Backup Documents 01/28/2025 Item #16E 1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 6 E 1
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 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 routinglines#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.
2. (Enter your Dept here)
3. County Attorney Office County Attorney Office
r
4. BCC Office Board of County B5 ,1 by MB
Commissioners [s] 2/3/25
5. Minutes and Records Clerk of Court's Office 1..)S-
PRIMARY ?lA
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 Madison Bird Phone Number 2939
Contact/Department
Agenda Date Item was Agenda Item Number
Approved by the BCC I/22/ 2.5 1661
Type of Document(s) Number of Original
Attached A/ne.a r 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 signature?(stamped unless otherwise stated) MB
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 MB
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 MB
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 MB
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 MB
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 h and all changes made during 4 A.is not
the meeting have been incorporated in the attac ed document. The County Attorney ShT'p an option for
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 "!�"'nllittb 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;2.24.05; 11/30/12;4/22/16;9/10/21
16E 1
THIRD AMENDMENT TO AGREEMENT##15-6474R
FOR MEDICAL DIRECTOR FOR COLLIER COUNTY
AND EMPLOYMENT PHYSICALS AND DRUG TESTING
THIS THIRD AMENDMENT, made and entered into on this 29 day
of, . 2025,by and between Advancef Medical of Naples, LLC(the"Provider")and
Collier County,a political subdivision of the State of Florida, (the "County"):
WHEREAS, on February 9, 2016 (Agenda Item 16.E.I), the County entered into an
Agreement with the Provider to provide medical oversight for the County's Occupational Health
Program; and
WHEREAS, on October 15, 2018, the County administratively approved the First
Amendment to the Agreement to add two additional testing categories to Exhibit B- Price, Part B to
include Pre-Placement Health Screening at a cost of$45.00, and Hepatitis A/B Vaccination at a cost of
$110.00; and
WHEREAS, on January 14, 2020, the County amended the Agreement to extend the
Agreement term an additional five years, beginning on February 9, 2020, and ending on February 8,
2025, and to include Exhibit B-1 containing updated pricing.
WHEREAS,the Parties desire to further amend the Agreement to extend the Agreement term
one additional year, beginning on February 9. 2025 and ending on February 8, 2026, and to include
Exhibit B-1, which contains updated pricing.
NOW, THEREFORE, in consideration of the mutual promises and covenants herein
contained, it is agreed by the Parties as follows:
1. The Agreement is hereby extended one additional year from the Agreement end date of February
8, 2025. with a new end date of February 8, 2026.
2. Exhibit B-1 Pricing is hereby incorporated to the Agreement containing revised pricing effective
on February 9, 2025.
3. Except as modified through this Amendment, all other terms and conditions of the Agreement
shall remain the same.
SIGNATURE PAGE TO FOLLOW
**Remainder of this page left blank intentionally**
Page I of 4
Third Amendment to Agreement tt I5-6474R
i6E 1
IN WITNESS WHEREOF,the Parties have executed this Third Amendment by an authorized person
or agent on the date and year first written above.
ATTEST:
Crystal K. Kinzel, Clerk of Courts & BOARD OF COUNTY COMMISSIONERS
Comptroller COLLIER COUNTY, FI,ORIDA
By' , By: Aftxx,eze..)..an
;1Y}� est as to Chairman's Burt L. Saunders, Chairman
Uatedt';},j. signature only
Provider's Witnesses: PROVIDER:
ADVANC MEDICAL OF NAPLES, LLC:
first Witness By:
keri Signature
TTType/print witne amet j7
TType prin signature and title"
econd W. ss
/� w/�il LI'a h) 6 Date
"Type/print witness namet
A roved as to F i at I Legality:
Scott R. each, Deputy County Attorney
Page 2 of 4
Third Amendment to Agreement k I5-6474R /
EXHIBIT B-1 PRICING 1 6E I
(Effective 02/09/2025)
Annual Cost
PART A:Medical Director Services Annual Cost
$ 15,000.00
Unit of Pricing
PART B:Item Description Physical Exam/Testing Types: Measure
Pre-Placement Employment Physical ea $ 125.00
Pre Plaeemeft-Physical-W/COMhysical ea $ 4-28:00
Firefighter/EMT Physicals preplacement/annual ea $ 150.00
Respiratorea $ 120.00
SCUBA Diving Medical Examination and Certification ea $ 100.00
CDL Physical(DOT)annual or preplacement ea $ 140.00
Fitness for Duty Examination ea $ 250.00
Asbestos-Medics ea $ 110410
Laboratory Services:
Laboratory Work includes the following tests ea $ 52.00
Cbc
Chem
Lipid
UA
Great!+ ea $ 2:8A
RUN ea $ 2-00
TSH Thyroid Stimulating Hormone ea $ 17.00
C Reactive Protein ea $ 14.00
Heavy Metals Test includes following: ea $ 137.00
Arsenic-Blood
Cadmium-Blood
Lead-Blood
Mercury-Blood
Heavy Metals Test-Blood-Aluminum ea $ 35.00
Heavy Metals Test-Blood-Antimony ea $ 152.00
Heavy Metals Test-Blood-Bismuth ea $ 152.00
Heavy Metals Test-Blood-Chromium ea $ 61.00
Heavy Metals Test-Blood-Copper ea $ 20.00
Heavy Metals Test-Blood-Nickel ea $ 145.00
Heavy Metals Test-Blood-Zinc ea $ 22.00
HbA1c ea $ 18.00
RBCCholinesterase ea $ 52.00
E—Ur-i+e ea $ 87:09
Mercury—Urine ea $ S5:00
Page 3 of 4
Third Amendment to Agreement I1 I 5-6474R
)(1
1 6 E 1
Polychlorinated Biphenyls ea $ 189.00
Hepatitis B Surface AB testing(immune status) ea $ 32.00
MMR Titer includes the following ea $ 71.00
Measles
Mumps
Rubeolla
Rabies Titer(if previously immunized) ea $ 152.00
Varicella Titer(if previously immunized or active disease) ea $ 32.00
Hepatitis-Titer ea $ 46:00
HIV 1&2 Antibody Test ea $ 32.00
PAP Test w/HPV ea $ 165.00
PSA,Total ea $ 22.00
Quantiferon Gold(TN ea $ 100.00
Drug Screening Services
Blood Alcohol Test ea $ 50.00
Breath Alcohol Test-(Administered by a Breath Alcohol Technician
meeting DOT Qualifications Only) ea $ 40.00
Drug Screen w/MRO - DOT 5 Panel (Collected per DOT Urine
Specimen Collection Guidelines-49 CFR Part 40) ea _ $ 50.00
Drug Screen w/MRO-HRS 5 Panel ea $ 45.00
Drug Screen w/MRO-HRS 10 Panel ea $ 50.00
Vaccines
Measles,Mumps,Rubella Vaccination(MMR) ea $ 120.00
Varicella Vaccination(Price per injection) ea $ 220.00
ea $ 94O0
Hepatitis B Vaccination Series(Price per injection) ea $ 75.00
Twinrix Hep A/B vaccine combined ea $ 135.00
Pre-exposure Rabies Vaccination Series(Price per injection) ea $ 685.00
Tetanus/diphtheria Vaccination ea $ 58.00
Tdap Vaccination ea $ 68.00
Diagnostic Testing
Chest x-ray(2-view) ea $ 75.00
Chest x-ray(4-view) ea $ 90.00
Sigmoidoscopy ea $ 400.00
Chest CT without contrast ea $ 350.00
PPD Testing w/Reading(Induration measurement) ea $ 21.00
Audiometric Screening Test(per OSHA) ea $ 12.00
Pulmonary Function Test(with Interpretation) ea $ 45.00
EKG-12 Lead(with interpretation and physician confirmation) ea $ 47.00
Cardiac Stress Test(with interpretation and physician confirmation) ea $ 175.00
Echocardiogram(with interpretation and physician confirmation) ea $ 265.00
Prostate Exam ea $ 0.00
Page 4 of 4
Third Amendment to Agreement it I 5-6474R
16E 1
AFFIDAVIT REGARDING LABOR AND SERVICES
Effective July 1, 2024,pursuant to § 787.06(13), Florida Statutes, when a contract is executed, renewed, or extended
between a nongovernmental entity and a governmental entity, the nongovernmental entity must provide the
governmental entity with an affidavit signed by an officer or a representative of the nongovernmental entity under
penalty of perjury attesting that the nongovernmental entity does not use coercion for labor or services.
Nongovernmental Entity's Name: Advance Medical of Naples, LLC
Address: 720 Goodlette Frank Road North, Suite 500, Naples, FL 34102
Phone Number: 239.566.7676
Authorized Representative's Name: Gregory E. Leach
Authorized Representative's Title: MD, MBA, Owner
Email Address: Iraymond@advmednaples.com
AFFIDAVIT
Gregory E.Leach (Name of Authorized Representative), as authorized representative attest
that Advance Medical of Naples, LLC (Name of Nongovernmental Entity)does not use coercion for labor or
services as defined in§787.06, Florida Statutes.
Under p?:a pen `, I declare that I have read the foregoing Affidavit and that the facts stated in it are true.
0.-
1/9/2025
.
( lg ure o authorized eentative Date
STATE OF Florida
COUNTY OF Collier
Sworn to(or affirmed)and subscribed before me, by means of III physical presence or El online notarization this
9th day of January 20 by Gregory E. Leach (Name of Affiant),who produced his Florida Driver's License
as identification.
/ 21 ,iiGt __,-/ _ A" .. P% AUDREYM.DENIHAN
'`I 1*1 MYCOMMISSION#HH 374928
Notary Pu-t c( of required when digital) , -.:-i'•
EXPIRES:May 11,2027
1/9/2025 ' '
Commission Expires
Personally Known ® OR Produced Identification EI
Type of Identification Produced: Florida Drivers License
CO