Backup Documents 12/13/2022 Item #16E 4 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 E 4
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.County Attorney Office County Attorney Office
A// 12/3/2 z
2. BCC Office Board of County
Commissioners tiObifinisi I2//3/2 Z
3. Minutes and Records Clerk of Court's Office jn ,�
I' ( 4 14-0- '1 32-
4. Tabatha Butcher EMS
5.
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees
above,may need to contact staff for additional or missing information.
Name of Primary Staff Cherie DuBock Phone Number 239-252-3756
Contact/ Department
Agenda Date Item was 12/13/2022 Agenda Item Number 23950
Approved by the BCC 16 E, y
Type of Document Agreement for Field Internship and Number of Original 1
Attached classroom instruction Documents Attached
PO number or account
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? CD
2. Does the document need to be sent to another agency for additional signatures? If yes, CD
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be CD
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's CD
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the CD
document or the fmal negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's CD
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip CD
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 12/13/2022(enter date)and all changes CD N/A is not
made during the meeting have been incorporated in the attached document. The an option for
County Attorney's Office has reviewed the changes,if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the N/A is not
BCC, all changes directed by the BCC have been made,and the document is ready for the an option for
Chairman's signature. this line.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
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STANDARD FORM AGREEMENT FOR FIELD INTERNSHIP
AND CLASSROOM INTRUCTION EXPERIENCE
BRAXTON COLLEGE
THIS AGREEMENT entered into this 13ft, day of December , 2022, by and between
Braxton College, 27975 Old US 41 Rd, Ste 201, Bonita Springs, FL 34135 (College) and the
Collier County Board of County Commissioners, on behalf of the Collier County Emergency
Medical Services Department(County).
WITNESSETH:
WHEREAS, Braxton College provides Emergency Medical Services Technology
Programs as a part of its curriculum for its enrolled students; and
WHEREAS, Braxton College desires to augment said programs by providing skill
training/field experiences for its students through the association of certain of its student with the
activities and practices of the Collier County Emergency Medical Services Department; and
WHEREAS, Collier County Emergency Medical Services Department has the ability to
assist Braxton College in its Program endeavors, including providing opportunities for students to
observe and perform appropriate Emergency Medical Technician and/or Paramedic skills under
supervision during field and classroom experiences; and
WHEREAS, the objective of the herein described relationship of the parties is to benefit
the community by and through the enhance education of its students; and
WHEREAS, Braxton College and Collier County Emergency Medical Services previously
entered into an Agreement for Field Internship Experience on October 27, 2020, and the parties
now desire to enter into a revised agreement in order to expand their clinical partnership; and
NOW, THEREFORE, based on the premises and the mutual covenants, conditions and
considerations hereafter expressed,the parties agree as follows:
SECTION ONE: Term
This Agreement shall become effective upon approval by the Board of County
Commissioners and shall automatically renew each year unless one party gives the other party
notice it wishes to amend or terminate the Agreement. This Agreement may be amended only by
written agreement of the parties executed with the same formalities as entered into.
SECTION TWO: Instruction and Curriculum
1. The COUNTY rules and regulations shall be followed by all students and faculty of
COLLEGE when they are receiving training and education provided by the terms of this
agreement. All COLLEGE students shall be required to wear identification mandated by both
COLLEGE and the COUNTY in accordance with the policies of the COUNTY and COLLEGE.
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2. The COUNTY shall not substitute students of COLLEGE for paid COUNTY staff for
any purpose, function or task while the students are participating in any activity that is covered by
this Agreement. No student shall be considered to be an employee of the COUNTY during the
clinical courses.
3. Prior to participating in any of the COUNTY programs pursuant to this Agreement, all
students must have completed training on compliance with the confidentiality and privacy
provisions of the Health Insurance Portability and Accountability Act (HIPAA). COUNTY is
required to provide documentation of this training for each student prior to the student participating
in any COUNTY program.
SECTION THREE: Compliance with I-IIPAA.
COLLEGE and its agents, students, faculty, representatives and employees agree to keep
strictly confidential and hold in trust all confidential information of the COUNTY and its patients
and not disclose or reveal any confidential information to any third party without the express prior
written consent of the COUNTY. COUNTY will train all students related to current HIPAA
compliance prior to enrollment in any program pursuant to this Agreement. COLLEGE agrees to
comply with the applicable provisions of the Administrative Simplification section of the Health
Insurance Portability and Accountability Act of 1996, as codified at 42 U.S.C. § 1320 through d-
8 ("HIPAA"),and the requirements of any regulations promulgated thereunder,including,without
limitation, the federal privacy regulations as contained in 45 C.F.R. Part 164, and the federal
security standards as contained in 45 C.F.R. Part i42 (collectively, the"Regulations"). COUNTY
shall not use or further disclose any protected health information, as defined in 45 C.F.R. 164.504,
or individually identifiable health information, as defined in 42 U.S.C. § 1320d (collectively, the
Protected Health Information"), other than as permitted by this Agreement and the requirements
of HIPAA or the Regulations. COLLEGE will implement appropriate safeguards to prevent the
use of disclosure of Protected Health Information other than as contemplated by this Agreement.
SECTION FOUR: Obligation of Braxton College
Braxton College and/or its Emergency Medical Services Technology Programs shall:
1. Provide administrative oversight of the program, in collaboration with Collier County
Emergency Medical Services.
2. Provide current copies of the Program's objectives, curricula, and course objectives, and
field experiences objectives to the Collier County Emergency Medical Services Department.
Provide administrative and instructional material for the program as needed.
3. Submit a request for approval to the Florida Department of Health and other accreditation
bodies for a classroom to be named by Collier County Emergency Medical Services along with a
physical address.
4. Provide classroom space as needed and requested.
5. Provide space for FISDAP exams to be taken at COLLEGE.
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6. Provide instructor led simulation in cooperation with Collier County Emergency Medical
Services at Braxton College or Collier County EMS classroom space.
7. Provide ACLS, PALS, ITLS or PHTLS provider cards. Instruction of these provider
courses will be conducted by Collier County EMS, with a Braxton College instructor if needed.
8. Provide the learning management system for the program.
9. Provide a clinical coordinator liaison.
10. Provide tuition for the Paramedic program, registration to the college, for an all-inclusive
price of$5,775.00 per student.
11. Provide a schedule of students' related courses/activities to the appropriate personnel of
the Collier County Emergency Medical Services Department. Schedules will include names and
identification numbers of students, dates and times of student association/experience(s) with
Collier County Emergency Medical Services Department and its personnel. The determination of
the number of students to be assigned to the COUNTY and their scheduled placement shall be at
the sole discretion of the COUNTY and shall not be altered by the COLLEGE or the student.
12. The College participates in a program of shared risk management created by the Florida
College System Risk Management consortium (FCSRMC). The College provides professional
liability insurance coverage for students participating in externship activities in the amount of$2
million per claim/$5 million aggregate.
13. It is understood between the parties that those students participating in this program shall
not be deemed to be employees, servants, agents, or volunteers of the Collier County Emergency
Medical Services Department or the Collier County Board of Commissioners and that the Collier
County Emergency Medical Services Department and the Collier County Board of Commissioners
shall not be liable for injury to a participant under Ch. 440, Florida Statutes, Florida's Workers'
Compensation law.
14. Neither the Collier County Emergency Medical Services Department, the Collier County
Board of Commissioners, nor their employees, or agents shall be responsible for the compliance
of participants with State or Federally mandated occupational safety laws. Braxton College shall
ensure and document if appropriate that students and interns maintain compliance.
15. All students must complete background screening through Collier County Facilities
Management Department at students' expense in compliance with Ordinance No. 04-52, as
amended. The COUNTY will only allow students who have passed the screening to participate in
the program.
SECTION FIVE: Obligations of Collier County Emergency Medical Services Department
The Collier County Emergency Medical Services Department shall:
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1. Provide opportunities for those qualified students of Braxton College to observe and
perform appropriate Emergency Medical Technician and/or Paramedic skills during field and
classroom experiences with department personnel.
2. Provide for direct supervision of the student interns while in association with the
Department and during field experiences, observation and training.
3. Provide the current Paramedic textbook edition recommended by Braxton College and
FISDAP access for students. FISDAP accounts must be ordered through BRAXTON College and
then invoiced to Collier County EMS for payment. Paramedic textbook may be purchased through
Braxton College at a discounted price if requested.
4. Provide Braxton College required polos for students.
5. Provide required instructors for the programs that meet requirements set forth by FAC 64J
and Braxton College.
6. Students will not be subject to call while in class, internships or externships.
7. Provide the first payment prior to the commencement of class followed by a mutually
agreed upon date for the balance.
SECTION SIX: Mutual Responsibilities and Goals.
The Parties shall:
1. Communication. Communicate and act cooperatively through meetings and operational
plans to plan and evaluate the field experience segment of the Emergency Medical Services
Technology Programs and assist each other within the limits of their respective professional
abilities to ensure a successful field experience program for qualified students. Students will be
evaluated by Collier County preceptors on evaluation forms furnished by Braxton College.
2. Resolution. Utilize established lines of authority and communication in effectuating this
Agreement or addressing/solving problems which may arise in the implementation of this
Agreement.
3. No compensation. Each party shall perform the duties and responsibilities specified in this
Agreement without compensation unless otherwise stated in this agreement. Participating students
shall be treated by the COUNTY as trainees and shall have no expectation of receiving
compensation or future employment from either party. Students shall pay for their own meal and
expenses, if any, while participating in the program.
4. Participant's Medical Care. COLLEGE and/or the students participating in the program
shall be responsible for arranging for the student's medical care and/or treatment, if necessary,
including transportation in the event of illness or injury while participating in the program provided
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at the COUNTY'S premises. In no event shall the COUNTY be financially or otherwise
responsible for said medical care and treatment.
5. Emergency Health Care Services. The COUNTY shall provide immediate emergency
health care services to students participating in the program in the event of accidental injury' or
illness while on the COUNTY'S premises. At the time of providing such services, the COUNTY
and emergency health care facility shall accept assignment of the affected individual's personal or
student basic accident insurance policy. The COUNTY shall not be responsible for costs involved
in the provision of such services, the follow-up care, or hospitalization.
6. Professional Liability Insurance. The COLLEGE shall furnish to COUNTY,
Certificate(s) of Insurance which indicate that insurance coverage has been obtained which meets
the requirements as outline below:
A. Commercial General Liability Insurance on a comprehensive basis in an amount
not less than $1,000,000 combined single limit per occurrence for bodily injury and
property damage. Collier County Board of County Commissioners must be shown
as an additional insured with respect to this coverage.
B. Professional Liability Insurance in an amount not less than $1,000,000.
If the COLLEGE changes its name, the COUNTY must be notified immediately and a
new Agreement must be entered into under the new name. A Certificate of Insurance
must be resubmitted with the current name of the COLLEGE. When the COUNTY is
notified of such a change, the student rider program will be suspended until a new
agreement is signed and new certificates of insurance are approved by Collier County
Department of Risk Management.
SECTION SEVEN: Termination
1. At any time, Collier County Emergency Medical Services staff may refuse any Braxton
College student(s) from participating in the Program including but not limited to performing
observation, classroom instruction, ambulance ride time or practice.
2. Either party may terminate this Agreement upon ten(10)days written notice.
SECTION EIGHT: Government Regulations
To the extent applicable, the parties agree that they will comply with:
1. Title VI of the Civil Rights Act of 1964, as amended. 42 U.S.C. 2000d et seq., which
prohibits discrimination on the basis of'race, color, or national origin in programs and
activities receiving or benefiting from federal financial assistance.
2. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794, which
prohibits discrimination on the basis of handicap in programs and activities receiving or
benefiting from federal financial assistance.
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3. Title IX of the Education Amendments of the 1972, as amended, 20 U.S.C. 1681 et. Seq.,
which prohibits discrimination on the basis of sex in education programs and activities
receiving or benefiting from federal financial assistance.
4. The Age Discrimination Act of 1975. as amended, 42 U.S.C. 6101 et seq., which
prohibits discrimination on the basis of age in programs or activities receiving or
benefiting from federal financial assistance.
5. The Omnibus Budget Reconciliation Act of 1981, P.L. 97-35, which prohibits
discrimination on the basis of sex and religion in programs and activities receiving or
benefiting from federal financial assistance.
6. Executive Order 11246 of September 24, 1965 as amended, and of the rules, regulations,
and relevant orders of the Secretary of Labor, which prohibit discrimination in
government employment on the basis of race, creed, color, or national origin.
7. The Vietnam Era Veteran's Readjustment Assistance Act of 1974, as amended, 38 U.S.C.
219 et seq., covering rehabilitation measures for Vietnam Veterans.
8. The Americans with Disabilities Act of 1990 and the Americans with Disabilities
Amendment Act, which prohibits discrimination on the basis of disability and/or
perceived disability.
9. Chapter 760, Florida Statutes, which prohibits discrimination on the basis race, color,
religion, sex, national origin, age handicap, or marital status.
10. Title 45 C. F. R. 160.103, Health Insurance Portability and Accountability Act which
governs privacy regulations associated with medical information.
11. All regulations, guidelines, and standards which are now or may be lawfully adopted
under the above statutes, as well as any other federal, state, or local rules, regulations and
ordinances.
SECTION NINE: Equal Opportunity
Braxton College is committed to providing an educational and working environment free from
discrimination and harassment. All programs, activities, employment and facilities of Braxton
College are available to all on a non-discriminatory basis, without regard to race, sex, age, color,
religion,national origin,ethnicity,disability,sexual orientation,marital status,genetic information
or veteran's status. The University is an equal access/equal opportunity institution. Questions
pertaining to educational equity,equal access,or equal opportunity should be addressed to College
Equity Officer, Office of Human Resources, 8099 College Parkway, Fort Myers, FL 33919,(239)
489-9293.
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SECTION TEN: Indemnification
To the maximum extent permitted by Florida law, the COLLEGE shall indemnify and hold
harmless Collier County, its officers and employees from any and all liabilities, damages, losses
and costs,including,but not limited to,reasonable attorneys' fees and paralegals' fees,to the extent
caused by the negligence, recklessness, or intentionally wrongful conduct of the COLLEGE or
anyone employed or utilized by the COLLEGE in the performance of this Agreement. This
indemnification obligation shall not be construed to negate, abridge or reduce any other rights or
remedies which otherwise may be available to an indemnified party or person described in this
paragraph. This section does not pertain to any incident arising from the sole negligence of Collier
County.The foregoing indemnification shall not constitute a waiver of sovereign immunity beyond
the limits set forth in section 768.28, Florida Statutes.
SECTION ELEVEN: Public Records Compliance
IF THE CONTRACTOR/COLLEGE HAS QUESTIONS REGARDING THE APPLICATION
OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO PROVIDE
PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT TI-IE CUSTODIAN OF
PUBLIC RECORDS AT
Collier County Communication and Customer Relations Division
3299 Tamiami Trail East, Suite 202
Naples, FL 34112
(239)252-8999
PublicRecordRequest(colliercountyfl.gov
The CONTRACTOR/COLLEGE is required to comply with the public records laws, specifically
to:
1. Keep and maintain public records required by the public agency to perform the service.
2. Upon request from the public agency's custodian of public records, provide the public
agency with a copy of the requested records or allow the records to be inspected or copied within
a reasonable time at a cost that does not exceed the cost provided in this chapter or as otherwise
provided by law.
3. Ensure that public records that are exempt or confidential and exempt from public records
disclosure requirements are not disclosed except as authorized by law for the duration of the
contract term and following completion of the contract if the contractor does not transfer the
records to the public agency.
4. Upon completion of the contract,transfer,at no cost, to the public agency all public records
in possession of the contractor or keep and maintain public records required by the public agency
to perform the service. If the contractor transfers all public records to the public agency upon
completion of the contract,the contractor shall destroy any duplicate public records that are exempt
or confidential and exempt from public records disclosure requirements. If the contractor keeps
and maintains public records upon completion of the contract, the contractor shall meet all
applicable requirements for retaining public records. All records stored electronically must be
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provided to the public agency, upon request from the public agency's custodian of public records,
in a format that is compatible with the information technology systems of the public agency.
SECTION TWELVE: This agreement supersedes and replaces the Agreement for Field Internship
Experience entered into by the parties on October 27, 2020, which is hereby terminated in all
respects.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement, this 13 ' day
of IJece".4e/ , 2022.
ATTEST: - BOARD OF COUNTY COMMISSIONERS
CRYSTAL K. KINZEL, CLERK COLLIER CO, . ' DA
r , .' , .ftr-- Oil_ ,. .
(11).
-- .Q By: —�—� _
Clerk Will•m L. McDaniel, Jr., Chairman
....jai as to�`Chairr '
signature 1
Ap - , la form and legality:
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Jef fry 7474141!i. ow
Co +7 ty t orney
WITNESS: Braxton College
By:
(Signature) (Signatur
Richard Gonzalez,Vice President of Admissions and Compliance
Print Name and Title Print Name&Title
WITNESS:
(Signature)
Print Name and Title
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