOCUMENTATION The Contractor agrees to make available to Agency staff and/or any party designated by the Agency any and all contract related records and documentation. The Contractor shall ensure the collection and maintenance of all program related information and documentation on any such system designated by the Agency. Maintenance includes valid exports and backups of all data and systems according to Agency standards. J. CERTIFICATION REGARDING INSPECTION OF PUBLIC RECORDS 1. In addition to the requirements of sections 10.1 and 10.2 of the Standard Contract, sections 119.0701(3) and (4) F.S., and any other applicable law, if a civil action is commenced as contemplated by section 119.0701(4), F.S., and the Agency is named in the civil action, Contractor agrees to indemnify and hold harmless the Agency for any costs incurred by the Agency and any attorneys' fees assessed or awarded against the Agency from a Public Records Request made pursuant to Chapter 119, F.S., concerning this contract or services performed thereunder. a. Notwithstanding section 119.0701, F.S., or other Florida law, this section is not applicable to contracts executed between the Agency and state agencies or subdivisions defined in section 768.28(2), F.S. 2. Section 119.01(3), F.S., states if public funds are expended by an agency in payment of dues or membership contributions for any person, corporation, foundation, trust, association, group, or other organization, all the financial, business, and membership records of such an entity which pertain to the public agency (Area Agency on Aging for Southwest Florida, Inc.) are public records. Section 119.07, F.S, states that every person who has custody of such a public record shall permit the record to be inspected and copied by any person desiring to do so, under reasonable circumstances. Additionally, d certify this organization does _does not provide for institutional memberships. Contractor's signature below attests that records pertaining to the dues or membership application by the Agency are available for inspection if applicable, as stated above. By execution of this contract, Contractor must include these provisions (A-J) in all related subcontract agreements (if applicable). By signing below, Contractor certifies that the representations outlined in parts A through J above are true and correct. e � ��/ r tU � iQIYS i (�Ci(4 ign d Title of Authorized Representative Street Address ` r& U`1 aq p I �a 6+- e P L 33�5 Contractor Date City, State, Zip code GCA-6 7/7/2021 1:18 PM P. 38 Collier County Solicitation 18-7470S EXHIBIT 13 GRANT CERTIFICATIONS AND ASSURANCES ATTACHMENT IV ASSURANCES--NON-CONSTRUCTION PROGRAMS Public reporting burden for this collection of information is estimated to average forty-five (45) minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget. Paperwork Reduction Project (0348-0043), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET, SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. Note: Certain of these assurances may not be applicable to your project or program. If you have questions please contact the awarding agency. Further, certain federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. 1. Has the legal authority to apply for federal assistance, and the institutional, managerial and financial capability (including funds sufficient to pay the non-federal share of project cost) to ensure proper planning, management, and completion of the project described in this application. 2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the state, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives. 3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain. 4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awardingagency. 5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. §47284763) relating to prescribed standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F). 6. Will comply with all federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. §6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for federal assistance is being made; and 0) the requirements of any other nondiscrimination statute(s) which may apply to the application. ocA-7 7/7/2021 1:18 PM P 39 Collier County Solicitation 18-7470S EXHIBIT LB GRANT CERTIFICATIONS AND ASSURANCES 7. Will comply, or has already complied, with the requirements of Titles 11 and III of the uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of federal or federally assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of federal participation inpurchases. 8. Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C. §1501-1508 and 7324-7328), which limit the political activities of employees whose principal employment activities are funded in whole or in part with federal funds. 9. Will comply, as applicable, with the provisions of the Davis -Bacon Act (40 U.S.C. §276a to 276a-7), the Copeland Act (40 U.S.C. 276c and 18 U.S.C. §874) and the Contract Work Hours and Safety Standards Act (40 U.S.C. §327-333), regarding labor standards for federally assisted construction sub -contracts. 10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000.00 or more. 11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. §1451 et seq.); (f) conformity of federal actions to State (Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. §7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-523); and (h) protection of endangered species under the Endangered Species Act of 1973, as amended, (P.L. 93-205). 12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. §1721 et seq.) related to protecting components or potential components of the national wild and scenic rivers system. 13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. §470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. §469a-1 et seq.). 14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and related activities supported by this award of assistance. 15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. §2131 et seq.) pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities supported by this award of assistance. 16. Will comply with the Lead -Based Paint Poisoning Prevention Act (42 U.S.C. §4801 et seq.), which prohibits the use of lead- based paint in construction or rehabilitation of residence structures. GCA-8 7/7/2021 1:18 PM p. 40 Collier County Solicitation 18-7470S EXHIBIT 1.B GRANT CERTIFICATIONS AND ASSURANCES 17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and 2 CFR Part 200. 18. Will comply with all applicable requirements of all other federal laws, executive orders, regulations and policies governing this program. NA URE O AUTHORIZED CERTIFYING OFFICIAL TITLE n 57 �tn^in 5 APPLICANT ORGANIZATION ct/lvt Cal-e_, GCA-9 DATE SUBMITTED 7/7/2021 1:18 PM p. 41 EXHIBIT LB /ATTACHMENT V Collier County Solicitation 18-7470S STATE OF FLORIDA DEPARTNIF,NT OF F.1 nFR AFFATRC (`TVTT. Tarnrrrc rnMPT TAni r r VnVn r TQT ZFaciliTyN e: ���.,�j(�'� Q & 6ce 0 t9 I? S &e . Coun e) [ 1," AAA/Contractor Address: `(� rn � am ` 1 r �e � P Qom 1 � ltArocnC r - CiTy, State, Zip Gt „ Date: V L �� 1 p gu M Tele hul i 1 —81- j rtin a a: REAv i na v i a r cxi .0 uv� A ttu L 1IUNN r Vx 1LLU SI KA I1 V E 1NEUHMA'I ION WHICH WILL HELP YOU COMPLETE THIS FORM. 1. Briefly describe the geographic area served by the program/facility and the type of service provided: For questions 2-5, please indicate the following: Total # White Black Hispanic % Other % Female % Disabled % Over 40 2.Population of area served Source of data .3 6• UnLrdc„thy 3.Staff curremly, employed Source of data a . 1'� I v �� to O 0/0 S' / e 9 bGL/F b 4.Clients currently enrolled/registered Source of data 5.Advisory/Governing Board if applicable Source of data r�uca u: USE A SFPARt Y.E am rz i yr rA Etc t lH AN z r:XPLANA I MNS REQUIRING MORE SPACE. 1. Is an Assurance of Compliance on file with DOEA? N/A L y YES NO ❑ ❑ 2. Compare the staff composition to the population. Is staff representative of the population? N/❑ IL�7A YES NOO / El 3. Are eligibility requirements for services applied to clients and applicants without regard to race, color, national origin, sex, age, religion or disability? N/A ❑ YEES/ NO L ❑ 4. Are all benefits, services and facilities available to applicants and participants in an equally effective manner regardless of race, sex, color, age, national origin, religion or disability? N/A ElL7 YES NO NO ❑ 5. For in -patient services, are room assignments made without regard to race, color, national origin or disability? N/A ❑ YES NO NO E ❑ 6. Is the prod arn/facility accessible to non-English speaking clients? N/A YEES/ NO 7. Are employees, applicants anarticip informed of their protection against discrimination? If YES, how? Verbal Written Oster N/A ❑ YES NO ❑ ❑ 8. Give the number and current status of any discrimination complaints regarding services or employment filed against the program/facility. NSA NUMBER ) 7/7/2021 1:18 PM p 42 GCA -10 7. Are employees, applicants an)articip informed of their protection against discrimination? If YES, how? Verbal Written Oster YES NO El 11TqK El 8. Give the number and current status of any discrimination complaints regarding services or employment filed against the program/facility. N/A DUMBER 9. Is the program/facility physically accessible to mobility, hearing, and sight -impaired individuals? N/A YES,,NO ❑ PART HI: THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15 OR MORE EMPLOYEES. IF NO EXPLAIN 10. Has a self -evaluation been conducted to identify any barriers to serving disabled individuals, and to make any necessary modifications? YE 11. Is there an established grievance procedure that incorporates due process in the resolution of complaints? YES NO � u 12. Has a person been designated to coordinate Section 504 compliance activities? YESNO L� ❑ 13. Do recruitment and notification materials advise applicants, employees and participants of nondiscrimination on the basis of disability? YEAS NO ❑ 64 14. Are auxiliary aids available to assure accessibility of services to hearing and sight -impaired individuals? YES NO PART IV: FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF $50,000.00 OR MORE. 15. Do you have a written affirmative action plan? If NO, explain. kk YES NO or ❑ ❑ DOEA Reviewed By USE ONLY In Com liance: YES ❑ NO* ❑ Program Office *Notice of Corrective Action Sent Date Telephone Response Due / / On -Site ❑ Desk Review ❑ Response Received / / Revised August 2010, Page 2 of 2 2 EXHIBIT LB/ATTACIINIENT V Collier County INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST Solicitation 18-7470S 1. Describe the geographic service area such as a district, county, city or other locality. If the program/facility serves a specific target population such as adolescents, describe the target population. Also, define the type of service provided. 2. Enter the percent of the population served by race and sex. The population served includes persons in the geographical area for which services are provided such as a city, county or other regional area. Population statistics can be obtained from local chambers of commerce, libraries, or any publication from the 1980 Census containing Florida population statistics. Include the source of your population statistics. ("Other' races include Asian/Pacific Islanders and American Indian/Alaskan Natives.) 3. Enter the total number of full-time staff and their percent by race, sex and disability. Include the effective date of your summary. 4. Enter the total number of clients who are enrolled, registered or currently served by the program or facility, and list their percent by race, sex and disability. Include the date that enrollment was counted. 5. Enter the total number of advisory board members and their percent by race, sex, and disability. If there is no advisory or governing board, leave this section blank. 6. Each recipient of federal financial assistance must have on file an assurance that the program will be conducted in compliance with all nondiscriminatory provisions as required in 45 CFR 80. This is usually a standard part of the contract language for DOEA recipients and their sub -grantees, 45 CFR 80.4 (a). 7. Is the race, sex, and national origin of the staff reflective of the general population? For example, if 10% of the population is Hispanic, is there a comparable percentage of Hispanic staff? 8. Where there is a significant variation between the race, sex or ethnic composition of the clients and their availability in the population, the program/facility has the responsibility to determine the reasons for such variation and take whatever action may be necessary to correct any discrimination. Some legitimate disparities may exist when programs are sanctioned to serve target populations such as elderly or disabled persons, 45 CFR 80.3 (b) (6). 9. Do eligibility requirements unlawfully exclude persons in protected groups from the provision of services or employment? Evidence of such may be indicated in staff and client representation (Questions 3 and 4) and also through on -site record analysis of persons who applied but were denied services or employment, 45 CFR 80.3 (a) and 45 CFR 80.1 (b) (2). 10. Participants or clients must be provided services such as medical, nursing and dental care, laboratory services, physical and recreational therapies, counseling and social services without regard to race, sex, color, national origin, religion, age or disability. Courtesy titles, appointment scheduling and accuracy of record keeping must be applied uniformly and without regard to race, sex, color, national origin, religion, age or disability. Entrances, waiting rooms, reception areas, restrooms and other facilities must also be equally available to all clients, 45 CFR 803 (b). 11. For in -patient services, residents must be assigned to rooms, wards, etc., without regard to race, color, national origin or disability. Also, residents must not be asked whether they are willing to share accommodations with persons of a different race, color, national origin, or disability, 45 CFR 80.3 (a). 12. The program/facility and all services must be accessible to participants and applicants, including those persons who may not speak English. In geographic areas where a significant population of non-English speaking people live, program accessibility may include the employment of bilingual staff. In other areas, it is sufficient to have a policy or plan for service, such as a current list of names and telephone numbers of bilingual individuals who will assist in the provision of services, 45 CFR 803 (a). GCA-12 3 7/7/2021 1:18 PM p. 44 EXHIBIT LB /ATTACHMENT V Collier County Solicitation 18-7470S 13. Programs/facilities must make information regarding the nondiscriminatory provisions of Title VI available to their participants, beneficiaries or any other interested parties. This should include information on their right to file a complaint of discrimination with either the Florida Department of Elder Affairs or the U.S. Department of HHS. The information may be supplied verbally or in writing to every individual, or may be supplied through the use of an equal opportunity policy poster displayed in a public area of the facility, 45 CFR 80.6 (d). 14. Report number of discrimination complaints filed against the program/facility. Indicate the basis, e.g., race, color, creed, sex, age, national origin, disability, retaliation; the issues involved, e.g., services or employment, placement, termination, etc. Indicate the civil rights law or policy alleged to have been violated along with the name and address of the local, state or federal agency with whom the complaint has been filed. Indicate the current status, e.g., settled, no reasonable cause found, failure to conciliate, failure to cooperate, under review, etc. 15. The program/facility must be physically accessible to disabled individuals. Physical accessibility includes designated parking areas, curb cuts or level approaches, ramps and adequate widths to entrances. The lobby, public telephone, restroom facilities, water fountains, information and admissions offices should be accessible. Door widths and traffic areas of administrative offices, cafeterias, restrooms, recreation areas, counters and serving lines should be observed for accessibility. Elevators should be observed for door width, and Braille or raised numbers. Switches and controls for light, heat, ventilation, fire alarms, and other essentials should be installed at an appropriate height for mobility impaired individuals. 16. Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance conduct a self - evaluation to identify any accessibility barriers. Self -evaluation is a four step process: a. With the assistance of a disabled individual/organization, evaluate current practices and policies which do not comply with Section 504. b. Modify policies and practices that do not meet Section 504 requirements. c. Take remedial steps to eliminate any discrimination that has been identified. d. Maintain self -evaluation on file. (This checklist may be used to satisfy this requirement if these four steps have been followed.), 45 CFR 84.6. 17. Programs or facilities that employ 15 or more persons must adopt grievance procedures that incorporate appropriate due process standards and provide for the prompt and equitable resolution of complaints alleging any action prohibited by Section 504.45 CFR 84.7 (b). 18. Programs or facilities that employ 15 or more persons must designate at least one person to coordinate efforts to comply with Section 504.45 CFR 84.7 (a). 19. Continuing steps must be taken to notify employees and the public of the program/facility's policy of nondiscrimination on the basis of disability. This includes recruitment material, notices for hearings, newspaper ads, and other appropriate written communication, 45 CFR 84.8 (a). 20. Programs/facilities that employ 15 or more persons must provide appropriate auxiliary aids to persons with impaired sensory, manual or speaking skills where necessary. Auxiliary aids may include, but are not limited to, interpreters for hearing impaired individuals, taped or Braille materials, or any alternative resources that can be used to provide equally effective services, 45 CFR 84.52 (d). 21. Programs/facilities with 50 or more employees and $50,000.00 in federal contracts must develop, implement and maintain a written affirmative action compliance program in accordance with Executive Order 11246, 41 CFR 60 and Title VI of the Civil Rights Act of 1964, as amended. DOEA Fotm 101-B, Revised August 2010 GCA - 13 4 7/7/2021 1:18 PM p.45 EXMrr 1B / ATTACHMENT VI] DEPARTMENT OF Collier County Solicitation 18-7470S ELDER AFFAIRS STATE OF moo i7A BACKGROUND SCREENING Affidavit of Compliance - Employer AUTHORITY: This form is required annually of all employers to comply with the attestation requirements set forth in section 435.05(3), Florida Statutes. ➢ The term "employer" means any person or entity required by law to conduct background screening, including but not limited to, Area Agencies on Aging, Aging Resource Centers, Aging and Disability Resource Centers, Lead Agencies, Long -Term Care Ombudsman Program, Serving Health Insurance Needs of Elders Program, Service Providers, Diversion Providers, and any other person or entity which hires employees or has volunteers in service who meet the definition of a direct service provider. See §§ 435.02, 430.0402, Fla. Stat. ➢ A direct service provider is "a person 18 years of age or older who, pursuant to a program to provide services to the elderly, has direct, face-to-face contact with a client while providing services to the client and has access to the client's living area, funds, personal property, or personal identification information as defined in s. 817.568. The term includes coordinators, managers, and supervisors of residential facilities; and volunteers." § 430.0402(1)(b), Fla. Stat. ATTESTATION: �` As the duly authorized representative of _ e I'CQq [ octly Sc,I?yYcBS G'f 10 . q/ Employer me - loc ed at tJtterD �Qii1 i G r» 1 Y % PC � 3��� StreetAd lresss City State ZIP code I, � hMCr<' Fu'koc— do hereby affirm under penalty of perjury that the above named employer is in compliance with the provisions of Chapter 435 and section 430.0402,Florida Statutes, regarding level background screening. ure of Representative Date STATE OF FLORIDA, COUNTY OF NtlV1 Sworn to (or affirmed) and subscribed before me this Q day of �� ty 2QL by 1 l iMME,'­ ALO L (Name of Representative) who is personally known to me or produced YpU 6 AMANDAPERTUCH ��.., Gonxi5610fl9HH099776 9 T� Print, Public as proof of identification. 2&4z_'01 Notary Public DOEA Form 235, Affidavit of Compliance - Employer, Effective April 2012 Form available at: http://elderaffairs.state.fl.us/english/backgroundscreening.php 7/7/2021 1:18 PM Section 435.05(3), F.5. p. 46 GCA- 14 Collier County Solicitation 18-74705 EXHIBIT 1.13 GRANT CERTIFICATIONS AND ASSURANCES COLLIER COUNTY Conflict of Interest Certification f)- Collier County Solicitation No. I, I "'-- hereby certify that to the best of my knowledge, neither I nor y spouse, dependent child, general partner, or any organization for which I am serving as an officer, director, trustee, general partner or employee, or any person or organization with whom I am negotiating or have an arrangement concerning prospective employment has a financial interest in this matter. I further certify to the best of my knowledge that this matter will not affect the financial interests of any member of my household. Also, to the best of my knowledge, no member of my household; no relative with whom I have a close relationship; no one with whom my spouse, parent or dependent child has or seeks employment; and no organization with which I am seeking a business relationship nor which I now serve actively or have served within the last year are parties or represent a party to the matter. I also acknowledge my responsibility to disclose the acquisition of any financial or personal interest as described above that would be affected by the matter, and to disclose any interest I, or anyone noted above, has in any person or organization that does become involved in, or is affected at a later date by, the cc riftct of this matter. _ Name Tic Date Privacy Act Statement Title I of the Ethics in Government Act of 1978 (5 U.S.C. App.), Executive Order 12674 and 5 CFR Part 2634, Subpart I require the reporting of this information. The primary use of the information on this form is for review by officials of The Justice Department to determine compliance with applicable federal conflict of interest laws and regulations. Additional disclosures of the information on this report may be made: (1) to a federal, state or local law enforcement agency if the Justice Department becomes aware of a violation or potential violation of law or regulations; (2) to a court or party in a court or federal administrative proceeding if the government is a party or in order to comply with a judge -issued subpoena; (3) to a source when necessary to obtain information relevant to a conflict of interest investigation or decision; (4) to the National Archives and Records Administration or the General Services Administration in records management inspections; (5) to the Office of Management and Budget during legislative coordination on private relief legislation; and (6) in response to a request for discovery or for the appearance of a witness in a judicial or administrative proceeding, if the information is relevant to the subject matter. This confidential certification will not be disclosed to any requesting person unless authorized by law. See also the OGE/GOVT-2 executive branch -wide Privacy Act system of records. cCA-15 7/7/2021 1:18 PM p 47 COLLIER COUNTY ANTICIPATED DISADVANTAGED, MINORITY, WOMEN OR VETERAN PARTICIPATION STATEMENT will he vvadzed Vnverd3ble statuses wall require tie PRIME to either proude a revised staemaot or prmside m¢ a doalmanS+ion that validates a IST PRIME A FWMA-CER1FIED VS�AGED, E,rEp-" Y ?HE Ai'TtVih'OFTHS CONTRA._ MINORITY OR WOMEN SUSM aS ENTER,PRLEE 1 E3 .Y CONSTRIh^TION? Y N (D1E?k93EAV5E) OR HAVE 3 SMALL DIS.tMANTAGEL BUSINESSSA CEIMUTION FROM THE S7A4LL BUSINESS MBE. 2 CONSULTATioN? Y N ADNONISTRAION? A SERVICE DIS,CBIED VETERAN? W5E? Y 4T'tBER? Y N SD3 SAY d. 15-3 KS SUHML4SDON A REVISION? 'Y LF YES, RF4`51074 NUMBER B.;i iF PR'i3171E kIA'S SUBIMNTRACTOR OR SUPffPLIER WHO IS A DISADVANTAGED MINORITY, WOMEN -OWNED, SMALL BUSiY19ET5 CONEERN OR SERVICE DISABLED VETERAN, PRIME IS TOCOMPLETE THIS NEX SECHON DBE MIME SUBCONMR OR OR SU"UM TYPE OFMWORii OR ETNNIC[i'{ CODE SUB, SUPPL¢R PERCENT 0; COMMACT VETERNAME SR: AN LW isee Below) I OOLL DOLLARS `.., C_ SECTION TO BE COMPLETED BY .PRIME VENDOR/CONTRACTO, _ NF:ME OF 51JBMT17ER DATE TNLE OF SCBM17MR Sv�l1 haMc 6eCd'KCyrc I °lu I—a3— LID $ty NOTE: This information L used to track and raparsnrbdpated DBE or dLIBE partidpation in iaderalip-imded cent m_ Yne anticipated DBE or MBE OMOUd is Voft n ryy and rAil not biome part U-; the contractual terms. This form must to submitted at dine U. response in a solw=bon- .f and wheys awarded a CU-My contract, the prime'..rill be asked to update the irr,-ormatien for the grant compliance ales. MNICM -CODE &lack A.meri�n BA E°.apanic.wmerican FLA Native American NA S]ILCi%1t. Asian Anwrican SAA Ason,VaciFcAmerican APA Nan-Mimwirf women MlvV Other notofanv athee:group listed O D. SECTION TO BE COMPLETED BY GUILDER COUNTY GCA-16 1 _''113IT I.R 011) OPPORTUNITY LIST FOR COMPADDITIES AND CONTRACTUAL SERVICES AND PROFESSIONAL CONSULTANT SERVICES RU Prime Conbrac#m /Prime Consultant: r[ we H-Orl 1w (C _ i hC�chaY Addressard Phone Number. ��� (� ��(t,� 61 -�, "\C l , V��✓� PruCSlremteM N.umber/,:dver55x�rC Ncvn6zr ��, -1 -1 � - � � � � p� � a. The fst below is intended � bee IsUng; of firms the are, or attempting to, pariciate on the prnja numbered above. The fist mart indudethe�umbiddmgmquotingasprime,W,,1las sUbsandsu�iamgoting-,orprtkjpnbm primecomr- assandcnnwi3ntsmurt provide hdorma-tim for Numbers 1, e, 3, and 4; and, should provide any infann-don they have for Numbers 5, 6, 7, and S. -,his form must be submhted sui`.h the bid package- 1- Federat TaxiDNumber: S.® DEE a. annual Grass Recceipts 2. Pon Name: Noo- !;E less than $1 mnnon 3. phone Number: Betviaen $1-5 minirm A. Address q=.. 5-SD minion7.® Snbcontrs. n $1Pis million $ubconsuBaM 'more than $ 15 million 5. Year Firm Established.: 1. Federal Tax ID Number: 6. ® DBE S. Annual Gross PeCdpts 2- Form Name: Nan. -DBE less than $1 mdfi.n 3. phone Number Barvxen $1-5 minion 4. Address Beriteen$5-1D minion 3. a+nbContr.Cbior BEC ,,n $1 15 mrnlIXi subcomulYant morethan$lsmiilion S. Year Vim Established: 1. Federal Tax HY Number: 6. DBB S. Annual Gross ReCaipts 2. Ffms Name: B Non -DBE less than $1 minnon 3. phone Numb Number Eetraen $1-5 million 4. Address BE-%n$5-1D minion T.eSub[aMraxW Bei+ftezn$1D-lS minion Subcormstant Mom th ri$15munon 5. Year Firm Estabihed: 1. Federal Tax lD Number. 6. DBE 3. Annual Cross asrisfpts 2. Firm Name: a Nat -DBE than $1 -1non 3. Phone Numbers: 1-5mdnlonAdder JL— r'5-SDminion7-R5ubtaM:==TtNraen51D_15 mnionsubconsultanx orexhan $ 15 million 5. Year Firm Established GCA-17 Collier County solicitation 18-74703 EXHIBIT LB GRANT CERTIFICATIONS AND ASSURANCES COLLIER COUNTY Acknowledgement of Terms, Conditions, and Grant Clauses Flow Down of Terms and Conditions from the Grant Agreement Subcontracts: If the Contractor subcontracts any of the work required under this Agreement, a copy of the signed subcontract must be available to the County for review and approval. The Contractor agrees to include in the subcontract that (1) the subcontractor is bound by the terms of this Agreement, (ii) the subcontractor is bound by all applicable state and federal laws and regulations, and (N) the subcontractor shall hold the County and the Grantor Agency harmless against all claims of whatever nature arising out of the subcontractor's performance of work under this Agreement, to the extent allowed and required by law. The County may document in the quarterly report the Contractor's progress in performing its work under this agreement. Certification On behalf of my firm acknowledge, and agree to perform all of the specifications and grant requirements idftntified in this s citation document(s). yendContractor Name Signature Address &ICJ - I AK4 i CtY c l rLc c Solicitation/Contract # GCA-18 Date 0 (cc) 9 1 91 05/20 R4 717/2021 1:18 PM P. 50 Collier County REQUEST FOR PROPOSAL (RFP) INSTRUCTIONS Solicitation 18-7470S 1. OUES TIONS 1.1 Direct questions related to this Request for Proposal (RFP) to the Collier County Procurement Services Division Online Bidding Systemwebsite: https://www.bidsyne.cora/bidsvnc-cas/. 12 Proposer/Vendor/Firm must clearly understand that the only official answer or position of the County will be the one stated on the Collier County Procurement Services Division Online Bidding Systemwebsite. Forgeneral questions, please call the referenced Procurement Strategist noted on the cover page. 2. PRE -PROPOSAL CONFERENCE of aunlicable) 2.1 The purpose of the pre -proposal conference is to allow an open forum for discussion and questioning with County staff regarding the RFP with all prospective vendors having an equal opportunity to hear and participate. Oral questions will receive oral responses, neither of which will be official, nor become part of the REP. Only written responses to written questions will be considered official, and will be included as part ofthe RFP as an addendum 2.2 All prospective vendors are strongly encouraged to attend, as, this will usually be the only pre -proposal conference for this solicitation. If this pre -proposal conference is denoted as "mandatory", prospective Vendors must be present in order to submit a proposal response. 3. COMPLIANCE W1TH THE RFP Proposals must be in strict compliance with this RFP. Failure to comply with all provisions of the RFP may result in disqualification. 4. AMBIGUITY. CONFLICT. OR OTHER ERRORS IN THE RFP It is the sole responsibility of the vendor if they discover any ambiguity, conflict, discrepancy, omission or other error in the RFP, to immediately notify the Procurement Professional, noted herein, of such error in writing and request modification or clarification of the document prior to submitting the proposal. The Procurement Professional will make modifications by issuing a written revision and will give written notice to all parties who have received this RFP fromthe Procurement Services Division. 5. ADDENDA The County reserves the right to formally amend and/or clarify the requirements of the solicitation where it deems necessary. Any such addendutn/clarification shall be in writing and notifications shall be distributed electronically to all parties who received the original RFP prior to the deadline for submission of proposals. All changes to this RFP will be conveyed electronically through a notice of addendum or questions and answers to all Vendors registered under the applicable comarodity, code(s) at the time when the original RFP was released, as well as those Vendors who downloaded the RFP document. All addendums are posted on the Collier County Procurement Services Division Online Bidding Systemwebsite: httpsl/www.bidsyne.com/bidsync-cas/. Before submitting a proposal, please make sure that you have read all documents provided, understood clearly and complied completely with any changes stated in the addenda as failure to do so may deeming your submittal non -responsive. 6. PROPOSALS. PRESENTATIONS. AND PROTEST COSTS The County will not be liable in any way for any costs incurred by any Vendor in the preparation of its proposal in response to this RFP, nor for the presentation of its proposal and/or participation in any discussions, negotiations, or, if applicable, any protest procedures. 7. DELIVERY OF PROPOSALS 7.1 All proposals are to be submitted by the due date and Naples local time, on the Collier County Procurement Services Division Online Bidding Systemwebsite: https.//www.bidsvne.com/bidsvnc-cas/. 7.2 The County does not bear the responsibility for proposals delivered to the Procurement Services Division past the stated date and/or time indicated. 8. VALIDITY OF PROPOSALS No proposal can be withdrawn after it is opened unless the vendormakes theirrequest in writing to the County. Allproposals shallbe valid fora period of one hundred eighty (180) days fromthe submission date to accommodate evaluation and selection process. 9. MEEHOD OF SOURCE SELECTION 9.1 The County is using the Competitive Sealed Proposals methodology of source selection for this procurement, as authorized by Ordinance Number 2017-08, as amended, establishing and adopting the Collier County Procurement Ordinance. 9.2 If the County receives proposals from less than three (3) firms, the Procurement Director shall review all the facts and detemrine if it is in the best interest of the County to solicit additional proposals or request that the Selection Committee 7/7/2021 1:18 PM **Updated on 022820*'p� 51 Collier County Solicitation 18-7470S rank order the received proposals. 10. EVALUATION OF PROPOSALS 10.1 The County's procedure for selection is as follows: 10.1.1 The Procurement Services Director shall appoint a selection committee to review all proposals submitted. 10.1.2 The Request for Proposal is issued. 10.1.3 Subsequent to the closing date of the solicitation, the Procurement Professional will review the proposals received and verify each proposal to determine if it minimally responds to the requirements of the published RFP. 10.1.4 Selection committee meetings will be open to the public and publicly noticed by the Procurement Services Division. 10.1.5 In an initial organization meeting, the selection committee members will receive instructions, the submitted proposals, and establish the next selection committee meeting date and time. After the fast meeting, the Procurement professional will publicly announce all subsequent cortnnittee meeting dates and times. The subsequent meeting dates and times will be publicly posted with at least seventy-two hours advanced notice. 10.1.6 Selection committee members will independently review and score each proposal based on the evaluation criteria stated in the request for proposal using the Individual Selection Committee Scoresheet and prepare coffilents for discussion at the nex meeting. The Individual Selection Committee Scoresheet is merely a tool to assist the selection conmrittee member in their review of the proposals. 10.1.7 At the publicly noticed selection corrnnittee meeting, the members will present their independent findings / conclusions / comments based on their reading and interpretation of the materials presented to each other, and may ask questions of one another. Time will be allowed for public comment. 10.1.8 Collier County selection committee members may consider all the material submitted by the Proposer and other information Collier County may obtain to determine whether the Proposer is capable of and has a history of successfully completing projects of this type, including, without limitation, additional information Collier County may request, clarification of proposer information, and/or additional credit information. 10.1.9 Once the individual scoring has been completed, the Procurement professional will read the results publicly. The committee will make a determination if oral presentations are needed and which funs will be invited to give oral presentations by short listing the proposals submitted. The selection committee may ask for additional information, present materials, interview, ask questions, etc. The members may consider any and all information obtained through this method in formulating their final ranking. 10.1.10 The selection committee's overall rank of firms in order of preference (from highest score or beginning with a rank of one (1) if presentations were held) will be discussed and reviewed by the Procurement Professional. By final tabulation, and having used all information presented (proposal, presentation, references, etc.), the selection committee members will vote and thus create a final ranking and staff will subsequently enter into negotiations. 10.2 The County reserves the right to withdraw this RFP at any time and for any reason, and to issue such clarifications, modifications, addendums, and/or amendments as it may deem appropriate, including, but not limited, to requesting supplemental proposal information. 10.3 Receipt of a proposal by the County offers no rights upon the proposer nor obligates the County in any manner. 10.4 Acceptance of the proposal does not guarantee issuance of any other governmental approvals. 11. REFERENCES The County reserves the right to contact any and all references submitted as a result of this solicitation. 12. RESERVED RIGHTS Collier County reserves the right in any solicitation to accept or reject any or all bids, proposals or offers; to waive minor irregularities and technicalities; or to request resubmission. Also, Collier County reserves the right to accept all or any p art of any bid, proposal, or offer, and to increase or decrease quantities to meet additional or reduced requirements of Collier County. Collier County reserves the right to cancel, extend, or modify any or all bids, proposals or offers and to negotiate with any responsible providers to secure the best tents and conditions when it is deemed to be in the best of the County. County reserves its right to reject any sole response. 13. INSURANCE AND BONDING REQUIREMENTS 13.1 The Vendor shall at its own expense, carry and maintain insurance coverage frommsponsible companies duly authorized to do business in the State of Florida as set forth in the Insurance and Bonding attachment of this solicitation. The Vendor shall be required to provide the Certificate of hisurance(s) with the limits set forth in the solicitation within five (5) days upon notification of selection for award. If the Vendor cannot provide the document within the referenced timeframe, the County reserves the right to award to another Vendor. The Vendor shall procure and maintain property 7/7/2021 1:18 PM xxxlJpdated on 022820*�q� 52 Collier County Solicitation 18-7470S insurance upon the entire project, if required, to the full insurable value of the scope of work 13.2 The County and the Vendor waive against each other and the County's separate Vendors, Contractors, Design Vendor, Subcontractors agents and employees of each and all of them, all damages covered by property insurance provided herein, except such rights as they may have to the proceeds of such insurance. The Vendor and County shall, where appropriate, require similar waivers of subrogation from the County's separate Vendors, Design Vendors and Subcontractors and shallrequire each ofthemto include similar waivers in their contracts. 13.3 Collier County shall be responsible forpurchasing and maintaining, its own liability insurance. 13.4 Certificates issued as a result of the award of this solicitation mast identify "For any and allworkperformed on behalf of Collier County." - 13.5 The General Liability Policy provided by Vendor to meet the requirements of this solicitation shall name Collier County, Florida, as an additional insured as to the operations of Vendor under this solicitation and shall contain a severability of interests provisions. 13.6 Collier County Board of County Commissioners shall be named as the Certificate Holder. The Certificates of Insurance most state the Contract Number, or Project Number, or specific Project description, or must read: For any and all work performed on behalf of Collier County. The "Certificate Holder" should read as follows: Collier County Board of County Commissioners Naples, Florida 13.7 The amounts and types of insurance coverage shall conform to the minimum requirements set forth in Insurance and Bonding attachment, with the use of Insurance Services Office (ISO) forts and endorsements or their equivalents. If Vendor has any self -insured retentions or deductibles under any of the below listed minimumrequired coverage, Vendor most identify on the Certificate of Insurance the nature and amount of such self- insured retentions or deductibles and provide satisfactory evidence of financial responsibility for such obligations. All self -insured retentions or deductibles will be Vendor's sole responsibility. 13.8 Covemge(s) shall be maintained without interruption from the date of commencement of the Work until the date of completion and acceptance of the scope of workby the County or as specified in this solicitation, whichever is longer. 13.9 The Vendor and/or its insurance carrier shall provide 30 days written notice to the County of policy cancellation or non - renewal on the part of the insurance carrier or the Vendor. The Vendor shall also notify the County, in a like manner, within twenty-four (24) hours after receipt, of any notices of expiration, cancellation, non -renewal or material change in coverage or limits received by Vendor from its insurer and nothing contained herein shall relieve Vendor of this requirement to provide notice. In the event of a reduction in the aggregate limit of any policy to be provided by Vendor hereunder, Vendor shall immediately take steps to have the aggregate limit reinstated to the full extent perrnitted under such policy. 13.10 Should at any time the Vendor not maintain the insurance coverage(s) required herein, the County may terminate the Agreement or at its sole discretion shall be authorized to purchase such coverage(s) and charge the Vendor for such coverage(s) purchased. If Vendor fails to reimburse the County for such costs within thirty (30) days after demand, the County has the right to offset these costs from any amount due Vendor under this Agreement or any other agreement between the County and Vendor. The County shall be under no obligation to purchase such insurance, nor shall it be responsible for the coverage(s) purchased or the insurance company or companies used. The decision ofthe County to purchase such insurance coverage(s) shall in no way be construed to be a waiver of any of its rights underthe Contract Documents. 13.11 If the initial or any subsequently issued Certificate of Insurance expires prior to the completion of the scope of work, the Vendor shall famish to the County renewal or replacement Certificate(s) of Insurance not later than ten (10) calendar days after the expiration date on the certificate. Failure of the Vendor to provide the County with such renewal certificate(s) shall be considered justification for the County to terminate any and all contracts. 14. ADDMONAL ITEMS AND/OR SERVICES Additional items and / or services may be added to the resultant contract, or purchase order, in compliance with the Procurement Ordinance. 15. COUNTY'S RIGHT TO INSPECT The County or its authorized Agent shall have the right to inspect the Vendor's facilities/project site during and after each work assignment the Vendor is performing. The County reserves the right to take into consideration a vendor's past performance under a prior or current County contract when it is considering the granting of a new contract, the assignment of a work order, or any additional work Past poor performance may result in the County deeming the vendor non -responsible and therefore refraining from awarding such work 7/7/2021 1:18 PM **Upda[edon022820**P. 53 Collier County Solicitation 18-7470S 16. VENDOR PERFORMANCE EVALUATION The County has implemented a Vendor Performance Evaluation System for all contracts awarded in excess of $25,000. To this end, vendors will be evaluated on their performance upon completion/termination of this Agreement. The County reserves the right to take into consideration a Vendor's past performance under a prior or current County contract when it is considering the granting of a new contract, the assignment of a work order, or any additional work Past poor performance may result in the County deeming the vendor non -responsible and therefore refraining from awarding such work 17. ADDMONAL TERMS AND CONDMONS OF CONTRACT 17.1 The selected Vendor shall be required to sign a standard Collier County contract or accept the County's Purchase Order terms and conditions to serve as a formal contact. 172 The resultant contract(s) may include purchase or work orders issued by the County's Project Manager (a/k/a Contract Administrative Agent). 17.3 The County reserves the right to include in any contract document such terms and conditions, as it deems necessary for the proper protection of the rights of Collier County. A sample copy of this contract is available upon request. The County will not be obligated to sign any contracts, maintenance and/or service agreements, other documents or agree to any exceptions to the County's terms and conditions provided by the Vendor. 17A The County's Project Manager shall coordinate with the Vendor / Contractor the return of any surplus assets, including materials, supplies, and equipment associated with the scope orwork. 18. PUBLIC RECORDS COMPLIANCE 18.1 Florida Public Records Law Chapter 119, including specifically those contractual requirements in 119.0701(2)(a)-(b) as follows: IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT: Communication and Customer Relations Division 3299 Tamiami Trail East Suite 102 Naples, FL 34112-5746 Telephone: (239) 252-8999 18.2 The Contractormust specifically comply with the Florida Public Records Law to: 18.2.1 Keep and maintain public records required by the public agency to perform the service. 18.2.2 Upon request fromthe public agency's custodian ofpublic records, provide the public agency with a copy ofthe requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law. 18.2.3Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law for the duration of the contract term and following completion of the contract if the Contractor does not transfer the records to the public agency. 18.2.4 Upon completion of the contract, transfer, at no cost, to the public agency all public records in possession of the Contractor or keep and maintain public records required by the public agency to perform the service. If the Contractor transfers all public records to the public agency upon completion of the contract, the Contractor shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the Contractor keeps and maintains public records upon completion of the contract, the Contractor shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to the public agency, upon request fromthe public agency's custodian of public records, in a format that is compatible with the information technology systems of the public agency. 19. PAYMENT METHOD 19.1 Payments are made in accordance with the Local Govemment Prompt Payment Act, Chapter 218, Florida Statutes. Vendor's invoices must include: 7/7/2021 1:18 PM ***Upda[edon 022820*'P- 54 Collier County 19.1.1 Purchase Order Number Solicitation 18-7470S 19.1.2 Description and quantities of the goods or services provided per instructions on the County's purchase order or contract. Invoices shall be sent to: Board of County Commissioners Clerk's Finance Department ATTN: Accounts Payable 3299 Tamiami Trail East, Suite 700 Naples FL 34112 Or Emailed to: becapelerkg..collierelerk.com 19.2 Payments will be made for articles and/or services furnished, delivered, and accepted, upon receipt and approval of invoices submitted on the date of services or within six (6) months after completion of contract. Any untimely submission of invoices beyond the specified deadline period is subject to non-payment under the legal doctrine of "lathes" as untimely submitted. Time shall be deemed of the essence with respect to the timely submission of invoices under this agreement. 19.3 In instances where the successful Vendor may owe debts (including, but not limited to taxes or other fees) to Collier County and the contractor has not satisfied nor made arrangement to satisfy these debts, the County reserves the right to off -set the amount owed to the County by applying the amount owed to the vendor or contractor for services performed of for materials delivered in association with a contract. 19.4 Invoices shall not reflect sales tax After review and approval, the invoice will be transmitted to the Finance Division for payment. Payment will be made upon receipt of proper invoice and in compliance with Chapter 218 Florida Statutes, otherwise known as the `Local Government Prompt Payment Act" Collier County reserves the right to withhold and/or reduce an appropriate amount of any payment for work not performed or for unsatisfactory performance of Contractual requirements. 20. ENVIRONMENTAL HEALTH AND SAFEFY 20.1 All Vendors and Sub Vendors performing service for Collier County are required and shall comply with all Occupational Safety and Health Administration (OSHA), State and County Safety and Occupational Health Standards and any other applicable rules and regulations. Vendors and Sub Vendors shall be responsible forthe safety of their employees and any unsafe acts or conditions that may cause injury or damage to any persons orproperty within and around the work site. All firewall penetrations must be protected in order to meet Fire Codes. 20.2 Collier County Government has authorized OSHA representatives to enter any Collier County facility, property and/or rightof--way for the purpose of inspection of any Vendor's work operations. This provision is non-negotiable by any department and/or Vendor. 20.3 All new electrical installations shall incorporate NFPA 70E Short Circuit Protective Device Coordination and Are Flash Studies where relevant as detemrined by the engineer. 20.4 All electrical installations shall be labeled with appropriate NFPA 70E arch flash boundary and PPE Protective labels. 21. POLLUTION PREVENTION The vendor is required to implement industry relevant pollution prevention and best management practices. Should pollution incidents occur, Collier County Pollution Control most be notified immediately. 22. LICENSES 22.1 The Vendor is required to possess the correct Business Tax Receipt, professional license, and any other authorizations necessary to carry out and perform the work required by the project pursuant to all applicable Federal, State and Local Law, Statute, Ordinances, and rules and regulations of any kind. Additionally, copies of the required licenses must be submitted with the proposal response indicating that the entity proposing, as well as the team assigned to the County account, is properly licensed to perform the activities or work included in the contract documents. Failure on the part of any Vendor to submit the required documentation may be grounds to DEEM VENDOR NON -RESPONSIVE. A Vendor, with an office within Collier County is also required to have an occupational license. 22.2 All State Certified contractors who may need to pull Collier County permits or call in inspections most complete a Collier County Contractor License registration form and submit the required fee. After registering the license/registration will need to be renewed thereafter to remain "active" in Collier County. 22.3 If you have questions regarding professional licenses contact the Contractor Licensing, Conmrunity Development and Environmental Services at (239) 252-2431, 252-2432 or 252-2909. Questions regarding required occupational licenses, please contact the TaxCollector's Office at (239) 252-2477. 23. SURVIVABILITY The Vendor agrees that any Purchase Order/Work Order/Solicitation Documents that extends beyond the expiration date of the 7/7/2021 1:18 PM *xUpdated on 022820•"0- 55 Collier County Solicitation 18-7470S original Solicitation will survive and remain subject to the terms and conditions of that Agreement until the completion or termination. 24. PRINCIPAL/COLLUSION By submission of this Proposal the undersigned, as Vendor, does declare that the. only person or persons interested in this Proposal as principal or principals is/are named therein and that no person other than therein mentioned has any interest in this Proposal or in the contract to be entered into; that this Proposal is made without connection with any person, company or parties making a Proposal, and that it is in all respects fair and in good faith without collusion or fraud. 25. RELATION OF COUNTY It is the intent of the parties hereto that the Vendor shall be legally considered an independent Vendor, and that neither the Vend or nor their employees shall, under any circumstances, be considered employees or agents of the County, and that the County shall be at no time legally responsible for any negligence on the part of said Vendor, their employees or agents, resulting in either bodily or personal injury or property damage to any individual, firm, or corporation. 26. TERMINATION Should the Vendor be found to have failed to perform services in a manner satisfactory to the County, the County may terminate this Agreement immediately for cause; further the County may terminate this Agreement for convenience with a thirty (30) day written notice. The County shall be sole judge of nonperformance. In the event that the award of this solicitation is made by the Procurement Services Director, the award and any resultant purchase orders may be terminated at any time by the County upon thirty (30) days written notice to the awarded vendors) pursuant to the Board's Procurement Ordinance. 27. LOBBYING After the issuance of any solicitation, no current or prospective vendor or any person acting on their behalf, shall contact, communicate with or discuss any matter relating to the solicitation with any Collier County employee or elected or appointed official, other than the Procurement Services Director or his/her designees. This prohibition ends upon execution of the final contract or upon cancellation of the solicitation. Any current or prospective vendor that lobbies any Collier County employe e or elected or appointed official while a solicitation is open or being recommended for award O may be deemed ineligible for award of that solicitation by the Procurement Services Director, and (ii) will be subject to Suspension and Debarment outlined in section Twenty -Eight of County Procurement Ordinance 2017-08, as amended. 28. CERTIFICATE OF AUTHORITY TO CONDUCT BUSINESS IN TBE STATE OF FLORIDA (FL Statute 607.1501) In order to be considered for award, firms must be registered with the Florida Department of State Divisions of Corporations in accordance with the requirements of Florida Statute 60T1501 and provide a certificate of authority (www.sunbiz.org/seaxch.htrnl) prior to execution of a contract. A copy of the document should be submitted with the solicitation response and the document number should be identified. Firms who do not provide the certificate of authority at the time of response shall be required to provide same within five (5) days upon notification of selection for award. If the fimn cannot provide the document within the referenced timeframe, the County reserves the right to award to another firm 29. SINGLE PROPOSAL Each Vendor must submit, with their proposal, the required forms included in this RFP. Only one proposal from a legal entity as a primary will be considered. A legal entity that submits a proposal as a priruary or as part of a partnership or joint venture submitting as primary may not then act as a sub -vendor to any other firm submitting under the same RFP. If a legal entity is not submitting as a primary or as part of a partnership orjoint venture as a primary, that legal entity may act as a sub-vendorto any other firm or finis submitting under the same RFP. All submittals in violation of this requirement will be deemed non- responsive and rejected from further consideration. 30. PROTEST PROCEDURES 30.1 Any Vendor who alleges to be aggrieved in connection with the solicitation or award of a contract, may protest to the Procurement Services Director, who shall serve as the sole receipt of the any and all notices of intent to protest and all formal protests. 30.2 With respect to a protest of the terms, conditions and specifications contained in a solicitation, including any provisions governing the methods for evaluation of bids, proposals or replies, awarding contracts, reserving rights for further negotiation or modifying or amending any contract, the protesting party shall file a notice of intent to protest within three (3) days, excluding weekends and County holidays, after the first publication, whetherby posting or formal advertisement of the solicitation. The formal written protest shall be filed within five (5) days of the date the notice of intent is filed. Formal protests of the terms, conditions and specifications shall contain all of the information required for the Procurement Services Director, to render a decision on the formal protest and determine whether postponement of the bid opening or proposal/response closing time is appropriate. The Procurement Services Director's decision shall be considered final and conclusive unless the protesting party files an appeal of the Procurement Services Director's decision. 30.3 Any actual proposer or respondent to who desires to protest a recommended contract award shall submit a notice of intent 7/7/2021 1:18 PM YxUpdatedoo 022820•�P- 56 Collier County Solicitation 18-7470S to protest to the Procurement Services Director within three (3) calendar days, excluding weekends and County holidays, from the date of the initial posting of the recommended award. 30.4 All formal protests with respect to a recomawrided contract award shall be submitted in writing to the Procurement Services Director for a decision. Said protests shall be submitted within five (5) calendar days, excluding weekends and County holidays, from the date that the notice of intent to protest is received by the Procurement Services Director, and accompanied by the required fee. 30.5 Complete instructions for formal protest are set forth in Section 23 of Collier County Procurement Ordinance 2017-08, as amended. The protesting party most have standing as defined by established Florida case law to maintain a protest. 31. PUBLIC ENTITY CRIME A person or affiliate who has been placed on the convicted Vendor list following a conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the construction or repair of a public building or public work; may not submit bids, proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or vendor under a contract with any public entity; and may not transact business with any public entity in excess of the threshold amount provided in s. 287.017 for CATEGORY TWO for a period of 36 months following the date of being placed on the convicted Vendor list. 32. SECURITY AND BACKGROUND CHECKS 32.1 The Contractor is required to comply with County Ordinance 2004-52, as amended. Background checks are valid for five (5) years and the Contractor shall be responsible for all associated costs. If required, Contractor shall be responsible for the costs of providing background checks by the Collier County Facilities Management Division for all employees that shall provide services to the County under this Agreement. This may include, but not be limited to, checking federal, state and local law enforcement records, including a state and FBI fingerprint check, credit reports, education, residence and employment verifications and other related records. Contractor shall be required to maintain records on each employee and make them available to the County for at least four (4) years. 32.2 All of Contractor's employees and subcontractors =at wear Collier County Government Identification badges at all times while performing services on County facilities and properties. Contractor ID badges are valid for one (1) year from the date of issuance and can be renewed each year at no cost to the Contractor during the time period in which their background check is valid, as discussed below. All technicians shall have on their shirts the name of the contractor's business. 32.3 The Contractor shall urnnediately notify the Collier County Facilities Management Division via e-mail (DL FMOPS@colliergov.net) whenever an employee assigned to Collier County separates from their employment. This notification is critical to ensure the continued security of Collier County facilities and systems. Failure to notify within four (4) hours of separation may result in a deduction of S500 per incident. 32.4 CCSO requires separate fingerprinting prior to work being performed in any of their locations. This will be coordinated upon award ofthe contract. If there are additional fees for this process, the vendor is responsible for all costs. 33. CONFLICT OF MTEREST Vendor shall complete the Conflict of Interest Affidavit included as an attachment to this RFP document. Disclosure of any potential or actual conflict of interest is subject to County staff review and does not in and of itself disqualify a firm from consideration. These disclosures are intended to identify and orprechmde conflict of interest situations during contract selection and execution. 34. PROHIBITION OF GIFTS TO COUNTY EMPLOYEES No organization or individual shall offer or give, either directly or indirectly, any favor, gift, loan, fee, service or other item of value to any County employee, as set forth in Chapter 112, Part III, Florida Statutes, the current Collier County Ethics Ordinance and County Administrative Procedure 5311. Violation of this provision may result in one or more of the following consequences: a. Prohibition by the individual, firm, and/or any employee of the firm from contact with County staff for a specified period of time; b. Prohibition by the individual and/or firm from doing business with the County for a specified period of time, including but not limited to: submitting bids, RFP, and/or quotes; and, c. immediate termination of any contract held by the individual and/or firm for cause. 35. IMMIGRATION LAW AFFIDAVIT CERTIFICATION 35.1 Statutes and executive orders require employers to abide by the inin igration laws of the United States and to employ only individuals who are eligible to work in the United States. 35.2 The Employment Eligibility Verification System (E-Verify) operated by the Department of Homeland Security (DHS) in partnership with the Social Security Administration (SSA), provides an Internet -based means of verifying employment eligibility of workers in the United States; it is not a substitute for any other euployrnent eligibility verification requirements. The program will be used for Collier County formal Invitations to Bid (ITB) and Request for Proposals 7/7/2021 1:18 PM **Updatedon 022820*"p. 57 Collier County Solicitation 18-7470S (RFP) including Request for Professional Services (RFP) and construction services. 35.3 Exceptions to the program 35.3.1 Commodity based procurement where no services are provided. 35.3.2 Where the requirement for the affidavit is waived by the Board of County Commissioners 35.4 Vendors are required to be enrolled in the E-Verify program at the titre of submission of the bid. Acceptable evidence of your enrollment consists of a copy of the properly completed E-Verify Company Profile page or a copy of the fully executed &Verify Memorandum of Understanding for the company which will be produced at the time of the submission of the Vendor's proposal/bid or within five (5) day of the County's Notice of Recommend Award. FAILURE TO EXECUTE THIS AFFIDAVIT CERTIFICATION AND SUBMIT WITH VENDOR'S PROPOSAL/BID MAY DEEM THE VENDOR'S AS NON-RESPONS IVE. 35.5 Additionally, Vendors shall require all subcontracted Vendors to use the &Verify system for all purchases not covered under the "Exceptions to the program' clause above. All vendors shall familiarize themselves with the statutory requirements set fort in the Florida Statutes §448.095 pertaining to the responsibilities of Public Employers, Contractors and Subcontractors. 35.6 For additional information regarding the Employment Eligibility Verification System (E-Verify) program visit the following website: http://www.dhs.gov/E-Verify. It shall be the Vendor's responsibility to familiarize themselves with all rules and regulations governing this program 35.7 Vendor acknowledges, and without exception or stipulation, any fhnXs) receiving an award shall be fully responsible for complying with the provisions of the humigration Reform and Control Act of 1986 as located at 8 U.S.C. 1324, et seq. and regulations relating thereto, as either may be amended and with the provisions contained within this affidavit. Failure by the awarded firms) to comply with the laws referenced herein or the provisions of this affidavit shall constitute a breach of the award agreement and the County shall have the discretion to unilaterally terminate said agreement immediately. 36. COLLIER COUNTY INFORMATION TECHNOLOGY REQUIREMENTS All vendor access will be done via VPN access only. All access mat comply with current published County Manager Agency (CMA) policies. Current policies that apply are CMAs 5402, 5403 and 5405. These policies will be available upon request from the Information Technology Department. All vendors will be required to adhere to IT policies for access to the County network Vendors are required to notify the County in writing twenty-four (24) hours in advance as to when access to the network is planned. Included in this request must be a detailed work plan with actions that will be taken at the time of access. The County IT Department has developed a Technical Architecture Requirements Document. 37. GRANT COMPLIANCE The purchase of any goods and/or services that are funded through Federal Grant Appropriations, the State of Florida, orany other public or private foundations shall be subject to the compliance and reporting requirements ofthe granting agency. The Vendor agrees include with the bid submission all the completed and fully executed Grant documents provided as an attachment to the solicitation, or you may BE DEEMED NON -RESPONSIVE. 38. LOCAL VENDOR PREFERENCE (LVP) Any Vendor claiming local vendor preference must complete the required form and submit a Collier or Lee Business Tax receipt with their submission. 39. OFFER EXTENDED TO OTHER GOVERNMENTAL ENTITIES Collier County encourages and agrees to the successful vendor extending the pricing, terms and conditions ofthis solicitation orresultant contract to other governmental entities at the discretion ofthe successful vendor. Certification: The Vendor hereby agrees to comply with the instructions above, by submission of a bid/proposal. 7/7/2021 1:18 PM **'Updated on 022820xxp. 58 Collier County Solicitation 18-7470S e D Collier County Purchase Order Terms and Conditions 1. Offer This offer is subject to cancellation by the COUNTY without notice if not accepted by VENDOR within fourteen (14) days of issuance. 2. Acceptance and Confirmation This Purchase Order (including all documents attached to or referenced herein) constitutes the entire agreement between the parties, unless otherwise specifically noted by the COUNTY on the face of this Purchase Order. Each delivery of goods and/or services received by the COUNTY from VENDOR shall be deemed to be upon the terms and conditions contained in this Purchase Order. No additional terms may be added and Purchase Order may not be changed except by written instrument executed by the COUNTY. VENDOR is deemed to be on notice that the COUNTY objects to any additional or different terms and conditions contained in any acknowledgment, invoice or other communication from VENDOR, notwithstanding the COUNTY'S acceptance or payment for any delivery of goods and/or services, or any similar act by VENDOR. 3. Inspection All goods and/or services delivered hereunder shall be received subject to the COUNTY'S inspection and approval and payment therefore shall not constitute acceptance. All payments are subject to adjustment for shortage or rejection. All defective or nonconforming goods will be returned pursuant to VENDOR'S instruction at VENDOR'S expense. To the extent that a purchase order requires a series of performances by VENDOR, the COUNTY prospectively reserves the right to cancel the entire remainder of the Purchase Order if goods and/or services provided early in the term of the Purchase Order are non -conforming or otherwise rejected by the COUNTY. 4. Shipping and Invoices a) All goods are FOS destination and must be suitably packed and prepared to secure the lowest transportation rates and to comply with all carrier regulations. Risk of loss of any goods sold hereunder shall transfer to the COUNTY at the time and place of delivery; provided that risk of loss prior to actual receipt of the goods by the COUNTY nonetheless remain with VENDOR. b) No charges will be paid by the COUNTY for packing, crating or cartage unless otherwise specifically stated in this Purchase Order. Unless otherwise provided in Purchase Order, no invoices shall be issued nor payments made prior to delivery. Unless freight and other charges are itemized, any discount will be taken on the full amount of invoice. c) All shipments of goods scheduled on the same day via the same route must be consolidated. Each shipping container must be consecutively numbered and marked to show this Purchase Order number. The container and Purchase Order numbers must be indicated on bill of lading. Packing slips must show Purchase Order number and must be included on each package of less than container load (LCL) shipments and/or with each car load of equipment. The COUNTY reserves the right to refuse or return any shipment or equipment at VENDOR'S expense that is not marked with Purchase Order numbers. VENDOR agrees to declare to the carrier the value of any shipment made under this Purchase Order and the full invoice value of such shipment. d) All invoices must contain the Purchase Order number and any other specific information as identified on the Purchase Order. Discounts of prompt payment will be computed from the date of receipt of goods or from date of receipt of invoices, whichever is later. Payment will be made upon receipt of a proper invoice and in compliance with Chapter 218, Fla. Slats., otherwise known as the "Local Government Prompt Payment Act," and, pursuant to the Board of County Commissioners Purchasing Policy. 5. Time Is Of the Essence Time for delivery of goods or performance of services under this Purchase Order is of the essence. Failure of VENDOR to meet delivery schedules or deliver within a reasonable time, as interpreted by the COUNTY alone, shall entitle the COUNTY to seek all remedies available to it at law or in equity. VENDOR agrees to reimburse the COUNTY for any expenses incurred in enforcing its rights. VENDOR further agrees that undiscovered delivery of nonconforming goods and/or services is not a waiver of the COUNTY S right to insist upon further compliance with all specifications. G/ Operations/Document Approved by Attorney 7/7/2021 1:18 PM Reviewed 12118113; 5/5/10p' 59 Collier County Solicitation 18-7470S 6. Changes The COUNTY may at any time and by written notice make changes to drawings and specifications, shipping instructions, quantities and delivery schedules within the general scope of this Purchase Order. Should any such change increase or decrease the cost of, or the time required for performance of the Purchase Order, an equitable adjustment in the price and/or delivery schedule will be negotiated by the COUNTY and VENDOR. Notwithstanding the foregoing, VENDOR has an affirmative obligation to give notice if the changes will decrease costs. Any claims for adjustment by VENDOR must be made within thirty (30) days from the date the change is ordered or within such additional period of time as may be agreed upon by the parties. 7. Warranties VENDOR expressly warrants that the goods and/or services covered by this Purchase Order will conform to the specifications, drawings, samples or other descriptions furnished or specified by the COUNTY, and will be of satisfactory material and quality production, free from defects and sufficient for the purpose intended. Goods shall be delivered free from any security interest or other lien, encumbrance or claim of any third party. These warranties shall survive inspection, acceptance, passage of title and payment by the COUNTY. 8. Statutory Conformity Goods and services provided pursuant to this Purchase Order, and their production and transportation shall conform to all applicable laws, including but not limited to the Occupational Health and Safety Act, the Federal Transportation Act and the Fair Labor Standards Act, as well as any law or regulation noted on the face of the Purchase Order. 9. Advertising No VENDOR providing goods and services to the COUNTY shall advertise the fact that it has contracted with the COUNTY for goods and/or services, or appropriate or make use of the COUNTY S name or other identifying marks or property without the prior written consent of the COUNTY S Purchasing Department. 10. Indemnification VENDOR shall indemnify and hold harmless the COUNTY from any and all claims, including claims of negligence, costs and expenses, including but not limited to attorneys' fees, arising from, caused by or related to the injury or death of any person (including but not limited to employees and agents of VENDOR in the performance of their duties or otherwise), or damage to property (including property of the COUNTY or other persons), which arise out of or are incident to the goods and/or services to be provided hereunder. 11. Warranty of Non -Infringement a) VENDOR represents and warrants that all goods sold or services performed under this Purchase Order are: a) in compliance with applicable laws; b) do not infringe any patent, trademark, copyright or trade secret; and c) do not constitute unfair competition. b) VENDOR shall indemnify and hold harmless the COUNTY from and against any and all claims, including claims of negligence, costs and expense, including but not limited to attorneys' fees, which arise from any claim, suit or proceeding alleging that the COUNTY S use of the goods and/or services provided under this Purchase Order are inconsistent with VENDOR'S representations and warranties in section 11 (a). c) If any claim which arises from VENDOR'S breach of section 11 (a) has occurred, or is likely to occur, VENDOR may, at the COUNTY'S option, procure for the COUNTY the right to continue using the goods or services, or replace or modify the goods or services so that they become non -infringing, (without any material degradation in performance, quality, functionality or additional cost to the COUNTY). 12. Insurance Requirements The VENDOR, at its sole expense, shall provide commercial insurance of such type and with such terms and limits as may be reasonably associated with the Purchase Order. Providing and maintaining adequate insurance coverage is a material obligation of the VENDOR. All insurance policies shall be executed through insurers authorized or eligible to write policies in the State of Florida. 13. Compliance with Laws In fulfilling the terms of this Purchase Order, VENDOR agrees that it will comply with all federal, state, and local laws, rules, codes, and ordinances that are applicable to the conduct of its business. By way of non -exhaustive example, this shall include the American with Disabilities Act and all prohibitions against discrimination on the basis of race, religion, sex creed, national origin, handicap, marital status, or veterans status. Further, VENDOR acknowledges and without exception or stipulation shall be fully responsible for complying with the provisions of the Immigration Reform and Control Act of 1986 as located at 8 U.S.C. 1324, et sec. and regulations relating thereto, as either may be amended. Failure by the awarded firm(s) to comply with the laws referenced herein shall constitute a breach of the award agreement and the County shall have the discretion to unilaterally terminate said 7/7/2021 1-18 PM G/ Operations/Document Approved by Attorney Reviewed 12/18/13; 5/5/10p, 60 Collier County Solicitation 18-7470S agreement immediately. Any breach of this provision may be regarded by the COUNTY as a material and substantial breach of the contract arising from this Purchase Order. 14. Force Majeure Neither the COUNTY nor VENDOR shall be responsible for any delay or failure in performance resulting from any cause beyond their control, including, but without limitation to war, strikes, civil disturbances and acts of nature. When VENDOR has knowledge of any actual or potential force majeure or other conditions which will delay or threatens to delay timely performance of this Purchase Order, VENDOR shall immediately give notice thereof, including all relevant information with respects to what steps VENDOR is taking to complete delivery of the goods and/or services to the COUNTY. 15. Assignment VENDOR may not assign this Purchase Order, nor any money due or to become due without the prior written consent of the COUNTY. Any assignment made without such consent shall be deemed void. 16. Taxes Goods and services procured subject to this Purchase Order are exempt from Florida sales and use tax on real property, transient rental property rented, tangible personal purchased or rented, or services purchased (Florida Statutes, Chapter 212), and from federal excise tax. 17. Annual Appropriations The COUNTY'S performance and obligation to pay under this Purchase Order shall be contingent upon an annual appropriation of funds. 18. Termination This Purchase Order may be terminated at any time by the COUNTY upon 30 days prior written notice to the VENDOR. This Purchase Order may be terminated immediately by the COUNTY for breach by VENDOR of the terms and conditions of this Purchase Order, provided that COUNTY has provided VENDOR with notice of such breach and VENDOR has failed to cure within 10 days of receipt of such notice. 19. General a) This Purchase Order shall be governed by the laws of the State of Florida. The venue for any action brought to specifically enforce any of the terms and conditions of this Purchase Order shall be the Twentieth Judicial Circuit in and for Collier County, Florida b) Failure of the COUNTY to act immediately in response to a breach of this Purchase Order by VENDOR shall not constitute a waiver of breach. Waiver of the COUNTY by any default by VENDOR hereunder shall not be deemed a waiver of any subsequent default by VENDOR. c) All notices under this Purchase Order shall be sent to the respective addresses on the face page by certified mail, return receipt requested, by overnight courier service, or by personal delivery and will be deemed effective upon receipt. Postage, delivery and other charges shall be paid by the sender. A party may change its address for notice by written notice complying with the requirements of this section. d) The Vendor agrees to reimbursement of any travel expenses that may be associated with this Purchase Order in accordance with Florida Statute Chapter 112.061, Per Diem and Travel Expenses for Public Officers, employees and authorized persons. e) In the event of any conflict between or among the terms of any Contract Documents related to this Purchase Order, the terms of the Contract Documents shall take precedence over the terms of the Purchase Order. To the extent any terms and /or conditions of this Purchase Order duplicate or overlap the Terms and Conditions of the Contract Documents, the provisions of the Terms and/or Conditions that are most favorable to the County and/or provide the greatest protection to the County shall govern. 7/7/2021 1:18 PM G/ Operations/Document Approved by Attorney Reviewed 12118/13; 5/5/10p- 61 Collier County Solicitation 18-7470S Question and Answers for Solicitation #18-7470S - Services for Seniors There are no questions associated with this Solicitation. Question Deadline: Aug 3, 2021 3:00:00 PM EDT 7/7/2021 1:18 PM p_ 62 3425 10th Street North, Unit 1-3 Naples, Florida 34103 ram; PHONE 239-234-4608 The Club E-MAIL info@harmoniatheclub.com FAX239-320-3232 I LICENSE# 9475 Cover Letter Harmonia the Club opened in October 2020 as independently owned and operated by a caring and dedicated staff of professionals. Its philosophy is embedded in its vision, mission and core values: Vision statement - to be recognized leading resources and provider of a professional care and innovative practices in a day care setting for seniors experiencing memory loss, physical challenges or social isolation, their families and community. Mission statement - Harmonia the Club is a safe, homelike and nurturing care place connecting multiple generations to the innovative, personalized and compassionate care of an honored senior b engaging and stimulating activities, nutritious meals and personalized care approach. y providing Core Values: H — High Standards A — Accountable R — Respectful M — Memorable O — Open-minded N — Nurturing I — Innovative A — Affordable We provide a safe, secure and a lively environment in newly fully remodeled premises, with affordable stimulating programs and balanced nutritious meals for adults experiencing memory loss, physical challenges or social isolation and respite care for families in a club -like setting. Being a medical model, we have nurse on staff every day to ensure medical supervision and care. The Club, as we refer to our center, offers an opportunity for frail seniors to live their lives with dignity and independence, so they can remain at home. Our core services include: • Stimulating cognitive and physical activities and exercise • Respite care • Nutritious meals and snacks • Pet therapy • Music therapy • Wellness monitoring • IT innovative approaches • Personal care • Information resources Our highly experienced, passionate team works hard every day with the focus to provide utmost care for our members (as we referred to our participants in the Club); increase socialization of our members; engage them Re -imagining Adult Day stay www.HarmoniaTheClub.com VQ 0 �' >.0 The Club 3425 10th Street North, Unit 1-3 Naples, Florida 34103 PHONE 239-234-4608 E-MAIL info@harmoniatheclub.com FAX239-320-3232 I LICENSE# 9475 in new, stimulating and fun activities; avoid burnout of the families; and to work in and with the community to promote best possible access and standards of care giving to our elderly population. The benefits of our programs can be summarized as follows: Benefits for our Members ► Safe supervised care with resident registered nurse ► Improve behavior, mood and quality of life ► Activities for physical and mental stimulation ► Increase socialization, dignity and self-esteem ► Opportunity to meet people, learn new things and enjoy the time in a safe and lively environment ► Individualized care plan Benefits for Caregivers ► Peace of mind, that your loved one is safe in a caring community ► Caregiver relief for time to relax, work, hobbies or family ► Access to information and resources ► Reduced stress Moreover, the day care program is financially more available alternative to more expensive care services. On behalf of the team at Harmonia the Club, we look forward to continue serving the community. With regards, Miriam Leskanicova HEMO MEDIKA CARE LLC DBA HARMONIA THE CLUB 3425 10TH ST N SUITE 1 NAPLES FL 34103 PHONE: 239-234-4608 EMAIL: miriam@harmoniatheclub.com www.harmoniatheclub.com Re -imagining Adult Day Stay www.HarmoniaTheClub.com View current license information at: Floridahealthfinder.gov LICENSE #: 9475 CERTIFICATE #: 3693 State of Florida AGENCY FOR HEALTH CARE ADMINISTRATION DIVISION OF HEALTH QUALITY ASSURANCE Adult Day Care Center LICENSED This is to confirm that HEMO MEDIKA CARE, LLC has complied with the rules and regulations adopted by the State of Florida, Agency for Health Care Administration, as authorized by Chapter 429, Part III, Florida Statues, and 59A-16. Florida Administrative Code, and is authorized to operate the following: EFFECTIVE DATE: 09/10/2020 EXPIRATION DATE: 09/09/2022 HARMONIA THE CLUB 3425 1 Oth St N 1 Naples, FL 34103 Total Capacity: 53 04 � sir T F *� _= �'S Secreta Agency for Heafth Care Administration �D September 11, 2020 Janet Sue Maxwell, Administrator Harmonia The Club 3425 1 Oth St N Suite 1 Naples, FL 34103 RE: 3425 1Oth St N 1, Naples Dear Administrator: RON DESANTIS GOVERNOR MARY C. MAYHEW SECRETARY File Number: 12962643 License Number: 9475 Provider Type: Adult Day Care Center The enclosed Adult Day Care Center license with license number 9475 and certificate number 3693 is issued for the above provider effective September 10, 2020 through September 9, 2022. The license is being issued for: approval of the initial application. Review your certificate thoroughly to ensure that all information is correct and consistent with your records. If errors are noted, please contact the Assisted Living Unit. Please take a short customer satisfaction survey on our website at ahca.myflorida.com/survey/ to let us know how we can serve you better. Additional licensure information can be found at http://ahca.myflorida.com/assistedliving. If we maybe of further assistance, please contact me by phone at (850) 412 - 4450 or by email at CaseyE.Bogart@ahca.myflorida.com. Sincerely, is',� I rii Health Services & Facilities Consultant Assisted Living Unit Division of Health Quality Assurance 2727 Mahan Drive • MS#30 Tallahassee, FL 32308 AHCA.MyFlorida.com Facebook.com/AHCAFIorida Youtube.com/AHCAFIorida Twitter.com/AHCA_FL SlideShare.net/AHCAFIorida Collier County Solicitation 18-7470S ***Proposals must be assembled, at minimum, in the order of the Evaluation Criteria listed or your proposal may be deemed non -responsive' EVALUATION CRITERIA NO. 1: COVER LETTER/MANAGEMENT SUMMARY (5 Total Points) Provide a cover letter, signed by an authorized officer of the firm, indicating the underlying philosophy of the firm in providing the services stated herein. Include the name(s), telephone number(s) and email(s) of the authorized contact person(s) concerning proposal. Submission of a signed Proposal is Vendor's certification that the Vendor will accept any awards as a result of this RFP. Submit proposer's Agency for Health Card Administration (AHCA) Certification: If certification is not provided at time of proposal submission, the firm will be deemed non -responsive. Indicate by selecting any one, or multiple services which the proposer is interested in providing to the County (descriptive information is outlined in the above scope of work. Item Services Interested in Providing Service (Place X) Not Interested in Providing Service (Place X) 1 Adult Day Care 2 Chore 3 Chore (Enhanced) 4 Homemaking 5 Personal Care 6 Respite (In -home) 7 Skilled Nursing 8 Emergency Alert Response Services EARS 9 Specialized Medical Equipment, Services, and Supplies 10 Respite (Facility Based) EVALUATION CRITERIA NO. 2: ORGANIZATIONAL CAPABILITIES AND EXPERIENCE (20 Total Points) Complete each of the items below in the format requested and submit evidence of documentations where indicated. Proposers who do not complete in the format indicated below may be deemed non -responsive. Yes/No 1. The proposer has received license from Agency for Health Care V/CJ Administration (AHCA). Provide evidence of license. Ir— a t�-ol( col 2. The proposer has by-laws which describe how business will be conducted. 3. The proposer has the appropriate license for the services it intends to V provide to Collier County. Provide license evidence. 4. Board members are required to sign a conflict of interest statement. ycs 5. The proposer has a written business plan that is updated regularly. 6 7/8/2021 1:08 PM P. 9 Collier County Solicitation 18-7470S 6. Organizational Chart: Proposer has to provide a copy of the organizational y�4 chart indicating lines of authority and permanent and full-time positions. I Provide evidence. �acill C-d 7. Total number of years that the proposer has been in business. on C V1 -HIS 8. Proposer has supervisory staff on call 24 hours per day/ 365 days per year. p 9. Proposer's Owner/Operator license has never been denied, suspended or revoked by Medicare, Medicaid, any Federal and/or any State Agency. If ��0 es, please attach a letter or explanation. The County requests that the vendor submits no fewer than three (3) and no more than ten (10) completed reference forms from clients during a period of the last 5 years whose services provided are of a similar nature to this solicitation as a part of their proposal. Provide information on the services completed by the Proposer that best represent services of similar size, scope and complexity of this scope of work using Form 5 — Reference Questionnaire. Proposers may include two (2) additional pages for each reference to illustrate aspects of the completed services that provides the information to assess the experience of the Proposer on relevant work. EVALUATION CRITERIA NO 3: FINANCIAL AND HUMAN RESOURCES CAPABILITIES (20 Total Points) Complete each of the items below in the format requested and submit evidence of documentations where indicated. Proposers who do not complete in the format indicated below may be deemed non -responsive. Yes/No 1. Proposer maintains daily, monthly and annual financial records of payroll, benefits, operating and capital equipment. 2. Proposer prepares annual 1099 forms for all employees. 3. Proposer has a certified public accountant or an independent accounting/auditing firm to prepare financial records. / 4. Proposer uses an accounting software product. 5. Proposer has an accounting staff produce monthly financial statements. */ES 6. Proposer has annual audit completed. Provide copy recently completed. 'jo — in O?ef q -cc I yeah Wi h 7. Proposer has written recruitment policy. 8. Proposer provides criminal background check for employees on this contract. y� 9. Proposer conducts formal orientation for all new staff. yLs 10. Proposer distributes written personnel policies to staff. _ 7 7/8/2021 1:08 PM P. 10 Collier County Solicitation 18-7470S 11. Proposer distributes written personnel policies. 12. Workman's Compensation Policy information clearly posted for staff. 13. Proposer maintains written, signed Job Descriptions. y 14. Proposer's employees are evaluated at least annually in writing. 15. Proposer has written hiring practices. 16. Proposer has written retention policies. 17. Proposer has formal progressive disciplinary procedures. 18. Proposer has written policies regarding theft and falsification of time sheets y� 19. Proposer has policy to prevent fraud and formalized methods to report suspected incidents. 20. Agency has written disaster plan. yc � 1. Proposer agrees to utilize electronic means to submit documentation, as determined by CHS, to include invoices. 7 EVALUATION CRITERIA NO 4: GENERAL SERVICE DELIVERY (25 total points) Complete each of the items below in the format requested and submit evidence of documentations where indicated. Proposers who do not complete in the format indicated below may be deemed non -responsive. Yes/No 1. Proposer maintains a formal record of in -services, available for review. / 2. Proposer maintains copies of training schedule for last year, available for review. \� S 3. Proposer maintains sign in sheets for in-service training, available for review. y C 4. Proposer maintains evidence of attendance and completion in employee files. y C 5. Proposer has copies on file of training materials. _ f�5 7/8/2021 1:08 PM P. 11 Collier County Solicitation 18-7470S 6. Proposer has written Quality Assurance plan. Provide plan. / P+A GtCv e Of 7. Proposer surveys clients for satisfaction in writing at least once per year. Provide J Yes sample. ��7} eo( 8. Proposer analyzes surveys and uses reports for transmission to administration and to employees. l> 9. Proposer incorporates results of Quality Assurance activities to annual plan. \J 10. Proposer has Quality Assurance Committee as standing subcommittee of Board 11. Proposer has written policy for reporting incidents. Provide copy and a ample of the incident report. b% +A- 12. Proposer has formal training for staff regarding reporting of suspected \J S cases of abuse or neglect. / L 13. Proposer maintains anti -discrimination policies related to service consumer. / 14. Proposer has written policy regarding consumers rights. �t 15. Proposer has written system for registering consumers' complaints. yes 16. Proposer has written policy to follow up on consumers' complaints. �J cS 17. Proposer has written description of how service is delivered from point of request through provision and termination. Provide copy. �LS 18. Proposer has written procedures for assuring confidentiality of consumer records. EVALUATION CRITERIA NO. 5: ACCEPTANCE OF COST (20 Total Points) In this criterion you will be provided a list of services needed by the County. Those services with rates, In -kind match and Cost already completed are standard rates in which you will be required to accept. Please sign as an acceptance to the rates if you deem these standard rates to be acceptable. ,�'rGLp1[G�Lrr `il/ I accept the standard contract rates listed below. Cost Per Service In -kind 10% Reimbursement Unit (Cost your Match (Grant Rate Per Unit Item Services Grant Service Unit company charges for Amount your (Amount the County will the service) company will be reimburse your paying) company for a given service) 1. Skilled Nursing CCE, OAA Per Hour $40.00 $4.00 $36.00 9 7/8/2021 1:08 PM p. 12 Collier County Solicitation 18-7470S 2. Enhance Chore ADI, CCE, OAA Per Hour $40.00 $4.00 $36.00 3. Respite (In -Home) ADI, CCE, OAA Per Hour $24.11 $2.41 $21.70 4. Respite (Facility Based) ADI, CCE, OAA Daily Rate $225.00 0 $225.00 5. Personal Care ADI, CCE, OAA Per Hour $24.11 $2.41 $21.70 6. Chore ADI, CCE, OAA Per Hour $24.00 $2.40 $21.60 7. Homemaking ADI, CCE, OAA Per Hour $23.33 $2.33 $21.00 8. Adult Day Care ADI, CCE, OAA Per Hour $13.89 $1.39 $12.50 9. Emergency Alert Response ADI, CCE, OAA Per Day $1.09 $0.11 $0.98 EVALUATION CRITERIA NO. 6: COST OF SERVICES TO THE COUNTY (10 Total Points) In this tab, insert your cost for the services listed below. Reimbursement Cost Per Service In -kind 10% Rate Per Unit Unit (Cost your Match (Grant (Amount the Item Services Grant Service company charges Amount your County will Unit for the service) company will be reimburse your paying) company for a given service) Specialized Medical ADI, CCE, OAA Per Episode 10. Equipment, Services, and Supplies VENDOR CHECKLIST ***Vendor should check off each of the following items as the necessary action is completed (please see, Vendor Check List)*** 10 7/8/2021 1:08 PM p. 13 Collier County Solicitation 18-7470S Collier County Administrative Services Department Procurement Services Division Vendor Check List IMPORTANT: Please review carefully and submit with your Proposal/Bid. All applicable documents shall be submitted electronically through BidSyne. Vendor should checkoff each of the following items: General Bid Instructions has been acknowledged and accepted. Collier County Purchase Order Terms and Conditions have been acknowledged and accepted. Form 1: Vendor Declaration Statement Form 2: Conflict of Interest Certification Proof of status from Division of Corporations - Florida Department of State (If work performed in the State) - http://dos.Mflorida.com/sunbiz/ should be attached with your submittal. Vendor MUST be enrolled in the E-Verify - https://www.e-vedfy.gov/ at the time of submission of the proposal/bid. Form 3: Immigration Affidavit Certification MUST be signed and attached with your submittal or you MAY be DEEMED NON-RESPONS IV E E•Verify Memorandum of Understanding or Company Profile page should be attached with your submittal. Form 4: Certification for Claiming Status as a Local Business, if applicable, has been executed and returned. Collier or Lee County Business Tax Receipt should be attached with yoursubmittal to be considered. Form 5: Reference Questionnaires form must be utilized for each requested reference and included with your submittal, id applicable to the solicitation. Form 6: Grant Provisions and Assurances package in its entirety, if applicable, are executed and should be included with yoursubmittal. All forms must be executed, oryou MAY be DEEMED NON -RESPONSIVE. Vendor W-9 Form. Vendor acknowledges Insurance Requirements and is prepared to produce the required insurance certificate(s) within five (5) days of the County's issuance of a Notice of Recommend Award. The Bid Schedule has been completed and attached with your submittal, applicable to bids. Copies of all requested licenses and/or certifications to complete the requirements of the project. All addenda have been signed and attached, or you MAY be DEEMED NON -RESPONSIVE. County's IT Technical Architecture Requirements has been acknowledged and accepted, if applicable. Any and all supplemental requirements and terms has been acknowledged and accepted, if applicable. 7/8/2021 1:08 PM p. 14 ***UPDATED JANUARY 28, 2020*** Collier C;O County Solicitation 18-7470S er Ceu-nty Administrative Services Department Procurement Services Division Form 1: Vendor Declaration Statement BOARD OF COUNTY COMMISSIONERS Collier County Government Complex Naples, Florida 34112 Dear Commissioners: The undersigned, as Vendor declares that this response is made without connection or arrangement with any other person and th is proposal is in every respect fair and made in good faith, without collusion or fraud. The Vendor hereby declares the instructions, purchase order terms and conditions, requirements, and specifications/scope of work of this solicitation have been fully examined and accepted. The Vendor agrees, if this solicitation submittal is accepted by Collier County, to accept a Purchase Order as a form of a formal contract or to execute a Collier County formal contract for purposes of establishing a contractual relationship between the Vendor and Collier County, for the performance of all requirements to which this solicitation pertains. The Vendor states that the submitted is based upon the documents listed by the above referenced solicitation. The Vendor agrees to comply with the requirements in accordance with the terms, conditions and specifications denoted herein and according to the pricing submitted as a part of the Vendor's bids. Further, the Vendor agrees that if awarded a contract for these goods and/or services, the Vendor will not be eligible to compete, submit a proposal, be awarded, or perform as a sub -vendor for any future associated work that is a result of this awarded contract. IN W ITNESS WHEREOF, WE have hereunto subscribed our names on this A day of /q LtA Is, 2021 in the County of GoJ-46f , in the State of Uoridq—� Firm's Legal Name Address: City, State, Zip Code: Florida Certificate of Authority Document Number - Federal Tax Identification Number *CCR # or CAGE Code *Only if Grant Funded Heuo HEDI►,�A LAZE LIZ— Zb/3- H�9iZhotii H THE C—W3 Lf 2 5r 10+l S -I I`1 .S uu. -ice I �Jn�ze_,� FL S� ►o2) "Telephone: 13Gi — 2-5if — -- Lt60S Email: Yl'll/IG.1'Y►, r1/ `1cywoOYIIci+he— l.4b- Wta Signature by: �i� O✓rl9 �x C�� (Typed and written) Title: h I �I ti f'1 I —ES �A AJ1 4009 Cr✓--O 7/8/2021 1:08 PM P. 15 ***UPDATED.IANUARY 28, 2020*** Collier County Solicitation 18-7470S Additional Contact Information Send payments to: H A (L. M p Ni A T FI E CLl1 (required if different from Company name used as payee above) Contact name: F j I fZI I7 Les W) I" leOM Title: c E- Q Address: 3 4 2 10419 -C,+ 1J S64n. City, State, ZIP �Jo.. )-a—s FL Telephone: �j Ll 46 0Y Email: bl1 ✓!G+A1'1 (G l {�CZi;✓YI �iYI /Gd'�T1Y�� C1. (aOli7 Office servicing Collier County to place orders (required if different from above) Contact name: Title: Address: City, State, ZIP Telephone: Email: 7/8/2021 1:08 PM p. 16 ***UPDATED JANUARY 28, 2020*** Collier County Solicitation 18-7470S Co ler County Administrative Services Department Procurement Services Division Form 2: Conflict of Interest Certification Affidavit The Vendor certifies that, to the best of its knowledge and belief, the past and current work on any Collier County project affiliated with this solicitation does not pose an organizational conflict as described by one of the three categories below: Biased ground rules —The firm has not set the "ground rules" for affiliated past or current Collier County project identified above (e.g., writing a procurement's statement of work, specifications, or performing systems engineering and technical direction for the procurement) which appears to skew the competition in favor of my firm. Impaired objectivity — The firm has not performed work on an affiliated past or current Collier County project identified above to evaluate proposals / past performance of itself or a competitor, which calls into question the contractor's ability to render impartial advice to the government. Unequal access to information —The firm has not had access to nonpublic information as part of its performance of a Collier County project identified above which may have provided the contractor (or an affiliate) with an unfair competitive advantage in current or future solicitations and contracts. In addition to this signed affidavit, the contractor / vendor must provide the following: 1. All documents produced as a result of the work completed in the past or currently being worked on for the above -mentioned project; and, 2. Indicate if the information produced was obtained as a matter of public record (in the "sunshine") or through non-public (not in the "sunshine") conversation (s), meeting(s), document(s) and/or other means. Failure to disclose all material or having an organizational conflict in one or more of the three categories above be identified, may result in the disqualification for future solicitations affiliated with the above referenced project(s). By the signature below, the firm (employees, officers and/or agents) certifies, and hereby discloses, that, to the best of their knowledge and belief, all relevant facts concerning past, present, or currently planned interest or activity (financial, contractual, organizational, or otherwise) which relates to the project identified above has been fully disclosed and does not pose an organizational conflict. I.1 ry fZNaN► � HEMO ?IEDIM iCr92E uc' ibatq TH aQb Compan Signature MIR► N I eC-o Print Name and Title Stateof County of QZW,t"r The foregoing instrument was acknowledged before me by means of �A p ysical presence or ❑ online notarization, this ��N day of Lw,SN a, ,A" Jl , , (name of person acknowledging). (Signature of Notary Public - State of Florida) ` �.•r'r: \ Cam. W a Y S� ; _ (Print, Type, or Stamp Commissioned Name of Notary Public) Personally Known OR I r�.du^"ced"Identific�ion F l+a r•� c(^ �ri� rS L:.my� TERRI TAWORSKI Type of Identification Produced ?Ak- Notary Public, State of Florida " Commission# GG 340455 comet. expires July 6, 2023 7/8/2021 1 :08 PM .m, My My c.Y.,.�-1� p. 17 ***UPDATED JANUARY 28, 2020*** Collier County Solicitation 18-7470S collier County Administrative Services Department Procurement Services Division Form 3: Immigration Affidavit Certification This Affidavit is required and should be signed, by an authorized principal of the firm and submitted with formal solicitation submittals. Further, Vendors are required to be enrolled in the E-Verify program (httr)s://www.e-verifv.gov/), at the time of the submission of the Vendor's proposal/bid. Acceptable evidence of your enrollment consists of a copy of the properly completed E- Verify Company Profile page or a copy of the fully executed E-Verify Memorandum of Understanding for the company which will be produced at the time ofthe submission ofthe Vendor's proposal/bid or within five (5) day ofthe County's Notice of Recommend Award. FAILURE TO EXECUTE THIS AFFIDAVIT CERTIFICATION AND SUBMIT WITH VENDOR'S PROPOSAL/BID MAY DEEM THE VENDOR'S AS NON -RESPONSIVE. Collier County will not intentionally award County contracts to any Vendor who knowingly employs unauthorized alien workers, constituting a violation of the employment provision contained in 8 U.S.C. Section 1324 a(e) Section 274A(e) of the Immigration and Nationality Act ("INA"). Collier County may consider the employment by any Vendor of unauthorized aliens a violation of Section 274A (e) of the INA. Such Violation by the recipient of the Employment Provisions contained in Section 274A (e) of the INA shall be grounds for unilateral termination of the contract by Collier County. Vendor attests that they are fully compliant with all applicable immigration laws (specifically to the 1986 Immigration Act and subsequent Amendment(s)) and agrees to comply with the provisions of the Memorandum of Understanding with E-Verify and to provide proof of enrollment in The Employment Eligibility Verification System (E-Verify), operated by the Department of Homeland Security in partnership with the Social Security Administration at the time of submission of the Vendor's proposal/bid. ifemo P1E-DI bg vm-_ ae_ b8tl HH A MOA/M THE CL iika 0111 Compan e Signature tZ 19-I 6M 1,66 kfi AJI 40 ✓4 I C&—o Print Name and Title Stateof Q r County of The foregoing instrument was acknowledged before me by means of I9 physical presence or ❑ online notarization, this 10�h day of Jwvr4 �L_ (month), _r '��1 (year), by Ww-i&ft n k_As.� tN i WVC. (name of person acknowledging). �T"— �— (Signature of Notary Public - State of Florida) \C, W.rrS� i _�-- (Print, Type, or Stamp Commissioned Name of Notary Public) Personally Known OR Prod�cgd Identification 1P 'G® TERRTAWORSIe of Identification Produced = Notary Public, Floridac, state of F Type Commission# GG 340455 My comm. expires July 6, 2023 7/8/2021 1:08 PM p. 18 * * *UPDAT® JANUARY 28, 2020** * Collier County Solicitation 18-7470S Collier County Administrative Services Department Procurement Services Division Form 4: Vendor Submittal — Local Vendor Preference Certification (Check Appropriate Boxes Below) State of FI rida (Select County if Vendor is described as a Local Business) Collier County ❑ Lee County Vendor affirms that it is a local business as defined by the Procurement Ordinance of the Collier County Board of County Commissioners and the Regulations Thereto. As defined in Section Fifteen of the Collier County Procurement Ordinance: Local business means the vendor has a current Business Tax Receipt issued by the Collier County Tax Collector prior to bid or proposal submission to do business within Collier County, and that identifies the business with a permanent physical business address located within the limits of Collier County from which the vendor's staff operates and performs busines s in an area zoned for the conduct of such business. A Post Office Box or a facility that receives mail, or a non -permanent structure such as a construction trailer, storage shed, or other non -permanent structure shall not be used for the purpose of establishing said physical address. In addition to the foregoing, a vendor shall not be considered a "local business" unless it contributes to the economic development and well-being of Collier County in a verifiable and measurable way. This may include, but not be limited to, the retention and expansion of employment opportunities, support and increase to the County's tax base, and residency of employees and principals of the business within Collier County. Vendors shall affirm in writing their compliance with the foregoing at the time of submitting their bid or proposal to be eligible for consideration as a "local business" under this section. A vendor who misrepresents the Local Preference status of its firm in a proposal or bid submitted to the County will lose the privilege to claim Local Preference status for a period of up to one year under this section. Vendor must complete the following information: Year Business Established in 19Collier County or ❑ Lee County: �(� mt�O44S a�{ �►Ol'l i i l�1fA►'PO ✓Cld 2O I Number of Employees (Including Owner(s) or Corporate Officers): Number of Employees Living in 0 Collier County or %Lee (Including Owner(s) or Corporate Officers): If requested by the County, Vendor will be required to provide documentation substantiating the information given in this certification. Failure to do so will result in vendor's submission being deemed not applicable. Sign and Date Certification: Under penalties ofveriury I terrify that the information shown on this form is correct to my knowledge HARitotuO THE7CLAk Company Name: HE'Ho M �D)L1fl e&RE Lr Z819 Date: I F/Zp ZI Address in Collier or Lee County: +7J�25 (' �i sf %,� Sl�l i �e 'l, 06FLES FL 3 111 �3 Signature: W4Z 4-ai,2e � s� _ Title: CUL 7/8/2021 1:08 PM p. 20 *** UPDATED JANUARY 28, 2020** * Collier County Solicitation 18-7470S COLT County Administrative Services Department Procurement Services Division Form 5 Reference Questionnaire (USE ONE FORM FOR EACH REQUIRED REFERENCE) Solicitation: Reference Questionnaire for: C (Name of Company Requesting Reference Information) (Name of Individuals Requesting Reference Information) n Name:�� (`e ( CT i1\»ram. Company: P��rv� C=o��k ` 4�ysi"I (Evaluator completing reference questionnaire) (Evaluator's Company completing reference) Email: � %\\\o,—,P,P � MFAX: 23S \-(3p 01?_ hone: 237 1-(30 o Collier County has implemented a process that collects reference information on firms and their key personnel to be used in the selection of firms to perform this project. The Name of the Company listed in the Subject above has listed you as a client for which they have previously performed work. Please complete the survey. Please rate each criteria to the best of your knowledge on a scale of 1 to 10, with 10 representing that you were very satisifed (and would hire the firm/individual again) and 1 representing that you were very unsatisfied (and would never hire the firm/indivdival again). If you do not have sufficient knowledge of past performance in a particular area, leave it blank and ,,the y item or form will be scored "0." Project Description: '11 1 cd Completion Date: 0CI(_ t H e c-0 P�P Project Budget: `nln Project Number of Days: Item Criteria Score (must be completed) 1 Ability to manage the project costs (minimize change orders to scope). 2 Ability to maintain project schedule (complete on -time or early). 3 Quality of work. 4 Quality of consultative advice provided on the project. 5 Professionalism and ability to manage personnel. 6 Project administration (completed documents,final invoice, final producttumover; invoices; manuals or going forward documentation, etc.) I J t 7 Ability to verbally communicate and document information clearly and succinctly. 8 Abiltity to manage risks and unexpected project circumstances. 9 Ability to follow contract documents, policies, procedures, rules, regulations, etc. (0 10 Overall comfort level with hiring the company in the future (customer satisfaction). I TOTAL SCORE OF ALL ITEMS 7/8/2021 1:08 PM p. 21 ***t PDAIVDJAM ARI'28,2020"* Collier County Solicitation 18-7470S C011ier COunty Administrative Services Department Procurement Services Division Form 5 Reference Questionnaire (USE ONE FORM FOR EACH REQUIRED REFERENCE) Solicitation: Reference Questionnaire for: HUM0 het bb kA Lf p E t LC (Name of Company Requesting Reference Information) (Name of Individuals Requesting Reference Information) Name:,.Pav,'c/ :j (Evaluator completing reference questionnaire) Email: Zs- ✓_ FAX: %MM Company: (Evaluator's Company completing reference) Collier County has implemented a process that collects reference information on firms and their key personnel to be used in the selection of firms to perform this project. The Name of the Company listed in the Subject above has listed you as a client for which they have previously performed work. Please complete the survey. Please rate each criteria to the best of your knowledge on a scale of 1 to 10, with 10 representing that you were very satisifed (and would hire the firm/individual again) and I representing that you were very unsatisfied (and would never hire the firm/indivdival again). If you do not have sufficient knowledge of past performance in a particular area, leave it blank and the item or form will be scored "0." Project Description: Kit755ct- fin%verS:-Iy' Dffl lre5r&w Completion Date: Project Budget: 8/V a I Project Number of Days: n ( a Item Criteria Score (must be completed) 1 Ability to manage the project costs (minimize change orders to scope). Q 2 Ability to maintain project schedule (complete on -time or early). C� d 3 Quality of work. 4 Quality of consultative advice provided on the project. 5 Professionalism and ability to manage personnel. l� 6 Project administration (completed documents, final invoice, final produetturnover; invoices; manuals or going forward documentation, etc.) 7 Ability to verbally communicate and document information clearly and succinctly. C. 8 Abiltity to manage risks and unexpected project circumstances. 9 Ability to follow contract documents, policies, procedures, rules, regulations, etc. 10 Overall comfort level with hiring the company in the future (customer satisfaction). TOTAL SCORE OF ALL ITEMS 7/8/2021 1:08 PM p. 21 ***UPDATMJANUARY 28, 2020' Collier County Solicitation 18-7470S Collier County Administrative Services Department Procurement Services Division Form 5 Reference Questionnaire (USE ONE FORM FOR EACH REQUIRED REFERENCE) Solicitation: Reference Questionnaire for: (Name of Compan Requesting Reference Information) 1 (Name of Individuals Requesting Reference Information) Name: Y [�-i�jO-LlJ Company: (Evaluator completing reference questionnaire) (Evaluator's Company completing reference) Email: d�41T-)�6V_141 e �e FAX: ZqlQ1-4;; TelenhoneA::�IN--,-315--050 Collier County has implemented a process that collects reference information on firms and their key personnel to be used in the selection of firms to perform this project. The Name of the Company listed in the Subject above has listed you as a client for which they have previously performed work. Please complete the survey. Please rate each criteria to the best of your knowledge on a scale of 1 to 10, with 10 representing that you were very satisifed (and would hire the firm/individual again) and 1 representing that you were very unsatisfied (and would never hire the frrm/indivdival again). If you do not have sufficient knowledge of past performance in a particular area, leave it blank and the item or form will be scored "0." Project Description: N I q Project Budget: Completion Date: Project Number of Days: I-) Item Criteria Score (must be completed) 1 Ability to manage the project costs (minimize change orders to scope). a 2 Ability to maintain project schedule (complete on -time or early). 3 Quality of work. 4 Quality of consultative advice provided on the project. 5 Professionalism and ability to manage personnel. J 6 Project administration (completed documents, final invoice, final product turn over; invoices; manuals or going forward documentation, etc.) l(% 7 Ability to verbally communicate and document information clearly and succinctly. 8 Abiltity to manage risks and unexpected project circumstances. 9 Ability to follow contract documents, policies, procedures, rules, regulations, etc. 10 Overall comfort level with hiring the company in the future (customer satisfaction). //) / l/ TOTAL SCORE OF ALL ITEMS 7/8/2021 1:08 PM p. 21 ***UPDATED JANUARY 28, 2020*** Collier County Solicitation 18-7470S INSURANCE AND BONDING REQUIREMENTS Insurance / Bond Type Required Limits 1. ® Worker's Compensation Statutory Limits of Florida Statutes, Chapter 440 and all Federal Government Statutory Limits and Requirements Evidence of Workers' Compensation coverage or a Certificate of Exemption issued by the State of Florida is required. Entities that are formed as Sole Proprietorships shall not be required to provide a proof of exemption. An application for exemption can be obtained online at https:Happs.fldfs.com/bocexeml2 2. ® Employer's Liability $1,000,000 single limit per occurrence 3. ® Commercial General Bodily Injury and Property Damage Liability (Occurrence Form) patterned after the current $1,000,000_single limit per occurrence, $2,000,000 aggregate for Bodily Injury ISO form Liability and Property Damage Liability. This shall include Premises and Operations; Independent Contractors; Products and Completed Operations and Contractual Liability. 4. ® Indemnification To the maximum extent permitted by Florida law, the Contractor/Vendor shall defend, indemnify and hold harmless Collier County, its officers and employees from any and all liabilities, damages, losses and costs, including, but not limited to, reasonable attorneys' fees and paralegals' fees, to the extent caused by the negligence, recklessness, or intentionally wrongful conduct of the Contractor/ Vendor or anyone employed or utilized by the Contractor/Vendor in the performance of this Agreement. 5. ❑ Automobile Liability $500,000 Each Occurrence; Bodily Injury & Property Damage, Owned/Non-owned/Hired; Automobile Included 6. ❑ Other insurance as noted: ❑ Watercraft $ Per Occurrence ❑ United States Longshoreman's and Harborworker's Act coverage shall be maintained where applicable to the completion of the work. $ Per Occurrence ❑ Maritime Coverage (Jones Act) shall be maintained where applicable to the completion of the work. $ Per Occurrence ❑ Aircraft Liability coverage shall be carried in limits of not less than $5,000,000 each occurrence if applicable to the completion of the Services under this Agreement. $ Per Occurrence ❑ Pollution $ Per Occurrence ® Professional Liability $ 1,000,000 Per claim & in the aggregate ❑ Project Professional Liability $ Per Occurrence ❑ Valuable Papers Insurance $ Per Occurrence ❑ Cyber Liability $ Per Occurrence ❑ Technology Errors & Omissions $ Per Occurrence X Crime/Employee Dishonesty $50,000 Per Occurrence 7. ❑ Bid bond Shall be submitted with proposal response in the form of certified funds, cashiers' check or an irrevocable letter of credit, a cash bond posted with the County Clerk, or proposal bond in a sum equal to 5% of the cost proposal. All checks shall be made payable to the Collier County Board of County Commissioners on a bank or trust company located in the State of Florida and insured by the Federal Deposit Insurance 7/8/2021 1:08 PM p. 24 Collier County Solicitation 18-7470S Corporation. 8. ❑ Performance and Payment For projects in excess of $200,000, bonds shall be submitted with the executed Bonds contract by Proposers receiving award, and written for 100% of the Contract award amount, the cost borne by the Proposer receiving an award. The Performance and Payment Bonds shall be underwritten by a surety authorized to do business in the State of Florida and otherwise acceptable to Owner; provided, however, the surety shall be rated as "A-" or better as to general policy holders rating and Class V or higher rating as to financial size category and the amount required shall not exceed 5% of the reported policy holders' surplus, all as reported in the most current Best Key Rating Guide, published by A.M. Best Company, Inc. of 75 Fulton Street, New York, New York 10038. 9. ® Vendor shall ensure that all subcontractors comply with the same insurance requirements that he is required to meet. The same Vendor shall provide County with certificates of insurance meeting the required insurance provisions. 10. ® Collier County must be named as "ADDITIONAL INSURED" on the Insurance Certificate for Commercial General Liability where required. This insurance shall be primary and non-contributory with respect to any other insurance maintained by, or available for the benefit of, the Additional Insured and the Vendor's policy shall be endorsed accordingly. 11. ® The Certificate Holder shall be named as Collier County Board of County Commissioners, OR, Board of County Commissioners in Collier County, OR Collier County Government, OR Collier County. The Certificates of Insurance must state the Contract Number, or Project Number, or specific Project description, or must read: For any and all work performed on behalf of Collier County. 12. ® On all certificates, the Certificate Holder must read: Collier County Board of County Commissioners, 3295 Tamiami Trail East, Naples, FL 34112 13. ® Thirty (30) Days Cancellation Notice required. 14. Collier County shall procure and maintain Builders Risk Insurance on all construction projects where it is deemed necessary. Such coverage shall be endorsed to cover the interests of Collier County as well as the Contractor. Premiums shall be billed to the project and the Contractor shall not include Builders Risk premiums in its project proposal or project billings. All questions regarding Builder's Risk Insurance will be addressed by the Collier County Risk Management Division. GG - 6/29/2021 Vendor's Insurance Statement We understand the insurance requirements of these specifications and that the evidence of insurability may be required within five (5) days of the award of this solicitation. The insurance submitted must provide coverage for a minimum of six (6) months from the date of award. HI A -THC-; c1-t13 Name of Firm NEHO MEN) kA L-ARE LU_ DF,19 Date 9 I s/ZV 2-/ Vendor Signature _ a2121 941 r W ,U, Print Name -rTf 12 I AtJ LE.S k l 01 CO ✓A Insurance Agency l �lr�_ Se, Go V(�u Agent Name ZJ-4" %%hrj� � Telephone Number — 311 lip 7/8/2021 1:08 PM p. 25 AC"J?"° CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 06/09/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: William Mennitt Sena & Whitney LLC 190 Glades Road Suite C BOCA RATON, FL 33432 (561)391-4661 wmennitt0thes INSURED INSURER B : HEMO MEDIKA CARE LLC DBA HARMONIA THE CLUB INSURERC: 3425 10TH ST N UNITS 1,2,3 INSURERD: NAPLES, FL 34103 INSURER E: INSURER F : r0VFRAGFS CFRTIFICATF N11MRFR* nnn5Q1Qd_1n29R3 RFVISION Nl1MRFR- 5 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY W2A7D929210201 03/05/2021 03/05/2022 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) $ rJ 000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY jE LOC PRODUCTS - COMP/OP AGG $ 1,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DIED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N I A E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below $ E.L. DISEASE - POLICY LIMIT A PROFESSIONAL LIAB W2A7D929210201 03/05/2021 03/05/2022 EACH CLAIM 1,000,000 A PROFESSIONAL LIAB W2A7D929210201 03/05/2021 03/05/2022 AGGREGATE 3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE HEMO MEDIKA CARE LLC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN DBA HARMONIA THE CLUB ACCORDANCE WITH THE POLICY PROVISIONS. 3425 10TH ST N UNITS 1,2,3 NAPLES, FL 34103 AUTHORIZED REPRESENTATIVE per- (WIM) © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by WIM on June 09, 2021 at 11:36AM A AUTO BUYERS INS 2749 E TAMIAMI TRL NAPLES, FL 34112 1-239-793-0555 Certificate of Insurance Certificate Holder HEMO MEDIKA CARE LLC 3425 10TH ST. N STE 1 NAPLES, FL 34103 Insured ................................. HEMO MEDIKA CARE LLC 3425 10TH ST. N STE 1 NAPLES, FL 34103 PROGREl W C01WWRC/AL Policy number: 06275046-3 Underwritten by: PROGRESSIVE EXPRESS INS COMPANY August 7, 2021 Page 1 of 1 Agent/Surplus Lines Broker ................................. A AUTO BUYERS INS 2749 E TAMIAMI TRL NAPLES, FL 34112 This document certifies that insurance policies identified below have been issued by the designated insurer to the insured named above for the period(s) indicated. This Certificate is issued for information purposes only. It confers no rights upon the certificate holder and does not change, alter, modify, or extend the coverages afforded by the policies listed below. The coverages afforded by the policies listed below are subject to all the terms, exclusions, limitations, endorsements, and conditions of these policies. Policy Effective Date: Oct 30, 2020 Policy Expiration Date: Oct 30, 2021 Insurance coverage(s) Limits ..........................................................................................,....000/$25........,.000........................... BODILY INJURY/PROPERTY DAMAGE $50,000/$100 .................................................................................................................................. PERSONAL INJURY PROTECTION $10,000 W/$0 DED - NAMED INSURED ONLY Description of LocationNehicles/Special Items Scheduled autos only .................................................................................... 2009 VOLKSWAGEN CC WVWML73C69E539620 COMPREHENSIVE $500 DED COLLISION $500 DED Certificate number 21921NET046 Form 5241 (10102) WORKERS' COMPENSATION cR FrankWinstonCrum- BINDER Producer: Ardent Insurance Group, Inc Quote Date: December 28, 2020 DBA Ardent Insurance & Risk Management Quote Number: Q-154462 1004 Collier Center Way #203 Naples, 34110 Policy Number: FWFL0022420400 (239) 919-3916 Effective Date: December 28, 2020 - December 28, 2021 Insured: HEMO MEDIKA CARE LLC 3425 10th St N, ste 1 , Naples, FL 34103 Totals: Estimated Premium $2,818 Assessments & Surcharges $28 Total Estimated Premium Workers' Compensation Insurer: Frank Winston Crum Insurance Company B++ Employers' Liability Limit: Bodily Injury by Accident $100,000 Each Accident Bodily Injury by Disease $500,000 Policy Limit Bodily Injury by Disease $100,000 Each Employee Florida Description School -All Other Employees School -Professional Employees & Clerical School -Professional Employees & Clerical Salespersons or Collectors -Outside Class Code Payroll 9101 $40,000 8868 $125,000 8868 $93,600 8742 $25,000 100 South Missouri Avenue, Clearwater, FL 33756 WC@fwcrum.com 12/28/2020 09:49:45 AM www.FrankWinstonCrum.com/login Phone: 866-218-4219 xl 153 • Fax: 727-608-1531 WORKERS' cP FrankWinstonCrum BINDER COMPENSATION Policy Installment Schedule: Pay Plan: 15% Down / 9 Installments Installment # Amount Due Down Payment 12/28/2020 $451 Installment 1 01/28/2021 $266 Installment 2 02/28/2021 $266 Installment 3 03/28/2021 $266 Installment 4 04/28/2021 $266 Installment 5 05/28/2021 $266 Installment 6 06/28/2021 $266 Installment 7 07/28/2021 $266 Installment 8 08/28/2021 $266 Installment 9 09/28/2021 $266 Dividend Program Eligibility This policy qualifies for our Dividend Program for Non -Construction, which could result in a dividend reward at the end of your policy period. 12/28/2020 09:49:45 AM 100 South Missouri Avenue, Clearwater, FL 33756 www.FrankWinstonCrum.com/login WC@fwcrum.com Phone: 866-218-4219 xl 153 • Fax: 727-608-1531 WORKERS' COMPENSATION CS FrankWinstonCrum BINDER Florida Dividend Program for Non -Construction Frank Winston Crum Insurance rewards workers' compensation policyholders who maintain a safe work environment and manage risk for their employees. Eligible policies will qualify for a dividend reward based on either a flat -rate or a sliding scale of premium amount factored by incurred loss ratio. Program Highlights • Minimum policy premium starts at $1,500 (at inception and at final audit) for non -construction industry risks • Premiums between $1,500 and $4,999 are eligible for a flat 5% dividend reward • With premiums of $5,000 or more, dividend rewards start at 12% and increase with higher premiums - see chart below • Dividends can still be paid even if a non-payment cancellation notice occurs Premium levels to incurred Loss Ratio for Calculating Dividend Benefits Incurred losses are the total amount of paid claims and loss reserves Final Audited 0 0% 0.1% - 5.1% - 10.1% - 15.1% - 20.1% - 25.1% - >35.0% Premium 5.0% 10.0% 15.0% 20.0% 25.0% 35.0% $1,500 - $4,999 5% 5% 5% 5% 5% 5% 5% 0% $5,000 - $10,000 12% 9% 7% 6% 5% 5% 5% 0% $10,001 - $30,000 15% 13% 11% 10% 5% 5% 5% 0% $305000 + 20% 18% 16% 14% 12% 5% 5% 0% Eligibility Requirements Include: • The policy must have an incurred loss ratio of no more than 35 percent (%) during that policy term. • Eligible risks with only one non-payment cancellation notice during the policy period are elibigle for 50% of the dividend reward. • The policy must remain in force for the full policy period. • All premiums, including audited premium, must be paid in full by dividend evaluation date.' • Policyholders must comply with all policy terms and conditions, loss control, and risk management recommendations. Ineligible Risks: Consent -to -rate accounts, policies with 2 or more non -pay cancellation notices issued during the policy term, retrospective, high hazard accounts as defined by NCCI (hazard group G), and large -deductible policies. 'Dividend eligibility will be evaluated nine months after policy experation date, with dividend disbursement within 12 months of policy expiration. The Board of Directors does not guarantee dividends and reserves the right to use discretion when applying them. This program applies for new business effective 8/1/2020 or later and renewals effective 8/1/2020 or later. 100South Missouri Avenue, Clearwater, FL33756 www.FrankWinstonCrum.com/login WC@fwcrum.com phone: 866-218-4219 x1153 • Fax:727-608-1531 The Club ORGANIZATIONAL CHART Miriam Leskanicova Sue Gilmore Director of Activities 239-297-2746 owner / CEO 239-778-5582 Sue Maxwell Administrator 239-691-3079 Current Staff Cindi Ryerson Director of Nursing 239-671-6343 Patricia Boutilier Megan Ehrgott Nurse /Aid Aid 3425 10th Street North, Unit 1-3 Naples, Florida 34103 PHONE 239-234-4608 E-MAIL info@harmoniatheclub.com The Club FAX239-320-3232 I LICENSE# 9475 QUALITY ASSURANCE Policy: It is the policy of HARMONIA THE CLUB to have an interest in systematically evaluating and improving the quality of programs, processes and services to achieve a high level of efficiency, effectiveness and customer satisfaction. Purpose: To establish a procedure for quality improvement activities and provide assurance of customer satisfaction or dissatisfaction as well as the quality of the services provided. It is the intent to improve and enhance the performance of the service offered through the center. Procedure: Quality improvement (QI) consists of systematic and continuous actions that lead to measurable improvement in adult daycare services and the status of targeted demographic/participant/customer groups. To achieve a different level of performance (i.e., results) and improve quality, an organization's current system needs to change. A successful QI program always incorporates the following four key principles: ■ QI work as systems and processes ■ Focus on customers ■ Focus on being part of the team • Focus on use of the data To make improvements, the center needs to understand its own delivery system and key processes. The concepts behind the QI approaches recognize that both resources (inputs) and activities carried out (processes) are addressed together to ensure or improve quality of care (outputs/outcomes). QI can assume many forms and is most effective if it is individualized to meet the needs of a specific adult day service delivery system. Activities or processes within a center are the responsibility of each individual to be an active and contributing member of the team. Each person on a team brings a unique perspective to the process; i.e., how things work; what happens when changes are made, and how to sustain improvements during daily work. Contributions are made from each individual's skill set and the team's synthesis of ideas. In addition to staff, a key component of a well -functioning QI team is an effective infrastructure, such as, leadership, and policies and procedures to organize and facilitate the work of the team. Infrastructure support affords the team with tools, resources, clear expectations, and a forum for communication. There are two major components: 1) what is done (what care/services are provided), and 2) how it is done (when, where, and by whom care/services are delivered). Improvement can be achieved by addressing either component; however, the greatest impact for QI is when both are addressed at the same time. Re -imagining Adult Day Stay 1 www.HarmoniaTheClub.com 3425 10th Street North, Unit 1-3 Naples, Florida 34103 PHONE 239-234-4608 E-MAIL info@harmoniatheclub.com The Club FAX239-320-3232 I LICENSE# 9475 Focus on Customers An important measure of quality is the extent to which customer needs and expectations are met. This may include services that are designed to meet the needs and expectations of participants, caregivers, other service providers and the community includes: • Systems that affect customer access • Care/services provision that may be evidence -based • Customer safety • Support for customer engagement • Coordination of care with other resources/services/products • Cultural competence and age appropriate, including assessing health/social needs, person - centered culture, and appropriate care Focus on Being Part of the Team QI is a team process. Under the right circumstances, a team connects the knowledge, skills, experience, and perspectives of different individuals within the team to make lasting improvements. A team approach is most effective when: • No one person in an organization knows all the dimensions of an issue • The process involves more than one discipline or work area • Solutions require creativity • Staff commitment and buy -in are needed Focus on Use of the Data Data is the cornerstone of QI. It is used to describe how well current processes are working; what happens when changes are applied, and to document successful performance. Using data: • Separates what is thought to be happening from what is really happening ■ Establishes a baseline ■ Reduces placement of ineffective solutions ■ Allows monitoring of procedural changes to ensure that improvements are sustained ■ Indicates whether changes lead to improvements ■ Allows comparisons of performance across sites Both quantitative and qualitative methods of data collection are helpful in QI efforts. Quantitative methods involve the use of numbers and frequencies that result in measurable data. This type of information is easy to analyze statistically and is familiar to the industry or practices/processes. Examples in an adult day care setting include: ■ Finding the average of level of care/age • Calculating the average length of stay • Access of services by working caregivers Qualitative methods collect data with descriptive characteristics, rather than numeric values that draw statistical inferences. Qualitative data is observable but not measurable, and it provides important information about patterns, relationships between processes and is often used to provide context for needed improvements. Common strategies for collecting qualitative data in an adult day care are: ■ Patient and staff satisfaction surveys Re -imagining Adult Day Stay 2 www.HarmoniaTheClub.com 3425 1Oth Street North, Unit 1-3 Naples, Florida 34103 PHONE 239-234-4608 The Club E-MAIL info@harmoniatheclub.com FAX239-320-3232 I LICENSE# 9475 ■ Focus -group discussions/ town meetings ■ Independent observations It is the practice and license requirement of adult day services to review participant records quarterly to verify or evaluate: Compliance with ADCC license requirements, Appropriateness of admissions and discharges. Formulation, implementation, and adequacy of the plan of care. Appropriateness of the continuation of care. Appropriate use of personnel and coordination of services • Effective use of community resources in continuity of services. • Gaps in agency services, needs for in-service education, staffing concerns, consultation services, and review policies. To ensure documentation is complete, accurate, and timely. Compliance: Compliance is accomplished by the annual review of customer satisfaction, surveys and outcomes of established goals Reference: Health care standards of Practice Department of Health and Human Services Re -imagining Adult Day Stay 3 www.HarmoniaTheClub.com 3425 10th Street North, Unit 1-3 Naples, Florida 34103 PHONE 239-234-4608 The Club E-MAIL info@harmoniatheclub.com FAX239-320-3232 I LICENSE# 9475 Quality Assurance Program Quality Assurance Program will assure the maximum quality of care, services and operation of HARMONIA THE CLUB program: 1. The Administrator shall have the overall responsibility for the implementation of the Quality Assurance Program. 2. There will be an annual Quality Assurance meeting, to summarize and review the data collected under this program and recommendations made for opportunities for improvement. Quality Assurance activities shall be on -going throughout the year. 3. Client satisfaction surveys shall be distributed at the time of discharge from the program or annually. 4. Evaluation of operations (client care services, staffing, infection control, safety, housekeeping and sanitation, maintenance of physical facility and equipment, and client care statistics) shall be completed every six (6) months. 5. The following checklists / reports will be utilized for monitoring purposes: a. Safety Inspection b. Fire Drill reports c. Refrigerator, hot water and air conditioning temperature logs d. Incident, Client complaints and accident reports e. Census logs f. staff training and orientation checklists g. Incident and / or grievance reports 6. Client record audits shall be performed at the end of the initial assessment and as deemed necessary thereafter. 7. HARMONIA THE CLUB shall have an annual fire inspection done by North Collier Fire Department. 8. HARMONIA THE CLUB shall have quarterly food permit inspections done by the Collier County Health Department. 9. The Administrator shall address client grievances and / or complaints in writing no later than 7 days from time of occurrence. An Action Plan shall be provided in response to the grievance with a specific time frame for correction / improvement. Verbal acknowledgment of the grievance shall be done within 24 hours of the complaint / grievance. An incident report shall be completed and appropriate steps taken as per the Incident Reporting Policy. 10. Correction Action Plans are determined by the Administrator and are given a 30-day period to produce results, which are recorded on the Report of Follow-up to Quality Assurance Evaluation. Re -imagining Adult Day Stay 4 www.HarmoniaTheClub.com The Club 3425 10th Street North, Unit 1-3 Naples, Florida 34103 PHONE239-234-4608 E-MAIL info@ harmoniatheclub.com FAX239-320-3232 I LICENSE# 9475 11. The Administrator shall conduct a Quality Assurance Review at a minimum of once a year to review all components of the Quality Assurance Program and to review any reports noting deficiencies found and comments for corrections/ improvements. The Administrator shall do additional meetings on an ad hoc basis as deemed necessary. 12. HARMONIA THE CLUB will be governed by the State of Florida Statutes for Adult Day Care and be subject to state inspection every two years and as deemed necessary by the Agency for Healthcare Administration. Re -imagining Adult Day Stay 9 www.HarmoniaTheClub.com 3425 10th Street North, Unit 1-3 Naples, Florida 34103 ` PHONE239-234-4608 E-MAIL info@ harmoniatheclub.com The Club FAX239-320-3232 I LICENSE# 9475 Client Satisfaction Survey Our goal is to provide exceptional services to you and your family member. Please take a few moments to complete the following survey and help us to continue to improve our services to you. Your candid responses will be greatly appreciated. Thank you. Client Name: (optional) Overall Impression: Please rate the following questions: Date: Exceptional Very Good Average Fair Poor 1. The services provided to my loved are: 2. The overall attitude of the staff is: 3. The overall atmosphere and appearance of the facility is: 4. The activities provided at the facility were: Participation and Communication: Please answer the following questions: 1. Have you received updates as to the progress of your loved one's condition while attending adult day services? Yes No Comments: 2. Do you feel your loved one enjoys the activities at Make My Day Adult Day Care? Yes No Comments: 3. Are you satisfied with your loved one's level of participation in activities? Yes No Comments: Re -imagining Adult Day Stay 1 www.HarmoniaTheClub.com 3425 10th Street North, Unit 1-3 i� Naples, Florida 34103 ` PHONE 239-234-4608 E-MAIL info@harmoniatheclub.com The Club FAX239-320-3232 I LICENSE# 9475 4. Have you been kept informed of matters regarding personal care, diet, medications and safety? Yes No Comments: 5. Are there any needs for yourself or your loved one that have not been met? Yes No Comments: 6. Would you recommend the services of HARMONIA THE CLUB to someone else? Yes No Comments: 7. Has HARMONIA THE CLUB provided you with the necessary respite services that you needed? Yes _ No Comments: General Comments: 1. How would you like to see services improved or increased at HARMONIA THE CLUB? Re -imagining Adult Day Stay FEI www.HarmoniaTheClub.com The Club 2. What do you like the most about HARMONIA THE CLUB? 3. What do you like the least about HARMONIA THE CLUB? 4. How would you rate the overall program at HARMONIA THE CLUB? Excellent _ Very Good Good Fair Poor 3425 10th Street North, Unit 1-3 Naples, Florida 34103 PHONE239-234-4608 E-MAIL info@ harmoniatheclub.com FAX239-320-3232 (LICENSE# 9475 Thank you for taking a few minutes to answer these questions. Your input is very important to us. Please return this survey in the self-addressed, stamped envelope that has been provided. The Staff at HARMONIA THE CLUB Re -imagining Adult Day Stay 3 www.HarmoniaTheClub.com 3425 10th Street North, Unit 1-3 Naples, Florida 34103 PHONE 239-234-4608 The Club E-MAIL info@harmoniatheclub.com FAX239-320-3232 I LICENSE# 9475 INCIDENT REPORTING Policy: It is the policy of HARMONIA THE CLUB to have a mechanism for informing the corporation of an occurrence and circumstance that relate to employees, participants, volunteers, visitors or company property. HARMONIA THE CLUB will address all incidents completely and in a timely manner according to procedures defined in this policy statement. Purpose: The purpose of this policy is to ensure that incidents involving participants, employees and volunteers are addressed in a consistent, prompt and fair manner. The policy ensures compliance with all appropriate regulations. This policy will provide a system for identifying areas where performance improvement regarding safety practices, accident prevention and infection control are needed or required. Procedure: 1. An incident is defined as accidents or unplanned events for which the corporation, center or employee may be liable or which has resulted in injury or property damage. Unusual occurrences such as theft, break-ins, property damage, threats of violence, vehicular accidents, injury, assaults on or by a participant, illnesses, unsupervised/unannounced disappearance of a participant from a site/center, abuse/neglect/exploitation of a participant or employee work conduct resulting in a criminal violation, or potential violation of corporation code of ethics, must be documented. All employees are trained in the Incident Reporting Policy and the process for reporting all incidents. 2. All staff is knowledgeable regarding what events are considered policy to be an unusual occurrence that must be reported documented on an "Incident Report" form. 3. All staff is required to report immediately to their supervisor, center manager or owner/operator any incidents for which the corporation, center or employee may be liable or which has resulted in injury or property damage. The occurrence is documented on the Incident Report form and submitted to the appropriate authority within 24 hours. 4. In the case of serious injury or fatality, the owner/operator, Agency for Health Care Administration and police department will be notified immediately. 5. In the case of fatal injury, the owner/operator, center manager or designated authority will personally contact the family or next of kin. 6. If the incident pertains to an employee injury, the owner/operator will be notified immediately. An incident Report and Workers' Compensation form will be completed as required by Florida law. This applies to all on-the-job injuries, as well as anyone injured in a company vehicle accident or involving corporation equipment. Re -imagining Adult Day Stay _ 1 www.HarmoniaTheClub.com 3425 10th Street North, Unit 1-3 Naples, Florida 34103 PHONE 239-234-4608 The Club E-MAIL info@harmoniatheclub.com FAX239-320-3232 I LICENSE# 9475 7. The owner/operator will ensure that all major incidents in the Adult Day Care area as defined by the Florida Administrative Code (58A-6, 002) are reported to the Agency for Health Care Administration immediately. 8. Any employee or volunteer suspecting abuses, neglect or exploitation of a participant will report such to the Florida Abuse Registry at the 24-hour hotline, 1-800-96-ABUSE (962- 2873) as required by law. 9. The owner/operator will maintain an incident log for each funding source involving their clients. 10. The owner/operator will maintain a centralized log and file of all closed/resolved Incident Reports. 11. The Human Resource department maintains a record of all employee injuries including a file of all Workers Compensation forms and appropriate follow-up documentation. 12. The owner/operator will review and categorize the Incident Reports for the purpose of analyzing patterns and trends and identifying areas where Quality Improvement and staff training are needed. 13. All Incident Reports involving a potential exposure problem will be reviewed by the owner/operator, nurse, and other appropriate staff to determine an appropriate course of action to prevent recurrence and to ensure compliance with OSHA regulations as well as the Center's Exposure Control Policy. 14. All incident reports are to be forward to the Owner/operator. 15. Regulatory agencies may request to see the original reports. The reports will be provided as related and in compliance with HIPAA. Compliance: Is monitored by review of incident reports Reference: OSHA Standard 29 CFR Occupational Exposure to Blood borne Pathogens FLORIDA STATUTE 429 FS, FAC 58A-6.01 Adult Day Care Centers Re -imagining Adult Day Stay 2 www.HarmoniaTheClub.com 3425 10th Street North, Unit 1-3 Naples, Florida 34103 PHONE 239-234-4608 The Club E-MAIL info@harmoniatheclub.com FAX239-320-3232 I LICENSE# 9475 INCIDENT AND ACCIDENT REPORT FORM Employee: Date of Incident/Accident: Location of Incident / Accident: Time: Provide description of incident/accident in employee's own words: Accident Investigation: 1. Did the work area design contribute to the injury? 2. Was the area cluttered? 3. Were other conditions (noise, extreme temperature, etc) a contributing factor? Re -imagining Adult Day Stay 3 www.HarmoniaTheClub.com 3425 10th Street North, Unit 1-3 Naples, Florida 34103 PHONE 239-234-4608 The Club E-MAIL info@harmoniatheclub.com FAX239-320-3232 I LICENSE# 9475 4. Was the employee performing duties according to standard operating procedures? 5. Was there a better method to perform task? 6. Was the employee trained on necessary equipment? 7. Was the employee provided necessary training on body mechanics? Provide further explanation on an additional sheet. Recommendations / Corrective Actions: Completed by: Reviewed by: Re -imagining Adult Day Stay Date: Date: 4 www.HarmoniaTheClub.com = 3425 10th Street North, Unit 1-3 1 1� Naples, Florida 34103 PHONE 239-234-4608 ------- The Club E-MAIL info@harmoniatheclub.com INCIDENT / ACCIDENT REPORT FORM Employee: zo him C)nc , Date of Incident/Accident: 6-1171-1171 Location of Incident / Accident: b fc-1c, o rJ I u,l. k -i fc6f1 Time: Provide description of incident/accident in employee's own words: Accident Investigation: 1. Did the work area design contribute to the injury? )UL) 2. Was the area cluttered? 3. Were other conditions (noise, extreme temperature, etc) a contributing factor? A16 Re -imagining Adult Day Stay www.HarmoniaTheClub.com 3425 10th Street North, Unit 1-3 1 J� Naples, Florida 34103 (` PHONE 239-234-4608 The ClubE-MAIL info@harmoniatheclub.com ---_.____._ 4. Was the employee performing duties according to standard operating procedures? c/- - j-C) Ii n -Qb(fI ClO «0216) CIO s)r-e OA1 his 0,Od 5. Was there a better method to perform task? A'r0 6. Was the employee trained on necessary equipment? nlcU 7. Was the employee provided necessary training on body mechanics? ».S I Provide further explanation on an additional sheet. Recommendations / Corrective Actions: Completed by: C i \�7D 1 '6t�12 5 _DT) Date: &-/-V Reviewed by: 0 /,eilyi /E5',1':�yi ccte9 Date: (511y121 Re -imagining Adult Day Stay www.HarmoniaTheClub.com 3425 10th Street North, Unit 1-3 Naples, Florida 34103 ilapmema / ` PHONE 239-234-4608 The Club E-MAIL info@harmoniatheclub.com FAX239-320-3232 I LICENSE# 9475 Delivery of Service The services rendered at Harmonia the Club are based on the following flow: • Expressed request for services. • Invite to tour the facility and meet key staff members — Director of Nursing and Administrator/Owner to discuss the individual needs. • Physician order to be completed and signed by the physician of the interested party. • TB skin test to be done by the interested party either at the physician office or participating CVS Minute Clinics. Negative results are required for the admission into the program. • Having the physician order signed and negative TB skin test results completed next step is intake with the Director of Nursing. At the Intake the Director of Nursing performed SLUMS cognitive test with the future participant at the program and with the family member of the participant the following documentation is filled out, explained, and signed: ➢ Admission Policy ➢ Grievance Policy ➢ Discharge Policy ➢ Participant's Bill of Rights ➢ Financial Agreement ➢ Enrollment Agreement ➢ Medical history ➢ Social assessment ➢ Notice of Privacy Practice ➢ Liability Forms ➢ Authorization for Services ➢ Consent for Medical Emergency Treatment • At the Intake, the Participant chooses 2 required days per week of participation in the program. The choices are either full or half days. • For ach new participant and individualized care plan is developed and followed, along with progress notes, vital sign sheet, medication list. • For each participant family members are informed on regular basis about the progress of the participant and are given on regular basis client satisfaction survey to improve the services and get valued feedback. • Invoices are usually issued on weekly basis. • The program is based on carefully developed acitivities calendar and care plan, including large group, small group stimulating activities and exercise. • Balanced lunch, AM and PM snacks are served, along with required hydration monitoring during the entire opening hours. • Nurse on staff is monitoring the wellbeing of the participants, administers medication and regularly checks vital signs. • Termination of services can be voluntary upon request of the participant's family member or can be done based on discharge policy by the center. Re -imagining Adult Day Stay www.HarmoniaTheClub.com Collier County Solicitation 18-7470S EXH. 1.13 GRANT ASSURANCES AND CERTIFICATIONS ATTACHMENT III CERTIFICATIONS AND ASSURANCES Agency will not award this Contract unless Contractor completes this CERTIFICATIONS AND ASSURANCES. In performance of this contract, Contractor provides the following certifications and assurances: A. B. C. D. Certification Regarding Public Entity Crimes. section 287,133. F.S. E. Association of Communily Organizations for Reform Now (ACORN) Funding Restrictions Assurance (Pub. L. 111-117) F. Scrutinized Companies Lists and No Boycott of Israel Certification. section 287,135. F.S. G. Certification Regarding Data Integrity Compliance for Contracts. Agreements, Grants. Loans. and Cooperative Agreements H. Verification of ,m lloovment Status Certification I. Records and Documentation J. Certification Regarding Inspection of Public Records A. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS — PRIMARY COVERED TRANSACTION. The undersigned Contractor certifies, to the best of its knowledge and belief, that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by a Federal department or agency; 2. Have not within a three-year period preceding this Contract been convicted or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or perfonning a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; 3. Are not presently indicted or otherwise criminally or civilly charged by a government entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph A.2. of this certification; and/or 4. Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State, or local) terminated for cause of default. The undersigned shall require that language of this certification be included in the documents for all subcontracts atall tiers (including subcontracts, sub -grants, and contracts under grants, loans, and cooperative agreements) and that all sub -recipients and contractors shall provide this certification accordingly. GCA-2 7/8/2021 1:08 PM p. 34 Collier County Solicitation 18-7470S EXH. 1.13 GRANT ASSURANCES AND CERTIFICATIONS B. CERTIFICATION REGARDING LOBBYING — CERTIFICATION FOR CONTRACTS, GRANTS, LOANS, AND COOPERATIVE AGREEMENTS. The undersigned Contractor certifies, to the best of its knowledge and belief, that: No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of Congress or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or employee of a Member of Congress in connection with a Federal contract, grant, loan, or cooperative agreement, the undersigned shall also complete and submit Standard Form — LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. The undersigned shall require that language of this certification be included in the documents for all subcontracts atall tiers (including subcontracts, sub -grants, and contracts under grants, loans, and cooperative agreements) and that all sub -recipients and contractors shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this Contract was made or entered into. Submission of this certification is a prerequisite for making or entering into this Contract imposed by 31 U.S.C. 1352. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. C. NON- DISCRIMINATION & EQUAL OPPORTUNITY ASSURANCE (29 CFR PART 37 AND 45 CFR PART 80). - As a condition of the Contract, Contractor assures that it will comply fully with the nondiscrimination and equal opportunity provisions of the following laws: 1. Section 188 of the Workforce Investment Act of 1998 (WIA), (Pub. L. 105-220), which prohibits discrimination against all individuals in the United States on the basis of race, color, religion, sex, national origin, age, disability, political affiliation, or belief, and against beneficiaries on the basis of either citizenship/status as a lawfully admitted immigrant authorized to work in the United States or participation in any WIA Title I -financially assisted program or activity. 2. Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 80), to the end that, in accordance with Title VI of that Act and the Regulation, no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Agency. 3. Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-112), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 84), to the end that, in accordance with Section 504 of that Act and the Regulation, no otherwise qualified handicapped individual in the United States shall, solely by reason of his handicap, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Agency. GCA-3 7/8/2021 1:08 PM p. 35 Collier County Solicitation 18-7470S EXH. 1.13 GRANT ASSURANCES AND CERTIFICATIONS 4. The Age Discrimination Act of 1975 (Pub. L. 94-135), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 91), to the end that, in accordance with the Act and the Regulation, no person in the United States shall, on the basis of age, be denied the benefits of, be excluded from participation in, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Agency. 5. Title IX of the Education Amendments of 1972 (Pub. L. 92-318), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 86), to the end that, in accordance with Title IX and the Regulation, no person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any education program or activity for which the Applicant receives Federal financial assistance from the Agency. 6. The American with Disabilities Act of 1990 (Pub. L. 101-336), which prohibits discrimination in all employment practices, including job application procedures, hiring, firing, advancement, compensation, training, and other terms, conditions, and privileges of employment. It applies to recruitment, advertising, tenure, layoff, leave, fringe benefits, and all other employment -related activities. 7. Contractor also assures that it will comply with 29 CFR Part 37 and all other regulations implementing the laws listed above. This assurance applies to Contractor's operation of the WIA Title I — financially assisted program or activity, and to all contracts Contractor makes to carry out the WIA Title I — financially assisted program or activity. Contractor understands that the Agency and/or DOEA and the United States have the right to seek judicial enforcement of the assurance. The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all tiers (including subcontracts, sub -grants, and contracts under grants, loans, and cooperative agreements) and that all sub -recipients and contractors shall provide this assurance accordingly. D. CERTIFICATION REGARDING PUBLIC ENTITY CRIMES, SECTION 287.133, F.S. Contractor hereby certifies that neither it, nor any person or affiliate of Contractor, has been convicted of a Public Entity Crime as defined in section 287.133, F.S., nor placed on the convicted vendor list. Contractor understands and agrees that it is required to inform Agency immediately upon any change of circumstances regarding this status. E. ASSOCIATION OF COMMUNITY ORGANIZATIONS FOR REFORM NOW (ACORN) FUNDING RESTRICTIONS ASSURANCE (Pub. L. 111-117). As a condition of the Contract, Contractor assures that it will comply fully with the federal funding restrictions pertaining to ACORN and its subsidiaries per the Consolidated Appropriations Act, 2010, Division E, Section 511 (Pub. L. 111-117). The Continuing Appropriations Act, 2011, Sections 101 and 103 (Pub. L. 111-242), provides that appropriations made under Pub. L. 111-117 are available under the conditions provided by Pub. L. 111-117. The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all tiers (including subcontracts, sub -grants and contracts under grants, loans and cooperative agreements) and that all sub - recipients and contractors shall provide this assurance accordingly. F. SCRUTINIZED COMPANIES LISTS AND NO BOYCOTT OF ISRAEL CERTIFICATION, SECTION 287.135, F.S. In accordance with section 287.135, F.S., Contractor hereby certifies that it has not been placed on the Scrutinized Companies that Boycott Israel List and that it is not participating in a boycott of Israel. GCA-4 7/8/2021 1:08 PM p. 36 Collier County Solicitation 18-7470S EXH. 1.13 GRANT ASSURANCES AND CERTIFICATIONS If this Contract is in the amount of $1 million or more, in accordance with the requirements of section 287.135, F.S., Contractor hereby certifies that it is not listed on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List and that it does not have business operations in Cuba or Syria. Contractor understands that pursuant to section 287.135, F.S., the submission of a false certification may result in the Agency terminating this contract and the submission of a false certification may subject Contractor to civil penalties and attorney fees and costs, including any costs for investigations that led to the finding of false certification. If Contractor is unable to certify any of the statements in this certification, Contractor shall attach an explanation to this Contract. G. CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR CONTRACTS, AGREEMENTS, GRANTS, LOANS, AND COOPERATIVE AGREEMENTS 1. The Contractor and any Subcontractors of services under this contract have financial management systems capable of providingcertain information, including: (1) accurate, current, and complete disclosure of the financial results of each grant -funded project or program in accordance with the prescribed reporting requirements; (2) the source and application of funds for all contract supported activities; and (3) the comparison of outlays with budgeted amounts for each award. The inability to process information in accordance with these requirements could result in a return of grant funds that have not been accounted for properly. 2. Management Information Systems used by the Contractor, Subcontractors, or any outside entity on which the Contractor is dependent for data that is to be reported, transmitted, or calculated have been assessed and verified to be capable of processing data accurately, including year -date dependent data. For those systems identified to be non -compliant, Contractors will take immediate action to assure data integrity. 3. If this contract includes the provision of hardware, software, firmware, microcode, or imbedded chiptechnology, the undersigned warrants that these products are capable of processing year -date dependent data accurately. All versions of these products offered by the Contractor (represented by the undersigned) and purchased by the state will be verified for accuracy and integrity of data prior to transfer. 4. In the event of any decrease in functionality related to time and date related codes and internal subroutines that impede the hardware or software programs from operating properly, the Contractor agrees to immediatelymake required corrections to restore hardware and software programs to the same level of functionality as warranted herein, at no charge to the state, and without interruption to the ongoing business of the state, time being of the essence. 5. The Contractor and any Subcontractors of services under this contract warrant that their policies and procedures include a disaster plan to provide for service delivery to continue in case of an emergency, including emergencies arising from data integrity compliance issues. H. VERIFICATION OF EMPLOYMENT STATUS CERTIFICATION As a condition of contracting with the Agency, Contractor certifies the use of the U.S. Department of Homeland Security's E-verify system to verify the employment eligibility of all new employees hired by Contractor during the contract term to perform employment duties pursuant to this contract, and that any subcontracts include an express requirement that Subcontractors performing work or providing services pursuant to this Contract utilize the E-verify system to verify the employment eligibility of all new employees hired by the Subcontractor during the entire contract term. GCA-5 7/8/2021 1:08 PM p. 37 Collier County Solicitation 18-7470S EXH. 1.13 GRANT ASSURANCES AND CERTIFICATIONS The Contractor shall require that the language of this certification be included in all sub -agreements, sub -grants, and other agreements/contracts and that all Subcontractors shall certify compliance accordingly. This certification is a material representation of fact upon which reliance was placed when this Contract was made or entered into. Submission of this certification is a prerequisite for making or entering into this Contract imposed by Circulars A-102 and 2 CFR Part 200 and 215 (formerly OMB Circular A -I 10). I. RECORDS AND DOCUMENTATION The Contractor agrees to make available to Agency staff and/or any party designated by the Agency any and all contract related records and documentation. The Contractor shall ensure the collection and maintenance of all program related information and documentation on any such system designated by the Agency. Maintenance includes valid exports and backups of all data and systems according to Agency standards. J. CERTIFICATION REGARDING INSPECTION OF PUBLIC RECORDS 1. In addition to the requirements of sections 10.1 and 10.2 of the Standard Contract, sections 119.0701(3) and (4) F.S., and any other applicable law, if a civil action is commenced as contemplated by section 119.0701(4), F.S., and the Agency is named in the civil action, Contractor agrees to indemnify and hold harmless the Agency for any costs incurred by the Agency and any attorneys' fees assessed or awarded against the Agency from a Public Records Request made pursuant to Chapter 119, F.S., concerning this contract or services performed thereunder. a. Notwithstanding section 119.0701, F.S., or other Florida law, this section is not applicable to contracts executed between the Agency and state agencies or subdivisions defined in section 768.28(2), F.S. 2. Section 119.01(3), F.S., states if public funds are expended by an agency in payment of dues or membership contributions for any person, corporation, foundation, trust, association, group, or other organization, all the financial, business, and membership records of such an entity which pertain to the public agency (Area Agency on Aging for Southwest Florida, Inc.) are public records. Section 119.07, F.S, states that every person who has custody of such a public record shall permit the record to be inspected and copied by any person desiring to do so, under reasonable circumstances. Additionally, I certify this organization does does not provide for institutional memberships. Contractor's signature below attests that records pertaining to the dues or membership application by the Agency are available for inspection if applicable, as stated above. By execution of this contract, Contractor must include these provisions (A-J) in all related subcontract agreements (if applicable). By signing below, Contractor certifies that the representations outlined in parts A through J above are true and correct. t t 3 � 25_ 1V4h V Signature and Title of Authorized Representative Street Address L-Meatolvo9 THE CL V,s_12,02_1 A,/ FL- 3 Ll o3 Contractor Date City, State, Zip code GCA-6 7/8/2021 1:08 PM p. 38 Collier County Solicitation 18-7470S EXHIBIT 1.13 GRANT CERTIFICATIONS AND ASSURANCES ATTACHMENT IV ASSURANCES--NON-CONSTRUCTION PROGRAMS Public reporting burden for this collection of information is estimated to average forty-five (45) minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget. Paperwork Reduction Project (0348-0043), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET, SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. Note: Certain of these assurances may not be applicable to your project or program. If you have questions please contact the awarding agency. Further, certain federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. 1. Has the legal authority to apply for federal assistance, and the institutional, managerial and financial capability (including funds sufficient to pay the non-federal share of project cost) to ensure proper planning, management, and completion of the project described in this application. 2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the state, throughany authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives. 3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain. 4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awardingagency. 5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. §4728-4763) relating to prescribed standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F). 6. Will comply with all federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. §6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for federal assistance is being made; and 0) the requirements of any other nondiscrimination statute(s) which may apply to the application. GCA-7 7/8/2021 1:08 PM p. 39 Collier County Solicitation 18-7470S EXHIBIT 1.13 GRANT CERTIFICATIONS AND ASSURANCES 7. Will comply, or has already complied, with the requirements of Titles II and III of the uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of federal or federally assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of federal participation in purchases. 8. Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C. §1501-1508 and 7324-7328), which limit the political activities of employees whose principal employment activities are funded in whole or in part with federal funds. 9. Will comply, as applicable, with the provisions of the Davis -Bacon Act (40 U.S.C. §276a to 276a-7), the Copeland Act (40 U.S.C. 276c and 18 U.S.C. §874) and the Contract Work Hours and Safety Standards Act (40 U.S.C. §327-333), regarding labor standards for federally assisted construction sub -contracts. 10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000.00 or more. 11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. §1451 et seq.); (f) conformity of federal actions to State (Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. §7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-523); and (h) protection of endangered species under the Endangered Species Act of 1973, as amended, (P.L. 93-205). 12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. §1721 et seq.) related to protecting components or potential components of the national wild and scenic rivers system. 13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. §470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. §469a-1 et seq.). 14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and related activities supported by this award of assistance. 15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. §2131 et seq.) pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities supported by this award of assistance. 16. Will comply with the Lead -Based Paint Poisoning Prevention Act (42 U.S.C. §4801 et seq.), which prohibits the use of lead- based paint in construction or rehabilitation of residence structures. GCA-8 7/8/2021 1:08 PM p. 40 Collier County Solicitation 18-7470S GRANT CERTIFICATIONS AND ASSURANCES 17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and 2 CFR Part 200. 18. Will comply with all applicable requirements of all other federal laws, executive orders, regulations and policies governing this program. SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL eg11tic -/ TITLE C45-O APPLICANT ORGANIZATION DATE SUBMITTED HiE�tO d1a'z)l(o`1 C,,jpg- tie i' E ' eI.5-lZv21 GCA-9 7/8/2021 1:08 PM p. 41 EXHIBIT 1.B / ATTACHMENT V Collier County Solicitation 18-7470S STATE OF FLORIDA DEPARTMENT OF FI,DF,R AFFATRC CIVIL RIC.HTc COMPLIANCF. CHF.C1CI.ICT Program/Facility Name: County: AAA/Contractor NI Address: 3 rn S AJ Completed By: hl�lN ✓/9 City, State, Zip Code: .S r-L_ 54io3 Date: /5 Aw Telepho e: -') a Lt - G� rAN1 1: KL'AU 1HE Al 1ALHEU IANIKUUIIUNS NUR ILLUS'1'KA'IIVE INh'UKMA'11UN WHICH WILL HELP YOU COMPLETE THIS FORM. 1. Briefly describe the geographic area served by the program/facility and the type of service provided: ejLaE'2L y POP111.197-MA) 60 + fl.DUL i Prey 94TVI� For questions 2-5, please indicate the following: Total # Rio White pro Black era Hispanic pro Other pro Female pro Disabled pro Over 40 2.Population of area served Source of data (e q j 2 j JT p C� 3.Staff currently employed Source of data 4.Clients currently enrolled/registered Source of data ?)10 3 � 100 5.Advisory/Governing Board if applicable Source of data rAKi ir: UaL A JLYAKA t E NHLL I UNrAYEK N'OK ANY EXPLANA'l'IUNS REQUIRING MORE SPACE. 1. Is an Assurance of Compliance on file with DOEA? N/ YES ❑ NO ❑ 2. Compare the staff composition to the population. Is staff representative of the population? WE HOVE 0"01 Feli LE STAFFyo Z�i2�S�f�TlortJ 47� N/A ❑ YES ❑ NO Mftlo -SrEAFTE lirr 3. Are eligibility requirements for services applied to clients and applicants without regard to race, color, national origin, sex, age, religion or disability? N/A ❑ YES X NO ❑ 4. Are all benefits, services and facilities available to applicants and participants in an equally effective manner regardless of race, sex, color, age, national origin, religion or disability? N/A ❑ YES NO ❑ ` 5. For in -patient services, are room assignments made without regard to race, color, national origin or disability? N/A K YES ❑ NO ❑ 6. Is the program/facility accessible to non-English speaking clients? N/A ❑ YES � NO El 7. Are employees, applicants and participants informed of their protection against discrimination? If YES, how? Verbal [% Written ❑ Poster W1 N/A ❑ YES $� NO ❑ 8. Give the number and current status of any discrimination complaints regarding services or employment filed against the program/facility. N/A ❑ NUMBER 0 1 7/8/2021 1:08 PM GCA -10 p. 42 EXHIBIT 1.13 / ATTACHMENT V Collier County Solicitation 18-7470S 9. Is the program/facility physically accessible to mobility, hearing, and sight -impaired individuals? N/A ❑ YES NO [� ❑ PART III: THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15 OR MORE EMPLOYEES. IF NO EXPLAIN 10. Has a self -evaluation been conducted to identify any barriers to serving disabled individuals, and to make any necessary modifications? YES NO ❑ ❑ 11. Is there an established grievance procedure that incorporates due process in the resolution of complaints? YES ❑ NO ❑ 12. Has a person been designated to coordinate Section 504 compliance activities? YES ❑ NO ❑ 13. Do recruitment and notification materials advise applicants, employees and participants of nondiscrimination on the basis of disability? YES ❑ NO ❑ 14. Are auxiliary aids available to assure accessibility of services to hearing and sight -impaired individuals? YES ❑ NO ❑ PART IV: FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF $50,000.00 OR MORE. 15. Do you have a written affirmative action plan? If NO, explain. YES NO ❑ ❑ DOEA USE ONLY Reviewed B In Compliance: YES ❑ NO* ❑ Program Office *Notice of Corrective Action Sent Date Telephone Response Due On -Site ❑ Desk Review ❑ Response Received Revised August 2010, Page 2 of 2 GCA - 11 2 7/8/2021 1:08 PM p. 43 EXIIIBIT LB / ATTACHMENT V INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST 1. Describe the geographic service area such as a district, county, city or other locality. If the program/facility serves a specific target population such as adolescents, describe the target population. Also, define the type of service provided. 2. Enter the percent of the population served by race and sex. The population served includes persons in the geographical area for which services are provided such as a city, county or other regional area. Population statistics can be obtained from local chambers of commerce, libraries, or any publication from the 1980 Census containing Florida population statistics. Include the source of your population statistics. ("Other" races include Asian/Pacific Islanders and American Indian/Alaskan Natives.) 3. Enter the total number of full-time staff and their percent by race, sex and disability. Include the effective date of your summary. 4. Enter the total number of clients who are enrolled, registered or currently served by the program or facility, and list their percent by race, sex and disability. Include the date that enrollment was counted. 5. Enter the total number of advisory board members and their percent by race, sex, and disability. If there is no advisory or governing board, leave this section blank. 6. Each recipient of federal financial assistance must have on file an assurance that the program will be conducted in compliance with all nondiscriminatory provisions as required in 45 CFR 80. This is usually a standard part of the contract language for DOEA recipients and their sub -grantees, 45 CFR 80.4 (a). 7. Is the race, sex, and national origin of the staff reflective of the general population? For example, if 10% of the population is Hispanic, is there a comparable percentage of Hispanic staff? 8. Where there is a significant variation between the race, sex or ethnic composition of the clients and their availability in the population, the program/facility has the responsibility to determine the reasons for such variation and take whatever action may be necessary to correct any discrimination. Some legitimate disparities may exist when programs are sanctioned to serve target populations such as elderly or disabled persons, 45 CFR 80.3 (b) (6). 9. Do eligibility requirements unlawfully exclude persons in protected groups from the provision of services or employment? Evidence of such may be indicated in staff and client representation (Questions 3 and 4) and also through on -site record analysis of persons who applied but were denied services or employment, 45 CFR 80.3 (a) and 45 CFR 80.1 (b) (2). 10. Participants or clients must be provided services such as medical, nursing and dental care, laboratory services, physical and recreational therapies, counseling and social services without regard to race, sex, color, national origin, religion, age or disability. Courtesy titles, appointment scheduling and accuracy of record keeping must be applied uniformly and without regard to race, sex, color, national origin, religion, age or disability. Entrances, waiting rooms, reception areas, restrooms and other facilities must also be equally available to all clients, 45 CFR 80.3 (b). II. For in -patient services, residents must be assigned to rooms, wards, etc., without regard to race, color, national origin or disability. Also, residents must not be asked whether they are willing to share accommodations with persons of a different race, color, national origin, or disability, 45 CFR 80.3 (a). 12. The program/facility and all services must be accessible to participants and applicants, including those persons who may not speak English. In geographic areas where a significant population of non-English speaking people live, program accessibility may include the employment of bilingual staff. In other areas, it is sufficient to have a policy or plan for service, such as a current list of names and telephone numbers of bilingual individuals who will assist in the provision of services, 45 CFR 80.3 (a). GCA - 12 EXHIBIT LB / ATTACHM ENT V 13. Programs/facilities must make information regarding the nondiscriminatory provisions of Title VI available to their participants, beneficiaries or any other interested parties. This should include information on their right to file a complaint of discrimination with either the Florida Department of Elder Affairs or the U.S. Department of HHS. The information may be supplied verbally or in writing to every individual, or may be supplied through the use of an equal opportunity policy poster displayed in a public area of the facility, 45 CFR 80.6 (d). 14. Report number of discrimination complaints filed against the program/facility. Indicate the basis, e.g., race, color, creed, sex, age, national origin, disability, retaliation; the issues involved, e.g., services or employment, placement, termination, etc. Indicate the civil rights law or policy alleged to have been violated along with the name and address of the local, state or federal agency with whom the complaint has been filed. Indicate the current status, e.g., settled, no reasonable cause found, failure to conciliate, failure to cooperate, under review, etc. 15. The program/facility must be physically accessible to disabled individuals. Physical accessibility includes designated parking areas, curb cuts or level approaches, ramps and adequate widths to entrances. The lobby, public telephone, restroom facilities, water fountains, information and admissions offices should be accessible. Door widths and traffic areas of administrative offices, cafeterias, restrooms, recreation areas, counters and serving lines should be observed for accessibility. Elevators should be observed for door width, and Braille or raised numbers. Switches and controls for light, heat, ventilation, fire alarms, and other essentials should be installed at an appropriate height for mobility impaired individuals. 16. Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance conduct a self - evaluation to identify any accessibility barriers. Self -evaluation is a four step process: a. With the assistance of a disabled individual/organization, evaluate current practices and policies which do not comply with Section 504. b. Modify policies and practices that do not meet Section 504 requirements. c. Take remedial steps to eliminate any discrimination that has been identified. d. Maintain self -evaluation on file. (This checklist may be used to satisfy this requirement if these four steps have been followed.), 45 CFR 84.6. 17. Programs or facilities that employ 15 or more persons must adopt grievance procedures that incorporate appropriate due process standards and provide for the prompt and equitable resolution of complaints alleging any action prohibited by Section 504.45 CFR 84.7 (b). 18. Programs or facilities that employ 15 or more persons must designate at least one person to coordinate efforts to comply with Section 504.45 CFR 84.7 (a). 19. Continuing steps must be taken to notify employees and the public of the program/facility's policy of nondiscrimination on the basis of disability. This includes recruitment material, notices for hearings, newspaper ads, and other appropriate written communication, 45 CFR 84.8 (a). 20. Programs/facilities that employ 15 or more persons must provide appropriate auxiliary aids to persons with impaired sensory, manual or speaking skills where necessary. Auxiliary aids may include, but are not limited to, interpreters for hearing impaired individuals, taped or Braille materials, or any alternative resources that can be used to provide equally effective services, 45 CFR 84.52 (d). 21. Programs/facilities with 50 or more employees and $50,000.00 in federal contracts must develop, implement and maintain a written affirmative action compliance program in accordance with Executive Order 11246, 41 CFR 60 and Title VI of the Civil Rights Act of 1964, as amended. DOEA Form 101-B, Revised August 2010 GCA - 13 EXHIBIT l.B /ATTACHMENT VII Collier County Solicitation 18-7470S DEPARTMENT OF BACKGROUND SCREENING ELDER AFOF FLORIDA FAIRS' Affidavit of Compliance - Employer AUTHORITY: This form is required annually of all employers to comply with the attestation requirements set forth in section 435.05(3), Florida Statutes. ➢ The term "employer" means any person or entity required by law to conduct background screening, including but not limited to, Area Agencies on Aging, Aging Resource Centers, Aging and Disability Resource Centers, Lead Agencies, Long -Term Care Ombudsman Program, Serving Health Insurance Needs of Elders Program, Service Providers, Diversion Providers, and any other person or entity which hires employees or has volunteers in service who meet the definition of a direct service provider. See §§ 435.02, 430.0402, Fla. Stat. A direct service provider is "a person 18 years of age or older who, pursuant to a program to provide services to the elderly, has direct, face-to-face contact with a client while providing services to the client and has access to the client's living area, funds, personal property, or personal identification information as defined in s. 817.568. The term includes coordinators, managers, and supervisors of residential facilities; and volunteers." § 430.0402(1)(b), Fla. Stat. ATTESTATION: As the duly authorized representative of HL110 hC-DJ)-eJ'9 if, Pc JL6 ;D33<9 H/9911`10All /9 'fil�E a r Employer Name located at 3�%2. ) CI'�17 '-Sf /�<� e�JLGt JUFi�LC-`� % l /cO Street Address City State ZIP code I, niR.109ti k ,%19 A), Col"A do hereby affirm under penalty of perjury Name of Representative that the above named employer is in compliance with the provisions of Chapter 435 and section 430.0402, Florida Statutes, regarding level 2 background screening. d 16& i Signature of Representative Date STATE OF FLORIDA, COUNTY OF Sworn to (or affirmed) and subscribed before me this day of 1 UkX l.tSX 20 by W\ VcZC'w. rr (Name of Representative) who is personally known to me or produced _ as proof of identification. TERRI TAWORSKI `G-t-reiijeoiNotd,�oi&jR�ion#GG340455 pGa ^; L_ r Public, State of Florida Print, Type, or Stamp CommitaryPUbliC My comm. expires July 6, 2023 DOEA Form 235, Affidavit of Compliance - Employer, Effective April 2012 Form available at: http://elderaffairs.state.fl.us/english/backgroundscreening.phi) 7/8/2021 1:08 PM Section 435.05(3), F.S. p. 46 GCA - 14 Collier County Solicitation 18-7470S EXHIBIT 1.13 I1f - I t 3-as Collier County Solicitation No. GRANT CERTIFICATIONS AND ASSURANCES COLLIER COUNTY Conflict of Interest Certification 11 F1 I l? I do %F_qkAA/1 &(0 , hereby certify that to the best of my knowledge, neither I nor my spouse, dependent child, general partner, or any organization for which I am serving as an officer, director, trustee, general partner or employee, or any person or organization with whom I am negotiating or have an arrangement concerning prospective employment has a financial interest in this matter. I further certify to the best of my knowledge that this matter will not affect the financial interests of any member of my household. Also, to the best of my knowledge, no member of my household; no relative with whom I have a close relationship; no one with whom my spouse, parent or dependent child has or seeks employment; and no organization with which I am seeking a business relationship nor which I now serve actively or have served within the last year are parties or represent a party to the matter. I also acknowledge my responsibility to disclose the acquisition of any financial or personal interest as described above that would be affected by the matter, and to disclose any interest I, or anyone noted above, has in any person or organization that does become involved in, or is affected at a later date by, the conduct of this matter. H t I% M La_5M >ii W OA �� 2 Name Signature C-IFc� e 1-6-/z02 / Position Date Privacy Act Statement Title I of the Ethics in Government Act of 1978 (5 U.S.C. App.), Executive Order 12674 and 5 CFR Part 2634, Subpart I require the reporting of this information. The primary use of the information on this form is for review by officials of The Justice Department to determine compliance with applicable federal conflict of interest laws and regulations. Additional disclosures of the information on this report may be made: (1) to a federal, state or local law enforcement agency if the Justice Department becomes aware of a violation or potential violation of law or regulations; (2) to a court or party in a court or federal administrative proceeding if the government is a party or in order to comply with a judge -issued subpoena; (3) to a source when necessary to obtain information relevant to a conflict of interest investigation or decision; (4) to the National Archives and Records Administration or the General Services Administration in records management inspections; (5) to the Office of Management and Budget during legislative coordination on private relief legislation; and (6) in response to a request for discovery or for the appearance of a witness in a judicial or administrative proceeding, if the information is relevant to the subject matter. This confidential certification will not be disclosed to any requesting person unless authorized by law. See also the OGE/GOVT-2 executive branch -wide Privacy Act system of records. GCA - 15 7/8/2021 1:08 PM p. 47 EXHIBIT 1.13 GRANT CERTIFICATIONS AND ASSURANCES COLLIER COUNTY ANTICIPATED DISADVANTAGED, MINORITY, WOMEN OR VETERAN PARTICIPATION STATEMENT Status will be verified. Unverifiable statuses will require the PRIME to either proivde a revised statement or provide source documentation that validates a A. PRIME VENDOR/CONTRACTOR INFORMATION PRIME NAME PRIME FE4D NUMBER CONTRACT DOLLAR AMOUNT J4M N ( ISTHE PRIME A FLORIDA-CERTIFIED DISADVANTAGED, VETERAN V N pS THE ACTIVITY OF THIS CONTRACT._ MINORITi OR WOMEN BUSINESS ENTERPRISE? DBE? Y `N CONSTRUCTION ? Y N (DBUMBEJWBE) OR HAVE A SMALL DISADVANTAGED BUSINESSSA CERTIFICATION FROM THE SMALL BUSINESS MBE? Y N CONSULTATION? V N ADMINISTRATION? A SERVICE DISABLED VETERAN? WBE? Y N OTHER? (� N SOB SA? Y N IS THIS SUBMISSION A REVISION? 'Y N `F YES, REVISION NUMBER B. IF PRIME HAS SUBCONTRACTOR OR SUPPLIER WHO IS A DISADVANTACsED MINORITY, WOMEN -OWNED, SMALL BUSINESS CONCERN OR SERVICE DISABLED VETERAN, PRIME IS TO COMPLETE THIS NEXT SECTION DBE WWBE SUBCONTRACTOR OR SUPPLIER I TYPE OF WORK OR I ETHNICITY CODE I SUB/SUPPLIER PERCEW OF CONTRACT VETER1 I NAME SPECIALTY ISee Belov+l DOLLAR AMOUNT I DOLLARS -OTAL C. SECTION TO BE COMPLETED BY PRIME VENDOR/CONTRACTOR NAME OF SUBMTTTER DATE TFrLE OF SUBMrrTER EMAIL ADDRESS OF PRIME {SUBMITTER) TELEPHONE NUMBER FAX NUMBER him,grf nHAe►16A)i ►-rr,FCJ/A .23�I-V3Lt- 41;V, U 39C--A23e2 NOTE: This information is used to track and report anticipated DBE or MBE participation in federally -funded contracts_ The anticipated DBE or M BE amount is vol unary and will not become part of the contractual terms. This form must be submitted at time of response to a solicitation_ if and when awarded a County contract, the prime will be asked to update the information for the grant compliance files. ETHNICITY CODE Black American BA MispanicAmerican HA Native American NA Subcant. Asian American SAA Asian-PacificAmencan APA Non -Minority Women tJF.'ItiV Other: not of any other group listed o D. SECTION TO BE COMPLETED BY COLLIER COUNTY DEPARTMENT NAME I COLLIER CONTRACT; (IFBfRFP or PQ/REOS I GRANT PROGRAWCONTRACT IIAOCEPTEDBY: I DATE I GCA - 16 EXHIBIT 13 GRANT CERTIFICATIONS AND ASSURANCES COLLIER COUNTY GRANT (701APLIANCE FORM PID OPPORTUNITY LIST FOR COMMODITIES AND CONTRACTUAL SERVICES AND PROFESSIONAL CONSULTANT SERVICES rr is the policy cf cofAer county that disadvantaged businesses and minority vendors, as defined in the code of Federal Regufations (cFR) or Florida Statutes fFS1 must have the opportunity to portkipate an c �ontracts *YrhA.de ro(orWor state 'ran�tf7ass©isranceel.. A sn r Prime Comractor/Prime Consultant: yC�f 0 h�.DI �} l_.tyz /ILC�C� �v iO I' / 116� ' `0N ( %9 Address and Phone Number: 3 / )v r , l st /V Procurement Number/Advertisement Number: The list below is intended to be a listing aF firms that are, or attempting to, participate on the project numbered above. The list must include the firm bidding or quoting as prime, as well as subs and suppliers quoting for participation_ Prime contractors and consultants must provide irtformation for Numbers 1, 2, 3, and a, and, should provide anv information they have for Numbers 5,. 6, 7, and 8. This form must be submitted with the bid package_ 1. Federal Tax ID Number: V — L f o 55- 4t 2—) 6. DBE 8.. Ann I G toss Receipts 2. Firm Name: HfIletiollikhE CLU Non -DBE Less than $ 1 million 3. Phone Number: .216? 0 I Lj 4,604fv Between $1-5 million 4. Address .342 6 1,D th Jt 0 Between $ 5-10 million ? subcontractor Between $ 10-15 mNlion IV Subconsuttant More than 515 million S. Year Firm Established: K 01'1 - o" 'i2oaQ 1. Federal Tax ID Number: 6. DBE a. Annual Gross Receipts 2. Firm Name: Non -DBE Less than $ 1 million 3. Phone Number: Between $ 1-5 million 4. Address Between $ 5-10 million 7.8 Subcontractor Between $ 10-15 million Subconsuttant More than $ 15 mil lion 5. Year Firm Established: 1. Federal Tax ID Number: 6. DBE 8_ Annual Gross Receipts 2. Firm Name: Nan -DBE Less than $ 1 million 3. Phone Number: Between 5 1-5 million a. Address Between 5 5-10 million 7. Between $ 10-15 million aSubcontractor Subconsuttant More than $ 15 million 5. Year Firm Established: 1. Federal Tax 10 Number: 6.R DBE a. Annual G toss Receipts 2. Firm Name: Nort-DBE Less than $ 1 and lion 3. Phone Number: Between $ 1-5 million 4. Address Between $ 5-10 million 7. �—r 1 1 subcontractor Between $ 10-15 million IIL—J11 Subconsuftant More than 5 15 million 5. Year Firm Established: GCA - 17 TN E- CLC),b 31i i 03 Collier County Solicitation 18-7470S EXHIBIT I.B GRANT CERTIFICATIONS AND ASSURANCES COLLIER COUNTY Acknowledgement of Terms, Conditions, and Grant Clauses Flow Down of Terms and Conditions from the Grant Agreement Subcontracts: If the Contractor subcontracts any of the work required under this Agreement, a copy of the signed subcontract must be available to the County for review and approval. The Contractor agrees to include in the subcontract that (1) the subcontractor is bound by the terms of this Agreement, (ii) the subcontractor is bound by all applicable state and federal laws and regulations, and (iii) the subcontractor shall hold the County and the Grantor Agency harmless against all claims of whatever nature arising out of the subcontractor's performance of work under this Agreement, to the extent allowed and required by law. The County may document in the quarterly report the Contractor's progress in performing its work under this agreement. Certification On behalf of my firm, I acknowledge, and agree to perform all of the specifications and grant requirements identified in this solicitation document(s). Vendor/Contractor Name Nf'p.Mok.,l9 THE CLU1_ Date S'/5/2v2/ Authorized Signature Address 3�2li- iio-fh A./ �u-4�4e 1. kjAD1O_� FL 3 Solicitation/Contract# Af — 1430's GCA-18 05/20 R4 7/8/2021 1:08 PM p. 50 COLLIER COUNTY BUSINESS TAX BUSINESS TAX NUMBER: 210764 COLLIER COUNTY TAX COLLECTOR - 2800 N. HORSESHOE DRIVE - NAPLES FLORIDA 34104 - (239) 252-2477 VISIT OUR WEBSITE AT: www.colliertax.com THIS RECEIPT EXPIRES SEPTEMBER 30, 2021 ` DISPLAY AT PLACE OF BUSINESS FOR PUBLIC INSPECTION, LOCATION: 3425 10TH ST N #1 ZONED C 4 �" FAILURE TO DO SO IS CONTRARY TO LOCAL LAWS. BUSINESS PHONE: 239-234-4608 I �q FL (" ' HEMO MEDIKA CARE LLC STATE OR COUNTY LIC #: 9475 LLC HARMONIA THE CLUB "HEMO MEDIKA CARE LLC 1-5 EMPLOYEES / ADULT DAY CARE CEN R CLASSIFICATION: FAMILY DAY CARE CLASSIFICATION CODE: 03719001,rM" This document is a business tax only. This is not certification that license- is qualified. It does not permit the licensee to violate any existing regulatory zoning laws of the state, county; or cities` nor does it exempt the licensee from any other taxes or permits that may be required by law. 3425 10TH ST N #1 NAPLES, FL 34103 -THIS TAX IS NON -REFUNDABLE - DATE 09/28/2020 AMOUNT 22.00 RECEIPT 502-21-00140787 State of Florida Department of State I certify from the records of this office that HEMO MEDIKA CARE LLC is a limited liability company organized under the laws of the State of Florida, filed on April 18, 2017, effective April 13, 2017. The document number of this limited liability company is L17000085859. I further certify that said limited liability company has paid all fees due this office through December 31, 2021, that its most recent annual report was filed on May 1, 2021, and that its status is active. Given under my hand and the Great Seal of the State of Florida at Tallahassee, the Capital, this the Third day of July, 2021 *04 Secretary State Tracking Number: 1729535874CU To authenticate this certificate,visit the following site,enter this number, and then follow the instructions displayed. https:Hservices.sunbiz.org/FilingsICertificateOfStatus/C ertificateAuthentication � sect v- orE-Verif Company ID Number: 1723880 THE E-VERIFY MEMORANDUM OF UNDERSTANDING FOR EMPLOYERS ARTICLE I PURPOSE AND AUTHORITY The parties to this agreement are the Department of Homeland Security (DHS) and the HEMO MEDIKA CARE LLC (Employer). The purpose of this agreement is to set forth terms and conditions which the Employer will follow while participating in E-Verify. E-Verify is a program that electronically confirms an employee's eligibility to work in the United States after completion of Form 1-9, Employment Eligibility Verification (Form 1-9). This Memorandum of Understanding (MOU) explains certain features of the E-Verify program and describes specific responsibilities of the Employer, the Social Security Administration (SSA), and DHS. Authority for the E-Verify program is found in Title IV, Subtitle A, of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996 (IIRIRA), Pub. L. 104-208, 110 Stat. 3009, as amended (8 U.S.C. § 1324a note). The Federal Acquisition Regulation (FAR) Subpart 22.18, "Employment Eligibility Verification" and Executive Order 12989, as amended, provide authority for Federal contractors and subcontractors (Federal contractor) to use E-Verify to verify the employment eligibility of certain employees working on Federal contracts. ARTICLE II RESPONSIBILITIES A. RESPONSIBILITIES OF THE EMPLOYER 1. The Employer agrees to display the following notices supplied by DHS in a prominent place that is clearly visible to prospective employees and all employees who are to be verified through the system: a. Notice of E-Verify Participation b. Notice of Right to Work 2. The Employer agrees to provide to the SSA and DHS the names, titles, addresses, and telephone numbers of the Employer representatives to be contacted about E-Verify. The Employer also agrees to keep such information current by providing updated information to SSA and DHS whenever the representatives' contact information changes. 3. The Employer agrees to grant E-Verify access only to current employees who need E-Verify access. Employers must promptly terminate an employee's E-Verify access if the employer is separated from the company or no longer needs access to E-Verify. Page 1 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 � sect v- orE-Verif Company ID Number: 1723880 4. The Employer agrees to become familiar with and comply with the most recent version of the E-Verify User Manual. 5. The Employer agrees that any Employer Representative who will create E-Verify cases will complete the E-Verify Tutorial before that individual creates any cases. a. The Employer agrees that all Employer representatives will take the refresher tutorials when prompted by E-Verify in order to continue using E-Verify. Failure to complete a refresher tutorial will prevent the Employer Representative from continued use of E-Verify. 6. The Employer agrees to comply with current Form 1-9 procedures, with two exceptions: a. If an employee presents a "List B" identity document, the Employer agrees to only accept "List B" documents that contain a photo. (List B documents identified in 8 C.F.R. § 274a.2(b)(1)(B)) can be presented during the Form I-9 process to establish identity.) If an employee objects to the photo requirement for religious reasons, the Employer should contact E-Verify at 888-464-4218. b. If an employee presents a DHS Form 1-551 (Permanent Resident Card), Form 1-766 (Employment Authorization Document), or U.S. Passport or Passport Card to complete Form 1-9, the Employer agrees to make a photocopy of the document and to retain the photocopy with the employee's Form 1-9. The Employer will use the photocopy to verify the photo and to assist DHS with its review of photo mismatches that employees contest. DHS may in the future designate other documents that activate the photo screening tool. Note: Subject only to the exceptions noted previously in this paragraph, employees still retain the right to present any List A, or List B and List C, document(s) to complete the Form 1-9. 7. The Employer agrees to record the case verification number on the employee's Form 1-9 or to print the screen containing the case verification number and attach it to the employee's Form 1-9. 8. The Employer agrees that, although it participates in E-Verify, the Employer has a responsibility to complete, retain, and make available for inspection Forms 1-9 that relate to its employees, or from other requirements of applicable regulations or laws, including the obligation to comply with the antidiscrimination requirements of section 274B of the INA with respect to Form 1-9 procedures. a. The following modified requirements are the only exceptions to an Employer's obligation to not employ unauthorized workers and comply with the anti -discrimination provision of the INA: (1) List B identity documents must have photos, as described in paragraph 6 above; (2) When an Employer confirms the identity and employment eligibility of newly hired employee using E-Verify procedures, the Employer establishes a rebuttable presumption that it has not violated section 274A(a)(1)(A) of the Immigration and Nationality Act (INA) with respect to the hiring of that employee; (3) If the Employer receives a final nonconfirmation for an employee, but continues to employ that person, the Employer must notify DHS and the Employer is subject to a civil money penalty between $550 and $1,100 for each failure to notify DHS of continued employment following a final nonconfirmation; (4) If the Employer continues to employ an employee after receiving a final nonconfirmation, then the Employer is subject to a rebuttable presumption that it has knowingly Page 2 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 � sect v- orE-Verif Company ID Number: 1723880 employed an unauthorized alien in violation of section 274A(a)(1)(A); and (5) no E-Verify participant is civilly or criminally liable under any law for any action taken in good faith based on information provided through the E-Verify. b. DHS reserves the right to conduct Form 1-9 compliance inspections, as well as any other enforcement or compliance activity authorized by law, including site visits, to ensure proper use of E-Verify. 9. The Employer is strictly prohibited from creating an E-Verify case before the employee has been hired, meaning that a firm offer of employment was extended and accepted and Form 1-9 was completed. The Employer agrees to create an E-Verify case for new employees within three Employer business days after each employee has been hired (after both Sections 1 and 2 of Form 1-9 have been completed), and to complete as many steps of the E-Verify process as are necessary according to the E-Verify User Manual. If E-Verify is temporarily unavailable, the three-day time period will be extended until it is again operational in order to accommodate the Employer's attempting, in good faith, to make inquiries during the period of unavailability. 10. The Employer agrees not to use E-Verify for pre -employment screening of job applicants, in support of any unlawful employment practice, or for any other use that this MOU or the E-Verify User Manual does not authorize. 11. The Employer must use E-Verify for all new employees. The Employer will not verify selectively and will not verify employees hired before the effective date of this MOU. Employers who are Federal contractors may qualify for exceptions to this requirement as described in Article II.B of this MOU. 12. The Employer agrees to follow appropriate procedures (see Article III below) regarding tentative nonconfirmations. The Employer must promptly notify employees in private of the finding and provide them with the notice and letter containing information specific to the employee's E-Verify case. The Employer agrees to provide both the English and the translated notice and letter for employees with limited English proficiency to employees. The Employer agrees to provide written referral instructions to employees and instruct affected employees to bring the English copy of the letter to the SSA. The Employer must allow employees to contest the finding, and not take adverse action against employees if they choose to contest the finding, while their case is still pending. Further, when employees contest a tentative nonconfirmation based upon a photo mismatch, the Employer must take additional steps (see Article III.B. below) to contact DHS with information necessary to resolve the challenge. 13. The Employer agrees not to take any adverse action against an employee based upon the employee's perceived employment eligibility status while SSA or DHS is processing the verification request unless the Employer obtains knowledge (as defined in 8 C.F.R. § 274a.1(1)) that the employee is not work authorized. The Employer understands that an initial inability of the SSA or DHS automated verification system to verify work authorization, a tentative nonconfirmation, a case in continuance (indicating the need for additional time for the government to resolve a case), or the finding of a photo mismatch, does not establish, and should not be interpreted as, evidence that the employee is not work authorized. In any of such cases, the employee must be provided a full and fair opportunity to contest the finding, and if he or she does so, the employee may not be terminated or suffer any adverse employment consequences based upon the employee's perceived employment eligibility status Page 3 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 � sect v- orE-Verif Company ID Number: 1723880 (including denying, reducing, or extending work hours, delaying or preventing training, requiring an employee to work in poorer conditions, withholding pay, refusing to assign the employee to a Federal contract or other assignment, or otherwise assuming that he or she is unauthorized to work) until and unless secondary verification by SSA or DHS has been completed and a final nonconfirmation has been issued. If the employee does not choose to contest a tentative nonconfirmation or a photo mismatch or if a secondary verification is completed and a final nonconfirmation is issued, then the Employer can find the employee is not work authorized and terminate the employee's employment. Employers or employees with questions about a final nonconfirmation may call E-Verify at 1-888-464- 4218 (customer service) or 1-888-897-7781 (worker hotline). 14. The Employer agrees to comply with Title VI of the Civil Rights Act of 1964 and section 274B of the INA as applicable by not discriminating unlawfully against any individual in hiring, firing, employment eligibility verification, or recruitment or referral practices because of his or her national origin or citizenship status, or by committing discriminatory documentary practices. The Employer understands that such illegal practices can include selective verification or use of E-Verify except as provided in part D below, or discharging or refusing to hire employees because they appear or sound "foreign" or have received tentative nonconfirmations. The Employer further understands that any violation of the immigration -related unfair employment practices provisions in section 274B of the INA could subject the Employer to civil penalties, back pay awards, and other sanctions, and violations of Title VI could subject the Employer to back pay awards, compensatory and punitive damages. Violations of either section 274B of the INA or Title VII may also lead to the termination of its participation in E-Verify. If the Employer has any questions relating to the anti -discrimination provision, it should contact OSC at 1-800-255-8155 or 1-800-237-2515 (TDD). 15. The Employer agrees that it will use the information it receives from E-Verify only to confirm the employment eligibility of employees as authorized by this MOU. The Employer agrees that it will safeguard this information, and means of access to it (such as PINS and passwords), to ensure that it is not used for any other purpose and as necessary to protect its confidentiality, including ensuring that it is not disseminated to any person other than employees of the Employer who are authorized to perform the Employer's responsibilities under this MOU, except for such dissemination as may be authorized in advance by SSA or DHS for legitimate purposes. 16. The Employer agrees to notify DHS immediately in the event of a breach of personal information. Breaches are defined as loss of control or unauthorized access to E-Verify personal data. All suspected or confirmed breaches should be reported by calling 1-888-464-4218 or via email at E-Verify(@dhs.gov. Please use "Privacy Incident — Password" in the subject line of your email when sending a breach report to E-Verify. 17. The Employer acknowledges that the information it receives from SSA is governed by the Privacy Act (5 U.S.C. § 552a(i)(1) and (3)) and the Social Security Act (42 U.S.C. 1306(a)). Any person who obtains this information under false pretenses or uses it for any purpose other than as provided for in this MOU may be subject to criminal penalties. 18. The Employer agrees to cooperate with DHS and SSA in their compliance monitoring and evaluation of E-Verify, which includes permitting DHS, SSA, their contractors and other agents, upon Page 4 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 � sect v- orE-Verif Company ID Number: 1723880 reasonable notice, to review Forms 1-9 and other employment records and to interview it and its employees regarding the Employer's use of E-Verify, and to respond in a prompt and accurate manner to DHS requests for information relating to their participation in E-Verify. 19. The Employer shall not make any false or unauthorized claims or references about its participation in E-Verify on its website, in advertising materials, or other media. The Employer shall not describe its services as federally -approved, federally -certified, or federally -recognized, or use language with a similar intent on its website or other materials provided to the public. Entering into this MOU does not mean that E-Verify endorses or authorizes your E-Verify services and any claim to that effect is false. 20. The Employer shall not state in its website or other public documents that any language used therein has been provided or approved by DHS, USCIS or the Verification Division, without first obtaining the prior written consent of DHS. 21. The Employer agrees that E-Verify trademarks and logos may be used only under license by DHS/USCIS (see M-795 (Web)) and, other than pursuant to the specific terms of such license, may not be used in any manner that might imply that the Employer's services, products, websites, or publications are sponsored by, endorsed by, licensed by, or affiliated with DHS, USCIS, or E-Verify. 22. The Employer understands that if it uses E-Verify procedures for any purpose other than as authorized by this MOU, the Employer may be subject to appropriate legal action and termination of its participation in E-Verify according to this MOU. B. RESPONSIBILITIES OF FEDERAL CONTRACTORS 1. If the Employer is a Federal contractor with the FAR E-Verify clause subject to the employment verification terms in Subpart 22.18 of the FAR, it will become familiar with and comply with the most current version of the E-Verify User Manual for Federal Contractors as well as the E-Verify Supplemental Guide for Federal Contractors. 2. In addition to the responsibilities of every employer outlined in this MOU, the Employer understands that if it is a Federal contractor subject to the employment verification terms in Subpart 22.18 of the FAR it must verify the employment eligibility of any "employee assigned to the contract" (as defined in FAR 22.1801). Once an employee has been verified through E-Verify by the Employer, the Employer may not create a second case for the employee through E-Verify. a. An Employer that is not enrolled in E-Verify as a Federal contractor at the time of a contract award must enroll as a Federal contractor in the E-Verify program within 30 calendar days of contract award and, within 90 days of enrollment, begin to verify employment eligibility of new hires using E-Verify. The Employer must verify those employees who are working in the United States, whether or not they are assigned to the contract. Once the Employer begins verifying new hires, such verification of new hires must be initiated within three business days after the hire date. Once enrolled in E-Verify as a Federal contractor, the Employer must begin verification of employees assigned to the contract within 90 calendar days after the date of enrollment or within 30 days of an employee's assignment to the contract, whichever date is later. Page 5 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 � sect v- orE-Verif Company ID Number: 1723880 b. Employers enrolled in E-Verify as a Federal contractor for 90 days or more at the time of a contract award must use E-Verify to begin verification of employment eligibility for new hires of the Employer who are working in the United States, whether or not assigned to the contract, within three business days after the date of hire. If the Employer is enrolled in E-Verify as a Federal contractor for 90 calendar days or less at the time of contract award, the Employer must, within 90 days of enrollment, begin to use E-Verify to initiate verification of new hires of the contractor who are working in the United States, whether or not assigned to the contract. Such verification of new hires must be initiated within three business days after the date of hire. An Employer enrolled as a Federal contractor in E-Verify must begin verification of each employee assigned to the contract within 90 calendar days after date of contract award or within 30 days after assignment to the contract, whichever is later. c. Federal contractors that are institutions of higher education (as defined at 20 U.S.C. 1001(a)), state or local governments, governments of Federally recognized Indian tribes, or sureties performing under a takeover agreement entered into with a Federal agency under a performance bond may choose to only verify new and existing employees assigned to the Federal contract. Such Federal contractors may, however, elect to verify all new hires, and/or all existing employees hired after November 6, 1986. Employers in this category must begin verification of employees assigned to the contract within 90 calendar days after the date of enrollment or within 30 days of an employee's assignment to the contract, whichever date is later. d. Upon enrollment, Employers who are Federal contractors may elect to verify employment eligibility of all existing employees working in the United States who were hired after November 6, 1986, instead of verifying only those employees assigned to a covered Federal contract. After enrollment, Employers must elect to verify existing staff following DHS procedures and begin E-Verify verification of all existing employees within 180 days after the election. e. The Employer may use a previously completed Form 1-9 as the basis for creating an E-Verify case for an employee assigned to a contract as long as: i. That Form 1-9 is complete (including the SSN) and complies with Article II.A.6, ii. The employee's work authorization has not expired, and iii. The Employer has reviewed the Form 1-9 information either in person or in communications with the employee to ensure that the employee's Section 1, Form 1-9 attestation has not changed (including, but not limited to, a lawful permanent resident alien having become a naturalized U.S. citizen). f. The Employer shall complete a new Form 1-9 consistent with Article II.A.6 or update the previous Form 1-9 to provide the necessary information if: i. The Employer cannot determine that Form 1-9 complies with Article II.A.6, ii. The employee's basis for work authorization as attested in Section 1 has expired or changed, or iii. The Form 1-9 contains no SSN or is otherwise incomplete. Note: If Section 1 of Form 1-9 is otherwise valid and up-to-date and the form otherwise complies with Page 6 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 � sect v- orE-Verif Company ID Number: 1723880 Article II.C.5, but reflects documentation (such as a U.S. passport or Form 1-551) that expired after completing Form 1-9, the Employer shall not require the production of additional documentation, or use the photo screening tool described in Article II.A.5, subject to any additional or superseding instructions that may be provided on this subject in the E-Verify User Manual. g. The Employer agrees not to require a second verification using E-Verify of any assigned employee who has previously been verified as a newly hired employee under this MOU or to authorize verification of any existing employee by any Employer that is not a Federal contractor based on this Article. 3. The Employer understands that if it is a Federal contractor, its compliance with this MOU is a performance requirement under the terms of the Federal contract or subcontract, and the Employer consents to the release of information relating to compliance with its verification responsibilities under this MOU to contracting officers or other officials authorized to review the Employer's compliance with Federal contracting requirements. C. RESPONSIBILITIES OF SSA 1. SSA agrees to allow DHS to compare data provided by the Employer against SSA's database. SSA sends DHS confirmation that the data sent either matches or does not match the information in SSA's database. 2. SSA agrees to safeguard the information the Employer provides through E-Verify procedures. SSA also agrees to limit access to such information, as is appropriate by law, to individuals responsible for the verification of Social Security numbers or responsible for evaluation of E-Verify or such other persons or entities who may be authorized by SSA as governed by the Privacy Act (5 U.S.C. § 552a), the Social Security Act (42 U.S.C. 1306(a)), and SSA regulations (20 CFR Part 401). 3. SSA agrees to provide case results from its database within three Federal Government work days of the initial inquiry. E-Verify provides the information to the Employer. 4. SSA agrees to update SSA records as necessary if the employee who contests the SSA tentative nonconfirmation visits an SSA field office and provides the required evidence. If the employee visits an SSA field office within the eight Federal Government work days from the date of referral to SSA, SSA agrees to update SSA records, if appropriate, within the eight -day period unless SSA determines that more than eight days may be necessary. In such cases, SSA will provide additional instructions to the employee. If the employee does not visit SSA in the time allowed, E-Verify may provide a final nonconfirmation to the employer. Note: If an Employer experiences technical problems, or has a policy question, the employer should contact E-Verify at 1-888-464-4218. D. RESPONSIBILITIES OF DHS 1. DHS agrees to provide the Employer with selected data from DHS databases to enable the Employer to conduct, to the extent authorized by this MOU: a. Automated verification checks on alien employees by electronic means, and Page 7 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 � sect v- orE-Verif Company ID Number: 1723880 b. Photo verification checks (when available) on employees. 2. DHS agrees to assist the Employer with operational problems associated with the Employer's participation in E-Verify. DHS agrees to provide the Employer names, titles, addresses, and telephone numbers of DHS representatives to be contacted during the E-Verify process. 3. DHS agrees to provide to the Employer with access to E-Verify training materials as well as an E-Verify User Manual that contain instructions on E-Verify policies, procedures, and requirements for both SSA and DHS, including restrictions on the use of E-Verify. 4. DHS agrees to train Employers on all important changes made to E-Verify through the use of mandatory refresher tutorials and updates to the E-Verify User Manual. Even without changes to E-Verify, DHS reserves the right to require employers to take mandatory refresher tutorials. 5. DHS agrees to provide to the Employer a notice, which indicates the Employer's participation in E-Verify. DHS also agrees to provide to the Employer anti -discrimination notices issued by the Office of Special Counsel for Immigration -Related Unfair Employment Practices (OSC), Civil Rights Division, U.S. Department of Justice. 6. DHS agrees to issue each of the Employer's E-Verify users a unique user identification number and password that permits them to log in to E-Verify. 7. DHS agrees to safeguard the information the Employer provides, and to limit access to such information to individuals responsible for the verification process, for evaluation of E-Verify, or to such other persons or entities as may be authorized by applicable law. Information will be used only to verify the accuracy of Social Security numbers and employment eligibility, to enforce the INA and Federal criminal laws, and to administer Federal contracting requirements. 8. DHS agrees to provide a means of automated verification that provides (in conjunction with SSA verification procedures) confirmation or tentative nonconfirmation of employees' employment eligibility within three Federal Government work days of the initial inquiry. 9. DHS agrees to provide a means of secondary verification (including updating DHS records) for employees who contest DHS tentative nonconfirmations and photo mismatch tentative nonconfirmations. This provides final confirmation or nonconfirmation of the employees' employment eligibility within 10 Federal Government work days of the date of referral to DHS, unless DHS determines that more than 10 days may be necessary. In such cases, DHS will provide additional verification instructions. ARTICLE III REFERRAL OF INDIVIDUALS TO SSA AND DHS A. REFERRAL TO SSA 1. If the Employer receives a tentative nonconfirmation issued by SSA, the Employer must print the notice as directed by E-Verify. The Employer must promptly notify employees in private of the finding and provide them with the notice and letter containing information specific to the employee's E-Verify Page 8 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 � sect v- orE-Verif Company ID Number: 1723880 case. The Employer also agrees to provide both the English and the translated notice and letter for employees with limited English proficiency to employees. The Employer agrees to provide written referral instructions to employees and instruct affected employees to bring the English copy of the letter to the SSA. The Employer must allow employees to contest the finding, and not take adverse action against employees if they choose to contest the finding, while their case is still pending. 2. The Employer agrees to obtain the employee's response about whether he or she will contest the tentative nonconfirmation as soon as possible after the Employer receives the tentative nonconfirmation. Only the employee may determine whether he or she will contest the tentative nonconfirmation. 3. After a tentative nonconfirmation, the Employer will refer employees to SSA field offices only as directed by E-Verify. The Employer must record the case verification number, review the employee information submitted to E-Verify to identify any errors, and find out whether the employee contests the tentative nonconfirmation. The Employer will transmit the Social Security number, or any other corrected employee information that SSA requests, to SSA for verification again if this review indicates a need to do so. 4. The Employer will instruct the employee to visit an SSA office within eight Federal Government work days. SSA will electronically transmit the result of the referral to the Employer within 10 Federal Government work days of the referral unless it determines that more than 10 days is necessary. 5. While waiting for case results, the Employer agrees to check the E-Verify system regularly for case updates. 6. The Employer agrees not to ask the employee to obtain a printout from the Social Security Administration number database (the Numident) or other written verification of the SSN from the SSA. B. REFERRAL TO DHS 1. If the Employer receives a tentative nonconfirmation issued by DHS, the Employer must promptly notify employees in private of the finding and provide them with the notice and letter containing information specific to the employee's E-Verify case. The Employer also agrees to provide both the English and the translated notice and letter for employees with limited English proficiency to employees. The Employer must allow employees to contest the finding, and not take adverse action against employees if they choose to contest the finding, while their case is still pending. 2. The Employer agrees to obtain the employee's response about whether he or she will contest the tentative nonconfirmation as soon as possible after the Employer receives the tentative nonconfirmation. Only the employee may determine whether he or she will contest the tentative nonconfirmation. 3. The Employer agrees to refer individuals to DHS only when the employee chooses to contest a tentative nonconfirmation. 4. If the employee contests a tentative nonconfirmation issued by DHS, the Employer will instruct the Page 9 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 � sect v- orE-Verif Company ID Number: 1723880 employee to contact DHS through its toll -free hotline (as found on the referral letter) within eight Federal Government work days. 5. If the Employer finds a photo mismatch, the Employer must provide the photo mismatch tentative nonconfirmation notice and follow the instructions outlined in paragraph 1 of this section for tentative nonconfirmations, generally. 6. The Employer agrees that if an employee contests a tentative nonconfirmation based upon a photo mismatch, the Employer will send a copy of the employee's Form 1-551, Form 1-766, U.S. Passport, or passport card to DHS for review by: a. Scanning and uploading the document, or b. Sending a photocopy of the document by express mail (furnished and paid for by the employer). 7. The Employer understands that if it cannot determine whether there is a photo match/mismatch, the Employer must forward the employee's documentation to DHS as described in the preceding paragraph. The Employer agrees to resolve the case as specified by the DHS representative who will determine the photo match or mismatch. 8. DHS will electronically transmit the result of the referral to the Employer within 10 Federal Government work days of the referral unless it determines that more than 10 days is necessary. 9. While waiting for case results, the Employer agrees to check the E-Verify system regularly for case updates. ARTICLE IV SERVICE PROVISIONS A. NO SERVICE FEES 1. SSA and DHS will not charge the Employer for verification services performed under this MOU. The Employer is responsible for providing equipment needed to make inquiries. To access E-Verify, an Employer will need a personal computer with Internet access. ARTICLE V MODIFICATION AND TERMINATION A. MODIFICATION 1. This MOU is effective upon the signature of all parties and shall continue in effect for as long as the SSA and DHS operates the E-Verify program unless modified in writing by the mutual consent of all parties. 2. Any and all E-Verify system enhancements by DHS or SSA, including but not limited to E-Verify checking against additional data sources and instituting new verification policies or procedures, will be covered under this MOU and will not cause the need for a supplemental MOU that outlines these changes. Page 10 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 � sect v- orE-Verif Company ID Number: 1723880 B. TERMINATION 1. The Employer may terminate this MOU and its participation in E-Verify at any time upon 30 days prior written notice to the other parties. 2. Notwithstanding Article V, part A of this MOU, DHS may terminate this MOU, and thereby the Employer's participation in E-Verify, with or without notice at any time if deemed necessary because of the requirements of law or policy, or upon a determination by SSA or DHS that there has been a breach of system integrity or security by the Employer, or a failure on the part of the Employer to comply with established E-Verify procedures and/or legal requirements. The Employer understands that if it is a Federal contractor, termination of this MOU by any party for any reason may negatively affect the performance of its contractual responsibilities. Similarly, the Employer understands that if it is in a state where E-Verify is mandatory, termination of this by any party MOU may negatively affect the Employer's business. 3. An Employer that is a Federal contractor may terminate this MOU when the Federal contract that requires its participation in E-Verify is terminated or completed. In such cases, the Federal contractor must provide written notice to DHS. If an Employer that is a Federal contractor fails to provide such notice, then that Employer will remain an E-Verify participant, will remain bound by the terms of this MOU that apply to non -Federal contractor participants, and will be required to use the E-Verify procedures to verify the employment eligibility of all newly hired employees. 4. The Employer agrees that E-Verify is not liable for any losses, financial or otherwise, if the Employer is terminated from E-Verify. ARTICLE VI PARTIES A. Some or all SSA and DHS responsibilities under this MOU may be performed by contractor(s), and SSA and DHS may adjust verification responsibilities between each other as necessary. By separate agreement with DHS, SSA has agreed to perform its responsibilities as described in this MOU. B. Nothing in this MOU is intended, or should be construed, to create any right or benefit, substantive or procedural, enforceable at law by any third party against the United States, its agencies, officers, or employees, or against the Employer, its agents, officers, or employees. C. The Employer may not assign, directly or indirectly, whether by operation of law, change of control or merger, all or any part of its rights or obligations under this MOU without the prior written consent of DHS, which consent shall not be unreasonably withheld or delayed. Any attempt to sublicense, assign, or transfer any of the rights, duties, or obligations herein is void. D. Each party shall be solely responsible for defending any claim or action against it arising out of or related to E-Verify or this MOU, whether civil or criminal, and for any liability wherefrom, including (but not limited to) any dispute between the Employer and any other person or entity regarding the applicability of Section 403(d) of IIRIRA to any action taken or allegedly taken by the Employer. E. The Employer understands that its participation in E-Verify is not confidential information and may be disclosed as authorized or required by law and DHS or SSA policy, including but not limited to, Page 11 of 17 E-Verify MOU for Employers i Revision Date 06/01/13 E-Verifv- Company ID Number: 1723880 Congressional oversight, E-Verify publicity and media inquiries, determinations of compliance with Federal contractual requirements, and responses to inquiries under the Freedom of Information Act (FOIA). F. The individuals whose signatures appear below represent that they are authorized to enter into this MOU on behalf of the Employer and DHS respectively. The Employer understands that any inaccurate statement, representation, data or other information provided to DHS may subject the Employer, its subcontractors, its employees, or its representatives to: (1) prosecution for false statements pursuant to 18 U.S.C. 1001 and/or; (2) immediate termination of its MOU and/or; (3) possible debarment or suspension. G. The foregoing constitutes the full agreement on this subject between DHS and the Employer. To be accepted as an E-Verify participant, you should only sign the Employer's Section of the signature page. If you have any questions, contact E-Verify at 1-888-464-4218. Page 12 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 riE-Vefv— or �y�N� Company ID Number: 1723880 Approved by: Employer HEMO MEDIKA CARE LLC Name (Please Type or Print) Title Miriam Leskanicova Signature Date Electronically Signed 08/05/2021 Department of Homeland Security — Verification Division Name (Please Type or Print) Title Signature Date Electronically Signed Page 13 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 � sect v- orE-Verif Company ID Number: 1723880 Information Required for the E-Verify Program Information relating to your Company: Company Name HEMO MEDIKA CARE LLC Company Facility Address 3425 10TH ST N SUITE 1 NAPLES, FL 34103 Company Alternate Address County or Parish COLLIER Employer Identification Number 384035421 North American Industry Classification Systems Code 624 Parent Company Number of Employees 5 to 9 Number of Sites Verified for 1 Page 14 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 E-Verifv- Company ID Number: 1723880 Are you verifying for more than 1 site? If yes, please provide the number of sites verified for in each State: FLORIDA 1 site(s) Page 15 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 E-Verifv- Company ID Number: 1723880 Information relating to the Program Administrator(s) for your Company on policy questions or operational problems: Name Peter Spisak Phone Number (239) 234 - 4608 Fax Number (239) 320 - 3232 Email Address peter@harmoniatheclub.com Name Miriam Leskanicova Phone Number (239) 234 - 4608 Fax Number (239) 320 - 3232 Email Address miriam@harmoniatheclub.com Page 16 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 E-Verifv- Company ID Number: 1723880 Page intentionally left blank Page 17 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 W=9 Request for Taxpayer Give Form Form (Rev. October2018) Identification Number and Certification to the requester. Do not Department of the Treasury send to the IRS. Internal Revenue Service ► Go to www.irs.gov/FormW9 for instructions and the latest information. 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. Hemo Medika CARE LLC 2 Business name/disregarded entity name, if different from above Harmonia The Club 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to following seven boxes. certain entities, not individuals; see a o ❑ C Cor ❑ Individual/sole proprietor or poration ❑ S Corporation ❑ Partnership ❑ Trust/estate instructions on page 3): c single -member LLC Exempt payee code (if any) o j; `o ✓❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ► C Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check Exemption from FATCA reporting H LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is a another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that code (if any) w is disregarded from the owner should check the appropriate box for the tax classification of its owner. N Oh Other see instructions ❑ ( ) ► (Applies to accounts maintained outside the U.S.) rn 5 Address (number, street, and apt. or suite no.) See instructions. Requester's name and address (optional) 3425 1Oth Street N, Suite 1 cn 6 City, state, and ZIP code Naples, FL 34103 7 List account number(s) here (optional) - i axpayer identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number backup withholding. For individuals, this is generally your social security number (S. However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. or Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Employer identification number Number To Give the Requester for guidelines on whose number to enter. r --- F--7 01MeMIU©©0©E Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later. Sign Signature n 1 - /r/e / Here U.S. person '�y�i 1, ��: Date► J General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099-INT (interest earned or paid) • Form 1099-DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231X Form W-9 (Rev. 10-2018) Form W-9 (Rev. 10-2018) By signing the filled out form, you: Page 2 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese 2. Certify that you are not subject to backup withholding, or student temporarily present in the United States. Under U.S. law, this student will become a resident alien for tax purposes if his or her stay in Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share the United Stes exceeds 5 calendr years.3. the first Protocol to the U.S.-China treaty (dated Apriillr30, 1984)pallo2 of ws the provisions of Article of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese effectively connected income, and student who qualifies for this exception (under paragraph 2 of the first 4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA protocol) and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship income would attach to Form reporting, is correct. See What is FATCA reporting, later, for further information. W-9 a statement that includes the information described above to Note: If you are a U.S. person and a requester gives you a form other than Form W-9 to request your TIN, support that exemption. If you are a nonresident alien or a foreign entity, give the requester the you must use the requester's form if it is substantially similar to this Form W-9. appropriate completed Form W-8 or Form 8233. Definition of a U.S. person. For federal tax purposes, you are Backup Withholding considered a U.S. person if you are: • An individual who is a U.S. citizen or U.S. resident alien; What is backup withholding? Persons making certain payments to you must under certain conditions withhold • A partnership, corporation, company, or association created or organized in the United States or under the and pay to the IRS 24% of such payments. This is called "backup withholding." Payments that may be subject to backup withholding include interest, laws of the United States; • An estate (other than a foreign estate); or tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, • A domestic trust (as defined in Regulations section 301.7701-7). nonemployee pay, payments made in settlement of payment card and third party network transactions, and certain from Special rules for partnerships. Partnerships that conduct a trade or business in the United States are payments fishing boat operators. Real estate transactions are not subject to backup withholding. generally required to pay a withholding tax under section 1446 on any foreign partners' share of effectively connected taxable income from business. You will not be subject to backup withholding on payments you such Further, in certain cases where a Form W-9 has not been received, the rules under section 1446 require a partnership to that receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax presume a partner is a foreign person, and pay the section 1446 withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting return. Payments you receive will be subject to backup withholding if: a trade or business in the United States, provide Form W-9 to the partnership to establish your 1 •You do not furnish your TIN to the requester, U.S. status and avoid section 1446 withholding on your share of partnership income. 2• You do not certify your TIN when required (see the instructions for Part 11 for details), In the cases below, the following person must give Form W-9 to the partnership for purposes of establishing its U.S. 3. The IRS tells the requester that you furnished an incorrect TIN, status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States. 4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on tax • In the case of a disregarded entity with a U.S. owner, the U.S. owner of the disregarded entity and your return (for reportable interest and dividends only), or 5. You do not certify to the requester that you are not not the entity; • In the case of a grantor trust with a U.S. grantor or other U.S. owner, subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only). generally, the U.S. grantor or other U.S. owner of the grantor trust and not the trust; and Certain payees and payments are exempt from backup withholding. • In the case of a U.S. trust (other than a grantor trust), the U.S. trust (other than a grantor trust) and not the beneficiaries See Exempt payee code, later, and the separate Instructions for the Requester of Form W-9 for more information. of the trust. Foreign person. If you are a foreign Also see Special rules for partnerships, earlier. person or the U.S. branch of a foreign bank that has elected to be treated as a U.S. person, do not use Form What is FATCA Reporting? W-9. Instead, use the appropriate Form W-8 or Form 8233 (see Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign The Foreign Account Tax Compliance Act (FATCA) requires a Entities). participating foreign financial institution to report all United States Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce account holders that are specified United States persons. Certain payees are exempt from FATCA reporting. See Exemption from FATCA reporting code, later, and the Instructions for or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as "saving the Requester of Form W-9 for more information. a clause." Exceptions specified in the saving clause may permit an exemption from tax to Updating Your Information continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes. You must provide updated information to any person to whom you If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this For from U.S. tax on certain types of income, you must attach a statement to Form W-9 that specifies the following five items. person. example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you no 1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a longer are tax exempt. In addition, you must furnish a new Form W-9 if the name or TIN changes for the account; for example, if the nonresident alien. 2. The treaty article addressing the income. grantor of a grantor trust dies. 3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions. Penalties 4. The type and amount of income that qualifies for the exemption from tax. Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure 5. Sufficient facts to justify the exemption from tax under the terms unless your failure is due to reasonable cause and not to willful neglect. the treaty article. of Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to $500 a penalty. Form W-9 (Rev. 10-2018) Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment. Misuse of TINs. If the requester discloses or uses TINs in violation of federal law, the requester may be subject to civil and criminal penalties. Specific Instructions Line 1 You must enter one of the following on this line; do not leave this line blank. The name should match the name on your tax return. If this Form W-9 is for a joint account (other than an account maintained by a foreign financial institution (FFI)), list first, and then circle, the name of the person or entity whose number you entered in Part I of Form W-9. If you are providing Form W-9 to an FFI to document a joint account, each holder of the account that is a U.S. person must provide a Form W-9. a. Individual. Generally, enter the name shown on your tax return. If you have changed your last name without informing the Social Security Administration (SSA) of the name change, enter your first name, the last name as shown on your social security card, and your new last name. Note: ITIN applicant: Enter your individual name as it was entered on your Form W-7 application, line 1 a. This should also be the same as the name you entered on the Form 1040/1040A/1040EZ you filed with your application. b. Sole proprietor or single -member LLC. Enter your individual name as shown on your 1040/1040A/1040EZ on line 1. You may enter your business, trade, or "doing business as" (DBA) name on line 2. c. Partnership, LLC that is not a single -member LLC, C corporation, or S corporation. Enter the entity's name as shown on the entity's tax return on line 1 and any business, trade, or DBA name on line 2. d. Other entities. Enter your name as shown on required U.S. federal tax documents on line 1. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or DBA name on line 2. e. Disregarded entity. For U.S. federal tax purposes, an entity that is disregarded as an entity separate from its owner is treated as a "disregarded entity." See Regulations section 301.7701-2(c)(2)(iii). Enter the owner's name on line 1. The name of the entity entered on line 1 should never be a disregarded entity. The name on line 1 should be the name shown on the income tax return on which the income should be reported. For example, if a foreign LLC that is treated as a disregarded entity for U.S. federal tax purposes has a single owner that is a U.S. person, the U.S. owner's name is required to be provided on line 1. If the direct owner of the entity is also a disregarded entity, enter the first owner that is not disregarded for federal tax purposes. Enter the disregarded entity's name on line 2, "Business name/disregarded entity name." If the owner of the disregarded entity is a foreign person, the owner must complete an appropriate Form W-8 instead of a Form W-9. This is the case even if the foreign person has a U.S. TIN. Line 2 If you have a business name, trade name, DBA name, or disregarded entity name, you may enter it on line 2. Line 3 Check the appropriate box on line 3 for the U.S. federal tax classification of the person whose name is entered on line 1. Check only one box on line 3. Paae 3 IF the entity/person on line 1 is THEN check the box for ... a(n) ... • Corporation Corporation • Individual Individual/sole proprietor or single- • Sole proprietorship, or member LLC • Single -member limited liability company (LLC) owned by an individual and disregarded for U.S. federal tax purposes. • LLC treated as a partnership for Limited liability company and enter U.S. federal tax purposes, the appropriate tax classification. • LLC that has filed Form 8832 or (P= Partnership; C= C corporation; 2553 to be taxed as a corporation, or S= S corporation) or • LLC that is disregarded as an entity separate from its owner but the owner is another LLC that is not disregarded for U.S. federal tax purposes. • Partnership Partnership • Trust/estate Trust/estate Line 4, Exemptions If you are exempt from backup withholding and/or FATCA reporting, enter in the appropriate space on line 4 any code(s) that may apply to you. Exempt payee code. • Generally, individuals (including sole proprietors) are not exempt from backup withholding. • Except as provided below, corporations are exempt from backup withholding for certain payments, including interest and dividends. • Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions. • Corporations are not exempt from backup withholding with respect to attorneys' fees or gross proceeds paid to attorneys, and corporations that provide medical or health care services are not exempt with respect to payments reportable on Form 1099-MISC. The following codes identify payees that are exempt from backup withholding. Enter the appropriate code in the space in line 4. 1—An organization exempt from tax under section 501(a), any IRA, or a custodial account under section 403(b)(7) if the account satisfies the requirements of section 401(f)(2) 2—The United States or any of its agencies or instrumentalities 3—A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions or instrumentalities 4—A foreign government or any of its political subdivisions, agencies, or instrumentalities 5—A corporation 6—A dealer in securities or commodities required to register in the United States, the District of Columbia, or a U.S. commonwealth or possession 7—A futures commission merchant registered with the Commodity Futures Trading Commission 8—A real estate investment trust 9—An entity registered at all times during the tax year under the Investment Company Act of 1940 10—A common trust fund operated by a bank under section 584(a) 11—A financial institution 12—A middleman known in the investment community as a nominee or custodian 13—A trust exempt from tax under section 664 or described in section 4947 Form W-9 (Rev. 10-2018) The following chart shows t es f Page 4 from payments that may be exemt backup withholding. The hart apples to the exempt payees listed above, 1 through 13. IF the payment is for interest and dividend payments Broker transactions Barter exchange transactions and patronage dividends Payments over $600 required to be reported and direct sales over $5,000' THEN the payment is exempt for... All exempt payees except for 7 Exempt payees 1 through 4 and 6 through 11 and all C corporations. S corporations must not enter an exempt payee code because they are exempt only for sales of noncovered securities acquired prior to 2012. Exempt payees 1 through 4 Generally, exempt payees 1 through 52 Payments made in settlement of Exempt payees 1 through 4 payment card or third party network transactions ' See Form 1099-MISC, Miscellaneous Income, and its instructions. 2 However, the following payments made to a corporation and reportable on Form 1099-MISC are not exempt from backup withholding: medical and health care payments, attorneys' fees, gross Proceeds paid to an attorney reportable under section 6045(f), and payments for services paid by a federal executive agency. Exemption from FATCA reporting code. The following codes identify payees that are exempt from reporting under FATCA. These codes apply to persons submitting this form for accounts maintained outside of the United States by certain foreign financial institutions. Therefore, if you are only submitting this form for an account you hold in the United States, you may leave this field blank. Consult with the person requesting this form if you are uncertain if the financial institution is subject to these requirements. A requester may indicate that a code is not required by providing you with a Form W-9 with "Not Applicable" (or any similar indication) written or printed on the line for a FATCA exemption code. A —An organization exempt from tax under section 501(a) or any individual retirement plan as defined in section 7701(a)(37) B—The United States or any of its agencies or instrumentalities C—A state, the District of Columbia, a U.S. commonwealth or Possession, or any of their political subdivisions or instrumentalities D—A corporation the stock of which is regularly traded on one or more established securities markets, as described in Regulations section 1.1472-1(c)(1)(i) E—A corporation that is a member of the same expanded affiliated group as a corporation described in Regulations section 1.1472-1(c)(1)(i) F—A dealer in securities, commodities, or derivative financial instruments (including notional principal contracts, futures, forwards, and options) that is registered as such under the laws of the United States or any state G—A real estate investment trust H—A regulated investment company as defined in section 851 or an entity registered at all times during the tax year under the Investment Company Act of 1940 I —A common trust fund as defined in section 584(a) J—A bank as defined in section 581 K—A broker L—A trust exempt from tax under section 664 or described in section 4947(a)(1) M—A tax exempt trust under a section 403(b) plan or section 457(g) plan Note: You may wish to consult with the financial institution requesting this form to determine whether the FATCA code and/or exempt payee code should be completed. Line 5 Enter your address (number, street, and apartment or suite number). This is where the requester of this Form W-9 will mail your information returns. If this address differs from the one the requester already has on file, write NEW at the top. If a new address is provided, there is still a chance the old address will be used until the payor changes your address in their records. Line 6 Enter your city, state, and ZIP code. Part I. Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. If you are a resident alien and you do not have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer identification number (ITIN). Enter it in the social security number box. If you do not have an ITIN, see How to get a TIN below. If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN. If you are a single -member LLC that is disregarded as an entity separate from its owner, enter the owner's SSN (or EIN, if the owner has one). Do not enter the disregarded entity's EIN. If the LLC is classified as a corporation or partnership, enter the entity's EIN. Note: See What Name and Number To Give the Requester, later, for further clarification of name and TIN combinations. How to get a TIN. If you do not have a TIN, apply for one immediately. To apply for an SSN, get Form SS-5, Application for a Social Security Card, from your local SSA office or get this form online at www.SSA.gov. You may also get this form by calling 1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN, or Form SS-4, Application for Employer Identification Number, to apply for an EIN. You can apply for an EIN online by accessing the IRS website at www.irs.gov/Businesses and clicking on Employer Identification Number (EIN) under Starting a Business. Go to www.irs.gov/Forms to view, download, or print Form W-7 and/or Form SS-4. Or, you can go to wwwdrs.gov/OrderForms to place an order and have Form W-7 and/or SS-4 mailed to you within 10 business days. If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN and write "Applied For" in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester. Note: Entering "Applied For" means that you have already applied for a TIN or that you intend to apply for one soon. Caution: A disregarded U.S. entity that has a foreign owner must use the appropriate Form W-8. Part II. Certification To establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W-9. You may be requested to sign by the withholding agent even if item 1, 4, or 5 below indicates otherwise. For a joint account, only the person whose TIN is shown in Part I should sign (when required). In the case of a disregarded entity, the person identified on line 1 must sign. Exempt payees, see Exempt payee code, earlier. Signature requirements. Complete the certification as indicated in items 1 through 5 below. Form W-9 (Rev. 10-2018) 1. Interest, dividend, and barter exchange accounts opened before 1984 and broker accounts considered active during 1983. You must give your correct TIN, but you do not have to sign the certification. 2. Interest, dividend, broker, and barter exchange accounts opened after 1983 and broker accounts considered inactive during 1983. You must sign the certification or backup withholding will apply. If you are subject to backup withholding and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form. 3. Real estate transactions. You must sign the certification. You may cross out item 2 of the certification. 4. Other payments. You must give your correct TIN, but you do not have to sign the certification unless you have been notified that you have previously given an incorrect TIN. "Other payments" include payments made in the course of the requester's trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments made in settlement of payment card and third party network transactions, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations). 5. Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments (under section 529), ABLE accounts (under section 529A), IRA, Coverdell ESA, Archer MSA or HSA contributions or distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification. What Name and Number To Give the Requester For this type of account: I Give name and SSN of: 1. Individual The individual 2. Two or more individuals (joint The actual owner of the account or, if account) other than an account combined funds, the first individual on maintained by an FFI the account' 3. Two or more U.S. persons Each holder of the account (joint account maintained by an FFI) 4. Custodial account of a minor The minor (Uniform Gift to Minors Act) 5. a. The usual revocable savings trust The grantor -trustee' (grantor is also trustee) b. So-called trust account that is not The actual owner' a legal or valid trust under state law 6. Sole proprietorship or disregarded The owner entity owned by an individual 7. Grantor trust filing under Optional The grantor* Form 1099 Filing Method 1 (see Regulations section 1.671-4(b)(2)(i) (A)) For this type of account: Give name and EIN of: 8. Disregarded entity not owned by an The owner individual 9. A valid trust, estate, or pension trust 10. Corporation or LLC electing corporate status on Form 8832 or Form 2553 11. Association, club, religious, charitable, educational, or other tax- exempt organization Legal entity4 The corporation The organization 12. Partnership or multi -member LLC The partnership 13. A broker or registered nominee The broker or nominee Page 5 For this type of account: I Give name and EIN of: 14. Account with the Department of The public entity Agriculture in the name of a public entity (such as a state or local government, school district, or prison) that receives agricultural program payments 15. Grantor trust filing under the Form The trust 1041 Filing Method or the Optional Form 1099 Filing Method 2 (see Regulations section 1.6714(b)(2)(i)(13)) ' List first and circle the name of the person whose number you furnish. If only one person on a joint account has an SSN, that person's number must be furnished. 2 Circle the minor's name and furnish the minor's SSN. 3 You must show your individual name and you may also enter your business or DBA name on the "Business name/disregarded entity" name line. You may use either your SSN or EIN (if you have one), but the IRS encourages you to use your SSN. 4 List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the personal representative or trustee unless the legal entity itself is not designated in the account title.) Also see Special rules for partnerships, earlier. *Note: The grantor also must provide a Form W-9 to trustee of trust. Note: If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed. Secure Your Tax Records From Identity Theft Identity theft occurs when someone uses your personal information such as your name, SSN, or other identifying information, without your permission, to commit fraud or other crimes. An identity thief may use your SSN to get a job or may file a tax return using your SSN to receive a refund. To reduce your risk: • Protect your SSN, • Ensure your employer is protecting your SSN, and • Be careful when choosing a tax preparer. If your tax records are affected by identity theft and you receive a notice from the IRS, respond right away to the name and phone number printed on the IRS notice or letter. If your tax records are not currently affected by identity theft but you think you are at risk due to a lost or stolen purse or wallet, questionable credit card activity or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit Form 14039. For more information, see Pub. 5027, Identity Theft Information for Taxpayers. Victims of identity theft who are experiencing economic harm or a systemic problem, or are seeking help in resolving tax problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service (TAS) assistance. You can reach TAS by calling the TAS toll -free case intake line at 1-877-777-4778 or TTY/TDD 1-800-829-4059. Protect yourself from suspicious emails or phishing schemes. Phishing is the creation and use of email and websites designed to mimic legitimate business emails and websites. The most common act is sending an email to a user falsely claiming to be an established legitimate enterprise in an attempt to scam the user into surrendering private information that will be used for identity theft. Form W-9 (Rev. 10-2018) The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does not request personal detailed information through email or ask taxpayers for the PIN numbers, passwords, or similar secret access information for their credit card, bank, or other financial accounts. If you receive an unsolicited email claiming to be from the IRS, forward this message to phishing@irs.gov. You may also report misuse of the IRS name, logo, or other IRS property to the Treasury Inspector General for Tax Administration (TIGTA) at 1-800-366-4484. You can forward suspicious emails to the Federal Trade Commission at spam@uce.gov or report them at www.ftc.gov/complaint. You can contact the FTC at www.ftc.gov/idtheft or 877-IDTHEFT (877-438-4338). If you have been the victim of identity theft, see www.ldentityTheft.gov and Pub. 5027. Visit wwwdrs.gov/ldentityTheft to learn more about identity theft and how to reduce your risk. Page 6 Privacy Act Notice Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (including federal agencies) who are required to file information returns with the IRS to report interest, dividends, or certain other income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form uses the information on the form to file information returns with the IRS, reporting the above information. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their laws. The information also may be disclosed to other countries under a treaty, to federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent information.