Agenda 09/27/2022 Item #16D 1 (Second Amendment between Collier County and Collier Health Services Inc forthe administration of the Community Development Block Grant -COVID Program)09/27/2022
EXECUTIVE SUMMARY
Recommendation to approve and authorize the Chairman to sign the Second Amendment between
Collier County and Collier Health Services, Inc., d/b/a Healthcare Network for the administration
of the Community Development Block Grant - COVID program with a net $0 impact. (Grant Fund
705)
OBJECTIVE: Continue to provide COVID-19 case management services to benefit the residents of
Collier County.
CONSIDERATIONS: The U.S. Department of Housing and Urban Development (HUD) provides
Community Development Block Grant (CDBG), HOME, and Emergency Solution Grant (ESG)
entitlement funds to the County annually to address program-specific needs in the community. The Board
of County Commissioners ("Board") previously approved the 2019-2020 One Year Action Plan on June
25, 2019 (Agenda Item #16D2).
On April 27, 2020, the County Manager signed the substantial amendment to Collier County’s U.S.
Department of Housing and Urban Development Annual Action plan for FY2019-2020 to address
additional funding and programs related to COVID-19. On May 12, 2020, Agenda Item #16F1(f) the
Board ratified the County Manager’s action to amend the 2019-2020 One Year Action Plan to recognize
the first round of CDBG COVID-19 (CDBG-CV) funding. On November 10, 2020, Agenda item #16D8,
the Board approved the second substantial amendment recognizing the second allocation of CDBG
COVID-19 funding, bringing the total award for Collier County to $4,232,728 respectively. On December
8, 2020, Agenda Item #16D18, the Board approved Collier Health Services, Inc dba Healthcare Network
for CDBG CV funding and waived the formal application process for funding. CDBG-CV funding will
provide assistance to prevent, prepare, and respond to the coronavirus.
On April 27, 2021, Agenda Item #16D3, the County entered into an Agreement with Collier Health
Services, Inc. dba Healthcare Network to further undertake the responsibilities and obligations of the
Community Development Block Grant (CDBG) - CV Program to provide Case Management services to
serve vulnerable patients who have been diagnosed or are at risk for contracting COVID-19.
On March 8, 2022, Agenda Item #16D11, the Board approved the first amendment to further assist
Collier Health Services, Inc. by adding a technology component to their case management program.
On June 21, 2022, CHSI requested a second amendment to their CDBG CV agreement. This amendment
includes the following:
(a) The addition of a fourth component for personal protective equipment (PPE)
(b) Reallocation of $220,000 from three project components to project component four; PPE. This
represents no change in the overall agreement amount.
(c) Reduction in the number of patients served due to the severity of patients’ health conditions and
the need for longer enrollment in the program to assist in combating chronic health conditions
(d) Remove the requirement of a Section 3 policy from Section 1.2 Grant and Special Conditions as
this is not a construction project and not applicable.
(e) Add language regarding the purchase of equipment to Section 3.14 Program Generated Income
FISCAL IMPACT: This action has no new Fiscal impact. The funding source for this grant is the United
States Department of Housing and Urban Development CDBG-CV grant. Funds are budgeted in the
Housing Grant Fund (705), Project 33674.
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09/27/2022
LEGAL CONSIDERATIONS: This item has been approved as to form and legality, and requires a
majority vote for Board approval. -DDP
GROWTH MANAGEMENT IMPACT: This item has no impact on the Growth Management Plan of
Collier County.
RECOMMENDATION: To approve and authorize the Chairman to sign the Second Amendment between
Collier County and Collier Health Services, Inc., d/b/a Healthcare Network for the administration of the
Community Development Block Grant - CV program with a net $0 impact.
Prepared By: Tracey Smith, Grants Coordinator, Community and Human Services Division
ATTACHMENT(S)
1. 05-17-2021 Fully Executed Collier Health Services Inc CDBG-CV agreement (PDF)
2. Collier Health Services Inc - Amendment 1 Executed (PDF)
3. 1737484 CHSI Amendment 2 w Exhibit C - DDP Cert (PDF)
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COLLIER COUNTY
Board of County Commissioners
Item Number: 16.D.1
Doc ID: 23124
Item Summary: Recommendation to approve and authorize the Chairman to sign the Second
Amendment between Collier County and Collier Health Services, Inc., d/b/a Healthcare Network for the
administration of the Community Development Block Grant – COVID program with a net $0 impact.
(Grant Fund 705)
Meeting Date: 09/27/2022
Prepared by:
Title: – Community & Human Services
Name: Tracey Smith
08/19/2022 11:53 AM
Submitted by:
Title: Manager - Federal/State Grants Operation – Community & Human Services
Name: Kristi Sonntag
08/19/2022 11:53 AM
Approved By:
Review:
Community & Human Services Donald Luciano Additional Reviewer Completed 08/22/2022 9:39 AM
Community & Human Services Blanca Aquino Luque Additional Reviewer Completed 08/22/2022 10:52 AM
Community & Human Services Kristi Sonntag CHS Review Completed 08/24/2022 1:41 PM
Operations & Veteran Services Jeff Newman Additional Reviewer Completed 08/25/2022 7:01 AM
Public Services Department Todd Henry PSD Level 1 Reviewer Completed 08/25/2022 10:08 AM
Grants Erica Robinson Level 2 Grants Review Completed 08/25/2022 1:29 PM
Public Services Department Tanya Williams PSD Department Head Review Completed 08/30/2022 4:39 PM
County Attorney's Office Derek D. Perry Level 2 Attorney Review Completed 09/13/2022 1:15 PM
Office of Management and Budget Debra Windsor Level 3 OMB Gatekeeper Review Completed 09/13/2022 2:16 PM
County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 09/14/2022 10:42 AM
Grants Therese Stanley Additional Reviewer Completed 09/16/2022 6:53 PM
Community & Human Services Maggie Lopez Additional Reviewer Completed 09/19/2022 10:13 AM
Office of Management and Budget Christopher Johnson Additional Reviewer Completed 09/19/2022 5:19 PM
County Manager's Office Dan Rodriguez Level 4 County Manager Review Completed 09/19/2022 6:12 PM
Board of County Commissioners Geoffrey Willig Meeting Pending 09/27/2022 9:00 AM
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FAIN# B-20-UW-12-0016
Federal Award Date 09/22/2020
Federal Award Agency HUD
CFDAName Community
Development Block
Grant-CV
CFDA/CSFA# 14.218
Total Amount of Federal $1,170,800.39
Funds A warded
Subrecipient Name Collier Health Services,
Inc. dba Healthcare
Network
DUNS# 0850)95 11
FEIN 59-1741277
R&D NA
Indirect Cost Rate NA
Period of Performance 04/01/2021 -03/30/2023
Fiscal Year End 3/31
Monitor End: 05/31/2023
AGREEMENT BETWEEN COLLIER COUNTY
AND
Collier Health Services, Inc. dba Healthcare Network
CDBG-CV Healthcare Services
THIS AGREEMENT is made and entered in to thi s n._ day of A(>n\ 201:I, by and between Collier
County, a political subdivision of the State of Florida, (COUNTY) having its principal address at 3339 E
Tamlami Trail, Suite 211, Naples FL 34112, and Collier Health Services, Inc, dba Healthcare Network.
(SUBRECIPIENT), a private non-profit organization having its principal office at 1454 Madison Ave,
Immokalee, FL 34142.
WHEREAS, th e COUNTY has entered into an Agreement with the United States Depa1tment of
Housing and Urban Development (HUD) for a grant for the execution and implementation ofa Community
Development Block Grant (CDBG) Program in ce1tain areas of Collier County, pursuant to Title I of the
Housing and Community Development Act of 1974 (as amended), codified as 42 USC 5301 et. se. and
su bj ect to 24 CFR Patt 570; and
WHEREAS, the Board of County Commissioners of Collier County (Board) approved the Collier
County Consolidated Plan -One-year Action Plan for Federal Fiscal Year 2019-2020 for the CDBG
Program on June 25, 20 19 -Agenda Item 16 .D.2; and
WHEREAS, in accordance with HUD regulations and the Colli e r County Consolidated Plan
concerning the preparation of various Annual Action Plans, the COUNTY advertised the 2019 -2020
Annual Action Plan, on April 21, 2020, with a 5-day Citizen Comment period from April 21, 2020 to April
26,2020;and
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WHEREAS, on May 12, 2020, Agenda Item 16.F.l(J) the Boa1·d ratified the County Manager's
action to amend the 2019-2020 One-Year Action Plan to recognize CDBG COVID-19 funding. On
Nove111ber 10, 2020, Agenda item 16.D.8, the Board approved another substantial amendment recognizing
further CDBG COVID-19 funding, bringing the total amount to $4,232,728 respectively.
WHEREAS, the COUNTY established a program to provide assistance to qualified healthcare
agencies from its Co111munity Develop111ent Block Grant (Program) due to the circumstances of the
COVID-19 health crisis; and
WHEREAS, the SUBREClPIENT has applied for and, based on the infonnation provided, is
qualified to receive funding from the Collier County CDBG-CV prngram; and
WHEREAS, the COUNTY and SUBRECIPJENT wish to set faith the responsibilities and
obligations of each in undertaking the CD BG-CV project -(CD-CV21-01) COVID Case Management
Healthcare Services.
NOW, THEREFORE, in consideration of the covenants and agree111ents contained herein, and for
other good and valuable consideration, the Parties hereby agree that the COUNTY will provide a Grant to
the SUBRECIPIENT upon and subject to all general conditions, terms, covenants, and agreements herein
set forth:
PART I
SCOPE OF WOIU(
The SUB RECIPIENT shall, in a satisfactory and proper manner and consistent with any standards required
as a condition of providing CD BG-CV assistance as provided herein and, as determined by Collier County
Community and Human Services (CHS) Division, perform the tasks necessa,y to conduct the prog1·am as
follows:
Project Name: COVJD Case Management Healthcare Services
Description of project and outcome: Collier Health Services l11c will provide a case
management/care navigation progrnm to serve the needs of our most vulnerable patients who have
been diagnosed or are at risk for contracting COVID-19 in an effort to minimize disease severity
and acute and/or chronic complications.
Project Component One: Staffing -Salary costs
Project Component Two: Testing and Testing Supplies.
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1.1 GRANT AND SPECIAL CONDITIONS
A. Within sixty (60) calendar days of the execution of this Agreement, the SUB RECIPIENT
must deliver, to CHS fo,· approval, a detailed project schedule for the completion of the
project.
B. The following resolutions and policies must be submitted within sixty (60) days of this
Agreement:
0 Affirnrntive Fair Housing Policy
0 Affirmative Action/ Equal Opp011m1ity Policy
0 Conflict oflnte,·est Policy
0 Procurement Policy
0 Uniform Relocation Act Policy
0 Sexual Harassment Policy
0 Section 3 Policy
0 Section 504/AOA Policy
0 Fraud, Waste, and Abuse Policy
0 Limited English Proficiency Policy (LEP)
0 Violence Against Women Act (VA WA) Policy
0 LGBTQ Policy
C. Annual Subrecipient Training-
New Subrccipients: All SUBREC!PIENT staff assigned to the administration and
implementation of the Project established by this Agreement shall attend the CHS-
sponsored Annual Subrecipient Fair Housing training and all other CHS-offered
Subrecipient training relevant to the Project, as determined by the Grant Coordinator, not
to exceed four ( 4) sessions,
0. Pre-Award Costs: Pmsuant to pre-agreement cost authority under 24 CFR 570.489(b)
(States) and pre-award cost authority under CFR 570.200(h):
"To account for the urgent activities and costs COBO recipients and
subrecipients have unde11aken to prevent, prepare for, and respond to
coronavirus, the recipient is authorized to use CDBG-CV fnnds to cover or
reimburse costs incurred before the period of performance, provided that the cost
to be covered would be otherwise allowable under the flexibilities and
requirements established for COBO-CV funds, COBO-CV funds may be used
to cover or reimburse allowable costs of activities to prevent, prepare for, and
respond to coronavirus incurred by a State or lacoality so long as costs we,·e
incurred on or after January 21, 2020. In accordance with pre-agreement cost
authority under 24 CFR 570.489(b) (States) and pre-award cost authority under
CFR 570.200(11) entitlements, reimbursed costs mnst comply with all grant
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requil'Cments, must be costs to prevent, prepare for, 01· respond to coronavirus,
and must not constitute a duplication of benefits."
PROJECT DETAILS
A. Project Description/Project Budget
Description Federnl Amount
Project Conmonent One: Staffing -Salary costs $ 950,000.00
Project Component Two: Testing and Testing Supplies $ 220,800.39
Total Federal Funds: $1,170,800.39
The SUB RECIPIENT will accomplish the following checked project tasks:
D Pay all closing costs related to property conveyance
[81 Maintain and provide to the COUNTY, as requested, beneficiary and/or income
certification documentation
[81 Maintain and provide National Objective Documentation
[81 Provide Quartel'ly Reports on National Objective and project progress
[81 Ensure attendance by a representative from executive management at scheduled
paitnership meetings, as requested by CHS
D Ensure attendance by SUBRECJPJENT and General Contractor at Pre-Constrnction
meetings, prior to SUBBRECIPJENf issuance of Notice to Proceed (NTP)
D Provide monthly constmction and rehabilitation progress reports until completion of
constrnction or rehabilitation
D Identify Lead Project Manager
0 Provide Site Design and Specifications
D Comply with Davis-Bacon Labor Standards
[81 Comply with Section 3 and maintain documentation
D Provide certified payroll weekly throughout construction and rehabilitation
D Comply with Uniform Relocation Act (URA), ifnecessmy
D Ensure applicable numbers of units at·e Section 504/ADA accessible
D Enst1re the applicable continued use period for the project is met
A. National Objective
The CDBG-CV prngram funds awarded to Collier County must benefit low-to moderate-income
persons (LMI). As such, the SUBRECIPIENT shall ensure that all activities and beneficiaries meet
the definition of:
0 LMA -Low/Mod Area Benefit
[81 LMC -Low/Mod Clientele Benefit
D LMH -Low/Mod Housing Benefit
0 LMJ -Low/Mod Job Benefit
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LMA: Must docume11t where at least 51 percent of the residents are LMI persons, based
on HUD determined eligible census tracts. Failure to achieve the national objective under this
Agreement will require repayment of the CD BG-CV investment under this Agreement.
LMC: Must document that at least 51 percent of persons served, are low-to moderate-
income persons or households, in order to meet a CDBG-CV National Objective. Failure to achieve
the national objective under this Agreement will require repayment of the CDBG-CV investment
under this Agreement,
LMH: Must document providing or improving permanent residential structures, which
upon completion will be occupied by LMI households. Structures with three or more units must
contain at least 51 percent occupied by LMI households, and structL1res with less than three units
must be occupied by l 00 percent LMI households. Failure to achieve the national objective under
this Agreement will require repayment of the CDBG-CV investment under this Agreement.
LMJ: Must document job creation and retention. The LMI benefit national objective
addresses activities designed to create or retain permanent jobs, at least 51 percent of which
(computed on a full-time equivalent basis) will be made available to or held by LMI persons.
Failure to achieve the national objective under this Agreement will l'equire repayment of the
CDBG-CV investment under this Agreement.
B. Performance Deliverables
Program Deliverable Deliverable Suppm1ing Submission Schedule
Documentation
Special Grant Condition Policies Policies as stated in this
/Section 1. J) Aoreement
Jnsurance Insurance Cc1tificate
Detailed Project Schedule Project Schedule
Proiect Plans and Snecifications Site Plans and Snecifications
Subcontractor Lov Subcontractol' Loo
Progress Repo1t Exhibit C
Section 3 Repo11 Quai1erly report of new hire
information
Davis-Bacon Act Certified Weekly Ce11ified Payroll
Payroll repm1s, forms, and supporting
documentation
Annual Audit Monitoring Exhibit E
Renmt
· Financial and Compliance Audit Audit, Management Letter, and
Supporting Documentation
Continued Use Certification Continued Use Affidavit, if
aoolicable
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Within sixty (60) days of
Aoreement execution
Within 30 days of Agreement
execution and Annually within
thil1v /30) davs of renewal
Within sixty (60) days of
A"reement execution.
Not annlicable
Not annlicable
Quarterly repo11s on the 10"' day
followin<> the end of the auarter.
Qua11erly; within 10 days
followino the end of the oua11er,
Not applicable
Annually, within 60 days after
FY end
Annually: nine (9) months after
FY end for Single Audit OR one
hundred eighty (180) days after
FY end
Not applicable
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Ca ital Needs Assessment Plan licable
licable
C. Payment Deliverables
Pavment Deliverable Pavment Sunnorling Documentation Submission Schedule
Project Component One: Staffing Submission of supporting documents Submission of
-Salai-y costs must be provided as backup, as evidenced monthly invoices no
by Exhibit B, signed and dated later than the 20'" day
timesheets, check stubs, payroll registers, of the following
bank statements/cancelled checks and any month
other additional documentation as
requested. 10% retainage will be held
from each pay request until final
monitoring clearance and achievement of
the national obiective.
Project Component Two: Testing Submission of supporting documents Submission of
and Testing Supplies must be provided as backup, as evidenced monthly invoices no
by receipts, invoices, credit card later than the 20'" day
statements, bank statements and any other of the following
additional documentation as requested. month
10% retainage will be held from each pay
request until final monitoring clearance
at1d achievement of the national
obiective.
Failure by the SUBRECIPIENT to achieve the National Objective will require repayment of the CDBG-
CV investment under this Agreement.
1,2 PERIOD OF PERFORMANCE
SUB RECIPIENT services shall begin on beginning March I, 2020 for all pre awai·d costs and term
of agreement shall begin April I, 2021 and shall end on March 30, 2023, unless terminated earlier,
in accordance with provisions of Paragraph 3.9 Defaults, Remedies, and Termination. In
accordance with 2 CFR 200 Subpmt E-Cost Principles and Section 2!5.97(1)(d) Florida Statutes,
the SUBRECIPIENT may expend funds authorized by this Agreement only for allowable costs
resulting from obligations incutTed during the specific Agreement period.
If the SUBRECIPIENT complies with all requirements set fo1th herin, this Agreement shall
terminate (Marnh 30, 2023), whernupon all SUB RECIPIENT obligations for repayment of funds
shall cease. Notwithstanding the foregoing, the COUNTY expressly reserves and does not waive
its rights to recover any damages arising from or relating to the SUBRECIPIENT's breach of any
of the Grant Documents, including but not limited to this Agreement and/or any attachments hereto
which occurred in whole or ill part before said termination.
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The County Manager or designee may extend the term of this Agreement for a period ofup to 180
days after the end of the Agreement. Extensions must be authorized, in writing, by formal letter to
the SUBRECIPIENT.
1.3 AGREEMENT AMOUNT
The COUNTY agrees to make available ONE MILLION ONE HUNDRED SEVENTY
THOUSAND EIGHT HUNDRED DOLLARS AND 39 CENTS ($1,170,800.39) for use by the
SUBRECIPIENT, during the term of the Agreement (hereinafter, referred to as the "Funds").
Modification to the "Budget and Scope" may only be made if approved in advance. Budgeted fund
shifts among line items shall not be more than IO percent of the total funding amount and shall not
signify a change in scope. Fund shifts that exceed 10 percent of the Agreement amount shall only
be made with Board of County Commissioners (Board) approval.
The COUNTY shall reimburse SUBRECIPIENT for the perfonnance of this Agreement upon
completion or pm1ial completion of the work tasks, as accepted and approved by CHS.
SUBRECIPIENT may not request disbursement ofCDBG-CV funds until needed for eligible costs;
and all disbursement requests must be limited to the amount needed at the time of the request.
SUBRECIPIENT may expend funds only for allowable costs resulting from obligations incurred
during the term of this Agreement. Invoices for work performed are required every month. If no
work has been performed during a month, or if the SUBRECIPIENT is not yet prepared to send the
required backup, a $0 invoice is required. Explanations may be required if two consecutive months
of$0 invoices are submitted. Payments shall be made to the SUBRECIPJENT, when requested, as
work progresses but not more frequently than once pet· month. Reimbursement will not occur if
SUB RECIPIENT fails to perfo1111 the minimum level of service required by this Agreement.
Final invoices are due no later than 90 days after the end of the Agreement. Work performed during
the term of the program but not invoiced within 90 days after the end of the Agreement may not be
processed without written authorization from the Grant Coordinator.
No payment will be made until approved by CHS for grnnt compliance and adherence to all
applicable Local, State, or Federal requirements. Except where disputed for noncompliance,
payment will be made upon receipt of a properly completed invoice, and in compliance with
§218.70, Florida Statutes, otherwise known as the "Local Government Prompt Payment Act."
1.4 COST PRINCIPLES
Payments to the SUBRECIPJENT are governed by the Federal grant management rules for cost
allowability, found at 2 CFR 200 Subpart E-Cost Principles. For the purposes of this section
(Section 1.5-Cost Principles) of the Agreement, SUB RECIPIENT is defined as described in 2 CFR
200.93. Accordingly, payments will be made on a cost reimbursement basis. Each request for
reimbursement shall identify the associated project and approved project task(s) listed under this
Scope of Work. The SUBRECJPIENT may only incur direct costs that may be attributed
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specifically to the project(s) referenced above, as defined in 2 CFR 200.413. The SUB RECIPIENT
must provide adequate documeutation for validatiug costs incurred. Payments to
SUBRECIPIENT'S contractors and vendors are conditioned upon compliance with the
procurement requirements provided in 2 CFR 200.318-200,327, Allowable costs incurred by
Subrecipients and Contractors shall comply with 2 CFR Subpart E-Cost Principles, A Developer is
not subject to 2 CFR Subpart E; however, the COUNTY is and may impose requirements upon the
Developer, to remain compliant with COUNTY's obligation to follow 2 CFR Subpmt E, The
Developer will use adequate internal controls and maintain necessaiy source documentation for all
costs incurred and adhere to any other accounting requirements included in this Agreement.
1,5 NOTICES
Notices required by this Agreement shall be in writing and delivered via mail (postage prepaid),
commercial courier, personal delivery, or sent by facsimile or other electronic means, Either paity
may change the address to which notices are to be sent by giving written notice of such change to
the other party in the manner herein provided for giving notice. Any notice delivered or sent as
aforesaid shall be effective on the date of delive1y or sending. All notices and other written
communications under this Agreement shall be addressed to the individuals in the capacities
indicated below, unless otherwise modified by subsequent written notice.
COLLIER COUNTY ATTENTION: Tracey Smith, Grant Coordinator
Collier County Government
Community and Human Services Division
3339 E Tamiami Trail, Suite 211
Naples, Florida 34112
Email: Tracey.Smlth@colliercountyfl.gov
Telephone: (239) 252-1428
SUBRECIPIENT ATTENTION: Tami Raznoff, Chief Financial Officer
Collie,· Health Services, Inc. dba Healthcare Network
1454 Madison Ave
Immokalee, Florida 34142
Email: TRaznoff@HealthcareSWFL.org
Telephone: (239) 658-3137
Remainder of Page Intentionally Left Blank
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2.1 AUDITS
PARTII
GRANT CONTROL
REQUIREMENTS
At any time during normal business hours and as often as the COUNTY (and/or its representatives)
may deem necessary, the SUBRECIPIENTshall make available for review, inspection, or audit all
records, documentation, and any other data relating to all mattern covered by the Agreement.
SUBRECIPIENT must fully clear any deficiencies noted in audit repmts within 30 days after its
receipt of the rnport. SUBRECIPIENT's failure to comply with the above audit requirements will
constitute a violation of this Agreement and may result in the withholding of future payments. The
SUBRECIPIENT hereby agrees to obtain an annual agency audit conducted in accordance with
current COUNTY policy concerning Subrecipient audits and 2 CFR 200.50 I.
The determination of Federal Award amounts expended shall be in accordance with guidelines
established by 2 CFR Part 200, Subpart F-Audit Requirements.
2.2 RECORDS AND DOCUMENTATION
The SUBRECIPIENT shall maintain sufficient records, in accordance with 24 CFR 570.506, to
determine compliance with the requirements of this Agreement, the CD BG-CV Prngram, and all
other applicable laws and regulations. This documentation shall include but is not limited to, the
following:
A. All records required by CDBG-CV regulations.
B. SUB RECIPIENT agrees to execute such further documents as may be required by law or
prepared by the COUNTY to confirm SUBRECIPIENT's Agreement.
C. SUBRECIPIENT shall keep and maintain public records that ordinarily and necessarily
would be required by the COUNTY in order to perform the service.
D, SUB RECIPIENT shall, at any time upon request, make available to the COUNTY or CHS
all reports, plans, surveys 1 info1·rnation, documents, maps, books, records, and other data
procedures developed, prepared, assembled, or completed by the SUB RECIPIENT for this
Agreement. Materials identified in the previous sentence shall be in accordance with
generally accepted accounting principles (GAAP), procedmes, and practices, which
sufficiently and properly reflect all revenues and expenditures of funds provided directly
or indirectly by this Agreement, including matching funds and Program Income. These
records shall be maintained to the extent of such detail to properly reflect all net costs,
direct and indirect labor, materials, equipment, supplies and services, and other costs and
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expenses of whatever nature for which reimbursement is claimed under the provisions of
this Agreement.
E. Upon completion of all work co11templated under this Agreement, copies of all documents
and records relating to this Agreement shall be surrendered to CHS, if requested. In any
event, SlJBRECIPIENT shall keep all documents and records in an orderly fashion, in a
readily accessible, permanent, and secured location for three (3) years after the date of
submission of the annual performance and evaluation report, as prescribed in 2 CFR
200,334. However, if any litigation, claim, or audit is started before the expiration date of
the three (3) year period, the records will be maintained until all litigation, claim, or audit
findings involving these records are resolved. If SUB RECIPIENT ceases to exist after the
closeout of this Agreement, the COUNTY shall be informed, in writing, of the address
where the records are to be kept, as outlined in 2 CFR 200.337. The SUBRECIPIENT shall
meet all requirements for retaining public records and transfer, at no cost to COUNTY, all
public records in SUBRECIPIENT's possession upon termination of the Agreement, and
destroy any duplicate exempt or confidential public records that are released from public
records disclosure requirements. All records stored electronically must be provided to the
COUNTY in a format that is compatible with the COUNTY'S information teclmology
systems.
IF SUBRECIPIENT HAS QUESTIONS REGARDING THE
APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO
THE SUBRECIPIENT'S DUTY TO PROVIDE PUBLIC
RECORDS RELATING TO THIS AGREEMENT, CONTACT
THE CUSTODIAN OF PUBLIC RECORDS AT 239-252-6832,
Michae!.Cox@colliercountyfl.gov, 3299 Tamiami Trail E, Naples
FL 34112.
F. SUBRECIP!ENT shall maintain records showing compliance with the Davis-Bacon Act of
1931, including files containing contractor payrolls, employee interviews, Davis-Bacon
wage rates, and administrative cross-referencing. SUBRECIPIENT shall maintain records
showing contractor compliance with the Contract Work Hours and Work Safety Law.
Similarly, the SUBRECIPIENT shall maintain records showing compliance with federal
purchasing requirements and other federal requirements for gmnt implementation.
G. SUB RECIPIENT will be responsible for the creation and maintenance of income eligible
files on clients served, and documentation that all households are eligible under HUD
Income Guidelines. SUBRECIPIENT agrees that CHS shall be the final arbiter on
SUBRECIPIENT's compliance.
H. SUBRECIPIENT shall document how compliance with the National Objective(s), as
defined in 24 CFR 570.208, and the eligibility requirement(s) under which funding has
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been received were accomlished, These also include special requirements, s\1ch as
necessary and appropriate determinations as defined it1 24 CPR 570.208, income
ce11ification, and written agreements with beneficiaries, where applicable.
I. SUBRECIPIENT shall provide the public with access to public records on the same terms
and conditions that the COUNTY would provide the records, and at a cost that does not
exceed the cost provided in Chapter 119, Flol'ida Statutes or as otherwise provided by law.
SUBRECIPIENT shall ensure that exempt or confidential public reco1·ds that are 1eleased
from public records disclosure requirements are not disclosed except as authorized by 2
CPR 200.331 and 2 CF'R 200.338.
J, Notwithstanding any provision in the Grant Documents to the contrary, the
SUB RECIPIENT agrees that the failure or delay by the COUNTY in giving any notice or
statement hereunder or under any other Grant Document, or any inaccuracy therein or
incompleteness thereof, shall not in any way alte1· or affect the absolute and unconditional
obligation of the SUBRECIPIENT to pay and perform, in full, the obligations set fm1h
hereunder, but any action taken or not taken by the SUBRECJPIENT as direct result of
such lack or delay of notice, or of the SUBRECIPIENT's good faith reliance upon a
material inaccuracy therein or the material incompleteness thereof, as the case may be,
shall not in and of itself, and to the extent thereof, constitute an Event of Default hereunder,
so long as the SUBREClPIENT does not otherwise have or receive notice or knowledge
of the material contents or substance of such notice, or of the intended substance of any
inaccurate or incomplete notice, as the case may be, and the SUB RECIPIENT acts, at all
times, in good faith.
2.3 MONITORING
During the term of this Agreement, SUBRECIPIENT shall submit to the COUNTY an
Annual Audit Monitoring report (Exhibit E) no later than 60 days after SUBRECIPIENT's
fiscal yea,· end. In addition, SUB RECIPIENT shall submit to the COUNTY a Single Audit
report, Management Letter, and s11ppo1ting documentation nine (9) months (crone hundred
eighty (180) days for Subrecipients exempt from Single Audit) after the
SUBRECIPIENT's fiscal year end, The COUNTY will conduct an annual financial and
progmmmatic rnview.
SUBRECJPIENT agrees that CHS may cany out no less than one (1) annual on-site monitoring
visit and evaluation activities, as determined necessa1y. At the COUNTY's discretion, a desktop
review of the activities may be conducted in lieu of an on-site visit. The continuation of this
Agreement is dependent upon satisfacto1y evaluations. Upon request by CHS, the
SUBREClPIENT shall submit information and status repol1s required by CHS or HUD, to enable
CHS to evaluate said progrnss and allow for completion ofrequired reports. The SUBRECIPIENT
shall allow CHS or HUD to monitor the SUB RECIPIENT on site. Such site visits may be scheduled
or unscheduled, as dete1111i11ed by CHS or HUD.
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COUNTY will monitor the SUBRECIPIENT'S performance in an attempt to mitigate fraud, waste,
abuse, or non-performance, based on goals and performance standards as stated with all other
applicable laws, regulations, and policies governing the funds provided unde,· this Agreement,
further defined by 2 CFR 200.332. Substandard performance, as determined by CHS, will constitute
noncompliance with this Agreement. If co!'l'ective action is not taken by the SUBRECIPIENT
within a reasonable time period after being notified by CHS, Agreement suspension or termination
procedures will be initiated. SUBRECIPIENTagrees to provide HUD, the HUD Office oflnspector
General, the General Accounting Office, the COUNTY, or the COUNTY's internal auditm{s)
access to all records related to performance of activities in this Agreement.
2,4 PREVENTION OF FRAUD, WASTE, AND ABUSE
SUBRECIPIENT shall establish, maintain, and utilize internal systems and procedures necessary
to prevent, detect, and correct incidents of fraud, waste, and abuse in the performance of this
Agreement, and provide proper and effective management of all Program and Fiscal activities of
the Agreement. SUBRECIPIENT's internal control systems and all transactions and other
significant events shall be clearly documented, and the documentation shall be readily available for
monitoring by COUNTY.
SUB RECIPIENT shall provide COUNTY with complete access to all of its records, employees,
and agents for the purpose of monitoring or investigating the performance of the Agreement.
SUBRECIPIENT shall fully cooperate with COUNTY's efforts to detect, investigate, and prevent
fraud, waste, and abuse.
SUBRECIPIENT may not discriminate against any employee or other person who reports a
violation of the terms of this Agreement or any law or regulation to the COUNTY, or to any
appropriate law enforcement authority, if the report is made in good faith.
2,5 CORRECTIVE ACTION
Corrective action plans may be required for noncompliance, nonperfonnance, or unacceptable
performance under this Agreement. Penalties may be imposed for failure to implement or to make
acceptable progress on such corrective action plans.
To effectively enforce COUNTY Resolution No. 2013-228, CHS has adopted an escalation policy
to ensure continued compliance by Subrecipients, Develope,·s, or any entity receiving grant funds
from CHS. The escalation policy for noncompliance is as follows:
I. Initial noncompliance may result in COUNTY issuing Findings or Concerns to the
SUB RECIPIENT, which requires SUBRECIPIENT to submit a corrective action
plan to CHS within 15 days following issuance of the repmt.
• Any pay requests that have been submitted to CHS for payment will be held
until the corrective action plan has been submitted.
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• CHS will be available to provide Technical Assistance (TA) to the
SUB RECIPIENT, as needed, in order to correct the noncompliance issue.
2. If SUB RECIPIENT fails to submit the corrective action plan to CHS in a timely
manner, the COUNTY may require a portion of the awarded grant funds be
returned to the COUNTY.
• CHS may require upwards of 5 percent of the award amount be returned to the
COUNTY, at the discretion of the Board.
• The SUBRECIPIENT may be denied future consideration, as set f011h in
Resolution No. 2013-228.
3. If SUB RECIPIENT remains noncom pliant, or repeats an issue that was previously
con·ected, and has been infonned by CHS of their substantial noncompliance by
ce11ified mail, CHS may require a portion of the awarded grant amount or the
amount of the COBO-CV investment for acquisition of the properties conveyed,
to be returned to the COUNTY,
• CHS may require upwards of IO percent of the award amount to be returned
to the COUNTY, at the discretion of the Board.
• The SUB RECIPIENT will be considered in violation of Resolution No. 2013-
228.
4, If after repeated notification, SUBRECIPIENT continues to be substantially
noncompliant, CHS may recommend the Agreement or award be terminated.
• CHS will make a recommendation to the Board to immediately terminate
Agreement. The SUB RECIPIENT will be required to repay all funds disbursed
by CHS for the terminated project. This includes the amount invested by the
COUNTY for the initial acquisition of properties 01· other activities,
• SUBRECIPJENTwill be considered in violation of Resolution No. 2013-228.
If SUBRECIPIENT has multiple agrnements with the COUNTY, and is found to be
noncompliant, the above sanctions may be imposed across all awards at the Board's
discretion.
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2.6 REPORTS
Reimbursement may be contingent upon the timely receipt of complete and accurate reports
required by this Agreement, and on the resolution of monitoring findings identified pursuant to this
Agreement, as deemed necessary by the County Manager or designee.
During the term of this Agreement, SUBRECIPIENT shall submit quartel'ly progress reports to the
COUNTY on the 10th day of January, April, July, and October, respectively, for the prior quarter
period end. As part of the report submitted in October, the SUB RECIPIENT agrees to include a
comprehensive final report covering the agreed-upon Program objectives, activities, and
expenditures including but not limited to, performance data on client feedback with respect to the
goals and objectives set fo11h in Exhibit C, which contains an example reporting form to be used in
fulfillment of this requh'ement. Other repot1ing requirements may be required by the County
Manager or designee if the Progrnm changes, the need for additional information or documentation
arises, and/or legislative amendments are enacted. Repotis and/or requested documentation not
received by the due date shall be considered delinquent and may be cause for default and
termination of this Agreement.
Remainder of Page Intentionally Ldt Blank
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PARTIII
TERMS AND CONDITIONS
3.1 SUBCONTRACTS
No part of this Agreement may be assigned or subcontracted without the written consent of the
COUNTY, which consent, if given al all, shall be at the COUNTY's sole discretion and judgment.
3.2 GENERAL COMPLIANCE
The SUBRECIP!ENT agrees to comply with the requirements of Title 24 of the Code of Federal
Regulations, Part 570 (the U.S. Housing and Urban Development regulations conceming
Community Development Block Grants), including subpart K of these regulations, except that (I)
the SUBRECIPIENT does not assume the COUNTY's environmental responsibilities described in
24 CFR 570.604; (2) the SUBRECIPIENT does not assume the COUNTY's responsibility for
initiating the review process under the provisions of24 CFR Part 52; (3) the SUBRECIPIENT is
required to follow the federal procUlement process; and ( 4) for Developers, revenue generated is
not considered program income. The CDBG-CV program is funded thrnugh the CARES ACT. The
SUBRECIPIENT also agrees to comply with all other applicable laws, regulations, and policies
governing the funds provided uncle,· this Agreement. The SUBRECIP!ENT fm1her agrees to utilize
funds available under this Agreement to supplement rather than supplant funds otherwise available.
3.3 INDEPENDENT CONTRACTOR
Nothing contained in this Agreement is intended to, or shall be constrned in any manner, as creating
or establishing the relationship of employer/employee between the parties. The SUBRECIPIENT
shall always remain an "independent contractor" with respect to the se1vices to be performed under
this Agreement. The COUNTY shall be exempt from payment of all Unemployment
Compensation, FICA, retirement, life and/or medical insurance, and Workers' Compensation
Insurance, as the SUB RECIPIENT is independent from the COUNTY.
3.4 AMENDMENTS
The COUNTY or SUBRECIPIENT may amend this Agreement, at any time, provided that such
amendments make specific reference to this Agreement, and are executed in writing, signed by a
duly authorized representative of each organization, and approved by the Board. Such amendments
shall not invalidate this Agreement, nor relieve or release the COUNTY or SUBRECIP!ENT from
its obligations under this Agreement.
The COUNTY may, in its discretion, amend this Agreement to conform with Federal, State, m·
Local governmental guidelines, policies, available funding amounts, or other reasons. If such
amendments result in a change in the funding, the scope of services, or schedule of the activities to
be undertaken as part of this Agreement, such modifications will be incorporated only by written
amendment, signed by both COUNTY and SUBRECIPIENT.
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No modification ot· waiver of any provision of the Grant Documents, nor consent to any departure
by SUBRECIPIENT therefrom shall in any event be effective unless the same is in writing, and
such waiver or consent shall be effective only in the specific instance and for the purpose for which
it is given. No failure or delay on the patt of the COUNTY in exercising any right, power, 01·
privilege hereunder or under the Grant Documents shall operate as a waiver thereof, nor shall a
single or partial exercise thereof preclude any other or further exercise thereof or the exercise of
any other right, power, or privilege.
3.5 AVAILABILITY OF FUNDS
The parties acknowledge that the Funds originate from HUD CD BG-CV grant funds and must· be
implemented in full compliance with all of HUD's rules and regulations and any agreement
between CXlUNTY and HUD governing CDBG-CV funds pertaining to this Agreement. In the
event of c,ntailment or non-prnduclion of said federal funds, or the reduction of funds awarded by
HUD to the COUNTY, to a level determined by the County Manager to be insufficient to
adequately administe1· the project, the financial resources necessary to continue to pay the
SUBRECIPJENT all or any portion of the funds will not be available. In either event, the COUNTY
may terminate this Agreement, which shall be effective as of the date it is determined by the County
Manager or designee, in his/her sole discretion and judgment, that the funds are no longer available.
[n the event of such termination, the SUB RECIPIENT agrees that it will not look to, nor seek to
hold the COUNTY, nor any individnal member of the County Commissione,s and/or County
Administration, personally liable for the performance of this Agreement, and the COUNTY shall
be released from any further liability to SlJBRECJPIENT under the terms of this Agreement.
SUBRECIPJENT shall use the Grant proceeds solely for necessary expenditures incurred due to
the COVID-19 public health emergency, and the proceeds of the Grant will not be loaned, granted,
or assigned to any pa,ty and shall in no event be used for any prupose prohibited by the Grant
Documents or Regulations. No Grant proceeds may be used for the purchase of property or
construction of existing property.
3,6 INDEMNIFICATION
To the maximum extent permitted by Florida law, the SUBREC!PIENT shall indemnify and hold
ha,mless the COUNTY, its officers, agents, and employees from any and all claims, liabilities,
damages, losses) costs, and causes of action which may arise out of an act ot· omission, including
but not limited to reasonable attomeys' and paralegals' fees, to the extent caused by the negligence,
recklessness, 01· intentionally wrongful conduct of the SUBRECIPIENT or any of its agents,
officers, servants, employees, contractors> patt·ons, guests, clients, licensees, invitees, or any
persons acting under the direction, control, or supervision of the SUBRECIPIENT in the
performance of this Agreement. This indemnification obligation shall not be construed to negate,
abridge, 01· reduce any other rights or remedies, which otherwise may be available to an indemnified
party or person described in this paragraph. The SUBRECJPJENT shall pay all claims and losses
of any nature whatsoever in connection therewith and shall defend all suits in the name of the
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COUNTY and shall pay all costs (including attomey's fees) and judgments which may issue there-
on. This Indemnification shall survive the termination and/or expiration of this Agreement, This
sectio11 does not pertain to any incident arising from the sole negligence of COUNTY. The
foregoing indemnification shall not constitute a waiver of sovereign immunity beyond the limits
set frnth in Section 768.28, Florida Statutes, This section shall survive the expiration of termination
of this Agreement.
3.7 GRANTEE RECOGNITION/SPONSORSHIPS
The SUBRECIPIENT agrees that all notices, informational pamphlets, press releases,
advertisements, descriptions of program sponsotships, research repotis, and similar public notices,
whether printed or digitally prepared and released by the SUBRECIPJENT for, on behalf of, and/or
about the Program shall include the statement:
"FINANCED IN PART BY U.S. DEPARTMENT OF HOUSING AND
URBAN DEVELOPMENT (HUD) AND COLLIER COUNTY
COMMUNITY AND HUMAN SERVICES DIVISION"
and shall appear in the same size letters or type as the name of the SUB RECIPIENT. This design
concept is intended to disseminate key information to the general public regarding the development
team, as well as Equal Housing Opportunity. Construction signs shall comply with applicable
COUNTY codes.
3.8 DEBARMENT AND SUSPENSION
SUBRECIPJENT certifies that neither it, nor its principals, is presently debarred, suspended,
proposed for debarment, declared ineligible, or voluntarily excluded from participation in this
trnnsaction by any Federal Depa1tment or agency; and the SUBRECIPIENI' shall not knowingly
enter into any lower tier contract, or other covered transaction, as outlined in Executive Orders
12549 (1986) and 12689 (1989), Debarment and Suspension and 2 CFR 200.213, as further detailed
in Section 4.18.
3,9 DEFAULTS, REMEDIES, AND TERMINATION
In accordance with 2 CPR 200.341, this Agreement may be terminated for convenience by either
the COUNTY or the SUBRECIPIENT, in whole or in pa1t, by setting forth the reasons for such
termination, the effective date, and in the case of partial tenninations, the portion to be terminated,
However, in the case ofa partial termination, if the COUNTY determines that the remaining portion
of the award will not accomplish the purpose for which the award was made, the COUNTY may
terminate the award in its entirety. This Agreement may also be terminated by the COUNTY, if the
award no longer effectuates the program goals or grantor agency priorities,
The following actions or inactions by SUBRECJPIENT shall constitute a Default under this
Agreement, in compliance with 2 CFR 200, Appendix 11 (A):
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A. SUBRECIPIENT's failure lo comply with any of the rules, regulations, or provisions
referred to herein, or such statutes, regulations, executive orders, and HUD guidelines,
policies, or directives as may become applicable at any time.
B. SUBRECIPIENT's failure, for any reason, to fulfill its obligations under this Agreement
in a timely and proper manner.
C. SUBRECIPIENT's ineffective or improper use of funds provided under this Agreement.
D. SUBRECIPIENT's submission to the COUNTY of reports that are incol'l'ect or incomplete
in any material respect.
E. SUBRECIPIENT's submission of any false ce1iification.
F, SUBRECIPIENT's failure to materially comply with any terms of this Agreement,
G. SUBRECIPIENT's failure to materially comply with the terms of any othe,· agreement
between the COUNTY and the SUBRECIPIENT relating to the project.
In the event of any default by SUBRECIPIENT under this Agreement, the COUNTY may seek any
combination of one or more of the following remedies, in compliance with 2 CFR 200, Appendix
II (B):
A. Require specific performance of the Agreement, in whole or in part.
B, Require the use of, or change in, professional property management.
C, Require SUBRECIPIENT to immediately repay lo the COUNTY all CDBG,CV funds
received under this Agreement.
D. Apply sanctions, if COUNTY determines them to be applicable,
E. Stop all payments until identified deficiencies are corrected.
F. Terminate this Agreement by giving written notice to SUBRECIPIENT and specifying the
effective date of such termination, If the Agreement is terminated by the COUNTY, as
provided herein, SUBRECIPIENT shall have no claim of payment or benefit for any
incomplete project activities unde1iaken under this Agreement.
3.10 REVERSION OF ASSETS
In the event of a termination of this Agreement and in addition to any and all other remedies
available to the COUNTY (whether under this Agreement, or at law, or in equity), the
SUB RECIPIENT shall immediately transfer to the COUNTY any property on hand at the time of
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termination ( or expiration) and any accounts receivable attributable to the use of CD BG-CV funds,
per 24 CFR 570.503(b)(7).
The COUNTY's receipt of any funds on hand at the time of termination shall not waive the
COUNTY's right (nor excuse SUBREC[PIENT's obligation) to recoup all or any portion of the
funds or property, as the COUNTY may deem necessary. Regulations regarding real prope11y are
subject to 2 CFR 200.311 and as otherwise provided at 24 CFR 570.503(b)(7).
3.11 INSURANCE
SUB RECIPIENT shall not commence any work and/or services pursuant to this Agreement until
all required insurance, as outlined in Exhibit A and 2 CFR 200.3 I 0, has been obtained. Said
insurance shall be carried continuously during SUBRECIPIENT's performance under the
Agreement.
3.12 ADMINISTRATIVE REQUIREMENTS
The SUBRECIPJENT agrees to perform the Scope of Work in compliance with the Grant Budget
and the Scope of Work (Part !), the Unifonn Administrative Requirements, Cost Principles and
Audit Requirements for Federal Awards (2 CFR 200 et seq.), and the federal regulations for the
Community Development Block Grant (24 CFR 570 et seq.).
3.13 PURCHASING
SUBRECIPIENT is required to follow Federal Procurement standards (2 CFR 200.318 through
200.327) and Collier County's Procurement Ordinance #2017-08, as amended. Current purchasing
thresholds are:
Federal Procurement Standards:
Ranoe: Mcthod/Comoetition Required
$0 -$10,000 Micro-Purchase
$10,001 -$250,000 Small Purchase
$250,001+ Sealed Biddin"
Collier County Procurement Standards
RanP-e: Comnctition Re{IUired
$0 -$50,000 3 Written nuotes
$50,001+ Formal Solicitation (1TB, RFP, etc.)
During the period of the Declared State of Emergency, emergency and exigent purchases will be
permitted, following Federal Procurement standards, pursuant to 2 CFR 200.320, provided that
SUBRECIPIENT submits sufficient documentation to support cost reasonableness. Acceptance of
said documentation shall be at the COUNTY's sole discretion. If the Declared State of Emergency
expires before December 30, 2020, SUB RECIPIENT shall ensure that non-emergency COUNTY
procmement standares is used for purchases under this Agreement. Regardless of the state of
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emergency, any purchase in excess of 250,000 will be assessed using a price or cost analysis
approved by CHS, prior to purchase.
In accordance with 2 CFR 200.322, to the greatest extent practicable, SUBRECIPJENT
shall procure, acquire, or use goods, products or materials produced in the United States.
In accordance with 2 CFR 200.323, SUBRECIPIENT shall procure items that contain the
highest percentage of recovered materials practicable, consistent with maintaining a
satisfactory level of completion, per 2 CFR 200, Appendix II (J) and 2 CFR 200.323.
All items specified in Part I Scope of Work shall be perfonned by SUB RECIPIENT employees, or
put out to competitive bidding, under a procedlll'e acceptable to COUNTY and Federal
requirements. The SUBRECIPIENT shall enter into contracts with the lowest, responsible, and
qualified bidder. [n accordance with 2 CFR 200,323, SUBRECJPIENT shall procme items that
contain the highest percentage of recovered materials practicable, consistent with maintaining a
satisfactory level of completion, per 2 CFR 200, Appendix ll(J) and 2CFR 200.323. Contract
administration shall be conducted by the SUBRECIPIENT and monitored by CHS, which shall
have access to all records and documents related to the Project.
3.14 PROGRAM GENERATED INCOME
No Program Income is anticipated. However, if Program Income is derived from the use ofCDBG-
CV funds disbursed under this Agreement, such Program Income shall be utilized by the
SUBRECIPIENT for CDBG-CV eligible activities approved by COUNTY. Any Program Income
(as such term is defined under applicable Federal regulations) gained from any activity of the
SUBRECIPIENT funded by CDBG-CV funds shall be reported to the COUNTY thrnugh an annual
Program Income Re-use Plan, utilized by the SUBREC!PIENT accordingly, and shall be in
compliance with 2 CFR 200.307 and 24 CFR 570.503(c) in the opemtion of the Prngram. When
Program Income is generated by an activity that is only partially assisted by CDBG-CV
funds, the incomcslrnll be prorated to reflect the percentage of CDBG-CV funds used. If there
is a Program Income balance at the end of the Program Year, such balance shall revert to the
COUNTY's CDBG Program, fOI' further reallocation.
3,15 GRANT CLOSEOUT PROCEDURES
SUBREC!PIENT's obligation to the COUNTY shall not end until all closeout requirements are
completed. The SUB RECIPIENT may close out the project with the COUNTY after the expiration
of the Agreement, Activities during this closeout period shall include, but are not limited to making
final payments; disposing of program assets (including the return of all unused materials,
equipment, program income balances, and receivable accounts to the COUNTY); and determining
the custodianship of records. In addition to the records retention outlined in Part 2.2, the
SUB RECIPIENT shall comply with Section l l 9,02 I, Florida Statutes, rcgat·ding records
maintenance, prese1vation, and retention. A conflict between state and federal records retention law
requirements will result in the more stringent law being applied, such that the record must be held
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for the longer duration. Any balance of unobligated funds that have been advanced or paid must be
returned to the COUNTY. Any funds paid exceeding the amount SUBRECIPJENT is entitled to
under the terms and conditions of this Agreement must be refunded to the COUNTY.
SUBRECIPIENT shall also produce 1·ecords and information complying with Section 215.97,
Florida Single Audit Act. Closeout procedures must take place in accordance with 2 CFR 200.344.
3.16 OPPORTUNITJFA~ FOR RESIDENTS AND CIVIL RIGHTS COMPLIANCE
The SUB RECIPIENT agrees that no person shall be excluded from the benefits of, or be subjected
to discrimination under any activity carried out by the performance of this Agreement based on
race, color, disability, national origin, religion, age, familial status, or sex. Upon receipt of evidence
of such discrimination, the COUNTY shall have the right to terminate this Agreement.
To the greatest extent feasible, lower-income residents of the project areas shall be given
opportunities for training and employment. In addition, to the greatest extent feasible, eligible
business cOllcerns located in 01· owned in substantial part by persons residing in the project areas
shall be awarded contracts in connection with the project. The SUB RECIPIENT shall comply with
Section 3 of the Housing and Community Development Act of 1968,
3.17 OPPORTUNITIES FOR SMALL AND MINORITY/WOMEN OWNED BUSINESS
ENTERPRISES
The SUB RECIPIENT will use its best efforts to afford small businesses and minority and women's
business enterprises the maximum practicable oppmtunity to participate in the performance of this
Agreement. As used in this Agreement, the term "small business" means a business that meets the
criteria set forth in section 3(a) of the Small Business Act, as amended (15 U.S.C. 632); and
"minority and women's business enterprise" means a business that is at least 51 percent owned and
controlled by minority grm1p membet~ or women. For the purpose of this definition, "minority
group members" are Afro-Americans, Spanish-speaking, Spanish surnamed 01· Spanish-heritage
Americans, Asian-Americans, and American Indians. The SUBREC!PIENT may rely on written
representations by businesses regarding their status as minority and women's business enterprises,
in lieu of an independent investigation.
3.18 PROGRAM BENEFICIARIES
If the Agreement is meeting a National Objective through an LMI strategy, at least 51 percent of
the beneficiaries of a project funded through this Agreement must be low-and moderate-income
persons, or presumed to be low-to moderate-income persons based on applicable regulation.
Determination ofincome eligibility is based on the annual income of the family or household. This
Agreement conforms to the definition of Annual Income, per 24 CFR 570.3(l)(i), where Annual
income is defined under the Section 8 Housing Assistance Payments. Details for calculating the
Annual Income are contained in 24 CFR 5.609, with practical instructions contained in HUD
Handbook 4350.3, Chapter 5.
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If the project is located in an entitlement city as defined by HUD, 01· serves beneficiaries
countywide, more than 30 percent of the beneficiaries directly assisted under this Agreement must
reside in unincorporated Collier County or in municipalities patticipating in the COUNTY's Urban
County Qualification Program. The project shall assist beneficiaries as defined above for the time
period designated in Exhibit C of this Agreement.
3.19 AFFIRMATIVE ACTION
The SUBRECIPIENT agrees that it shall be committed to carry out an Affirmative Action Program
pursuant to the COUNTY's specifications, in keeping with the principles as provided in President's
Executive Order 11246 of September 24, 1966. The SUBRECIPIENT shall submit a plan for an
Affirmative Action Program for approval prior to the award of funds. The Affirmative Action
Program will need to be updated throughout the continued use period and must be submitted to the
COUNTY within 30 days of any update/modification.
3.20 CONFLICT OF INTEREST
The SUBRECIPIENT covenants that no person under its employ, who presently exercises any
functions or responsibilities in connection with the Project, has any personal financial interest,
direct 01· indirect, in the Project areas or any parcels therein, which would conflict in any manner
01· degree with the performance of this Agreement SUB RECIPIENT also agrees that it will not
employ or subcontract any person having any conflict of interest. The SUBRECIPIENT covenants
that it will comply with all provisions of 24 CFR 570.6! 1 "Conflict oflnterest," 2 CFR 200.318,
and the State and County statutes, regulations, ordinances, or resolutions governing conflicts of
interest.
The SUBRECIPIENT will notify the COUNTY, in writing, and seek COUNTY approval prior to
entering into any contract with an entity owned in whole or in pait by a covered person, or an entity
owned or controlled in whole or in part by the SUBRECIPIENT. The COUNTY may review the
proposed contract to ensure that the contractor is qualified, and the costs are reasonable. Approval
of an identity of interest contract will be in the COUNTY's sole discretion. This provision is not
intended to limit SUBRECIPIENT's ability to self-manage the projects using its own employees.
Any possible conflict of interest on the part of the SUBRECIPIENT, its employees, or its
contractors shall be disclosed to CHS in writing, provided however, that this paragraph shall be
interpreted in such a manner so as not to unreasonably impede the statuto1y requirement that
maximum opportunity be provided for employment of and pa1ticipation of low-and moderate-
income residents of the project target area.
3.21 BYRD ANTI-LOBBYING AMENDMENT
Each tier certifies that the tier above it will not, and has not, used Federally appropriated funds to
pay any person or organization for influencing or attempting to influence the award of Federnl
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funds, as covered by 31 USC 1352, as more fully described in Section 4.47 of this Agreement.
Contractors who apply or· bid for an award of$100,000 or more shall file the required certification.
3.22 RELIGIOUS ORGANIZATIONS
CDBG-CV funds may be used by religious organizations or· on prope1ty owned by religious
organizations only in accordance with requirements set forth in Section 24 CFR 570.200(i). The
SUBRECIPIENT shall comply with First Amendment Church/State principles as follows:
A. It will not discriminate against any employee or applicant for employment based on
religion, and will not limit 01· give preference in employment to persons based on religion.
B. It will not discriminate against any person applying for public services based on religion,
and will not limit such services or give preference to persons based on religion.
C. It will retain its independence from Federal, State, and Local governments and may
continue to cany out its mission, including the definition, practice, and expression of its
religious beliefs, provided it does not use direct CDBG-CV funds to support any inherently
religious activities, such as worship, religious instrnction, 01· proselytizing.
D. The funds shall not be used for the acquisition, construction, 01· rehabilitation of strnctures
to the extent that those strnctures are used fo,• inherently religious activities. Whel'(, a
strncture is used for both eligible and inherently religious activities, CDBG-CV funds may
not exceed the cost of those pmtions of the acquisition, construction, or· rehabilitation that
are attributable to eligible activities, in accordance with the cost accounting requirements
applicable to CDBG-CV funds in this part. Sanctuaries, chapels, or other rooms that a
CD BG-CV funded religious congregation uses as its principal place of worship, however,
are ineligible for CDBG-CV funded improvements.
3,23 INCIDENT REPORTING
If services to clients are to be provided under this Agreement, the SUBRECIPIENT and any
subcontractors shall repo1t to the COUNTY knowledge or reasonable suspicion of abuse, neglect,
or exploitation of a child, aged person, or disabled person.
3.24 SEVERABILITY
Should any provision of the Agreement be determined to be unenforceable or invalid, such a
determination shall not affect the validity or enforceability of any other section or part thereof.
3,25 MISCELLANEOUS
The SUBRECIPIENT and the COUNTY each binds itself, its partners, successors, legal
representatives, and assigns of such other paity in respect to all covenants of this Agreement.
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The SUBRECIPIENT represents and warrants that the financial data, reports, and other information
regarding the Project that SUB RECIPIENT furnished to the COUNTY are accmate and complete,
and financial disclosmes fail'iy reprnsent the SUBRECIPIENT's financial position.
The SUBRECIPIENT certifies that it has the legal authority to receive the funds under this
Agreement and that its governing body has authorized the execution and acceptance of this
Agreement. The SUBRECIPIENT also certifies that the undersigned person has the authority to
legally execute and bind the SUB RECIPIENT to the terms of this Agrement.
The Grant Documents shall be constiued in accordance with and govemed by the laws of the State
of Florida, without giving effect to its provisions regarding choice oflaws.
All activities authorized by this Agreement shall be subject to and performed in accordance with
the provisions of the terms and c011ditions of the Agreement between the COUNTY, the
Regulations, all applicable federal, state, and municipal laws, ordinances, regulations, orders, and
guidelines, itwluding but not limited to any applicable regulations issued by CHS.
Electronic Signatmes. This Agreement, and related documents entered into in connection with this
Agreement are signed when a party's signature is delivered by facsimile, e-mail, or any other
electronic medium. These signatures must be treated in all respects as having the same force and
effect as original signatures.
Remainder of Page Intentionally Left Blank
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PART IV
GENERAL PROVISIONS
4,1 24 CPR 570 as amended-All the regulations regarding the CDBG program
https://www.ecfr.gov/cgi-bi1Jtcxt-idx?tpHecfrbrowse/Title24/24cfr570 main 02.tpl
4.2 24 CFR 58 -The regulations prescribing the Environmental Review procedure.
!llms://www.ecfr.gov/cgi-bi1Jtext-
idx?S1D= lacdb92f3b05c3l285dd76c26d I 4f54e&mc=irue&node=pt24. I .58&rgn=div5
4.3 Section l04(b) and Section I 09 of Title I of the Housing and Community Development Act of
1974 as amended
https://www.hud.gov/program offices/comm planning/communitydeveloprnent/iulesandregs/law
s/sec5309
4.4 The Fair Housing Act (42 U,S.C. 3601-20) Reasonable Accommodations Under the Fair Housing
Act. https://www.hud.gov/sites/documents/DOC 7771.PDF
https://www.justice.gov/cn/fail'-housing-act-1
Executive Order 11063 -Equal Opportunity in Housing https://www.archives.gov/federal-
register/codificatio,Jexecutive-order/J l 063 .html
Executive Order 11259 -Leadership & Coordination of Fair Housing in Federal Programs
https ://www .archives. gov/federal-register/codificatio,Jexecuti ve-ordel'i 12259 .html
24 CPR Part 107 -Non-Discrimination and Equal Opprniunity in Housing under E.O.
https://www.law.cornell.edu/cfr/text/24/part-l 07
4,5 Title VI of the Civil Rights Act of 1964 as amended, Title VIII of the Civil Rights Act of 1968, as
amended https://www.hud.gov/programdesc1'iptio,Jtitle6
4,6 24 CFR 570.601 Subpart K -The regulations issued pursuant to Executive Order 11063 which
prohibits discrimination and promotes equal oppo,tunity in housing.
https://www.gpo.gov/fdsys/pkg/CFR-2007-title24-vo13/pdf/CFR-2007-title24-vo13-sec570-
602.pdf
4,7 Executive Order 11246 ("Equal Employment Opportunity"), as amended by Executive Orders
11375 and 12086 -which establishes hiring goals for minorities and women on projects assisted
with federal funds and as supplemented in Depatiment of Labor regulations. EO 11246:
https://www.dol.gov/agencies/ofccp/executive-order-11246/as-amended
EO 11375 and 12086: see item #8 below
4.8 Title Vll of the 1968 Civil Rights Act as amended by the Equal Employment Opportunity Act of
1972, 42 USC § 2000e, et. seq. The SUB RECIPIENT will, in all solicitations or adve1iisements for
employees placed by or on behalf of the SUBRECIP!ENT, state that it is an Equal Opportunity or
Affirmative Action employer.
hltps://www.hud.gov/programdescdptio1Jtitle6
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4.9 24 CFR 75 -Regulations outlining requirements of Section 3 of the Housing and Urban
Development Act of 1968, as amended. Compliance with the provisions of Section 3 of the HUD
Act of 1968, as amended, and as implemented by the regulations set forth in 24 CFR 75, and all
applicable rnles and orders issued hereunder prior to the execution of this Agreement, shall be a
condition of the Federal financial assistance provided under this Agreement and binding upon the
COUNTY, the SUBRECIPIENT and any of the SUBRECIPIENT's Subrecipients and
subcontractors, Failure to fulfill these requirements shall subject the COUNTY, the
SUBRECIPIENT and any of the SUBRECIPIENT's Subrecipients and subcontractors, their
successors and assigns, to those sanctions specified by the Agreement through which Federal
assistance is provided. The SUBRECIPIENT certifies and agrees that no contractual or other
disability exists that would prevent compliance with these requirements,
https://www.hud.gov/sites/dfiles/FHEO/documents/Section3rule092820.pdf
The SUBRECIPIENT further agrees to comply with these "Section 3" requirements and to include
the following language in all subcontracts executed under this Agreement:
"The work to be performed under this Agreement is a project assisted under a program providing
direct Federal financial assistance from HUD and is subject to the requirements of Section 3 of the
Housing and Urban Development Act of 1968, as amended (12 U.S.C. 1701). Section 3 requires
that, to the greatest extent feasible, opportunities for training and employment be given to low-and
very low-income residents of the project area, and that contracts for work in connection with the
project be awarded to business concerns that provide economic opportunities for low-and very
lowMincome persons residing in the metropolitan area in which the project is located.'>
The SUBRECIPIENT further agrees to ensure that opportunities for training and employment
arising in connection with a housing rehabilitation (including reduction and abatement of lead-
based paint hazards), housing construction, or othe,· public constrnction project are given to low-
and vet·y low-income persons residing within the metrnpolitan area in which the COBO-funded
project is located; where feasible, priority should be given to low-and very low-income persons
within the service area of the project or the neighborhood in which the project is located, and to
low-and very low-income patticipants in other HUD programs; and award contracts for work
unde1taken in connection with a housing rehabilitation (including reduction and abatement oflead-
based paint hazards), housing constrnction, or other public construction project to business
concerns that provide economic opportunities for low-and very low-income persons residing
within the metropolitan area in which the COBO-funded project is located; where feasible, priority
should be given to business concerns that provide economic opportunities to low-and very low-
income residents within the service area or the neighborhood in which the project is located, and to
low-and very low-income pm·ticipants in other HUD programs,
The SUBRECIPIENT certifies and agrees that no contracttml or other legal incapacity exists that
would prevent compliance with these requirements.
https://www.hud.gov/sites/dfiles/FHEO/documents/Section3rule092820.pdf
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4,10 Age Discrimination Act of 1975, Executive Order 11063, and Executive Order 11246 as amended
by Executive Orders I 1375, 11478, 12107 and 12086,
Age Discrimination Act of 1975
https ://www.law.come\l.edu/uscode/text/42/chapter-76
I 1246: h!!Jls://www.dol.gov/ofccp/regs/statutes/eol 1246.htm
11375: Amended by EO 11478
I 1478: https://www.archives.gov/federal-register/codification/executive-order/ 114 78.httn I
12107: https://www.archives.gov/federal-register/codification/executive-order/J 2107.htm I
12086: https;//www ,archives.gov/federal-register/codification/executive-order/ 12086.htm I
4.11 Contract Work Hours and Safety Standards Act, 40 USC 327-332.
https ://www.dol.gov/whd/regs/statutes/safe01.pdf
4.12 Section 504 of the Rehabilitation Act of 1973, 29 USC 776(b) (5), 24 CFR 570.614 Subpart K.
Section 504: https://www.epa.gov/ocr
29 USC 776: https://law.onecle.com/uscode/29/776.html
24 CFR 570,614; https;//www.law.cornell,edu/efr/text/24/570.614
4.13 The Americans with Disabilities Act of 1990: -1:!!!Jls://www.hud.gov/hudprograms/eohudap
4.14 Uniform Relocation Assistance and Real Propel'ty Acquisition Policies Act of 1970, as amended.
https://www.fhwa.dot.gov/real estate/uniform act/index.cfin
4.15 29 CFR Patis 3 and 5 -Regulations that prescribe the payment of prevailing wages and the use of
apprentices and trainees on federally assisted projects. HUD Form 4010 must be included in all
construction contracts funded by CDBG.
Davis-Bacon Act: 42 USC 276a to 40 USC 276a:
https://uscode.house.gov/view .xhtm l?req=granulei d; USC-I 999-title40-section276a-
7 &num=0&edition= 1999
29 CFR Pati 3 -Contractors and Subcontractors on public building or Public Work Financed, in
whole or in pmi, by Loans or Grants from the United States
https://www.law.cornell.edu/cfr/text/29/part-3
29 CFR Pmt 5 -Labor Standards Provisions Applicable to Contracts Covering Federally Financed
and Assisted Constrnction (Also, Labor Standards Provision Applicable Subject to the Contract
Work Hours and Safety Standards Act)
l1ttps://www.law.cornell.edu/cfr/text/29/part-5
Executive Order 11914 -Prohibits discrimination with respect to the handicapped, in federally
assisted projects. https://www.presidcncy.ucsb.edu/ws/index.php?pid=23675
4.16 As a supplement to the Davis-Bacon Act requirements, the SUBRECIP!ENTagrees to comply with
the "Copeland Anti-Kickback Act," which prohibits the SlJBRECIPIENT, its contractors, or
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subcontractors from inducing an employee to relinquish any part of his/her compensation, tmder
the federally-funded contract.
18 U.S,C. 874 https://www.govlnfo.gov/content/pkg/USCODE--20 I 0-tltlel 8/pdf/USCODE-20 I 0-
title 18.pdf
40 U.S.C, 276c https://uscode,house.gov/view.xhtml?req~granuleid:USC-1999-title40-
section276c&num-0&edition-1999
4,17 Executive Order 11625 and U.S. Department of Housing and Urban Development Circular Letter
79-45 -which prescribes goal percentages for paiiicipation of minority businesses in Community
Development Block Grant Contracts.
E.O. I I 625 Prescribing additional arrangements for developing and coordinating a national
program for minority business enterprise.
https:llwww.archives.gov/federal-register/codification/executive-order/11625.html
4,18 The SUBRECIPIENT agrees to comply with the non-discrimination in employment and
contracting opportunities laws, regulations, and executive orders referenced in 24 CFR 570.607, as
revised by Executive Order 13279. The applicable non-discrimination provisions in Section 109 of
the Housing and Community Development Act (HCDA) are still applicable.
24 CFR 570.607:
j1t(ps:/1www.ecfr.gov/cgi-bin/text-
idx?SID-9eae3f1leaa99l ftl4 l 1 f383b74003bcb I &mc""lrue&node-pt24.3.570&rgn-div5/lse24.3.5
70 1607
E.O. 13279: hltp://www.fedgovcontracts.com/pe02-96.htm
4.19 Public Law I 00-430 -the Fair Housing Amendments Act of 1988.
ht tps:l /www ,nc bi. nl rn. nih.gov/pubmed/ 122 89709
4.20 2 CFR 200 et seq -Uniform Administrative Requirements, Cost Principles, and Audit
requirements for Grants and Agreements.
https://www.ecfr.gov/cgi-bin/text-idx'/tpl=lecfrbrowse/Title0212cft'200 main 02,tpl
4.21 2 CFR 200.2 I 6 -Prohibition on certain telecommunications and video surveillance services or
equipment. COUNTY and SUBRECIPIENT are prohibited from obligating 01· expending loan or
grant funds to: I) procure or obtain; 2) extend or renew a contract to procme or obtain; 3) enter into
a contract ( or extend or renew a conlrnct) to procure or obtain equipments, services, or systems that
use(s) covered telecommunications equipment or services as a substantial component of any
system, or as critical technology as part of any system.
4.22 Immigration Reform and Control Act of 1986
https://www.eeoc.gov/eeoclhistory/35thlthelaw/irca.htm1
4.23 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
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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 531 i.
Florida Statutes-
https://www.lawserver.com/law/state/florida/statutes/florida statutes chapter 112 pa,t iii
Collier County-
http://www.co I liergov. net/home/showdocument?id=35 J 3 7
4.24 Order of Precedence -In the event of any conflict between or among the teims of any of the Contract
Documents, the terms of the Ag1·eement shall take precedence over the terms of all other Contract
Documents, except that 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 Owner's discretion.
4,25 Venue-Any suit ofaction 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, FL which courts have sole jurisdiction on all such matters. (No reference required
for this item).
4.26 Dispute Resolution -Prior to the initiation of any action or proceeding permitted by this Agreement
to resolve disputes between the pmties, the pmties shall make a good faith effort to resolve any
such disputes by negotiation. Any situations when negotiations, litigation, and/or mediation shall
be attended by representatives of SUBRECIPIENT with full decision-making authmity 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 pmties arising out of this Agreement, the pm1ies shall
attempt to resolve the dispute through Mediation before an agreed-upon Circuit Court Mediator
ce1iified by the State of Flm·ida, Should either party fail to submit to mediation as required
hereunder, the other party may obtain a court order requiring mediation under§ 44.102, Florida
Statutes, The litigation arising out of this Agreement shall be adjudicated in Collier County, Florida,
if in state comt; and the US District Court, Middle District of Florida, if in federal court. BY
ENTERING INTO THIS AGREEMENT, COLLIER COUNTY AND THE SUBRECIPIENT
EXPRESSLY WAIVE ANY RIGHTS EITHER PARTY MAY HAVE TOA TRIAL BY JURY
OF ANY CIVIL LITIGATION RELATED TO, OR ARISING OUT OF, THIS AGREEMENT.
https://www.flsenate.gov/Laws/Statutes/2012/44.1 oi
4.27 The SUB RECIPIENT agrees to comply with the following requilements:
a. Clean Air Act, 41 USC 7401, et seq. https://www.govinfo.gov/content/pkg/USCODE-
20 I 0-title4 2/html/USCODE-20 I 0-ti tle42-chap85. htm
https://www.law.cornell.edu/uscode/text/42/chapter-85
b. Federal Water Pollution Control Act, 33 USC 1251, et seq., as amended.
https:l/www.govinfo.gov/contentlpkg/USCODE-20 l 1-title33/pdf/USCODE-20 I l-title33-
chap26.pdf
https:/lwww.law.cornell.edu/uscode/text/33/chapter-26
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4.28 In accordance with the requirements of the Flood Disaster Protection Act of 1973 (42 USC 4002
and 24 CFR 570.605 Subpart K), the SUB RECIPIENT shall asstll'e that for activities located in an
area identified by FEMA as having special flood hazards, flood insurance under the National Flood
Insurance Program is obtained and maintained. If appropriate, a letter of map amendment (LOMA)
may be obtained from FEMA, which would satisfy this requirement and/or reduce the cost of said
flood insurance.
https://www.law.comell.edu/cfr/text/24/570.605
4.29 The SUBRECIPIENT agrees that any construction or rehabilitation of residential strnctures with
assistance provided under this Agreement shall be subject to the HUD Lead-Based Paint Poisoning
Prevention Act, found at 24 CFR 570.608, Subpait K. https://www.gpo.gov/fdsys/granule/CFR-
2000-title24-vol3/CFR-2000-title24-vol3-sec570-608-id 163
4.30 The SUBRECIPIENT agrees to comply with the Historic Preservation requirements set forth in the
National Historic Preservation Act of 1966, as amended (16 U.S.C. 470) and the procedures set
forth in 36 CFR Part 800, Advisory Council on Historic Pt·eservation Procedures for Protection of
Historic Properties, insofa1· as they apply to the perfot'mance of this Agt'eement.
https:/ /www.nps.gov/history/local-law/nhpa 1966. htm
https:/iwww.achp.gov/sites/default/files/regulations/2017-02/l'egs-rev04.pdf
In general, this requires concurrence from the State Historic Prese1vation Officer for all
rehabilitation and demolition of historic properties that are fifty years old or older or that are
included on a Federal, State, or Local historic propetty list.
https://www.nps.gov/history/local-law/nhpa 1966.htm
4.31 The SUBREC!PIENT must certify that it will provide drug-free workplaces, in accordance with
the Drug-Free Workplace Act of 1988 (41 USC 70 !).
hltps://www.gpo.gov/fdsys/granule/USCODE-2009-title41/USCODE-2009-title4 l-chap IO-
sec70 I
4.32 The SUB RECIPIENT certifies that neither it, nor its principals, is presently debarred, suspended,
proposed for debarment, declared ineligible, or voluntarily excluded from participation in this
transaction by any Federal Depatiment or agency; and the SUBRECIPIENT shall not knowingly
enter into any lower tier contract, or other covered transaction, with a person who is similarly
debarred or suspended from pa11icipating in this covered transaction as outlined in 24 CFR 570.609,
SubpartK.
https://www.archives.gov/fcderal-register/co<lification/executive-order/12549.html
4.33 The S\JBRECIPIENT agrees to comply with the following 0MB Circulars whichever is applicable
and agrees to adhere to the accounting principles and procedures required therein, utilize adequate
internal controls, and maintain necessary source documentation for all costs incul'red. These
requirements are enumerated in 2 CFR 200, et seq.
4.34 Single Audits shall be conducted annually, in accordance with 2 CFR 200.501, and shall be
submitted to the COUNTY nine (9) months after the end of the SUBRECIPIENT's fiscal year. The
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SUB RECIPIENT shall comply with the requirements and standards of 2 CPR 200 Subpart F,
Section 500, SUBRECIPIENTS exempt from Single Audit requirements shall submit financial
statements to the COUNTY one hundred eighty (180) days after the end of the SUBRECIPJENT'S
fiscal year. Per 2 CFR 200.344, if this Agreement is closed out prior to the receipt of an audltrepo1i,
the COUNTY reserves the right to recover any disallowed costs identified in an audit after such
closeout.
https://www.ecfr.gov/cgi-bin/text-
idx?SID=5a78addefff9a535e83fed30 I 0308aef&mc=trne&node=se2. l .200 1344&rgn=div8
4.35 Any real prope1ty acquired by the SUBRECIPIENT for the purpose of carrying on the projects
stated herein, and approved by the COUNTY in accordance with the Uniform Relocation
Assistance and Real Property Acquisition Policies Act of 1970 and 49 CFR 24.101, shall be subject
to the prnvisions of CDBG including, but not limited to, the provisions on use and disposition of
property. Any real property within SUBRECIPIENT control, which is acquired or improved, in
whole or part, with CDBG funds in excess of $25,000, must adhere to the CDBG Regulations at
24 CFR 570,505.
https://www.gpo.gov/fdsys/granule/CFR-l999-title49-vol l/CFR-l 999-title49-vol l-sec24-l 0 1
https://www.govinfo ,gov/app/details/CFR-20 l 2-title24-vol3/CFR-20 l 2-title24-vo 13-sec570-505
4.36 As provided in§ 287.133, Florida Statutes, by entering into this Agreement or performing any work
in fmtherance hereof, the SUBRECIPIENT ce11ifies that it, its affiliates, suppliern, subcontractors
and consultants who will perfonn hereunder, have not been placed on the convicted vendor list
maintained by the State of Florida Depattment of Management Se1vices within the 36 months
immediately preceding the date hereof.
This notice is required by§ 287.133 (3) (a), Florida Statutes.
http://www. leg.state.fl. us/Statutes/index ,cfm? App mode=Display Statute&Search String=&UR
L~0Z00-0299/0287 /Sections/0287 .133 .html
4.37 No Federal appropriated funds have been paid 01· will be paid, by or on behalf of the undersigned,
to any person for influencing or attempting to influence an offlcer or employee of any 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 agreeme11t, 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 01· will
be paid to any person for influencing or attempting to influence an officer or employee of any
agency, a Member of Congl'Css, an offlcer or employee of Congress, or an employee of a Member
of Congress, in com,ection with this Federal contract, grant, loan, or cooperative agreement, the
undersigned shall complete and submit Standard Form.LLL, "Disclosme Form to Report
Lobbying", in accordance with its instrnctions. The undersigned shall require that the language of
this certification be included in the award documents for all sub-awards at all tiers (including
subcontracts, sub-grants, contracts under grants, loans, and cooperative agreements) and that all
SUBRECIPIENTS shall certify and disclose accordingly.
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4.38 Travel reimbursement will be based on the U.S. General Services Administration (GSA) per diem
rates in effect at the time of travel.
https :/ /www.gsa.gov/p011al/content/ I 04877
4.39 Equal access in accordance with the individual's gender identity in community planning and
development programs, per 24 CFR 5.106.
https://www.govregs.com/regulationslexpan<l/title24 pa1t5 subpartA section5. 106
4.40 Housing Counseling, including homeownership counseling m rental housing counseling, as defined
in §5. 100, required under or provided in connection with any program administered by HUD shall
be provided only by organizations and counselors ce1tified by the Secretary unde1· 24 CPR part 214
to provide housing counseling, consistent with 12 U.S.C. 170 Ix, per 24 CPR 5.111.
https://www.ecfr.goy/cgi-bin/text-
idx?SJD=e3J9ece9fdfd 1479eab67e850c7cddd4&node~4:2.1. I .2. l 0.4&rgn=div6
https;//www.law.comell.edu/cfi1tcxt/24/5.111
4.41 HUD Final Rule -Implementation of the Violence Against Women Reauthorization Act of 2013
which applies for all victims of domestic violence, dating violence, sexual assault, and stalking,
regardless of sex, gender identity, or sexual orientation, and which must be applied consistent
with all nondiscrimination and fair housing requirements.
https;//www.federalregister.gov/documents/2016/ 11/ 16/2016-25888/violence-against-women-
reauthorization-act-of-2013-implementation-in-hud-housing-programs
4.42 Any rule or regulation determined to be applicable by HUD.
4.43 Florida Statutes 7 I 3.20, Part I, Construction Liens
https://www. leg.state. fl. us/Statutes/index.cfin? App mode=Display Statute&URL=0700-
Q799/0713/0713 .html
4.44 Florida Statutes 119.021 Records Retention
http:/ /www. leg.state. fl. us/Statutes/i ndex.cfin.7Alip~111ode= Display Statutc&U RL~o I 00-
0199/0119/Sections/0119. 02 I.html
4.45 Florida Statutes, 119,071, Contracts and Public Records
http://www. leg.state. fl.us/Statutes/index.cfm ?App mode=Display Statute&URL=0 I 00-
0199/0119/Sectjons/0119.071.hnnl
4.46 Limited English Proficiency: The SUBRECIP!ENT agrees to take reasonable steps to provide
meaningful access to the program/project and activities funded under this Agreement for persons
with limited English proficiency pmsuant to information located at http://www.lep.gov.
4.47 Equal Treatment of Faith-Based Organizations: By regulation, HlID prohibits all recipient
organizations from using financial assistance from HUD to fund explicitly religious activities. The
SUBREClPIENT agrees to avoid such prohibited conduct. For more infmmation, see
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https://ojp.gov/about/oc1Jpal'tnerships.httn. Discrimination on the basis of religion in employment
is generally prohibited by federal law, but the Religious Freedom Restoration Act is interpreted on
a case-by-case basis to allow some faith-based organizations to receive HUD funds while taking
into account religion when hiring staff. Questions in this regard should be dil'ected to the Office
for Civil Rights.
4.48 Arrest and Conviction Recmds: Federal and state laws restrict use of arrest and conviction records
in the employment context, except when specifically authorized. The SUB RECIPIENT agrees to
avoid the misuse of arrest 01· conviction records to screen applicants for employment or employees
for retention or promotion that may have a disparate impact based on race or national origin,
resulting in unlawful employment discrimination unless use is otherwise specifically authorized by
law. See https:/lojp.gov/about/ocr/pdfs/UseofConviction Advisory.pdffor more details.
4.49 Byrd Anti-Lobbying Amendment (31 U.S.C. § 1352): The SUB RECIPIENT will not use and has
not used federal appropriated funds to pay at any tier, either directly or indirectly, any person or
organization for influencing or attempting to influence an officer or employee of any agency, a
member of Congress, an officer or employee ofCongrnss, or an employee of a member of Congress
in connection with obtaining any federal contract, grant, or any other award or subaward covered
by 3 I U.S.C. § 1352. Each tier shall also disclose any lobbying with nonfederal funds that takes
place in connection with obtaining any federal award or subaward. Such disclosures are forwarded
from tier to tier up to the recipient. The SUBRECIPIENf shall comply with the lobbying
restrictions of the Byrd Anti-Lobbying Amendment (31 U.S.C. § 1352) and (ii) ensure that its
officers, employees and its subcontractors hereunder comply with all applicable local, state, and
federal laws and regulations governing advocacy of and appearances before any legislative body.
None of the funds provided under this Agreement shall be used for publicity or propaganda
purposes designed to support or defeat any legislation pending before local, state, or federal
legislatures.
4.50 False Claim; Criminal, or Civil Violation: SUBRECIPJENT must promptly refer to COUNTY any
credible evidence that a principal, employee, agent, contractor, subgrantee, subcontractor, or other
person has either (i) submitted a false claim for grant funds under the False Claims Act m· (ii)
committed a criminal or civil violation of laws pe11aining to fraud, conflict of interest, bribery,
gratuity, or similar misconduct involving subaward agreement funds
4.51 Political Activities Prohibited: None of the funds provided directly or indirectly under this
Agreement shall be used for any political activities or to further the election or defeat of any
candidates for public office, Neither this Agreement nor any funds provided hereunder shall be
utilized in supp011 of any partisan political activities or activities for or against the election of a
candidate for an elected office.
4,52 Text Messaging: Pursuant to Executive Orde1· 13513, "Federal Leadeiship on Reducing Text
Messaging While Driving," 74 Federal Register 51225 (October l, 2009), HUD encourages
recipients and subrecipients to adopt and enforce policies banning employees from text messaging
while driving any vehicle during the course of perfonning work funded by HUD and to establish
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workplace safety policies and conduct education, awareness, and other outreach to decrease crashes
caused by distracted drivers.
4,53 Trafficking in Persons: The SUBRECIPIENT agrees to, at any tier, comply with all applicable
requirements (including requirements to repo1t allegations) pertaining to prohibited conduct ,·elated
to the trafficking of persons, whether on the pare of the SUB RECIPIENT and any employees of the
SUBRECIP!ENT. The details of the SUBRECIP!ENT'S obligations related to prohibited conduct
related to the trafficking of persons are posted at
https://ojp.gov/funding/Explore/ProhibitedConduct~Trafficking.htm.
4.54 Association of Community Organizations for Reform Now (ACORN): The SUBRECIPIENT
understands and acknowledges that it cannot use any federal funds, either directly or indirectly, in
support of any contract or subaward to either ACORN or its subsidiaries, without the express prior
written approval ofOJP.
4.55 If the SUBRECIPIENf wishes to enter into a contract with a small business firm or nonprofit
organization regarding the substitution of parties, assignment, or performance of experimental,
developmental, or research work under this funding agreement, the SUB RECIPIENT must comply
with the requirements of 3 7 CPR Part 401, "Rights ot Inventions Made by Nonprofit Organizations
and Small Busines Firms Under Government Grants, Contracts, and Cooperative Agreements," and
any implementing regulations issued by HUD.
https://www.ecfr.gov/cgi-
bin/retl'ieveECFR?gp=&SID=a004b6bf20934ace7a717de76 ldc64cO&mccctrue&n=pt37.1 .40 l &r
=PART&t,=HTML
(Signature Page to Follow)
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IN WITNESS WHEREOF, the SUBRECIPIENT and COUNTY, have each respectively, by an
authorized person or agent, hereunder set their hands and seals on the date first written above,
ATTEST:
ST ••I ' IN~ L CLERK
elpedio
Assistant County Attorney
Date: _ ___._,._'f/ fl~ ~ \
COLLIER HEALTH SERVICES, INC . dba 1-leALTHCARll NETWORK
CD-CV21-0 I
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PARTV
EXHIBITS
EXHIBIT A
INSURANCE REQUIREMENTS
The SUBRECIPIENT shall furnish to Collier County, c/o Community and Human Services Division, 3339
E. Tamiami Trail, Suite 21 l, Naples, Florida 34112, Certificate(s) of Insurance evidencing insurance
coverage that meets the requirements as outlined below:
I. Workers' Compensation as required by Chapter 440, Florida Statutes.
2. Commercial General Liability, including products and completed operations insurnnce, in the
amount of$1,000,000 per occurrence and $2,000,000 aggregate. Collier County must be shown as
an additional insured with respect to this coverage.
3. Automobile Liability Insurance covering all owned, non-owned and hired vehicles used in
connection with this Agreement, in an amount not less than $1,000,000 combined single limit for
combined Bodily Injury and Property Damage.
DESIGN STAGE (IF APPLICABLE)
In addition to the insurance required in I -3 above, a Certificate oflnsurance must be provided as follows:
4. Professional Liability lnsurnnce, in the name of the SUBRECIPIENT or the licensed design
professional employed by the SUBRECIPIENT, in an amount not less than $1,000,000 per
occurrence/$1,000,000 aggregate providing for all sums which the SUBREC!PIENT and/or the
design professional shall become legally obligated to pay as damages for claims arising out of the
services performed by the SUBRECIP!ENT or any person employed by the SUBRECIPIENT in
connection with this Agreement. This insurance shall be maintained for a period of two (2) years
after the ce1iificate of Occupancy is issued.
CONSTRUCTION PHASE (IF APPLICABLE)
In addition to the insurance required in I -4 above, the SUBRECIPIENT shall provide, or cause its
Subcontractors to provide, original ce1iificates indicating the following types of insurance coverage prior
to any construction:
5. Completed Value Builder's Risk Insurance on an "All Risk" basis, in an amount not less than one
hundred (100%) percent of the insurable value of the building(s) or slmcture(s). The policy shall
be in the name of Collier County and the SUBRECIPIENT.
6. In accordance with the requirements of the Flood Disaster Protection Act of 1973 (42 U.S.C. 400 I),
the SUBRECIPIENT shall assure that for activities located in an ai·ea identified by the Federal
Emergency Management Agency (FEMA) as having special flood hazards, flood insurance under
COLLIER HEALTH SERVICES, INC. dba HEALTHCARE NETWORK
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the National Flood Insurance Program is obtained and maintained, as a condition of financial
assistance for acquisition or constrnction purposes (including rehabilitation).
OPERATION/MANAGEMENT PHASE (IF APPLICABLE)
After the Construction Phase is completed and occupancy begins, the following insurance must be kept in
force throughout the duration of the loan and/or Agreement:
7. Workers' Compensation as required by Chapter 440, Florida Statutes.
8. Commercial General Liability including products and completed operations insurance in the
amount of$1,000,000 per occurrence and $2,000,000 aggregate. Collier County must be shown as
an additional insmed with respect to this coverage.
9. Automobile Liability Insurance covering all owned, non-owned and hired vehicles used in
connection with this Agreement in an amount not less than $1,000,000 combined single limit for
combined Bodily Injmy and Property Damage.
l 0. Property Insurance covernge on an "All Risk" basis, in an amount not less than one hundi-ed (100%)
of the replacement cost ofthe property. Collier County must be shown as a Loss payee, with respect
to this coverage A.T.I.M.A.
11. Flood Insurance coverage for those properties found to be within a flood hazard zone, for the full
replacement values of the structure(s) or the maximum amount of coverage available through the
National Flood Insurance Program (NFIP). The policy must show Collier County as a Loss Payee
A.T.I.M.A.
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EXHIBITB
COLLIER COUNTY COMMUNITY & HUMAN SERVICES
SECTION I: REQUEST FOR PAYMENT
SUB RECIPIENT Name: Collier Health Services, Inc. dba Healthcare Network
SUBRECIPIENT Address: 1454 Madison Ave, Jmmokalee, FL 34142
Project Name: COVID Case Management Healthcare Services
Project No: CD-CV2 l -O I_ Payment Request#
Total Payment Minus Retainage
Period of Availability: 04/01/2021 through 03/30/2023
Period for which the Agency has incurred the indebtedness
SECTION II: STATUS OF FUNDS
through
Subrecipient CHS Approved
1. Grant Amount Awarded $ $
2. Total Amount of Previous Requests $ $
3. Amount of Today's Request (Net ofRetainage, if $ $
annlicable)
4. Current Grant Balance (Initial Grant Amount Award $ $
request) (includes Retainage)
I certify that this request for payment has been made in accordance with the terms and conditions of the
Agreement between the COUNTY and us as the SUBRECIPIENT. To the best ofmy knowledge and belief,
all grant requirements have been followed.
Signature
Title
Authorizing Grant Coordinator
Supervisor (Approval required $15,000 and
above)
COLLffiR HEALTH SERVICES, INC. dba HEALTHCARE NETWORK
CD-CV2HJI
Case M1magcment Healthcure Services for Low to Moderate-Income Residents
Date
Authorizing Grant Accountant
Division Director (Approval Required
$15,000 and above)
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EXHJBITC
QUARTERLY PERFORMANCE REPORT DATA
The COUNTY is required to submit Performance Reports to HUD through the Integrated Disbursement
and Information System (!DIS). The COUNTY rep01ts information on a quarterly basis. To facilitate in the
preparation of such reports, SUB RECIPIENT shall submit the information contained herein within ten (l 0)
days of the end of each calendar quartet·. At COUNTY's discretion, SUBRECIPIENT may be required to
enter the information collected on this exhibit into an online grant management system,
Subrecipient Name: Collier Health Services, lnc,dba Date:
Healthcare Network
Project Title: COVID Case Management Healthcare !DIS#:
Services
Prol'mm1 Contact: Telenhonc Number:
Activitv Reoortin° Period Reo011 Due Date
Octobel' l st -Decem her 31 ~, January I 0th
Januai·v 1st -March 31 M Anril 10th
Anril l st -June 30 th Julv IO"
Julv I !t _ Sentem ber 30 th Octobe1· I O'li
REPORT FOR QUARTER ENDING: (check one that applies to the corresponding grant period):
12/31/XX 3/31/XX 6/30/XX 9/30/XX
Please note: The CDBG-CV/HOME/ESG Program year begins October I, 2020-September 30, 2023. Each qumterly
reoo11 must include cumulative data becinninP from the start of the nrn11ram year October l, 2020,
1. Please list the outcome goal(s) from your approved application and SUBRECIPIENT Agreement and indicate youl'
nroeress in meeline: those e.:oals since October I, 2020.
a. Outcome Goals: list the outcome eoal(s) from vom· a""roved a""lication and SUBREClPIENT Arrreement
Outcome I: 75% of staff time will be nrovidinP case manaf1ement sel'vices,
Outcome 2: At least 1,000 unduolicated LMC oersons will be served,
Outcome 3:
b. Goal Pro2:ress: Indicate the nroE?.ress to date in meetin2: each outcome 2:oal.
Outcome I: 4 Case managers will be hired snecificallv to focus on case management services,
Outcome 2: At least I 000 LMC will be served
Outcome 3: Documentation will be kent of the low to moderate income oersons se!'ved on a ouarterlv basis.
2. Is this nroiect still in comoliance with the orie.inal project schedule: Yes D No I I
If No, Ex•ilain:
3. Since October 1, 20XX; of the persons assisted, how many ...
Answer ONLY for Public Facilities & Infrastructure Activities *03 Matrix Codes
u. ... now have new access (continulne.) to this service or benefit?
b. . .. now have imnroved access to this service or benefit?
c. ... now receive a service or benefit that is no lon[ter substandard?
TotRI
I 4. What fundinu sources did the SUBRECJPIENT a•mlv for this c1·iod?
Section 108 Loan Guarantee $ CDBG-CV $
Othe1· Consolidated Plan Funds $ HOME $
Other Federal Funds $ ESG $
$ HOPWA $
$ Totnl Entitlement $
Funds
COLLIER HEALTH SERVICES, INC. dba HEALTHCARE NETWORK
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0
0
0
0
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5, What is the total numbel' oflJNDUPLlCATED Pel'sons (LMC) or Households (LMH) sel'ved this QUARTER, if
applicable? Answer question Sa or 5b; NOT both
For LMC activities: people, race/ethnicity I and income dala are reported by persons,
For LMH activities: households, race/ethnicity, and income level are reported by households, regardless
the numbe1' of persons in the household,
a. Total No. Pel'sons/Adults sel'ved (LMC) 0 Total No. persons served under 18 0
!LMC)
Oua11er Total No, of Pet·sons 0 Quarter Total No. of Persons 0
b. Total No. of Households sel'ved 0 Total No. of female head of household 0
fLMH\
6, What is the total number ofUNDUPLICATED clients served since Octobel', if applicable?
Answer question 6a or 6b 1 NOT both
For LMC activities: race/ethnicitv and income data are l'Cnorted by nersons,
a. Total No. Pel'Sons/Adults served (LMC) 0 Total No. Persons served under 18 0
!LMC)
YTD Toto!: 0 YTD Total 0
b. Total No. Households sel'ved (LMH) 0 Total No. female head of household (LMH) 0
YTD Toto! 0 YTD Toto! 0
Complete EITHER question 7 or 8, NOT both
Complete question 7n nud 7b if your program only serves clienls in one or more of the listed HUD Presumed
Benefit cateP-ories.
17. PRESUMED BENEFICIARY DATA ONLY: PRESUMED BENEFICIARY DATA ONLY
(LMC) Oua1·ter (LMC) YTD
Indicate the total number of UNDUPl/CATED persons Indicate the total number of UNDUPLICATED
served this qua1ter who fall into each presumed benefit persons served since Octobel' l who fall into each
category {the Iola/ should equal the total in question #6a presumed benefit category {the total should equal lhe
01' 6bl: tolal In aueslion #6a or 6b):
a Presumed Benefit Activities Onl (LMC)OTR b Presumed Benefit Activities Onlv (LMC) YTD
0 Abused Children ELI 0 Abused Children ELI
0 Homeless ELI 0 Homeless Person ELI
Person
0 Migrant Fal'm LI 0 Migrant Fal'm Workers LI
Workers
0 B'atte1·ed LI 0 Baltered Spouses LI
Soouses
0 Persons LI 0 Pel'sons w/HIV/AIDS LI
w/HIV/AIDS
0 Eldel'ly Persons LI or MOD 0 Elderly Persons LI or
MOD
0 Illiterate Adults LI 0 Illiterate Adults LI
0 Severely LI 0 Sevel'ety Disabled Adults LI
Disabled Adults
0 Q\1arter Totnl 0 YTDTotal
I 8. Comolete nuestion 8:1 nnd Sb ifanv client in vom· uroernm does not fall into a Presumed Benefit catee_orv.
Other Beneficiary Data: lncome RanPc Other Beneflcial'v Data: Income Ranee
Indicate the total number ofUNDUPLICATED persons Indicate the total number ofUNDUPLICATED
served this Quarter who fall into each income category persons served since October l (YTO) who fall into
(the total should equal the total In question #6): each income category {the total should equal the total
In nuestion #6):
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I" ELI Extremely Low Income (0-30%) 0 b ELI Extremely Low 0
Income {0-30%)
Li Low Income (31-50%) 0 LI Lowlncome 0
MOD Modcrnte Income (51 .. go%) 0 MOD Moderate Income 0
(51-80%)
NON-LIM Above Moderate Jncome (>80%) 0 NON-LIM Above Moderate 0
Income (>80%)
Qun1·ter Total 0 YTDTotfll 0
I 9. Is this project in a Low/Mod Area (LMA)? YES l lNO I
Was project completed this qua11er? YES I I NO I If yes, complete all of this section 9.
Date project completed
Block Group Census Tract Total Beneficiaries Low/Mod Low/Mod Percenlage Beneficiaries
0 0 0 0 0
Date LMA Narrative approved by CHS?
Whnl documentation supports project completion? (i.e.,
Certificate of Completion or Certificate of Occupancy,
etc.\
10. Racial & Ethnic Data (if am,ticablc)
Please indicate how many UNDUPLICATED Please indicate how many UNDUPLICATED clients
clients served this Quarter fall into each race served since Octobei· (YTD) fall into each race category. In
category. ln addition to each race category, please addition to each race category please indicate how many
indicate how many persons in each race category pel'sons in each race category consider themselves
consider themselves Hispanic. (Total Race column Hispanic. (Total Race column should equal the Iota/ in
should enua/ the Iota/ in question 6, > nuest/011 6.)
a, RACE ETHNIClTY b, RACE ETHNICITY
/HISPANIC /HISPANIC
White 0 0 White 0 0
Black/African American 0 0 Black/African American 0 0
Asian 0 0 Asian 0 0
Amel'icon Indian/Alaska Native 0 0 American Indian/Alaska 0 0
Native
Native Hawoiinn/Other Pacific Islander 0 0 Native Hawaiian/Other Pacific 0 0
Islander
Black/African American & White 0 0 Black/African American & 0 0
While
American 1ndian/Ah1ska Native & 0 0 American lndim1/Alaska 0 0
Native & Illack/African
Black/African American American
Other Multi-racial 0 0 Other Multi~rncial 0 0
0 0 0 0
Name: _______________ _
Signature: ______________ _
Title; _______________ _
Youl' typed name hcl'e renresents your electronic signatul'e
COLLIER HEALTH SERVICES, INC. dba HEALTHCARE NETWORK
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EXHIBITD
INCOME CERTIFICATION
INSTRUCTIONS
Complete this form and retain appropriate suppo11ing documentation proving CDBG-CV
assistance to an eligible beneficiary. Please retain in your organization's records and have on
hand for future monitoring visits.
Effective Date: ________ _
A, Household Information
Member Names-All Household Members Relationship
1
2
3
4
5
6
7
8
B. Assets: All Household Members, Including Minors
Member Asset Descl'iption Cash Value
I
2
3
4
5
6
7
8 0.00
Total Cash Value of Assets B(a) 0.00
Total Income from Assets Bib)
If line B(a) is greater than $5,000, multiply that amount by the rate specified
by HUD (applicable rate O .06%) and enter results in B(c), otherwise leave
blank. B/c)
COLLIER HEALTH SERVICES, INC. dba HEALTHCARE NETWORK
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Case Mnnagement Healthcare Services for Low to Modernte-lncomc Rcsidenls
Age
Income
from Assets
0,00
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C. Anticipated Annual Income: Includes Unearned Income and Support Paid on
Behalf of Minors
Member Wages/ Benefits/ Public Othc1· Asset
Salaries Pensions Assistance Income Income
(include tips,
commissions, (Enter the
bonuses, and greater of
overtime) box B(b) or
1 box B(c),
2 above, in
3
box C(e)
4
below)
5
6
7
8
Totals (a) (b) (c) (d) (e)
0.00 0.00, 0.00 0.00
Ente1· total of items C(a) through C(e). 0.00
This amount is the Annual Anticinated Household Income.
D, Recipient Statement: The information on this form is to be used to determine maximum
income for eligibility. I/we have pl'Ovided, for each person set fo1th in Item A, acceptable
vel'ification of cmrent and anticipated annual income. I/we certify that the statements are trne
and complete to the best of my/our knowledge and belief, and are given unde1· penalty ofpe1ju1y.
WARNING: Florida Statutes 817 provides that willful false statements or misrepresentations
concerning income and assets or liabilities relating to financial condition is a misdemeanor of the
first deg!'ee and is punishable by fines and impl'isonment provided under Section 775.082 and 775.083.
Signature of Head of Household
Signature of Spouse or Co-Head of Household
Adult Household Member (if applicable)
Adult Household Member (if applicable)
COLLIBR HEALTH SERVICES, INC. dba HEALTHCARE NETWORK
CD•CV21--0 I
C11se Management Healthc~rc Services for Low lo Modeni.te-h1comc Residents
Date
Date
Date
Date
Page 43
16.D.1.a
Packet Pg. 1089 Attachment: 05-17-2021 Fully Executed Collier Health Services Inc CDBG-CV agreement (23124 : Collier Health Services Inc CDBG COVID
E. CDBG-CV Grantee Statement: Based on the representations herein, the family or
individual(s) named in Item A of this Income Certification is/are eligible under the
provisions of the CDBG-CV Program. The family or individual(s) constitute(s) a:
D Extremely Low Income (ELI) Household means and individual or family whose annual income
does not exceed 30/S0'h of the Very Low Income (60 percent ofVLI) percent of the area median
income as determined by the U.S. Department of Housing and Urban Development with
adjustments for household size. (Maximum Income Limit$ ____ ~
D Very Low Income (VLI) Household means and individual or family whose annual income does
not exceed 50 percent of the area median income as determined by the U.S. Department of I-lousing
and Urban Development with adjustments for household size.
(Maximum Income Limit$ _____ _,
D Low Income (LI) Household means and individual or family whose annual incoine does not
exceed 80 percent of the area median income as determined by the U.S. Department of Housing
and Urban Development with adjustments for household size.
(Maximum Income Limit$, _____ ~
Based on the, ________ (year) income limits for the Naples-Marco Island Metropolitan
Statistical Area (MSA) of Collier County, Florida.
Signature of the CDBG-CV Administrator or His/Her Designated Representative:
Signature Date
Printed Name Title
F, Household Data
Numbel' of Persons
By Race/ EthnicUy n Aec
American Native Other
Indian Asian Black Hawaiian 01· White 0-25 26-40 41-61 62+
Other Pac.
Islander
Hispanic
Non-
Hispanic
NOTE: l1if'ormation concerning the race or ethnicity of the occnpants is being gathered for statistical
use only. No be11eficia1y is required to give such ilif'ormalion, and refusal to give such information
will not affect any right he or she has to the CD BG-CV program.
COLLIER HEALTH SERVICES, INC. dba HEALTHCARE NETWORK
CD-CV21---0l
Ct1se Management Healthcare Services for Low to Modernte-lncome Residen!s Page 44
16.D.1.a
Packet Pg. 1090 Attachment: 05-17-2021 Fully Executed Collier Health Services Inc CDBG-CV agreement (23124 : Collier Health Services Inc CDBG COVID
EXHIBITE
ANNUAL AUDIT MONITORING REPORT
Circular 2 CFR Part 200.332 requires Collier County to monitor subrecipients of federal awards to determine if
subrecipients are compliant with established audit requirements (Subpart F). Accordingly, Collier County requires
that all appropriate documentation is provided regarding the organization's compliance. In determining Federal
awards expended in a fiscal year, the subrecipient must consider all sources of Federal awards, based on when
the activity related to the Federal award occurs, including any Federal award provided by Collier County. The
determination of amounts of Federal awards expended shall be in accordance with the guidelines established by
2 CFR Part 200, Subpart F -Audit Requirements. This form may be used to monitor Florida Single Audit Act
!Statute 215.971 re uirements.
Subreclplent Collier Health Services, Inc. dba Healthcare Network Name
First Date of Fiscal Year IMM/DD/YYl Last Date of Fiscal Year IMM/DD/YYl
Total Federal Financial Assistance Expended Total State Financial Assistance Expended during
durinn most recentlv comoleted Fiscal Year most recentlv comoleted Fiscal Year
$ $
Check A. or B. Check C If applicable
A. The federal/state expenditure threshold for our fiscal year ending as indicated above has been
□ met, and a Single Audit as required by 2 CFR Part 200 Subpart F h<;ts been completed or will be
completed by . Copies of the audit report and management letter are attached
or will be nrovided within 30 davs of comnletion.
B. We are not subject to the requirements of 0MB 2 CFR Part 200, Subpart F because we:
D Did not exceed the expenditure threshold for the fiscal year indicated above
□ D Are a for-profit organization
D Are exempt for other reasons -explain
An audited financial statement is attached and if applicable, the independent auditor's
manaaement letter.
C. Findings were noted, a current Status Update of the responses and corrective action plan is
included separate from the written response provided within the audit report. While we
□ understand that the audit report contains a written response to the finding(s), we are requesting
an updated status of the corrective action(s) being taken. Please do not provide just a copy of
the written response from your audit report, unless it includes details of the actions, procedures,
nolicies, etc. imrlemented and when ii was or will be imolemented.
Certification Statement
I hereby certify that the above information is true and accurate.
Signature
Print Name and Title
COLLlER HEALTH SERVICES, INC. dba HEALTHCARE NETWORK
CD•CV21-0l
Case Management Healthcare Services for Low to Moderate-Income Residents
I Date
I
06/18
Page 45
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16.D.1.bPacket Pg. 1092Attachment: Collier Health Services Inc - Amendment 1 Executed (23124 : Collier Health Services Inc CDBG COVID Amendment #2)
16.D.1.bPacket Pg. 1093Attachment: Collier Health Services Inc - Amendment 1 Executed (23124 : Collier Health Services Inc CDBG COVID Amendment #2)
16.D.1.bPacket Pg. 1094Attachment: Collier Health Services Inc - Amendment 1 Executed (23124 : Collier Health Services Inc CDBG COVID Amendment #2)
16.D.1.bPacket Pg. 1095Attachment: Collier Health Services Inc - Amendment 1 Executed (23124 : Collier Health Services Inc CDBG COVID Amendment #2)
16.D.1.bPacket Pg. 1096Attachment: Collier Health Services Inc - Amendment 1 Executed (23124 : Collier Health Services Inc CDBG COVID Amendment #2)
COLLIER HEALTH SERVICES, INC. HEALTHCARE NETWORK
CD-CV21-01
Case Management Healthcare Services for Low to Moderate Income Residents
Page 1
FAIN # B-20-UW-12-0016
Federal Award Date 09/22/2020
Federal Award Agency HUD
CFDA Name Community
Development Block
Grant-CV
CFDA/CSFA# 14.218
Total Amount of
Federal Funds Awarded
$1,170,800.39
Subrecipient Name Collier Health
Services, Inc. dba
Healthcare Network
UEI# GPXBQKU6AJA5
FEIN 59-1741277
R&D NA
Indirect Cost Rate NA
Period of Performance 04/01/2021-03/30/2023
Fiscal Year End 03/31
Monitor End: 05/31/2023
SECOND AMENDMENT TO
AGREEMENT BETWEEN COLLIER COUNTY
AND
COLLIER HEALTH SERVICES, INC. dba HEALTHCARE NETWORK
CDBG-CV Healthcare Services
This AMENDMENT is made and entered into as of this day of 2022,
by and between Collier County, a political subdivision of the State of Florida (“COUNTY”) and
Collier Health Services, Inc. dba Healthcare Network (“SUBRECIPIENT”), a private non-profit
organization having its principal office at 1454 Madison Ave, Immokalee, FL 34142 existing under
the laws of the State of Florida.
RECITALS
WHEREAS, the COUNTY has entered into an Agreement with the United States
Department of Housing and Urban Development (HUD) for a grant for the execution and
implementation of a Community Development Block Grant (CDBG) Program in certain areas of
Collier County, pursuant to Title I of the Housing and Community Development Act of 1974 (as
amended), codified as 42 USC 5301 et. Se. and subject to 24 CFR Part 570 ; and
WHEREAS, on April 27, 2021, Agenda Item 16.D.3, the COUNTY entered into an
Agreement with Collier Health Services, Inc. dba Healthcare Network. to administer the
Community Development Block Grant (CDBG-CV) COVID Case Management Healthcare
Services Program; and
[22-SOC-00940]
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words underlined are additions.
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COLLIER HEALTH SERVICES, INC. HEALTHCARE NETWORK
CD-CV21-01
Case Management Healthcare Services for Low to Moderate Income Residents
Page 2
NOW, THEREFORE, in consideration of the mutual promises and covenants contained
herein, the parties hereto agree to amend the Agreement as set forth below.
Words Struck Through are deleted; Words Underlined are added.
* * *
PART 1
SCOPE OF WORK
The SUBRECIPIENT shall, in a satisfactory and proper manner and consistent with any standards
required as a condition of providing CDBG assistance as provided herein and, as determined by
Collier County Community and Human Services (CHS) Division, perform the tasks necessary to
conduct the program as follows:
Project Name: COVID Case Management Healthcare Services
Description of Project/Outcome: Collier Health Services, Inc. will provide a case
management/care navigation program to serve the needs of our most vulnerable patients
who have been diagnosed or are at risk for contracting COVID-19 in an effort to
minimize disease severity and acute and/or chronic complications.
Project Component One: Staffing – Salary costs
Project Component Two: Testing and Testing Supplies
Project Component Three: Technology including, but not limited to, laptops, software,
subscriptions/member fees, cell phones and services, and/or equipment and supplies.
Project Component Four: Personal Protective Equipment (PPE) – Costs associated with
purchase, freight, delivery and use of PPE including but not limited to masks, gloves, hand
sanitizer and face shields.
* * *
1.1 GRANT AND SPECIAL CONDITIONS
A. Within sixty (60) calendar days of the execution of this Agreement, the
SUBRECIPIENT must deliver to CHS for approval, a detailed project schedule for the
completion of the project.
[22-SOC-00940]
WHEREAS, the parties wish to amend the Agreement and the attached Exhibit C,
incorporated herein by reference, to include the language as stated below.
Words stricken are deletions;
words underlined are additions.
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COLLIER HEALTH SERVICES, INC. HEALTHCARE NETWORK
CD-CV21-01
Case Management Healthcare Services for Low to Moderate Income Residents
Page 3
B. The following resolutions and policies must be submitted within sixty (60) days of this
Agreement:
Affirmative Fair Housing Policy
Affirmative Action/ Equal Opportunity Policy
Conflict of Interest Policy (COI) and related COI Forms
Procurement Policy
Uniform Relocation Act Policy
Sexual Harassment Policy
Section 3 Policy
Section 504/ADA Policy
Fraud, Waste, and Abuse Policy
Limited English Proficiency Policy (LEP)
Violence Against Women Act (VAWA) Policy
LGBTQ Policy
* * *
1.2 PROJECT DETAILS
A. Project Description/Project Budget
Description Federal Amount
Project Component One: Staffing – Salary
costs
$898,375.00
$498,375.00
Project Component Two: Testing and
Testing Supplies
$220,800.39
$420,800.39
Project Component Three: Technology
including, but not limited to, laptops,
software, subscriptions/member fees, cell
phones and services, and/or equipment and
supplies
$51,625.00
$31,625.00
Project Component Four: Personal
Protective Equipment (PPE) – Purchase,
delivery and use of PPE including but not
limited to masks, gloves, hand sanitizer
and face shields
$220,000.00
Total Federal Funds: $1,170,800.39
* * *
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words underlined are additions.
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COLLIER HEALTH SERVICES, INC. HEALTHCARE NETWORK
CD-CV21-01
Case Management Healthcare Services for Low to Moderate Income Residents
Page 4
C. Payment Deliverables
Payment Deliverable Payment Supporting
Documentation
Submission Schedule
Project Component One:
Staffing – Salary costs
Submission of supporting
documents must be provided
as backup, as evidenced by
Exhibit B, signed and dated
timesheets, check stubs,
payroll registers, bank
statements/cancelled checks
and any other additional
documentation as requested.
10% retainage will be held
from each pay request until
final monitoring clearance and
achievement of the national
Objective
.
Submission of monthly
invoices no later than the 20th
day of the following month.
Project Component Two:
Testing and Testing Supplies
Submission of supporting
documents must be provided
as backup, as evidenced by
receipts, invoices, credit card
statements, bank statements
and any other additional
documentation as requested.
10% retainage will be held
from each pay request until
final monitoring clearance and
achievement of the national
objective.
Submission of monthly
invoices no later than the 20th
day of the following month.
Project Component Three:
Technology including but not
limited to laptops, software,
subscriptions/member fees,
cell phones and services,
and/or equipment and
supplies
Submission of supporting
documents must be provided
as backup, as evidenced by
Exhibit B, receipts, invoices,
credit card statements, bank
statements, cancelled checks
and any other additional
documentation as requested.
10% retainage will be held
from each pay request until
final monitoring clearance and
achievement of the national
objective.
Submission of monthly
invoices no later than the 20th
day of the following month.
[22-SOC-00940]
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words underlined are additions.
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COLLIER HEALTH SERVICES, INC. HEALTHCARE NETWORK
CD-CV21-01
Case Management Healthcare Services for Low to Moderate Income Residents
Page 5
Payment Deliverable Payment Supporting
Documentation
Submission Schedule
Project Component 4:
Personal Protective
Equipment (PPE) – Purchase,
delivery and use of PPE
including but not limited to
masks, gloves, hand sanitizer
and face shields
Submission of supporting
documents must be provided
as backup, as evidenced by
receipts and/or invoices,
credit card statements ( if
applicable), bank statements
or cancelled checks and any
other additional
documentation as requested.
10% retainage will be held
from each pay request until
final monitoring clearance and
achievement of the national
objective.
Submission of monthly
invoices no later than the 20th
day of the following month.
* * *
3.14 PROGRAM GENERATED INCOME
Purchase of Equipment: Equipment under the SUBRECIPIENT’S control that was acquired or
improved, in whole or in part, with CDBG-CV funds shall be used to meet one of the CDBG-CV
National Objectives, pursuant to 24 CFR 570.208, during the continued use period, as referenced
in section 3.14 (Grant Closeout Procedures) of this Agreement. If the SUBRECIPIENT sells,
transfers, disposes of, or otherwise fails to continue to use the CDBG -CV-assisted equipment in a
manner that meets a CDBG-CV National Objective, the SUBRECIPIENT shall pay the COUNTY
an amount equal to the current fair market value of the equipment, less the percentage of non-
CDBG-CV funds used to acquire the equipment.
Equipment no longer needed by the SUBRECIPIENT for CDBG-CV eligible activities under
this Agreement shall be: (a) transferred to the COUNTY for use elsewhere in the CDBG-CV
program, or (b) retained by the SUBRECIPIENT after compensating the COUNTY an amount
equal to the current fair market value of the equipment, less the percentage of non -CDBG-CV
funds used to acquire the equipment.
* * *
[22-SOC-00940]
Words stricken are deletions;
words underlined are additions.
[Signature Page and Attached Exhibit C to Follow]
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COLLIER HEALTH SERVICES, INC. HEALTHCARE NETWORK
CD-CV21-01
Case Management Healthcare Services for Low to Moderate Income Residents
Page 6
IN WITNESS WHEREOF, the SUBRECIPIENT and the COUNTY, have each
respectively, by authorized person or agent, hereunder set their hands and seals on the date first
written above.
ATTEST:
CRYSTAL K. KINZEL, CLERK
, Deputy Clerk
Dated:
(SEAL)
AS TO COUNTY:
BOARD OF COUNTY COMMISSIONERS OF
COLLIER COUNTY, FLORIDA
By:
WILLIAM L. MCDANIEL, JR.,
CHAIRPERSON
Date:
WITNESSES:
Witness #1 Signature
Witness #1 Printed Name
Witness #2 Signature
Witness #2 Printed Name
AS TO SUBRECIPIENT:
COLLIER HEALTH SERVICES, INC. dba
HEALTHCARE NETWORK
By:
TAMI RAZNOFF, CHIEF FINANCIAL
OFFICER
Date:
[Please provide evidence of signing authority]
Approved as to form and legality:
Derek D. Perry
Assistant County Attorney
Date:
[22-SOC-00940]
Words stricken are deletions;
words underlined are additions.
Attachments: Exhibit C - Quarterly Performance Report Data
CAO8/18/2022Witness #2 Printed Name
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EXHIBIT C
QUARTERLY PERFORMANCE REPORT DATA
The COUNTY is required to submit Performance Reports to HUD through the Integrated Disbursement
and Information System (IDIS). The COUNTY reports information on a quarterly basis. To facilitate in the
preparation of such reports, SUBRECIPIENT shall submit the information contained herein within ten (10)
days of the end of each calendar quarter. At COUNTY’s discretion, SUBRECIPIENT may be required to
enter the information collected on this exhibit into an online grant management system.
Subrecipient Name: Collier Health Services, Inc. dba
Healthcare Network
Date:
Project Title: COVID Case Management Healthcare
Services
IDIS #: 637
Program Contact: Telephone Number:
Activity Reporting Period Report Due Date
October 1st – December 31st January 10th
January 1st – March 31st April 10th
April 1st – June 30th July 10th
July 1st – September 30th October 10th
REPORT FOR QUARTER ENDING: (check one that applies to the corresponding grant period):
12/31/XX 3/31/XX 6/30/XX 9/30/XX
Please note: The HUD Program year begins October 1, 2020 – September 30, 2023. Each quarterly report must include
cumulative data beginning from the start of the program year October 1, 2020.
1. Please list the outcome goal(s) from your approved application and SUBRECIPIENT Agreement and indicate your
progress in meeting those goals since October 1, 2020.
a. Outcome Goals: list the outcome goal(s) from your approved application and SUBRECIPIENT Agreement
Outcome 1: At least 75% of staff time will be providing case management services.
Outcome 2: At least 1,000 500 unduplicated LMC persons will be served. Must document that at least 51% of
persons served are low-to moderate income persons or households.
Outcome 3:
b. Goal Progress: Indicate the progress to date in meeting each outcome goal.
Outcome 1: One Manager of Case Management, 4- Three Case Managers, One Community Social Worker will be
hired specifically to focus on case management services and continuity of care.
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words underlined are additions.
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Outcome 2: At least 1,000 500 LMC persons will be served.
Outcome 3: Documentation will be kept of the low to moderate income persons served on a quarterly basis.
2. Is this project still in compliance with the original project schedule: Yes No
If No, Explain:
3. Since October 1, 2020; of the persons assisted, how many…
Answer ONLY for Public Facilities & Infrastructure Activities *03 Matrix Codes
a. …now have new access (continuing) to this service or benefit? 0
b. …now have improved access to this service or benefit? 0
c. …now receive a service or benefit that is no longer substandard? 0
Total 0
4. What funding sources did the SUBRECIPIENT apply for this period?
Section 108 Loan Guarantee $ CDBG-CV $
Other Consolidated Plan Funds $ HOME $
Other Federal Funds $ ESG $
$ HOPWA $
$ Total Entitlement
Funds
$
5. What is the total number of UNDUPLICATED Persons (LMC) or Households (LMH) served this QUARTER, if
applicable? Answer question 5a or 5b; NOT both
For LMC activities: people, race/ethnicity, and income data are reported by persons.
For LMH activities: households, race/ethnicity, and income level are reported by households, regardless
the number of persons in the household.
a. Total No. Persons/Adults served (LMC) 0 Total No. persons served under 18
(LMC)
0
Quarter Total No. of Persons 0 Quarter Total No. of Persons 0
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b. Total No. of Households served 0 Total No. of female head of household
(LMH)
0
6. What is the total number of UNDUPLICATED clients served since October 1, if applicable?
Answer question 6a or 6b, NOT both
For LMC activities: race/ethnicity and income data are reported by persons.
a. Total No. Persons/Adults served (LMC) 0 Total No. Persons served under 18
(LMC)
0
YTD Total: 0 YTD Total 0
b. Total No. Households served (LMH) 0 Total No. female head of household (LMH) 0
YTD Total 0 YTD Total 0
Complete EITHER question 7 or 8, NOT both
Complete question 7a and 7b if your program only serves clients in one or more of the listed HUD Presumed
Benefit categories.
7. PRESUMED BENEFICIARY DATA ONLY:
(LMC) Quarter
PRESUMED BENEFICIARY DATA ONLY
(LMC) YTD
Indicate the total number of UNDUPLICATED persons
served this quarter who fall into each presumed benefit
category (the total should equal the total in question #6a
or 6b):
Indicate the total number of UNDUPLICATED
persons served since October 1 who fall into each
presumed benefit category (the total should equal the
total in question #6a or 6b):
a Presumed Benefit Activities Only (LMC) QTR b Presumed Benefit Activities Only (LMC) YTD
0 Abused Children ELI 0 Abused Children ELI
0 Homeless
Person
ELI 0 Homeless Person ELI
0 Migrant Farm
Workers
LI 0 Migrant Farm Workers LI
0 Battered
Spouses
LI 0 Battered Spouses LI
[22-SOC-00940]
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0 Persons
w/HIV/AIDS
LI 0 Persons w/HIV/AIDS LI
0 Elderly Persons LI or MOD 0 Elderly Persons LI or
MOD
0 Illiterate Adults LI 0 Illiterate Adults LI
0 Severely
Disabled Adults
LI 0 Severely Disabled Adults LI
0 Quarter Total 0 YTD Total
8. Complete question 8a and 8b if any client in your program does not fall into a Presumed Benefit category.
Other Beneficiary Data: Income Range Other Beneficiary Data: Income Range
Indicate the total number of UNDUPLICATED persons
served this Quarter who fall into each income category
(the total should equal the total in question #6):
Indicate the total number of UNDUPLICATED
persons served since October 1 , (YTD) who fall into
each income category (the total should equal the total
in question #6):
a ELI Extremely Low Income (0-30%) 0 b ELI Extremely Low
Income (0-30%)
0
LI Low Income (31-50%) 0 LI Low Income 0
MOD Moderate Income (51-80%) 0 MOD Moderate Income
(51-80%)
0
NON-L/M Above Moderate Income (>80%) 0 NON-L/M Above Moderate
Income (>80%)
0
Quarter Total 0 YTD Total 0
9. Is this project in a Low/Mod Area (LMA)? YES NO
Was project completed this quarter? YES NO If yes, complete all of this section 9.
Date project completed
Block Group Census Tract Total Beneficiaries Low/Mod
Beneficiaries Low/Mod Percentage
0 0 0 0 0
Date LMA Narrative approved by CHS?
What documentation supports project completion? (i.e.,
Certificate of Completion or Certificate of Occupancy,
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words underlined are additions.
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etc.)
10. Racial & Ethnic Data (if applicable)
Please indicate how many UNDUPLICATED
clients served this Quarter fall into each race
category. In addition to each race category, please
indicate how many persons in each race category
consider themselves Hispanic. (Total Race column
should equal the total in question 6.)
Please indicate how many UNDUPLICATED clients
served since October 1 (YTD) fall into each race category.
In addition to each race category please indicate how many
persons in each race category consider themselves
Hispanic. (Total Race column should equal the total in
question 6.)
a. RACE ETHNICITY
/HISPANIC
b. RACE ETHNICITY
/HISPANIC
White 0 0 White 0 0
Black/African American 0 0 Black/African American 0 0
Asian 0 0 Asian 0 0
American Indian/Alaska Native 0 0 American Indian/Alaska
Native
0 0
Native Hawaiian/Other Pacific Islander 0 0 Native Hawaiian/Other Pacific
Islander
0 0
Black/African American & White 0 0 Black/African American &
White
0 0
American Indian/Alaska Native &
Black/African American
0 0 American Indian/Alaska
Native & Black/African
American
0 0
Other Multi-racial 0 0 Other Multi-racial 0 0
0 0 0 0
Name:
Signature:
Title:
Your typed name here represents your electronic signature
[22-SOC-00940]
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words underlined are additions.
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