Backup Documents 07/12/2022 Item #16D 5 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP , 6 El 5
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.
** ROUTING SLIP**
Complete muting 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 Coun Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2. _ _ _.
3. County Attorney Office County Attorney Office
7/27/Z2
4. BCC Office Board of County
Commissioners 'h//Ivif-7 7/Z8/2 2_
5. Minutes and Records Clerk of Court's Office
IWO 12e120tiz 12:09t
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 Viviana Giarimoustas Phone Number 252-4915
Contact/Department
Agenda Date Item was 7/12/22 Agenda Item Number 16.D.5
Approved by the BCC
Type of Document(s) First Amendment Number of Original 2
Attached 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(instead of stamp)? N/A
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 legality. (All documents to be signed by Yes
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 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 N/A
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 Yes
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip N/A
should be provided to the County Attorney Office at the time the item is uploaded to the
agenda. 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 7/12/22 and all changes made during the Yes is not
meeting have been incorporated in the attached document. The County Attorney eption for
Office has reviewed the changes,if applicable. MI/firline.
9. Initials of attorney verifying that the attached document is the version approved by the Yes _ is not
BCC,all changes directed by the BCC have been made,and the document is ready for the option for
Chairman's signature. O ;s e.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04;Revised 1.26.05;2.24.05;11/30/12;4/22/16;9/10/21
160 5
MEMORANDUM
Date: June 29, 2022
To: Viviana Giarimoustas, Contract Admin Specialist
Operations & Veteran Services
From: Martha Vergara, Sr. Deputy Clerk
Minutes & Records Department
Re: 1st Amendment to Agreement
Collier Health Services, Inc., d/b/a Healthcare Network of
Southwest Florida
Attached is an original of each document referenced above, (Agenda Item #16D5)
approved by the Board of County Commissioners on Tuesday, July 12, 2022.
If you have any questions, please feel free to contact me at 252-7240.
Thank you.
Attachment
160 5
FIRST AMENDMENT TO AGREEMENT
THIS AMENDMENT, made and entered into on this 7/12/22 (date), by and
between Collier County, Florida, a political subdivision of the State of Florida, hereinafter
referred to as "the County" and Collier Health Services, Inc., d/b/a Healthcare Network of
Southwest Florida, a Florida not for profit incorporated under the laws of the State of Florida,
and a Federal Health Qualified Center hereinafter referred to as "Center".
WHEREAS, on September 28, 2021, the County entered into an Agreement with the
Center to become a community health partner to assist in providing payments for health
prevention programs, and medical health services to residents of the County.
WHEREAS, the parties desire to amend the Agreement to provide for payment of
eligible medical services authorized by County staff with proper documentation in an amount not
to exceed $250,000.
NOW, THEREFORE, in consideration of the mutual promises and covenants herein
contained, it is agreed by the parties as follows:
Effective upon execution of this First Amendment, the agreement shall be amended to reflect as
follows:
1. Center will make payments in an amount not to exceed $250,000 for eligible medical
services authorized by County staff Back up documentation will be provided for
services.
2. Upon execution of this First Amendment, the parties recognize such payments and will
be reviewed retroactively from the beginning of the agreement date of September 28,
2021.
3. Except as modified through this Amendment, all other terms and conditions shall remain
the same.
160 5
IN WITNESS WI{ELUDE. the parties have executed this First Amendment on tik• date and car
first ‘‘ritten ahme an authorized person or atient.
BOARD OF COL.NY CONINIISSIONERS
Col,LIER COL NI Y. 1.1.0RIDA
Ce) • CRYSTAOAIN '14.jaRK
BY: ASok
:
illiam I \IcDaniel Jr.. Chairman
Mkt' fOChai10.01..: ;7?
gara
COLLIER MAUI I SERVICES. INC.
d h a HEALTHCARE NH WORK OF
SOL I!WFS IllORIDA .\ppr ‘ed 's to form "Elld
140( A . Atf•
Ronald I lomasko
title: Assistant Count:‘ Attorney
bicqj Collier Cn out‘
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