Backup Documents 10/24/2023 Item #16D 7 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 D
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. Todd Henry Public Services Department TO. 9/18/23
2. Jeffrey A. Klatzkow County Attorney Office �--�n 0I Z y/23
4. BCC Office Board of County Commissioners '{
1Liby/10/4 loci t/Z3D,
5. Minutes and Records Clerk of Court's Office 1
it/0 6/9
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 Phone Number x-8206
Contact / Depailntent Alan Portis,DOH Finance&Accounting 252-8206 Please Call for Pick-up
Agenda Date Item was Agenda Item Number
Approved by the BCC 10/24/23 16D7
Type of Document FY23-24 Collier County Health Number of Original
Attached Depai tuient Annual Core Contract Documents Attached
(Between Collier County and DOH) 3
PO number or account
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature?STAMPED SIGNATURE IS OK
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be
signed by the Chairman,with the exception of most letters,must be reviewed and signed AP
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the AP
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's AP
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip
should be provided to the County Attorney Office at the time the item is input into SIRE. N/A
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 10/24/2023 (enter date)and all N/A is not
changes made during the meeting have been incorporated in the attached document. AP an option for
The County Attorney's Office has reviewed the changes,if applicable. _ 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 g (IA? an o `for
Chairman's signature. t
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
16D 1
MEMORANDUM
Date: October 30, 2023
To: Alan Portis, Buisness Manager
DOH Finance & Accounting
From: Martha Vergara, Sr. Deputy Clerk
Minutes & Records Department
Re: Contract between Collier County BCC & State of Florida Department
of Health for the operation of the Collier County Health Department
Contract for Year 2023-2024
Enclosed please find two (2) originals of each document referenced above (Agenda
Item #16D7), approved by the Board of County Commissioners on Tuesday, October
24, 2023.
The Minutes & Records Department has retained an original as part of the Board's
Official Records.
If you have any questions, please contact me at 252-7240.
Thank you.
Enclosure
16D 7
CONTRACT BETWEEN
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
AND
STATE OF FLORIDA DEPARTMENT OF HEALTH
FOR OPERATION OF THE
COLLIER COUNTY HEALTH DEPARTMENT
CONTRACT YEAR 2023-2024
This contract is made and entered into between the State of Florida, Department of Health
("State"), and the Collier County Board of County Commissioners ("County"), through their
undersigned authorities, effective October 1 , 2023. State and County are jointly referred to as
the "parties".
RECITALS
A. Pursuant to Chapter 154, Florida Statutes, the intent of the legislature is to
"promote, protect, maintain, and improve the health and safety of all citizens and visitors of this
state through a system of coordinated county health department services."
B. County Health Departments were created throughout Florida to satisfy this
legislative intent through the "promotion of the public's health, the control and eradication of
preventable diseases, and the provision of primary health care for special populations."
C. Collier County Health Department ("CHD") is one of the created County Health
Departments.
D. It is necessary for the parties hereto to enter into this contract to ensure
coordination between the State and the County in the operation of the CHD.
NOW, THEREFORE, in consideration of the mutual promises set forth herein, the
sufficiency of which is hereby acknowledged, the parties hereto agree as follows:
1. RECITALS. The parties mutually agree that the foregoing recitals are true and correct
and incorporated herein by reference.
2. TERM. The parties mutually agree that this contract shall be effective from October 1,
2023, through September 30, 2024, or until a written contract replacing this contract is entered
into between the parties, whichever is later, unless this contract is otherwise terminated
according to the termination provisions outlined in paragraph 8. below.
3. SERVICES MAINTAINED BY THE CHD. The parties mutually agree that the CHD shall
provide those services as outlined in Part III of Attachment II hereof, to maintain the following
three levels of service pursuant to section 154.01(2), Florida Statutes, as defined below:
a. "Environmental health services" are those services that are organized and operated to
protect the health of the general public by monitoring and regulating activities in the
environment that may contribute to the occurrence or transmission of disease. Environmental
health services shall be supported by available federal, state, and local funds and shall include
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1 6 D $; 7
those services mandated on a state or federal level. Examples of environmental health
services include but are not limited to, food hygiene, safe drinking water supply, sewage, and
solid waste disposal, swimming pools, group care facilities, migrant labor camps, toxic material
control, radiological health, and occupational health.
b. "Communicable disease control services" are those services that protect the health of
the general public through the detection, control, and eradication of diseases that are
transmitted primarily by human beings. Communicable disease services shall be supported by
available federal, state, and local funds and shall include those services mandated on a state
or federal level. Such services include, but are not limited to, epidemiology, sexually
transmissible disease detection and control, HIV/AIDS, immunization, tuberculosis control, and
maintenance of vital statistics.
c. "Primary care services" are acute care and preventive services that are made available
to well and sick persons who are unable to obtain such services due to lack of income or other
barriers beyond their control. These services are provided to benefit individuals, improve the
collective health of the public, and prevent and control the spread of disease. Primary health
care services are provided at home, in group settings, or in clinics. These services shall be
supported by available federal, state, and local funds and shall include services mandated on
a state or federal level. Examples of primary health care services include but are not limited to
first contact acute care services; chronic disease detection and treatment; maternal and child
health services; family planning; nutrition; school health; supplemental food assistance for
women, infants, and children; home health; and dental services.
4. FUNDING. The parties further agree that funding for the CHD will be handled as follows:
a. The funding to be provided by the parties and any other sources is outlined in Part II of
Attachment II hereof. This funding will be used as shown in Part I of Attachment II.
i. The State's appropriated responsibility (direct contribution excluding any state fees,
Medicaid contributions, or any other funds not listed on the Schedule C) as provided in
Attachment II, Part II is an amount not to exceed $7,681,378 (State General
Revenue, State Funds, Other State Funds and Federal Funds listed on the Schedule C).
The State's obligation to pay under this contract is contingent upon an annual
appropriation by the Legislature.
ii. The County's appropriated responsibility (direct contribution excluding any fees,
other cash, or local contributions)as provided in Attachment II, Part II is an amount
not to exceed $1,495,900 (amount listed under the "Board of County Commissioners
Annual Appropriations section of the revenue attachment).
b. Overall expenditures will not exceed available funding or budget authority, whichever is
less, (either the current year or from surplus trust funds) in any service category. Unless
requested otherwise, any surplus at the end of the term of this contract in the County Health
Department Trust Fund that is attributed to the CHD shall be carried forward to the next contract
period.
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16D , I
c. Either party may establish service fees as allowed by law to fund activities of the CHD.
Where applicable, such fees shall be automatically adjusted to at least the Medicaid fee
schedule.
d. Either party may increase or decrease funding of this contract during the term hereof by
notifying the other party in writing of the amount and purpose for the change in funding. If the
State initiates the increase or decrease, the CHD will revise Attachment II and send a copy of
the revised pages to the County and the State's Office of Budget and Revenue Management.
If the County initiates the increase or decrease, the County shall notify the CHD in writing. The
CHD will then revise Attachment II and send a copy of the revised pages to the State's Office
of Budget and Revenue Management.
e. The name and address of the official payee to whom payments shall be made is:
County Health Department Trust Fund
Collier County Health Department
3339 E. Tamiami Trail, Suite 145
Naples, FL 34112
5. CHD DIRECTOR or ADMINISTRATOR. Both parties agree the director or administrator
of the CHD shall be a State employee or under contract with the State and will be under the
day-to-day direction of the State's Deputy Secretary for County Health Systems. The director
or administrator shall be selected by the State with the concurrence of the County. The director
or administrator of the CHD shall ensure that non-categorical sources of funding are used to
fulfill public health priorities in the community and the Long-Range Program Plan.
6. ADMINISTRATIVE POLICIES AND PROCEDURES. The parties hereto agree that the
following standards should apply in the operation of the CHD:
a. The CHD and its personnel shall follow all State policies and procedures, except to the
extent permitted for the use of County purchasing procedures as outlined in subparagraph b.,
below. All CHD employees shall be State or State-contract personnel subject to State
personnel laws, rules, and procedures. Employees will report time in the Health Management
System compatible format by program component as specified by the State.
b. The CHD shall comply with all applicable provisions of federal and state laws and
regulations relating to its operation with the exception that the use of County purchasing
procedures shall be allowed when it will result in a better price or service and no statewide
purchasing contract has been implemented for those goods or services. In such cases, the
CHD director or administrator must sign a justification, therefore, and all County purchasing
procedures must be followed in their entirety, and such compliance shall be documented. Such
justification and compliance documentation shall be maintained by the CHD following the terms
of this contract. State procedures must be followed for all leases on facilities not enumerated
in Attachment IV.
c. The CHD shall maintain books, records, and documents following the Generally
Accepted Accounting Principles, as promulgated by the Governmental Accounting Standards
Board, and the requirements of federal or state law. These records shall be maintained as
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16D 7
required by the State's Policies and Procedures for Records Management and shall be open
for inspection at any time by the parties and the public, except for those records that are not
otherwise subject to disclosure as provided by law which is subject to the confidentiality
provisions of paragraphs 6.i. and 6.k., below. Books, records, and documents must be
adequate to allow the CHD to comply with the following reporting requirements:
i. The revenue and expenditure requirements in the Florida Accounting
Information Resource System; and
ii. The client registration and services reporting requirements of the minimum
data set as specified in the most current version of the Client Information
System/Health Management Component Pamphlet; and
iii. Financial procedures specified in the State's Accounting Procedures
Manuals, Accounting memoranda, and Comptroller's memoranda; and
iv. The CHD is responsible for assuring that all contracts with service providers
include provisions that all subcontracted services be reported to the CHD in
a manner consistent with the client registration and service reporting
requirements of the minimum data set as specified in the Client Information
System/Health Management Component Pamphlet.
d. All funds for the CHD shall be deposited in the County Health Department Trust Fund
maintained by the state treasurer. These funds shall be accounted for separately from funds
deposited for other CHDs and shall be used only for public health purposes in Collier County.
e. That any surplus or deficit funds, including fees or accrued interest, remaining in the
County Health Department Trust Fund account at the end of the contract year shall be credited
or debited to the State or County, as appropriate, based on the funds contributed by each and
the expenditures incurred by each. Expenditures will be charged to the program accounts by
State and County based on the ratio of planned expenditures in this contract and funding from
all sources is credited to the program accounts by State and County. The equity share of any
surplus or deficit funds accruing to the State and County is determined each month and at the
contract year-end. Surplus funds may be applied toward the funding requirements of each
party in the following year. However, in each such case, all surplus funds, including fees and
accrued interest, shall remain in the trust fund until accounted for in a manner that clearly
illustrates the amount which has been credited to each party. The planned use of surplus funds
shall be reflected in Attachment II, Part I of this contract, with special capital projects explained
in Attachment V.
f. There shall be no transfer of funds between the three levels of services without a contract
amendment unless the CHD director or administrator determines that an emergency exists
wherein a time delay would endanger the public's health and the State's Deputy Secretary for
County Health Systems have approved the transfer. The State's Deputy Secretary for County
Health Systems shall forward written evidence of this approval to the CHD within 30 days after
an emergency transfer.
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g. The CHD may execute subcontracts for services necessary to enable the CHD to carry
out the programs specified in this contract. Any such subcontract shall include all
aforementioned audit and record-keeping requirements.
h. At the request of either party, an audit may be conducted by an independent certified
public accountant on the financial records of the CHD, and the results made available to the
parties within 180 days after the close of the CHD fiscal year. This audit will follow requirements
contained in OMB Circular A-133, as revised, and may be in conjunction with audits performed
by the County government. If audit exceptions are found, then the director or administrator of
the CHD will prepare a corrective action plan and a copy of that plan and monthly status reports
will be furnished to the contract managers for the parties.
i. The CHD shall not use or disclose any information concerning a recipient of services
except as allowed by federal or state law or policy.
j. The CHD shall retain all client records, financial records, supporting documents,
statistical records, and any other documents (including electronic storage media) pertinent to
this contract for five years after termination of this contract. If an audit has been initiated and
audit findings have not been resolved at the end of five years, the records shall be retained
until the resolution of the audit findings.
k. The CHD shall maintain the confidentiality of all data, files, and records that are
confidential under the law or are otherwise exempted from disclosure as a public record under
Florida law. The CHD shall implement procedures to ensure the protection and confidentiality
of all such records and shall comply with sections 384.29, 381 .004, 392.65, and 456.057,
Florida Statutes, and all other state and federal laws regarding confidentiality. All confidentiality
procedures implemented by the CHD shall be consistent with the State's Information Security
Policies, Protocols, and Procedures. The CHD shall further adhere to any amendments to the
State's security requirements and shall comply with any applicable professional standards of
practice concerning client confidentiality.
I. The CHD shall abide by all State policies and procedures, which by this reference are
incorporated herein as standards to be followed by the CHD.
m. The CHD shall establish a system through which applicants for services and current
clients may present grievances over denial, modification, or termination of services. The CHD
will advise applicants of the right to appeal a denial or exclusion from services, of failure to take
account of a client's choice of service, and right to a fair hearing to the final governing authority
of the CHD. Specific references to existing laws, rules, or program manuals are included in
Attachment I of this contract.
n. The CHD shall comply with the provisions contained in the Civil Rights Compliance and
Non-Discrimination Certificate, hereby incorporated into this contract as Attachment III.
o. The CHD shall submit quarterly reports to the County that shall include at least the
following:
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i. The DE385L1 Contract Management Variance Report and the DE580L1
Analysis of Fund Equities Report; and
ii. A written explanation to the County of service variances reflected in the year-
end DE385L1 report if the variance exceeds or falls below 25 percent of the
planned expenditure amount for the contract year. However, if the amount
of the service-specific variance between actual and planned expenditures
does not exceed three percent of the total planned expenditures for the level
of service in which the type of service is included, a variance explanation is
not required. A copy of the written explanation shall be sent to the State's
Office of Budget and Revenue Management.
p. The dates for the submission of quarterly reports to the County shall be as follows unless
the generation and distribution of reports are delayed due to circumstances beyond the CHD's
control:
i. March 1, 2024, for the reporting period of October 1, 2023, through
December 31, 2023; and
ii. June 1, 2024, for the reporting period of October 1, 2023, through
March 31, 2024; and
iii. September 1, 2024, for the reporting period of October 1, 2023
through June 30, 2024; and
iv. December 1, 2024, for the reporting period of October 1, 2023
through September 30, 2024.
7. FACILITIES AND EQUIPMENT. The parties mutually agree that:
a. CHD facilities shall be provided as specified in Attachment IV to this contract and the
County shall own the facilities used by the CHD unless otherwise provided in Attachment IV.
b. The County shall ensure adequate fire and casualty insurance coverage for County-
owned CHD offices and buildings and all furnishings and equipment in CHD offices through
either a self-insurance program or insurance purchased by the County.
c. All vehicles will be transferred to the ownership of the County and registered as County
vehicles. The County shall ensure insurance coverage for these vehicles is available through
either a self-insurance program or insurance purchased by the County. All vehicles will be
used solely for CHD operations. Vehicles purchased through the County Health Department
Trust Fund shall be sold at fair market value when they are no longer needed by the CHD and
the proceeds returned to the County Health Department Trust Fund.
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Ls.
16D i
8. TERMINATION.
a. Termination at Will. This contract may be terminated by either party without cause upon
no less than 180 calendar days' notice in writing to the other party unless a lesser time is
mutually agreed upon in writing by both parties.
b. Termination Because of Lack of Funds. In the event funds to finance this contract
become unavailable, either party may terminate this contract upon no less than 24 hours'
notice.
c. Termination for Breach. This contract may be terminated by either party for a material
breach of an obligation hereunder, upon no less than 30 days' notice. Waiver of a breach of
any provisions of this contract shall not be deemed to be a waiver of any other breach and shall
not be construed to be a modification of the terms of this contract.
9. MISCELLANEOUS. The parties further agree:
a. Availability of Funds. If this contract, any renewal hereof, or any term, performance, or
payment hereunder, extends beyond the CHD fiscal year beginning July 1, 2024, it is agreed
that the performance and payment under this contract are contingent upon an annual
appropriation by the Legislature, under section 287.0582, Florida Statutes.
b. Contract Managers. The name and addresses of the contract managers for the parties
under this contract are as follows:
For the State: For the County:
Kimberly Kossler, MPH, RN, CPH Tanya R Williams
Name Name
Administrator & Health Officer Public Services Department Head
Title Title
3339 E. Tamiami Trail, Suite 145 3339 E. Tamiami Trail, Suite 217
Naples, FL 34112 Naples, FL 34112
Address Address
Kimberly.Kossler c(�FLHealth.gov Tanya.Williams(a�colliercountyfl.gov
Email Address Email Address
239-252-8201 239-252-7392
Telephone Telephone
If different contract managers are designated after the execution of this contract, the name,
address, email address, and telephone number of the new representative shall be furnished in
writing to the other parties and attached to the originals of this contract.
c. Captions. The captions and headings contained in this contract are for the convenience
of the parties only and do not in any way modify, amplify, or give additional notice of the
provisions hereof.
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16D 7
d. Notices. Any notices provided under this contract must be delivered by certified mail,
return receipt requested, in person with proof of delivery, or by email to the email address of
the respective party identified in Section 9.b., above.
In WITNESS THEREOF, the parties hereto have caused this 8 page contract, with its
attachments as referenced, including Attachment I (two pages), Attachment II (seven pages),
Attachment III (one pages), Attachment IV (one pages), and Attachment V (one pages), to be
executed by their undersigned officials as duly authorized effective the 1st day of October 2023.
BOARD OF COUNTY COMMISSIONERS STATE OF FLORIDA
FOR COLLIER COUNTY DEPARTMENT OF HEALTH
SIGNED BY: , SIGNED BY:
Rick LoCastro, Chairman NAME: Joseph A. Ladapo, M.D., Ph.D.
TITLE: State Surgeon General
DATE: IO/Z / (23 DATE:
ATTESTED TO:
,
SIGNED BY: trWe� SIGNED BY
ti NAME: brt i CL NAME: f )i(n 1 _
TITLE: (. iv, dj : L'01 DVE.t TITLE: CHD Director or Administrator
DATE: ( 'L''tL.,' )f, 1' v • DATE: C\ ` I S \ cA- C�a
AtteSt.,p ' c t"tl tcpan s
signatt14 �Y
Approved as to form and legality
AMA
Assistant County Attorney
Roogi J T ;To i (Ci
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ATTACHMENT I
COLLIER COUNTY HEALTH DEPARTMENT
PROGRAM SPECIFIC REPORTING REQUIREMENTS AND PROGRAMS REQUIRING
COMPLIANCE WITH THE PROVISIONS OF SPECIFIC MANUALS
Some health services must comply with specific program and reporting requirements in addition to the Personal Health
Coding Pamphlet(DHP 50-20), Environmental Health Coding Pamphlet(DHP 50-21)and FLAIR requirements because of
federal or state law, regulation or rule. If a county health department is funded to provide one of these services, it must
comply with the special reporting requirements for that service. The services and the reporting requirements are listed
below:
Service Requirement
1. Sexually Transmitted Disease Requirements as specified in F.A.C.64D-3, F.S. 381 and F.S.384.
Program
2. Dental Health Periodic financial and programmatic reports as specified by the
program office.
3. Special Supplemental Nutrition Service documentation and monthly financial reports as specified in
Program for Women, Infants and DHM 150-24*and all federal,state and county requirements
Children(including the WIC detailed in program manuals and published procedures.
Breastfeeding Peer Counseling
Program)
4. Healthy Start/Improved Pregnancy Requirements as specified in the 2007 Healthy Start Standards and
Outcome Guidelines and as specified by the Healthy Start Coalitions in
contract with each county health department.
5. Family Planning Requirements as specified in Public Law 91-572,42 U.S.C.300,et
seq.,42 CFR part 59,subpart A,45 CFR parts 74&92,2 CFR 215
(OMB Circular A-110)OMB Circular A-102, F.S.381.0051, F.A.C.
64F-7, F.A.C.64F-16,and F.A.C.64F-19. Requirements and
Guidance as specified in the Program Requirements for Title X
Funded Family Planning Projects(Title X Requirements)(2014)and
the Providing Quality Family Planning Services(QFP):
Recommendations of CDC and the U.S. Office of Population Affairs
published on the Office of Population Affairs website.
Programmatic annual reports as specified by the program office as
specified in the annual programmatic Scope of Work for Family
Planning and Maternal Child Health Services, including the Family
Planning Annual Report(FPAR),and other minimum guidelines as
specified by the Policy Web Technical Assistance Guidelines.
6. Immunization Periodic reports as specified by the department pertaining to
immunization levels in kindergarten and/or seventh grade pursuant
to instructions contained in the Immunization Guidelines-Florida
Schools, Childcare Facilities and Family Daycare Homes(DH Form
150-615)and Rule 64D-3.046, F.A.C. In addition, periodic reports
as specified by the department pertaining to the
surveillance/investigation of reportable vaccine-preventable
diseases,adverse events,vaccine accountability,and assessment
of immunization
ATTACHMENT I(Continued) (,,RC
Attachment_I-Page 1 of 2
16D 7
levels as documented in Florida SHOTS and supported by CHD
Guidebook policies and technical assistance guidance.
7. Environmental Health Requirements as specified in Environmental Health Programs
Manual 150-4*and DHP 50-21*
8. HIV/AIDS Program Requirements as specified in F.S.384.25 and F.A.C.64D-3.030
and 64D-3.031. Case reporting should be on Adult HIV/AIDS
Confidential Case Report CDC Form DH2139 and Pediatric
HIV/AIDS Confidential Case Report CDC Form DH2140.
Requirements as specified in F.A.C.64D-2 and 64D-3, F.S.381 and
F.S. 384. Socio-demographic and risk data on persons tested for
HIV in CHD clinics should be reported on Lab Request DH Form
1628 in accordance with the Forms Instruction Guide.
Requirements for the HIV/AIDS Patient Care programs are found in
the Patient Care Contract Administrative Guidelines.
9. School Health Services Requirements as specified in the Florida School Health
Administrative Guidelines(May 2012). Requirements as specified
in F.S.381.0056, F.S. 381.0057, F.S.402.3026 and F.A.C. 64F-6.
10. Tuberculosis Tuberculosis Program Requirements as specified in F.A.C.64D-3
and F.S. 392.
11. General Communicable Disease Carry out surveillance for reportable communicable and other acute
Control diseases,detect outbreaks, respond to individual cases of
reportable diseases, investigate outbreaks,and carry out
communication and quality assurance functions,as specified in
F.A.C.64D-3, F.S.381, F.S.384 and the CHD Epidemiology Guide
to Surveillance and Investigations.
12. Refugee Health Program Programmatic and financial requirements as specified by the
program office.
*or the subsequent replacement if adopted during the contract period.
Attachment_I-Page 2 of 2
16D 7
46
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ATTACHMENT II 1 6 I) 7
COLLIER COUNTY HEALTH DEPARTMENT
Part II,Sources of Contributions to County Health Department
October 1,2023 to September 30,2024
State CHD County Total CHD
Trust Fund CHD Trust Fund Other
(cash) Trust Fund (cash) Contribution Total
1.GENERAL REVENUE-STATE
015040 AIDS PATIENT CARE 140,000 0 140,000 0 140,000
015040 AIDS PREVENTION&SURVEILLANCE-GENERAL REVENUE 69,571 0 69,571 0 69,571
015040 CHD-TB COMMUNITY PROGRAM 216,959 0 216,959 0 216,959
015040 DENTAL SPECIAL INITIATIVE PROJECTS 6,933 0 6,933 0 6,933
015040 FAMILY PLANNING GENERAL REVENUE 122,952 0 122,952 0 122,952
015040 HEPATITIS AND LIVER FAILURE PREVENTION&CONTROL 89,286 0 89,286 0 89,286
015040 MIGRANT LABOR CAMP SANITATION 25,244 0 25,244 0 25,244
015040 PRIMARY CARE PROGRAM 313,432 0 313,432 0 313,432
015040 RACIALÐNIC DISPARITIES-CHD EXPENSES 52,000 0 52,000 0 52,000
015040 SCHOOL HEALTH SERVICES 218,073 0 218,073 0 218,073
015050 CHD GENERAL REVENUE NON-CATEGORICAL 2,551,377 0 2,551,377 0 2,551,377
GENERAL REVENUE TOTAL 3,805,827 0 3,805,827 0 3,805,827
2.NON GENERAL REVENUE-STATE
015010 ENVIRONMENTAL BIOMEDICAL WASTE PROGRAM 9,746 0 9,746 0 9,746
015010 TOBACCO STATE AND COMMUNITY INTERVENTIONS 184,466 0 184,466 0 184,466
NON GENERAL REVENUE TOTAL 194,212 0 194,212 0 194,212
3.FEDERAL FUNDS-STATE
007000 AIDS DRUG ASSISTANCE PROGRAM ADMIN HQ 104,059 0 104,059 0 104,059
007000 WIC BREASTFEEDING PEER COUNSELING PROG 49,687 0 49,687 0 49,687
007000 COASTAL BEACH WATER QUALITY MONITORING 14,709 0 14,709 0 14,709
007000 COMPREHENSIVE COMMUNITY CARDIO-PHBG 35,000 0 35,000 0 35,000
007000 STRENGTHENING STD PREVENTION AND CONTROL 52,744 0 52,744 0 52,744
007000 ELC COVID ENHANCED DETECTION EXPANSION GRANT 557,921 0 557,921 0 557,921
007000 EPID&LAB FOR INFECTIOUS DISEASE COVID-19 804 0 804 0 804
007000 FAMILY PLANNING TITLE X-GRANT 110,615 0 110,615 0 110,615
007000 HEALTH DISPARITIES GRANT COVID-19 101,930 0 101,930 0 101,930
007000 PUBLIC HLTH INFRASTRUCTURE&WORKFORCE/CENTRAL 1 181,235 0 181,235 0 181,235
007000 IMMUNIZATION&VACCINES CHILDREN COVID 19 RESPON 113,108 0 113,108 0 113,108
007000 INFANT MORTALITY 15,247 0 15,247 0 15,247
007000 IMMUNIZATION ACTION PLAN 125,154 0 125,154 0 125,154
007000 MCH SPECIAL PRJCT UNPLANNED PREGNANCY 38,182 0 38,182 0 38,182
007000 MCH SPEC PRJ SOCIAL DETERMINANTS HLTH COMM EDU 2,817 0 2,817 0 2,817
007000 BASE COMMUNITY PREPAREDNESS CAPABILITY 159,901 0 159,901 0 159,901
007000 BASE PUB HLTH SURVEILLANCE&EPI INVESTIGATION 88,796 0 88,796 0 88,796
007000 AIDS PREVENTION 315,984 0 315,984 0 315,984
007000 RYAN WHITE TITLE II GRANT/CHD CONSORTIUM 353,295 0 353,295 0 353,295
007000 TB CONTROL PROJECT 9,000 0 9,000 0 9,000
007000 WIC PROGRAM ADMINISTRATION 1,417,030 0 1,417,030 0 1,417,030
015075 SCHOOL HEALTH SERVICES 33,690 0 33,690 0 33,690
015075 REFUGEE HEALTH SCREENING REIMBURSEMENT ADMIN 326,000 0 326,000 0 326,000
015075 REFUGEE HEALTH SCREENING REIMBURSEMENT SERVICES 1,119,387 0 1,119,387 0 1,119,387
FEDERAL FUNDS TOTAL 5,326,295 0 5,326,295 0 5,326,295
Attachment_II_Part_II-Page 16Z)
ATTACHMENT II 1 6 D 7 ,if
COLLIER COUNTY HEALTH DEPARTMENT
Part II,Sources of Contributions to County Health Department
October 1,2023 to September 30,2024
State CHD County Total CHD
Trust Fund CHD Trust Fund Other
(cash) Trust Fund (cash) Contribution Total
4.FEES ASSESSED BY STATE OR FEDERAL RULES-STATE
001020 CHD STATEWIDE ENVIRONMENTAL FEES 514,873 0 514,873 0 514,873
001092 ON SITE SEWAGE DISPOSAL PERMIT FEES 204,681 0 204,681 0 204,681
001092 CHD STATEWIDE ENVIRONMENTAL FEES 11,280 0 11,280 0 11,280
001206 ON SITE SEWAGE DISPOSAL PERMIT FEES 15,000 0 15,000 0 15,000
001206 SANITATION CERTIFICATES(FOOD INSPECTION) 3,500 0 3,500 0 3,500
001206 SEPTIC TANK RESEARCH SURCHARGE 3,000 0 3,000 0 3,000
001206 SEPTIC TANK VARIANCE FEES 50% 250 0 250 0 250
001206 PUBLIC SWIMMING POOL PERMIT FEES-10%HQ TRANSFER 30,000 0 30,000 0 30,000
001206 DRINKING WATER PROGRAM OPERATIONS 1,000 0 1,000 0 1,000
001206 REGULATION OF BODY PIERCING SALONS 150 0 150 0 150
001206 TANNING FACILITIES 225 0 225 0 225
001206 ONSITE SEWAGE TRAINING CENTER 1,000 0 1,000 0 1,000
001206 TATTO PROGRAM ENVIRONMENTAL HEALTH 4,000 0 4,000 0 4,000
001206 MOBILE HOME&RV PARK FEES 2,500 0 2,500 0 2,500
FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 791,459 0 791,459 0 791,459
5.OTHER CASH CONTRIBUTIONS-STATE:
031005 GENERAL CLINIC RABIES SERVICES&DRUG PURCHASES 44,369 0 44,369 0 44,369
090001 DRAW DOWN FROM PUBLIC HEALTH UNIT 0 0 0 0 0
OTHER CASH CONTRIBUTION TOTAL 44,369 0 44,369 0 44,369
6.MEDICAID-STATE/COUNTY:
001050 CHD CLINIC FEES 0 4,540 4,540 0 4,540
001057 CHD CLINIC FEES 0 9,015 9,015 0 9,015
001147 CHD CLINIC FEES 0 81 81 0 81
001148 CHD CLINIC FEES 0 768,300 768,300 0 768,300
001148 GENERAL CLINIC RABIES SERVICES&DRUG PURCHASES 0 638 638 0 638
MEDICAID TOTAL 0 782,574 782,574 0 782,574
7.ALLOCABLE REVENUE.STATE:
001009 CHD CLINIC FEES 1 0 1 0 1
004010 VITAL STATISTICS CERTIFIED RECORDS 10 0 10 0 10
018000 340B PRESCRIPTION DRUG SERVICE AGREEMENT 1 0 1 0 1
018000 CHD CLINIC FEES 6,635 0 6,635 0 6,635
038000 CHD CLINIC FEES 3 0 3 0 3
038000 ELC COVID ENHANCED DETECTION EXPANSION GRANT 1 0 1 0 1
038000 CHD LOCAL ENVIRONMENTAL FEES 1 0 1 0 1
038000 CHD LOCAL REVENUE&EXPENDITURES 1 0 1 0 1
ALLOCABLE REVENUE TOTAL 6,653 0 6,653 0 6,653
8.OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND-STATE
ADAP 0 0 0 998,761 998,761
PHARMACY DRUG PROGRAM 0 0 0 13,420 13,420
Attachment_II_Part_II-Page eVf
ATTACHMENT II 1 6 1) 7
COLLIER COUNTY HEALTH DEPARTMENT
Part II,Sources of Contributions to County Health Department
October 1,2023 to September 30,2024 .,
State CHD County Total CHD
Trust Fund CHD Trust Fund Other
(cash) Trust Fund (cash) Contribution Total
WIC PROGRAM 0 0 0 5,734,624 5,734,624
BUREAU OF PUBLIC HEALTH LABORATORIES 0 0 0 43,673 43,673
IMMUNIZATIONS 0 0 0 1,801,533 1,801,533
OTHER STATE CONTRIBUTIONS TOTAL 0 0 0 8,592,011 8,592,011
9.DIRECT LOCAL CONTRIBUTIONS-BCC/TAX DISTRICT
008005 CHD LOCAL REVENUE&EXPENDITURES 0 1,495,900 1,495,900 0 1,495,900
DIRECT COUNTY CONTRIBUTIONS TOTAL 0 1,495,900 1,495,900 0 1,495,900
10.FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION-COUNTY
001025 CHD CLINIC FEES 0 92 92 0 92
001077 CHD CLINIC FEES 0 413,642 413,642 0 413,642
001077 GENERAL CLINIC RABIES SERVICES&DRUG PURCHASES 0 1 1 0 1
001094 CHD LOCAL ENVIRONMENTAL FEES 0 870,856 870,856 0 870,856
001110 VITAL STATISTICS CERTIFIED RECORDS 0 650,000 650,000 0 650,000
FEES AUTHORIZED BY COUNTY TOTAL 0 1,934,591 1,934,591 0 1,934,591
11.OTHER CASH AND LOCAL CONTRIBUTIONS-COUNTY
001029 340B PRESCRIPTION DRUG SERVICE AGREEMENT 0 100,000 100,000 0 100,000
001029 CHD CLINIC FEES 0 47,361 47,361 0 47,361
001090 CHD CLINIC FEES 0 6,902 6,902 0 6,902
010300 STATE UNDERGROUND PETROLEUM RESPONSE ACT 0 200 200 0 200
010300 MIGRANT LABOR HOUSING INSPECTION H-2A PROGRAM 0 8,000 8,000 0 8,000
011000 RYAN WHITE 0 30,000 30,000 0 30,000
011000 CHD CLINIC FEES 0 2 2 0 2
011000 CHD CASH DONATION/NON-SPECIFIC 0 220 220 0 220
011000 EARLY LEARNING COALITION OF SOUTHWEST FLORIDA 0 60,900 60,900 0 60,900
011001 CHD HEALTHY START COALITION CONTRACT 0 678,221 678,221 0 678,221
012020 CHD LOCAL ENVIRONMENTAL FEES 0 1,000 1,000 0 1,000
090002 DRAW DOWN FROM PUBLIC HEALTH UNIT 0 312,736 312,736 0 312,736
OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 0 1,245,542 1,245,542 0 1,245,542
12.ALLOCABLE REVENUE-COUNTY
001009 CHD CLINIC FEES 0 1 1 0 1
004010 VITAL STATISTICS CERTIFIED RECORDS 0 10 10 0 10
018000 340B PRESCRIPTION DRUG SERVICE AGREEMENT 0 1 1 0 1
018000 CHD CLINIC FEES 0 6,639 6,639 0 6,639
038000 CHD CLINIC FEES 0 3 3 0 3
038000 ELC COVID ENHANCED DETECTION EXPANSION GRANT 0 1 1 0 1
038000 CHD LOCAL ENVIRONMENTAL FEES 0 1 1 0 1
038000 CHD LOCAL REVENUE&EXPENDITURES 0 1 1 0 1
COUNTY ALLOCABLE REVENUE TOTAL 0 6,657 6,657 0 6,657
13.BUILDINGS-COUNTY
ANNUAL RENTAL EQUIVALENT VALUE 0 0 0 525,048 525,048
IT ALLOCATION 0 0 0 67,400 67,400
UTILITIES 0 0 0 204,700 204,700 O
Attachment_II_Part_II-Page 3�f�
160 7
ATTACHMENT II
COLLIER COUNTY HEALTH DEPARTMENT
Part II,Sources of Contributions to County Health Department
Ill October 1,2023 to September 30,2024
State CHD County Total CHD
Trust Fund CHD Trust Fund Other . ,.
(cash) Trust Fund (cash) Contribution Total
BUILDING MAINTENANCE 0 0 0 0 0
GROUNDS MAINTENANCE 0 0 0 195,149 195,149
INSURANCE 0 0 0 0 0
OTHER(Specify) 0 0 0 0 0
OTHER(Specify) 0 0 0 0 0
BUILDINGS TOTAL 0 0 0 992,297 992,297
14.OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND-COUNTY
EQUIPMENT/VEHICLE PURCHASES 0 0 0 0 0
VEHICLE INSURANCE 0 0 0 0 0
VEHICLE MAINTENANCE 0 0 0 0 0
OTHER COUNTY CONTRIBUTION(SPECIFY) 0 0 0 0 0
OTHER COUNTY CONTRIBUTION(SPECIFY) 0 0 0 0 0
OTHER COUNTY CONTRIBUTIONS TOTAL 0 0 0 0 0
GRAND TOTAL CHD PROGRAM 10,168,815 5,465,264 15,634,079 9,584,308 25,218,387
Attachment_II_Part_II-Peg f 44
ATTACHMENT II 1 6 D 7
COLLIER COUNTY HEALTH DEPARTMENT
Part III,Planned Staffing.Clients,Services and Expenditures By Program Service Area Within Each Level of Service
October 1,2023 to September 30,2024
Quarterly Expenditure Plan
FTE's Clients Services/ 1st 2nd 3rd 4th Grand
k: (0.00) Units Visits It. (Whole dollars only) State County Total
A. COMMUNICABLE DISEASE CONTROL:
IMMUNIZATION (101) 7.35 11,354 16,473 196,484 168,426 196,484 171,210 377,648 354,956 732,604
SEXUALLY TRANS.DIS. (102) 4.04 628 822 81,092 69,512 81,092 70,661 218,453 83,904 302,357
HIV/AIDS PREVENTION (03A1) 6.31 0 6,198 140,465 120,406 140,465 122,395 515,646 8,085 523,731
HIV/AIDS SURVEILLANCE (03A2) 1.32 0 20 29,305 25,120 29,305 25,536 109,266 0 109,266
HIV/AIDS PATIENT CARE (03A3) 8.13 439 1,342 219,515 188,167 219,515 191,277 661,834 156,640 818,474
ADAP (03A4) 1.89 28 209 41,718 35,761 41,718 36,352 155,549 0 155,549
TUBERCULOSIS (104) 5.20 350 4,020 120,512 103,302 120,512 105,010 442,421 6,915 449,336
COMM.DIS.SURV. (106) 10.25 0 6,946 356,412 305,515 356,412 310,565 1,089,839 239,065 1,328,904
HEPATITIS (109) 1.23 767 956 32,214 27,614 32,214 28,069 120,010 101 120,111
PREPAREDNESS AND RESPONSE (116) 3.05 0 0 113,023 96,883 113,023 98,485 280,920 140,494 421,414
REFUGEE HEALTH (118) 9.52 5,298 10,129 387,653 332,294 387,653 337,787 1,445,387 0 1,445,387
VITAL RECORDS (180) 3.61 16,337 78,122 76,495 65,571 76,495 66,654 5 285,210 285,215
COMMUNICABLE DISEASE SUBTOTAL 61.90 35,201 125,237 1,794,888 1,538,571 1,794,888 1,564,001 6,416,978 1,275,370 6,692,348
B. PRIMARY CARE:
CHRONIC DISEASE PREVENTION PRO (210) 1.07 0 30 29,582 25,358 29,582 25,778 34,445 75,855 110,300
WIC (21W1) 26.05 10,917 69,771 515,105 441,546 515,105 448,844 1,920,600 0 1,920,600
TOBACCO USE INTERVENTION (212) 3.33 0 9 66,304 56,836 66,304 57,775 247,219 0 247,219
WIC BREASTFEEDING PEER COUNSELING (21W2) 2.38 0 899 24,283 20,816 24,283 21,160 90,542 0 90,542
FAMILY PLANNING (223) 3.61 702 1,534 102,338 87,724 102,338 89,174 311,270 70,304 381,574
IMPROVED PREGNANCY OUTCOME (225) 0.25 236 240 91,645 78,558 91,645 79,857 15,247 326,458 341,705
HEALTHY START PRENATAL (227) 8.90 1,271 5,090 218,645 187,422 218,645 190,519 153,017 662,214 815,231
COMPREHENSIVE CHILD HEALTH (229) 0.81 363 562 20,339 17,434 20,339 17,722 0 75,834 75,834
HEALTHY START CHILD (231) 1.45 547 2,627 30,431 26,085 30,431 26,615 0 113,462 113,462
SCHOOL HEALTH (234) 8.19 0 579,464 142,974 122,556 142,974 124,582 251,764 281,322 533,086
COMPREHENSIVE ADULT HEALTH (237) 2.98 13,506 20,058 181,749 155,794 181,749 158,370 162,217 515,445 677,662
COMMUNITY HEALTH DEVELOPMENT (238) 5.94 0 252 200,035 171,469 200,035 174,302 745,841 0 745,841
DENTAL HEALTH (240) 12.12 4,265 8,794 287,890 246,778 287,890 250,857 6,934 1,066,481 1,073,415
PRIMARY CARE SUBTOTAL 77.08 31,807 689,330 1,911,320 1,638,376 1,911,320 1,665,455 3,939,096 3,187,375 7,126,471
C. ENVIRONMENTAL HEALTH:
Water and Onsite Sewage Programa
COSTAL BEACH MONITORING (347) 0.80 1,820 1,860 19,171 16,433 19,171 16,705 71,480 0 71,480
LIMITED USE PUBLIC WATER SYSTEMS (357) 0.70 182 1,483 18,804 16,119 18,804 16,384 10,853 59,258 70,111
PUBLIC WATER SYSTEM (358) 0.01 0 0 307 263 307 268 0 1,145 1,145
PRIVATE WATER SYSTEM (359) 0.26 0 0 4,764 4,083 4,764 4,151 0 17,762 17,762
ONSITE SEWAGE TREATMENT&DISPOSAL (361) 4.34 1,869 3,846 101,157 86,712 101,157 88,145 171,635 205,536 377,171
Group Total 6.11 3,871 7,189 144,203 123,610 144,203 125,653 253,968 283,701 537,669
Facility Programa
TATTOO FACILITY SERVICES (344) 0.82 468 653 18,244 15,638 18,244 15,897 68,023 0 68,023
FOOD HYGIENE (348) 0.88 157 598 22,630 19,399 22,630 19,720 35,700 48,679 84,379
Attachment_II_Part_III-Pt 2
ATTACHMENT II 16 D 7
COLLIER COUNTY HEALTH DEPARTMENT
Part III,Planned Staffing.Clients,Services and Expenditures By Program Service Area Within Each Level of Service
October 1,2023 to September 30,2024
li
Quarterly Expenditure Plan
F'fl's Clients Services/ 1st 2nd 3rd 4th Grand
(0.00) Units Visits (Whole dollars only) State County Total
BODY PIERCING FACILITIES SERVICES (349) 0.05 5 38 1,278 1,095 1,278 1,114 4,765 0 4,765
GROUP CARE FACILITY (351) 0.97 245 447 22,461 19,254 22,461 19,572 0 83,748 83,748
MIGRANT LABOR CAMP (352) 1.81 116 960 40,229 34,484 40,229 35,055 42,244 107,753 149,997
HOUSING&PUB.BLDG. (353) 0.00 0 0 0 0 0 0 0 0 0
MOBILE HOME AND PARK (354) 0.23 75 192 5,770 4,946 5,770 5,026 17,996 3,616 21,512
POOLSBATHING PLACES (360) 6.77 1,934 10,508 160,746 137,791 160,746 140,068 247,574 351,777 599,351
BIOMEDICAL WASTE SERVICES (364) 2.01 912 1,123 49,249 42,216 49,249 42,913 79,746 103,881 183,627
TANNING FACILITY SERVICES (369) 0.02 0 0 638 547 638 556 2,100 279 2,379
Group Total 13.56 3,912 14,519 321,245 275,370 321,245 279,921 498,148 699,633 1,197,781
Groundwater Contamination
STORAGE TANK COMPLIANCE SERVICES (355) 0.00 0 0 0 0 0 0 0 0 0
SUPER ACT SERVICES (356) 0.21 0 0 3,566 3,057 3,566 3,107 0 13,296 13,296
Group Total 0.21 0 0 3,566 3,057 3,566 3,107 0 13,296 13,296
Community Hygiene
COMMUNITY ENVIR.HEALTH (345) 0.00 0 0 0 0 0 0 0 0 0
INJURY PREVENTION (346) 0.00 0 0 0 0 0 0 0 0 0
LEAD MONITORING SERVICES (350) 0.00 0 0 0 0 0 0 0 0 0
PUBLIC SEWAGE (362) 0.00 0 0 0 0 0 0 0 0 0
SOLID WASTE DISPOSAL SERVICE (363) 0.00 0 0 0 0 0 0 0 0 0
SANITARY NUISANCE (365) 0.07 763 7 1,579 1,354 1,579 1,377 0 5,889 5,889
RABIES SURVEILLANCE (366) 0.00 0 0 0 0 0 0 0 0 0
ARBORVIRUS SURVEIL. (367) 0.00 0 0 0 0 0 0 0 0 0
RODENT/ARTHROPOD CONTROL (368) 0.00 0 0 0 0 0 0 0 0 0
WATER POLLUTION (370) 0.00 0 0 0 0 0 0 0 0 0
INDOOR AIR (371) 0.00 0 0 0 0 0 0 0 0 0
RADIOLOGICAL HEALTH (372) 0.00 0 0 0 0 0 0 0 0 0
TOXIC SUBSTANCES (373) 0.00 0 0 0 0 0 0 0 0 0
Group Total 0.07 763 7 1,579 1,354 1,579 1,377 0 5,889 5,889
ENVIRONMENTAL HEALTH SUBTOTAL 19.95 8,546 21,715 470,593 403,391 470,593 410,058 752,116 1,002,519 1,754,635
D. NON-OPERATIONAL COSTS:
NON-OPERATIONAL COSTS (599) 0.00 0 0 0 0 0 0 0 0 0
ENVIRONMENTAL HEALTH SURCHARGE (399) 0.00 0 0 16,260 13,938 16,260 14,167 60,625 0 60,625
MEDICAID BUYBACK (611) 0.00 0 0 0 0 0 0 0 0 0
NON-OPERATIONAL COSTS SUBTOTAL 0.00 0 0 16,260 13,938 16,260 14,167 60,625 0 60,625
TOTAL CONTRACT 158.93 75,554 836,282 4,193,061 3,594,276 4,193,061 3,653,681 10,168,815 5,465,264 15,634,079
Attachment_II_Part_III-gagtA�f 2
1 6 D 7
ATTACHMENT III
COLLIER COUNTY HEALTH DEPARTMENT
CIVIL RIGHTS COMPLIANCE AND NON-DISCRIMINATION CERTIFICATE
1. The CHD agrees to complete the Civil Rights Compliance Questionnaire, DH Forms 946 A and B(or the subsequent
replacement if adopted during the contract period), if so requested by the Department.
2. The CHD assures that it will comply with 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.
3. Assurance of Civil Rights Compliance: The CHD hereby agrees that it will comply with Title VI of the Civil Rights
Act of 1964 (42 U.S.C. 2000d et seq.); Title IX of the Education Amendments of 1972 (20 U.S.C. 1681 et seq.);
Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794); the Age Discrimination Act of 1975 (42 U.S.C. 6101
et seq.); Title II and Title III of the Americans with Disabilities Act (ADA) of 1990, as amended by the ADA
Amendment Act of 2008 (42 U.S.C. 12131-12189) and as implemented by Department of Justice regulations at 28
CFR Parts 35 and 36; Executive Order 13166, "Improving Access to Services for Persons with Limited English
Proficiency" (August 11, 2000); all provisions required by the implementing regulations of the U.S. Department of
Agriculture (7 CFR Part 15 et seq.); and FNS directives and guidelines to the effect that no person shall, on the
ground of race,color, national origin, age, sex, or disability, be excluded from participation in, be denied the benefits
of, or otherwise be subjected to discrimination under any program or activity for which the agency receives Federal
financial assistance from FNS; and hereby gives assurance that it will immediately take measures necessary to
effectuate this agreement.
By providing this assurance, the CHD agrees to compile data, maintain records and submit records and reports
as required to permit effective enforcement of the nondiscrimination laws, and to permit Department personnel
during normal working hours to review and copy such records, books and accounts, access such facilities, and
interview such personnel as needed to ascertain compliance with the non-discrimination laws. If there are any
violations of this assurance, the Department of Agriculture shall have the right to seek judicial enforcement of this
assurance.
This assurance is given in consideration of and for the purpose of obtaining any and all Federal financial
assistance, grants, and loans of Federal funds, reimbursable expenditures, grant or donation of Federal property
and interest in property, the detail of Federal personnel, the sale and lease of, and the permission to use Federal
property or interest in such property or the furnishing of services without consideration or at a nominal
consideration, or at a consideration that is reduced for the purpose of assisting the recipient, or in recognition of
the public interest to be served by such sale, lease, or furnishing of services to the recipient, or any improvements
made with Federal financial assistance extended to the Program applicant by USDA. This includes any Federal
agreement, arrangement, or other contract that has as one of its purposes the provision of cash assistance for the
purchase of food, and cash assistance for purchase or rental of food service equipment or any other financial
assistance extended in reliance on the representations and agreements made in this assurance.
This assurance is binding on the CHD, its successors, transferees, and assignees as long as it receives or retains
possession of any assistance from the Department. The person or persons whose signatures appear below are
authorized to sign this assurance on the behalf of the CHD.
4. Confidentiality of Data, Files,and Records:The CHD agrees to restrict the use and disclosure of confidential USDA,
Women, Infant, and Children (WIC) applicant and participant information as specified in 7 CFR § 246.26(d)(1)(i) in
accordance with 7 CFR § 246.26(d)(1)(ii), as applicable.
1 6 D 7
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1 6 D 7
ATTACHMENT V
COLLIER COUNTY HEALTH DEPARTMENT
SPECIAL PROJECTS SAVINGS PLAN
CASH RESERVED OR ANTICIPATED TO BE RESERVED FOR PROJECTS
CONTRACT YEAR STATE COUNTY TOTAL
2022-2023* $ 0 $ 0 $ 0
2023-2024** $ 0 $ 0 $ 0
2024-2025*** $ 0 $ 0 $ 0
2025-2026*** $ 0 $ 0 $ 0
PROJECT TOTAL $ 0 $ 0 $ 0
SPECIAL PROJECTS CONSTRUCTION/RENOVATION PLAN
PROJECT NUMBER:
PROJECT NAME:
LOCATION/ADDRESS:
PROJECT TYPE: NEW BUILDING ROOFING
RENOVATION PLANNING STUDY
NEW ADDITION OTHER
SQUARE FOOTAGE: 0
PROJECT SUMMARY: Describe scope of work in reasonable detail.
START DATE (Initial expenditure of funds)
COMPLETION DATE:
DESIGN FEES: $ 0
CONSTRUCTION COSTS: $ 0
FURNITURE/EQUIPMENT: $ 0
TOTAL PROJECT COST: $ 0
COST PER SQ FOOT: $ 0
Special Capital Projects are new construction or renovation projects and new furniture or equipment associated with these projects and
mobile health vans.
*Cash balance as of 9/30/23
**Cash to be transferred to FCO account.
***Cash anticipated for future contract years.
Attachment_V-Page 1 of 1 CIS'
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