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#24-8280 (Eleven Ash Inc DBA Health Force)
FIXED FEE PROFESSIONAL SERVICE AGREEMENT # 24-8280 for Services for Seniors THIS AGREEMENT, made and entered into on this ' day of i r 1- , 20 a S, by and between Eleven Ash, Inc. d/b/a Health Force authorized to do business in the State of Florida, whose business address is 5276 Summerlin Commons WA, Suite 702, Fort Myers, FL 33907 ,(the "Contractor") and Collier County, a political subdivision of the State of Florida, (the "County"): WITNESSETH: 1. The Agreement shall be for a one ( 1 ) year period, commencing ❑■ upon the date of Board approval; of n on ,and terminating on ( ) year(s) from that date or until all outstanding Purchase Order(s) issued prior to the expiration of the Agreement period have been completed or terminated. The County may, at its discretion and with the consent of the Contractor, renew the Agreement under all of the terms and conditions contained in this Agreement for five ( 5 ) additional one ( 1 ) year(s) periods. The County shall give the Contractor written notice of the County's intention to renew the Agreement term prior to the end of the Agreement term then in effect. The County Manager, or his designee, may, at his discretion, extend the Agreement under all of the terms and conditions contained in this Agreement for up to one hundred and eighty (180) days. The County Manager, or his designee, shall give the Contractor written notice of the County's intention to extend the Agreement term prior to the end of the Agreement term then in effect. 2. COMMENCEMENT OF SERVICES. The Contractor shall commence the work upon issuance of a ❑� Purchase Order ❑ Noticc to Proceed ❑ Order. 3. STATEMENT OF WORK. The Contractor shall provide services in accordance with the terms and conditions of 0 Request for Proposal (RFP) ❑ I tion-fie Bid (ITB) ❑ Othcr ( } # 24-8280 , including all Attachment(s), Exhibit(s) and Addenda and the Contractor's proposal referred to herein and made an integral part of this Agreement. ❑■ The Contractor shall also provide services in accordance with Exhibit A — Scope of Services attached hereto. Page 1 of 16 Fixed Price Professional Service Agreement [2024_ver.3] CA 3.1 This Agreement contains the entire understanding between the parties and any modifications to this Agreement shall be mutually agreed upon in writing by the Parties, in compliance with the County's Procurement Ordinance, as amended, and Procurement Procedures in effect at the time such services are authorized. 3.2 The execution of this Agreement shall not be a commitment to the Contractor to order any minimum or maximum amount. The County shall order items/services as required but makes no guarantee as to the quantity, number, type or distribution of items/services that will be ordered or required by this Agreement. 4. THE AGREEMENT SUM. The County shall pay the Contractor for the performance of this Agreement based on Exhibit B- Fee Schedule, attached hereto and the price methodology as defined in Section 4.1. Payment will be made upon receipt of a proper invoice and upon approval by the County's Contract Administrative Agent/Project Manager, and in compliance with Chapter 218, Fla. Stats., otherwise known as the "Local Government Prompt Payment Act". 4.1 Price Methodology (as selected below): 111 1, �m_n. (Fixed Price): fi o#al offering project' risks ��...,N,,,�a�a� .�, ,...,., , ,,v..,,-A-,.sm-'#Fxed-�t.,,.., priceoffering fora project; the r=v,.� are transferred from the County to'thi,--cT-t a ctcr• and, Us-a,business practice there are no hourly or-material invoices presented,a-ather 4he ccntr acter,"„mus't-perform to-the„'satisfaction of the County's '-project,-manager before payment for the fixed price contract-is authorized. n Time and Materials: The County agrees to pay the contractor for the amount of labor time spent by the contractor's employees and subcontractors to perform the work (number of hours times hourly rate), and for materials and equipment used in the project (cost of materials plus the contractor's markup). This methodology is generally used in projects in which it is not possible to accurately estimate the size of the project, or when it is expected that the project requirements would most likely change. As a general business practice, these contracts include back-up documentation of costs; invoices would include number of hours worked and billing rate by position (and company (or subcontractor) timekeeping or payroll records), material or equipment invoices, and other reimbursable documentation for the project. n unit.Price: The County---,agrees_to-pay-..a_firm_total"-fixed'--price-(inclusive-of-all cow; including-labor;-...materials;"equipment-overhead, etc---for-a repetitive product or--service-delivered--(be,in stailati on----pri'comer--ton;-delive'rry--pry'--per_package--or carton..,..-etc.)._.,..The-in'voi'ce- must---tdeatify-the-unit-prise-and-the-number-of- units received"'(no,contr-aetorinventory-or-cost-verific'ation): 4.2 Any County agency may obtain services under this Agreement, provided sufficient funds are included in their budget(s). Page 2 of 16 Fixed Price Professional Service Agreement [2024_ver.3] 4.3 Payments will be made for services furnished, delivered, and accepted, upon receipt and approval of invoices submitted on the date of services or within six (6) months after completion of the Agreement. Any untimely submission of invoices beyond the specified deadline period is subject to non-payment under the legal doctrine of "laches" as untimely submitted. Time shall be deemed of the essence with respect to the timely submission of invoices under this Agreement. 4.4 The County, or any duly authorized agents or representatives of the County, shall have the right to conduct an audit of Contractor's books and records to verify the accuracy of the Contractor's claim with respect to Contractor's costs associated with any Payment Application, Change Order, or Work Directive Change. 4 5 ❑ Travel-and-Reimbursable-Expenses:--Travel--and----Reimbursable Expenses-f amst-be approved in-advance in-wing by'-the-Cou aty.-Travel expenses shads--be•-rei.. Reimbursements shah at-the'-•4ollowiRg rates: Mileage . '$0:44,5.per iles I i mde _. Breakfast $6.-00 hunch $14OO Dinner $4.9:00 Airfare Actu'a -to-teurist:--er-G0ach class-fare Rental-car ActuaLrental-cost mited-".to---compact'--'or stan•dar -sizevehic-les Lodging Actual-cost of lodging-at-single-occupancy fate""with-acopof no"more"than'$150.00 per Bight Parking Aetna l cost-of-par-kin g Taxi-of-Airport Limousine Actual cost-ef ec taxi or.._airport-limousine Reimbursable-items other-than--travel--expenses-shad be'•limited-to-tbe following: telephoneµ-along~-distance—charges;_fax- har ;---photocopying- arges-_and postage:- --Reim'bu'rsable~ite s- +4N-be--paid'-only"-after--Oontractor has-provided-all receipts: Contractor-shall"--be--responsible---for all other costs and--expenses associated-with-activities-and . . . aken punt-to--this-Agreement: 5. SALES TAX. Contractor shall pay all sales, consumer, use and other similar taxes associated with the Work or portions thereof, which are applicable during the performance of the Work. Collier County, Florida as a political subdivision of the State of Florida, is exempt from the payment of Florida sales tax to its vendors under Chapter 212, Florida Statutes, Certificate of Exemption # 85-8015966531C. Page 3 of 16 Fixed Price Professional Service Agreement [2024 ver.3] CAo 6. NOTICES. All notices from the County to the Contractor shall be deemed duly served if mailed or emailed to the Contractor at the following: Company Name: Eleven Ash, Inc. d/b/a Health Force Address: 5276 Summerlin Commons Way#702 FT Myers, FL 33907 Authorized Agent: Charlene Miller Attention Name & Title: Telephone: 239-275-4747 E-Mail(s): cmiller©health-force.us All Notices from the Contractor to the County shall be deemed duly served if mailed or emailed to the County to: Board of County Commissioners for Collier County, Florida Division Name: Community and Human Services Division Director: Kristi Sonntag Address: 3339 East Tamiami Trail, Suite 211 Naples, FL 34112 Administrative Agent/PM: Joshua Thomas Telephone: 239-252-8995 E-Mail(s): Joshua.Thomas©colliercountyfl.gov The Contractor and the County may change the above mailing address at any time upon giving the other party written notification. All notices under this Agreement must be in writing. 7. NO PARTNERSHIP. Nothing herein contained shall create or be construed as creating a partnership between the County and the Contractor or to constitute the Contractor as an agent of the County. 8. PERMITS: LICENSES: TAXES. In compliance with Section 218.80, F.S., all permits necessary for the prosecution of the Work shall be obtained by the Contractor. The County will not be obligated to pay for any permits obtained by Subcontractors. Payment for all such permits issued by the County shall be processed internally by the County. All non-County permits necessary for the prosecution of the Work shall be procured and paid for by the Contractor. The Contractor shall also be solely responsible for payment of any and all taxes levied on the Contractor. In addition, the Contractor shall comply with all rules, regulations and laws of Collier County, the State of Florida, or the U. S. Government now in force or hereafter adopted. The Contractor agrees to comply with all laws governing the responsibility of an employer with respect to persons employed by the Contractor. Page 4 of 16 Fixed Price Professional Service Agreement [2024_ver.3] CAO 9. NO IMPROPER USE. The Contractor will not use, nor suffer or permit any person to use in any manner whatsoever, County facilities for any improper, immoral or offensive purpose, or for any purpose in violation of any federal, state, county or municipal ordinance, rule, order or regulation, or of any governmental rule or regulation now in effect or hereafter enacted or adopted. In the event of such violation by the Contractor or if the County or its authorized representative shall deem any conduct on the part of the Contractor to be objectionable or improper, the County shall have the right to suspend the Agreement of the Contractor. Should the Contractor fail to correct any such violation, conduct, or practice to the satisfaction of the County within twenty-four (24) hours after receiving notice of such violation, conduct, or practice, such suspension to continue until the violation is cured. The Contractor further agrees not to commence operation during the suspension period until the violation has been corrected to the satisfaction of the County. 10. TERMINATION. Should the Contractor be found to have failed to perform his services in a manner satisfactory to the County as per this Agreement, the County may terminate said Agreement for cause; further the County may terminate this Agreement for convenience with a thirty (30) day written notice. The County shall be the sole judge of non-performance. In the event that the County terminates this Agreement, Contractor's recovery against the County shall be limited to that portion of the Agreement Amount earned through the date of termination. The Contractor shall not be entitled to any other or further recovery against the County, including, but not limited to, any damages or any anticipated profit on portions of the services not performed. 11. NO DISCRIMINATION.The Contractor agrees that there shall be no discrimination as to race, sex, color, creed or national origin or any other class protected by federal or Florida law. 12. INSURANCE. The Contractor shall provide insurance as follows: A. • Commercial General Liability: Coverage shall have minimum limits of $ 1,000,000 Per Occurrence, $2,000,000 aggregate for Bodily Injury Liability and Property Damage Liability. The General Aggregate Limit shall be endorsed to apply per project. This shall include Premises and Operations; Independent Contractors; Products and Completed Operations and Contractual Liability. B. 0■ Business Auto Liability: Coverage shall have minimum limits of $ 1,000,000 Per Occurrence, Combined Single Limit for Bodily Injury Liability and Property Damage Liability. This shall include: Owned Vehicles, Hired and Non-Owned Vehicles and Employee Non-Ownership. C. ❑■ Workers' Compensation: Insurance covering all employees meeting Statutory Limits in compliance with the applicable state and federal laws. Page 5 of 16 Fixed Price Professional Service Agreement [2024_ver.3] CAG The coverage must include Employers' Liability with a minimum limit of $500,000 for each accident. D. n Professional Liability: Shall be maintained by the Contractor to ensure its legal liability for claims arising out of the performance of professional services under this Agreement. Contractor waives its right of recovery against County as to any claims under this insurance. Such insurance shall have limits of not less than $ 1,000,000 each claim and aggregate. E. ❑ Cyb-ec_Liability,:-Coverage-shall.....have...minimum li is of $.. per-occurrence: F. ❑ Technology Errors and Omissions:-Coverage shall-have minimum limits of,Q per occurrence. G. n Watercraft: Coverage shah have minimum- limits of $ per occurrence. H. 7 United States Longshoreman's and--Harborworker's Act•Coverage shall be maintained where-applicable-to-the completion of the f-the work.W__ -_ per ._, occurrence. I. n Maritime-Coverage-(Jones Act): Coverage shall have minimum limits of $ per occurrence. j. ❑■ Crime/Employee Dishonesty (other): Coverage shall have minimum limits of$1oo,000 per occurrence. K. ❑ (other):-Coverage shall have minimum limits of per occurrence. Special Requirements: Collier County Board of County Commissioners, OR, Board of County Commissioners in Collier County, OR, Collier County Government shall be listed as the Certificate Holder and included as an "Additional Insured" on the Insurance Certificate for Commercial General Liability where required. This insurance shall be primary and non-contributory with respect to any other insurance maintained by, or available for the benefit of, the Additional Insured and the Contractor's policy shall be endorsed accordingly. Current, valid insurance policies meeting the requirement herein identified shall be maintained by Contractor during the duration of this Agreement. The Contractor shall provide County with certificates of insurance meeting the required insurance provisions. Renewal certificates shall be sent to the County thirty (30) days prior to any expiration date. Coverage afforded under the policies will not be canceled or allowed to expire until the greater of: thirty (30) days prior written notice, or in accordance with policy provisions. Contractor shall also notify County, in a like manner, within twenty-four (24) hours after receipt, of any notices of expiration, Page 6of16 Fixed Price Professional Service Agreement [2024_ver.3] CAO cancellation. non-renewal or material change in coverage or limits received by Contractor from its insurer, and nothing contained herein shall relieve Contractor of this requirement to provide notice. Contractor shall ensure that all subcontractors comply with the same insurance requirements that the Contractor is required to meet. 13. INDEMNIFICATION. To the maximum extent permitted by Florida law, the Contractor shall defend, 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, whether resulting from any claimed breach of this Agreement by Contractor, any statutory or regulatory violations, or from personal injury, property damage, direct or consequential damages, or economic loss, to the extent caused by the negligence, recklessness, or intentionally wrongful conduct of the Contractor or anyone employed or utilized by the Contractor 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. 13.1 The duty to defend under this Article 13 is independent and separate from the duty to indemnify, and the duty to defend exists regardless of any ultimate liability of the Contractor, County and any indemnified party. The duty to defend arises immediately upon presentation of a claim by any party and written notice of such claim being provided to Contractor. Contractor's obligation to indemnify and defend under this Article 13 will survive the expiration or earlier termination of this Agreement until it is determined by final judgment that an action against the County or an indemnified party for the matter indemnified hereunder is fully and finally barred by the applicable statute of limitations. 14. AGREEMENT ADMINISTRATION. This Agreement shall be administered on behalf of the County by the Community and Human Services Division 15. CONFLICT OF INTEREST. Contractor represents that it presently has no interest and shall acquire no interest, either direct or indirect, which would conflict in any manner with the performance of services required hereunder. Contractor further represents that no persons having any such interest shall be employed to perform those services. 16. COMPONENT PARTS OF THIS AGREEMENT. This Agreement consists of the following component parts, all of which are as fully a part of the Agreement as if herein set out verbatim: Contractor's Proposal, Insurance Certificate(s), rah Exhibit A Scope of Services, Exhibit B Fee Schedule, IJ RFP/ ❑ !TB/ Other Federal Grant Provisions ( ) #24-8280 Page 7 of 16 Fixed Price Professional Service Agreement [2024_ver.3] CAO including Exhibits, Attachments and Addenda/Addendum, ❑ subsequent quotes, and El Other Exhibit/Attachment: Affidavit Regarding Labor and Services 17. APPLICABILITY. Sections corresponding to any checked box (• ) will expressly apply to the terms of this Agreement. 18. SUBJECT TO APPROPRIATION. It is further understood and agreed by and between the parties herein that this Agreement is subject to appropriation by the Board of County Commissioners. 19. PROHIBITION OF GIFTS TO COUNTY EMPLOYEES. No organization or individual shall offer or give, either directly or indirectly, any favor, gift, loan, fee, service or other item of value to any County employee, as set forth in Chapter 112, Part III, Florida Statutes, Collier County Ethics Ordinance No. 2004-05, as amended, and County Administrative Procedure 5311. Violation of this provision may result in one or more of the following consequences: a. Prohibition by the individual, firm, and/or any employee of the firm from contact with County staff for a specified period of time; b. Prohibition by the individual and/or firm from doing business with the County for a specified period of time, including but not limited to: submitting bids, RFP, and/or quotes; and, c. immediate termination of any Agreement held by the individual and/or firm for cause. 20. COMPLIANCE WITH LAWS. By executing and entering into this Agreement, the Contractor is formally acknowledging without exception or stipulation that it agrees to comply, at its own expense, with all federal, state and local laws, codes, statutes, ordinances, rules, regulations and requirements applicable to this Agreement, including but not limited to those dealing with the Immigration Reform and Control Act of 1986 as located at 8 U.S.C. 1324, et seq. and regulations relating thereto, as either may be amended, as well as the requirements set forth in Florida Statue, §448.095; taxation, workers' compensation, equal employment and safety including, but not limited to, the Trench Safety Act, Chapter 553, Florida Statutes, and the Florida Public Records Law Chapter 119, if applicable, including specifically those contractual requirements at F.S. § 119.0701(2)(a)-(b) as stated as follows: IT IS THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT. IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, IT SHOULD CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT: Division of Communications, Government and Public Affairs 3299 Tamiami Trail East, Suite 102 Naples, FL 34112-5746 Telephone: (239) 252-8999 Email: PublicRecordRequest(c colliercountvfl.gov Page 8 of 16 Fixed Price Professional Service Agreement [2024_ver.3] CA.o The Contractor must specifically comply with the Florida Public Records Law 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 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. If Contractor observes that the Contract Documents are at variance therewith, it shall promptly notify the County in writing. Failure by the Contractor to comply with the laws referenced herein shall constitute a breach of this Agreement and the County shall have the discretion to unilaterally terminate this Agreement immediately. 21. OFFER EXTENDED TO OTHER GOVERNMENTAL ENTITIES. Collier County encourages and agrees to the successful Contractor extending the pricing, terms and conditions of this solicitation or resultant Agreement to other governmental entities at the discretion of the successful Contractor. 22. AGREEMENT TERMS. If any portion of this Agreement is held to be void, invalid, or otherwise unenforceable, in whole or in part, the remaining portion of this Agreement shall remain in effect. 23. ADDITIONAL ITEMS/SERVICES. Additional items and/or services may be added to this Agreement in compliance with the Procurement Ordinance, as amended, and Procurement Procedures. Page 9 of 16 Fixed Price Professional Service Agreement [2024 ver.3] 24. DISPUTE RESOLUTION. Prior to the initiation of any action or proceeding permitted by this Agreement to resolve disputes between the parties, the parties shall make a good faith effort to resolve any such disputes by negotiation. The negotiation shall be attended by representatives of Contractor with full decision-making authority and by County's staff person who would make the presentation of any settlement reached during negotiations to County for approval. Failing resolution, and prior to the commencement of depositions in any litigation between the parties arising out of this Agreement, the parties shall attempt to resolve the dispute through Mediation before an agreed-upon Circuit Court Mediator certified by the State of Florida. The mediation shall be attended by representatives of Contractor with full decision-making authority and by County's staff person who would make the presentation of any settlement reached at mediation to County's board for approval. Should either party fail to submit to mediation as required hereunder, the other party may obtain a court order requiring mediation under section 44.102, Fla. Stat. 25. VENUE. Any suit or action brought by either party to this Agreement against the other party relating to or arising out of this Agreement must be brought in the appropriate federal or state courts in Collier County, Florida, which courts have sole and exclusive jurisdiction on all such matters. 26. ❑ KEY PERSONNEL:The Contractor's personnel"and management-to be utilized-"for this'pro)ect-s'haRte-kn owl edgeable-in--t'he lc-area kareas of-expertise.."The-County-reserves the-right--to---perform-inveetigatioes-as--may-be-deem ed- nece'ss-a'r-y---to-'-'ensure-that competent-persons-wiW-"-be-utilize -the -performance----of--the---Agreea re-nt:--The Contractor-shall--assign.as many people-as.,,.necessary-to...,complete-theservioes•.-on„_a. timely--basis, and---each person assigned "shall-'--be available--for-an -amount-of-time ade to-4e--meet-t.�he required service dates. The Contractor-„shall"not'ehacage-..Key P"e'rso'nnel 'ler58 the-following conditions are met (1) Proposed'-replacements have substantially-the-same or better qualifications"a'ndIor experiences--(23hat-the-County is—notifiedwriting as-far-in-advance--as-possible. The Contractor 'shall-make commercially-reasonable efforts to notify Collier'County--within seven- )days-of-the ehangeThe,-County, retains-final-approval of proposed-replacement-personnel: • AGREEMENT STAFFING. The Contractor's personnel and management to be utilized for this Agreement shall be knowledgeable in their areas of expertise. The County reserves the right to perform investigations as may be deemed necessary to ensure that competent persons will be utilized in the performance of the Agreement. The Contractor shall assign as many people as necessary to complete required services on a timely basis, and each person assigned shall be available for an amount of time adequate to meet required services. 27. ri ORDER OF-PI�REC�, ,DENCE 4n—the-event of-any-conflict between-or-among-the terms-of--'any'of theDoeuments,--the term&-of solicitation-the-Contracter Proposal;and'/or--thc County's Board approved Executive Sumrnary,--the- ct Doc s-s halt take.-.precedence [� ORDER OF PRECEDENCE (Grant Funded). In the event of any conflict between or among the terms of any of the Contract Documents and/or the County's Board Page 10 of 16 Fixed Price Professional Service Agreement [2024_ver.3] CAO approved Executive Summary, the terms of the Agreement shall take precedence over the terms of all other Contract Documents, except the terms of any Supplemental Conditions shall take precedence over the Agreement. To the extent any conflict in the terms of the Contract Documents cannot be resolved by application of the Supplemental Conditions, if any, or the Agreement, the conflict shall be resolved by imposing the more strict or costly obligation under the Contract Documents upon the Contractor at County's discretion. 28. ASSIGNMENT. Contractor shall not assign this Agreement or any part thereof, without the prior consent in writing of the County. Any attempt to assign or otherwise transfer this Agreement, or any part herein, without the County's consent, shall be void. If Contractor does, with approval, assign this Agreement or any part thereof, it shall require that its assignee be bound to it and to assume toward Contractor all of the obligations and responsibilities that Contractor has assumed toward the County. 29. SECURITY. The Contractor is required to comply with County Ordinance 2004-52, as amended. Background checks are valid for five (5) years and the Contractor shall be responsible for all associated costs. If required, Contractor shall be responsible for the costs of providing background checks by the Collier County Facilities Management Division for all employees that shall provide services to the County under this Agreement. This may include, but not be limited to, checking federal, state and local law enforcement records, including a state and FBI fingerprint check, credit reports, education, residence and employment verifications and other related records. Contractor shall be required to maintain records on each employee and make them available to the County for at least four (4) years. All of Contractor's employees and subcontractors must wear Collier County Government Identification badges at all times while performing services on County facilities and properties. Contractor ID badges are valid for one (1) year from the date of issuance and can be renewed each year at no cost to the Contractor during the time period in which their background check is valid, as discussed below. All technicians shall have on their shirts the name of the contractor's business. The Contractor shall immediately notify the Collier County Facilities Management Division via e-mail (DL-FMOPS(a7colliercountvfl.gov)whenever an employee assigned to Collier County separates from their employment. This notification is critical to ensure the continued security of Collier County facilities and systems. Failure to notify within four (4) hours of separation may result in a deduction of$500 per incident. Collier County Sheriff's Office (CCSO) requires separate fingerprinting prior to work being performed in any of their locations. This will be coordinated upon award of the contract. If there are additional fees for this process, the Contractor is responsible for all costs. (Intentionally left blank-signature page to follow) Page 11 of 16 Fixed Price Professional Service Agreement [2024_ver.3] CAO IN WITNESS WHEREOF, the parties hereto, by an authorized person or agent, have executed this Agreement on the date and year first written above. ATTEST: BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY, FLORIDA Crystal K. Kinzel, Clerk of the Circuit Court and Comptroller ' By: By: , ice . Saunde s Chair Dated: , (SEAL) Attest as to Chairwands ure Contractor's Witnessess: only. at Eleven Ash, Inc. d/b/a Health Force Contractor By: Contractor's First Witness Signature A6`,' ,^ /" Sad) S TType/print signature and titleT TType/print witness nameT Contractor's Second Witness Of/ S t.rIRlS VET I VRV TType/print witness nameT ?�' ``' Notary Public-State of°,orioa a: �.;�ygr Commission#NH 503745 .. 4r My Comm.Expires Mar 13,202E ..,...,Bonded through National Notary Assn. A baed as tRL gality: 4:2112v4y Cotorney rint Name Page 12 of 16 Fixed Price Professional Service Agreement [2024_ver.3] %� Exhibit A Scope of Services 0 following this page (containing 3 page/s) n this exhibit is not applicable Page 13 of 16 Fixed Price Professional Service Agreement [2024_ver.3] CAO EXHIBIT A—SCOPE OF SERVICES 24-8280"Services for Seniors" Those interested in providing the services detailed below must adhere to all requirements in this RFP, in addition to maintaining adherence with the guidelines set forth by the current DOEA Handbook. Lack of knowledge of all requirements of a service listed in the proposal SHALL NOT relieve the provider of liability and obligations under the agreement. Collier County Community&Human Services(CHS)shall lead all service authorization and coordination.In an effort to comply with the requirements of the, OAA,ADI,and CCE programs,Clients entering the service system will be assessed and prioritized by CHS.Upon determination of the service level to be provided,CHS will offer the client a listing of service vendors for the specific service(s)outlined within their care plan. The client will be encouraged to pick a service provider of their choice and have the option of interviewing potential service providers. Should the client not have a preference, CHS will select a service provider from the centralized provider list,using a rotation basis(rotating to the next vendor on the list). In this manner, all service providers will be equally treated unless the client has a preference.CHS shall not endorse one service provider over another. Upon the determination of the service,the service levels,and the selected vendor,CHS will contact the vendor agency, and authorize the service,number of hours,and frequency.In keeping with the state policy of client choice of service providers, Collier County does not guarantee a minimum or maximum number of clients that will be referred,nor a minimum or maximum number of service hours that will be requested during the contract period. Should a client later indicate dissatisfaction with the chosen service provider,they will again be offered their choice of provider. CHS shall send the agreed-upon Service Authorization to the chosen provider. These "service authorizations" or "service orders" must contain necessary client information, such as street address, telephone number,and services or items needed,as well as the name and telephone number of the CHS case manager authorizing the service. To meet client needs, some services may be required outside of normal office hours (6:00 AM to 7:00 PM,Seven(7)days a week,365 days a year). CHS reserves the right to request adding additional service providers throughout the resultant agreement period.The County may do so through a competitive and publicly announced selection process,which shall be coordinated through the County's Procurement Division. Services shall be provided in the manner described in the then current DOEA manual and outlined herein. Services covered by this agreement include but are not limited to (should funding for additional Senior Services be identified,the County reserves the right to add to the resultant agreements the services, descriptions,rates,etc.by way of a contract addendum). A. The following Services are requested: 1. Adult Day Care: A program of therapeutic social and health activities and services provided to adults who have functional impairments, in a protective environment that provides as non-institutional an environment as possible. 2.Chore:Performance of routine house or yard tasks including such jobs as seasonal cleaning,yard work,lifting and moving furniture,appliances,or heavy objects,household repairs which do not require a permit or specialist, and household maintenance.Pest control may be included when not performed as a distinct activity. 3. Enhanced Chore: This service is beyond the scope of chore due to the level of service needed. The service includes a more intensified,thorough cleaning to address more demanding circumstances. 4. Homemaking: Specific home management duties including housekeeping, laundry, cleaning refrigerators, clothing repair, minor home repairs, assistance with budgeting and paying bills, client transportation, meal planning and preparation,shopping assistance,and routine house-hold activities by a trained homemaker. Page I of 3 Exhibit A—Scope of Services CAO 5. Personal Care: Assistance with eating, dressing, personal hygiene, and other activities of daily living. This service may include assistance with meal preparation, housekeeping chores such as bed making, dusting, and vacuuming incidental to the care furnished or essential to the health and welfare of the individual.Personal care can include accompanying the client to clinics, physician office visits, or trips for the purpose of health care provided that the client does not require special medical transportation.Personal care can also include shopping assistance to purchase food,clothing,and other items needed for the client's personal care needs. 6. In Home Respite: Relief or rest for a primary caregiver from the constant/continued supervision, companionship,therapeutic and/or personal care, of a functionally impaired older person for a specified period of time. 7. Skilled Nursing: Part-time or intermittent nursing care administered to an individual by a licensed practical nurse,registered nurse,or advanced registered nurse practitioner,in the client's place of residence,pursuant to a care plan approved by a licensed physician. 8. Emergency Alert Response Services: Emergency alert/response service is defined as a community based electronic surveillance service which monitors the frail homebound elder by means of an electronic communication link with a response center. This will also include personal devices for seniors and disabled individuals to wear at all times, provided it is prescribed by a physician, to assist in keeping an eye on their whereabouts. 9.Specialized Medical Equipment,Services,and Supplies:Adaptive devices,controls,appliances,or services, which enable individuals to increase their ability to perform activities of daily living and repair of such services which may include: dentures,walkers,reaching devices,bedside commodes,telephone amplifiers,touch lamps, adaptive eating equipment,glasses, hearing aids,and other mechanical or non-mechanical, electronic,and non- electronic adaptive devices. Supplies may include such things as adult briefs, bed pads, oxygen, or nutritional supplements. 10.Facility Respite:24-hour care in a State of Florida Licensed Nursing home. B. Emergency Situations 1.Those interested in providing services will establish protocols for contacting CHS Case Managers in emergency or unusual circumstances and include the documentation requirements(oral and written)in the Service Provider Application. 2. Interested parties will be required to provide disaster response protocols,plans,and services:In the event of a natural disaster(hurricane,tropical storm,tornado,flood,heat wave,etc.),the provider will have staff available to serve those clients in critical need of services,as designated by the CHS Case Managers. C. Training and Grievance,Complaint,and Incident Reporting 1. Establish a client grievance process: Each service provider agency must have a policy addressing client grievances and/or complaints. 2. Establish and provide staff training:All services provided with funding from DOEA require service delivery personnel to have general pre-service orientation and training specific to the service being provided. Lead Agencies are responsible for provision of the pre-service training (on program and billing requirements, in particular)for all paid staff,volunteer staff and assigned staff of service providers. Pre-service orientation also must include: •An overview of the aging process •An overview of the aging network Page 2 of 3 Exhibit A—Scope of Services CAO •Communication techniques with the elderly •Observation of abuse,neglect,exploitation,mandated reporting,and incident reporting •Local agency service procedures and protocol •Client confidentiality and HIPPA •Grievances,Complaints,and Incident Reporting NOTE: All "hands-on" service personnel must receive training emphasizing the necessity of Universal Precautions.Home Health Aides must have documentation of successful completion of 40 hours required training, and CNAs must have on file a copy of their State of Florida certification.In-service training hours and topics are to be provided at the discretion of the service provider agency and shall meet state requirements. D. Billing&Record Keeping 1. Compile and report program service delivery statistics and other data as identified by CHS. This may be required to be provided in an electronic format at the choosing of CHS. These are reported to the Area Agency on Aging and Department of Elder Affairs in accordance with the reporting requirements developed by the Department. Lead agencies are responsible for entry of data in the Client Information and Registration Tracking System(eCIRTS),which generates payment to the service provider agency.Therefore,service provider agencies are required to provide Lead Agencies with correct and timely service data to comply with these requirements. Timely submission is no later than noon on Wednesday of the week following the week, services are performed (service week defined as Monday through Sunday). 2.Maintain complete and accurate records:Service delivery logs,at a minimum,must be legible and contain the name of client,type/s of services and date/s and hour/s of delivery.The client/caregiver must sign the log at the time of each service visit.The service worker must sign and date the log upon completion and submit it to the service provider agency. Provide complete, clear, and accurate invoices: Weekly invoices, which may be required to be provided electronically in a system provided by CHS,must be submitted by noon on the Wednesday following the week that the service was provided and shall include service provided.The service week is defined as Monday through Sunday.Monthly reporting requirements for eCIRTS dictate that all client and service data for the previous month to be entered into eCIRTS by the 10th day of the month. Collier County"Services for Seniors"will coordinate with vendors to determine due dates for invoices.This will ensure compliance with DOEA reporting requirements. Failure to record or report units of service will result in nonpayment(or delayed payment)for such services. Data required on weekly invoices and weekly timesheets include: •Vendor name •Vendor address •Vendor telephone number •Client name •Service Provider employee who delivered the service(s) •Services ordered and services delivered date •Number of service hours,cost per hour and total cost •Person preparing the report and the date it was prepared •Weekly timesheets signed and dated by the client and Service Provider employee •Additional information as determined by CHS Prepare for annual on-site compliance audits by CHS or members of the Collier County staff as directed by the CHS or grant requirements. Page 3 of 3 Exhibit A—Scope of Services CAO Exhibit B Fee Schedule following this page (pages 1 through 1 ) Page 14 of 16 Fixed Price Professional Service Agreement [2024_ver.3] CAO EXHIBIT B-FEE SCHEDULE #24-8280 "Services for Seniors" Cost Per Service CCE and OAA Reimbursement Unit(Cost your 10%Match Rate Per Unit Item Services Grant Service company charges (Grant Amount (Amount the Unit for the service) your company County will will be paying) reimburse your company for a given service) 1. Skilled CCE and OAA Per Hour $44.44 $4.44 $40.00 Nursing 2. Enhance Chore ADI,CCE and OAA Per Hour Negotiated rate 10%of negotiated prior to service. rate 3. Respite(In-Home) ADI,CCE and OAA Per Hour $27.71 $2.77 $24.94 4. Respite(Facility ADI,CCE and OAA Daily Rate 260.00 0 260.00 Based) 5. Personal Care ADI,CCE and OAA Per Hour $27.18 $2.72 $24.46 6. Chore ADI,CCE and OAA Per Hour $27.19 $2.72 $24.47 7. Homemaking ADI,CCE and OAA Per Hour $26.17 $2.62 $23.56 8. Adult Day Care ADI,CCE and OAA Per Hour $14.45 $1.44 $13.00 9. Emergency Alert ADI,CCE and OAA Per Day 1.20 .12 $1.08 Response Reimbursement Cost Per Service CCE and OAA Rate Per Unit Unit(Cost your 10%Match (Amount the Service company charges (Grant AmountCounty Item Services Grant P Y g will Unit for the service) your company reimburse your will be paying) company for a given service) Specialized Medical ADI,CCE and OAA Per Episode $27.18 $2.72 $24.47 1. Equipment,Services, and Supplies Page 1 of 1 Exhibit B-Fee Schedule CAO Other Exhibit/Attachment Federal Contract Provisions Description: ICI following this page (pages 1 through 15 this exhibit is not applicable Page 15 of 16 Fixed Price Professional Service Agreement [2024_ver.3] CAO EXHIBIT I FEDERAL CONTRACT PROVISIONS AND ASUSRANCES U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (ADMINISTRATION ON AGING) AND FLORIDA DEPARTMENT OF ELDER AFFAIRS The supplemental conditions contained in this section are intended to cooperate with, to supplement, and to modify the general conditions and other specifications. In cases of disagreement with any other section of this contract, the Supplemental Conditions shall govern.This is an acknowledgement that FEMA financial assistance will be used to fund all or a portion of the contract. Pursuant uniform requirements of federal awards(2 CFR Part 200.23)the definition of CONTRACTOR is an entity that receives a Contract/Purchase Order. Compliance with Federal Law, Regulations and Executive Orders:The Sub-Recipient(County)agrees to include in the subcontract that (i) the subcontractor is bound by the terms of the Federally-Funded Subaward and Grant Agreement, (ii) the subcontractor is bound by all applicable state and Federal laws and regulations, and (iii) the subcontractor shall hold the Division and Sub-Recipient harmless against all claims of whatever nature arising out of the subcontractor's performance of work under this Agreement,to the extent allowed and required by law. FCP-1 CAO EXHIBIT I FEDERAL CONTRACT PROVISIONS AND ASUSRANCES Administrative, Contractual, or Legal Remedies: (41 U.S.C. 1908, 2 CFR§200 Appendix II (A) Unless otherwise provided in this contract,all claims,counter-claims,disputes and other matters in question between the local government and the contractor, arising out of or relating to this contract,or the breach of it,will be decided by arbitration, if the parties mutually agree, or in a Florida court of competent jurisdiction. Access to Records and Reports: (2 CFR§200.337)The contractor/vendor agrees to maintain all books, records,accounts and reports required under this contract for a period of not less than three years after the date of termination or expiration of this contract, except in the event of litigation or settlement of claims arising from the performance of this contract, in which case the Contractor agrees to maintain same until the Purchaser, the Grantor Administrator, the Comptroller General, or any of their duly authorized representatives, have disposed of all such litigation, appeals, claims or exceptions related thereto. Furthermore, the County shall maintain written policies and procedures for computer system backup and recovery and shall have the same requirement of its Contractors. Affirmative Socioeconomic Steps: (2 CFR § 200.321) The County is dedicated to fostering the continued development and economic growth of small, minority-, women-, and service-disabled veteran business enterprises. All contracting and subcontracting opportunities afforded by this solicitation/contract are strongly encouraged to contribute as both Contractors and Sub-Contractors. If subcontracts are to be let, the prime contractor is required to take all necessary steps identified in 2 C.F.R. § 200.321(b)(1)-(5) to ensure that small and minority businesses,women's business enterprises, and labor surplus area firms are used when possible. Firms may be required to submit documentation describing the efforts being made to encourage the participation of small,minority-,women-, and service-disabled veteran business enterprises. Byrd Anti-Lobbying Amendment: (31 U.S.C. 1352)(2 CFR§200 Appendix II)Vendors must certify it will not and has not used Federal appropriated funds have been paid or will be paid, by or to any person or organization for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any Federal grant,the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. The certification includes any lobbying with non-Federal funds that takes place in connection with obtaining any Federal award. Civil Rights Compliance:The contractor and its subcontractor(s)who is the recipient of Federal funds(or assumes others with whom it arranges to provide services or benefits in connection with any of its programs and activities or assures others with whom it arranges to provide services or benefits to participants or employees)must comply with Title VI of the Civil Rights Act of 1964, which prohibits discrimination on the basis of race, color, or national origin (45 CFR 80), and Statutes and Regulations enforced by the Office of Civil Rights, U.S. Department of Health and Human Services, as follow: Section 504 of the Rehabilitation Act of 1973, as amended (29 USC §794), prohibits discrimination against otherwise qualified individuals on the basis of disability in programs and activities receiving financial assistance from HHS 45 CFR 84 and/or programs or activities conducted by HHS 45 CFR 85 in the provision of benefits and under the ADA that does not: a. Exclude a person with a disability from a program or activity; b. Deny a person with a disability the benefits of a program or activity; c. Afford a person with a disability an opportunity to participate in or benefit from a benefit or service that is not equal to what is afforded others; d. Provide a benefit or service to a person with a disability that is not as effective as what is provided others; e. Provide different or separate benefits or services to a person with a disability unless necessary to provide benefits or services that are as effective as what is provided others; or, f. Apply eligibility criteria that tend to screen out persons with disabilities unless necessary for the provision of the service, program or activity. CAO EXHIBIT I FEDERAL CONTRACT PROVISIONS AND ASUSRANCES • Section 508 of the Rehabilitation Act of 1973, as amended, (29 USC §794(d)) prohibits discrimination on the basis of disability in electronic and information technology as they relate to programs and activities conducted by HHS. The Age Discrimination Act of 1975,as amended (42 USC§6101) prohibits discrimination on the basis of age in programs or activities receiving Federal financial assistance 45 CFR 90; and/or programs or services receiving HHS financial assistance 45 CFR 91; Title II of the Americans with Disabilities Act(28 CFR Part 35), relating to Nondiscrimination on the Basis of Disability in State and Local Government Services 2010 ADA Standards for Accessible Design; The Drug Abuse Office and Treatment Act of 1972(P.L.92-255), as amended, relating to nondiscrimination on the basis of drug abuse; - The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616),as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g)§523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §290 dd-3 and 290 ee-3), as amended,as relating to confidentiality of alcohol and drug abuse patient records; Section 1908 of the Public Health Service Act(42 USC§ 300w-7)prohibits discrimination on the basis of age, race, color, national origin, disability, sex(gender), or religion in programs, services, and activities funded by Preventative Health and Health Services Block Grants. • Federal Health Care Conscience Protection Statutes (42 USC § 300a-7; 42 USC§ 300a-7; 42 USC §238n and the Weldon Amendment (Continuing Appropriations Resolution, Pub. L. No. 113- 164, Sec. 101(a) (Sept. 19, 2015); Regulation for the Enforcement of Federal Health Care Provider Conscience Protection Laws, which prohibit recipients of certain Federal funds from discriminating against certain health care providers who refuse to participate in certain health care services on religious or moral grounds. - Section 1557 of the Affordable Care Act prohibits discrimination on the basis of disability by entities that operate a health program or activity. • 45 CFR 80.The contractor must have on file an assurance that the program will be conducted in compliance with all nondiscriminatory provisions as required in 45 CFR 80. Clean Air Act and Federal Water Pollution Control Act: (2 CFR § 200 Appendix II) Contracts and subgrants of amounts in excess of $150,000 shall contain a provision that requires the Contractor or recipient to comply with all applicable standards, orders, or requirements issued pursuant to Section 306 of the Clean Air Act as amended (42 U.S.C. 7401-7671q.), Executive Order 11738, as amended,where applicable, the Federal Water Pollution Control Act as amended (33 U.S.C. 1251-1387), and Environmental Protection Agency regulations 2 CFR Part 1500. The Contractor shall report any violations of the above to the Federal awarding agency and the Regional Office of the Environmental Protection Agency (EPA). Debarment and Suspension: (2 CFR§200 Appendix II)Contract awards that exceed the small purchase threshold and certain other contract awards shall not be made to parties listed on the government wide Excluded Parties List System in the System for Award Management(SAM), in accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR Part 1986 Comp., p. 189) and 12689(3 CFR Part 1989 Comp., p. 235), "Debarment and Suspension."The Excluded Parties List System in SAM contains the names of parties debarred, suspended,or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549. The successful bidder, by administering each lower tier subcontract that exceeds $25.,000 as a "covered transaction", must verify each lower tier participant of a "covered transaction" under the project is not presently debarred or otherwise disqualified from participation in this federally assisted project. The Contractor shall comply with these provisions before doing business or entering into subcontracts receiving federal funds pursuant to this contract. The Contractor shall complete and sign the Certifications and Assurances Attachment prior to the execution of this contract. Domestic Preference for Procurements: (2 CFR § 200.322) (a) As appropriate and to the extent consistent with law,the non-Federal entity should,to the greatest extent practicable under a Federal award, E(:P3 CAO EXHIBIT I FEDERAL CONTRACT PROVISIONS AND ASUSRANCES provide a preference for the purchase, acquisition, or use of goods, products, or materials produced in the United States(including but not limited to iron,aluminum,steel, cement, and other manufactured products). The requirements of this section must be included in all subawards including all contracts and purchase orders for work or products under this award. (b) For purposes of this section: (1)"Produced in the United States"means,for iron and steel products,that all manufacturing processes,from the initial melting stage through the application of coatings, occurred in the United States. (2) "Manufactured products" means items and construction materials composed in whole or in part of non-ferrous metals such as aluminum; plastics and polymer-based products such as polyvinyl chloride pipe; aggregates such as concrete; glass, including optical fiber; and lumber. Drug Free Workplace:This certification is required by the regulations implementing Sections 5151-5160 of the Drug- Free Workplace Act of 1988(Pub. L. 100-690, Title V, Subtitle D; 41 USC 701 et seq.),7 CFR Part 3017, Subpart F, Section 3017-600, Purpose.The January 31, 1989, regulations were amended and published as Part II of the May 25, 1990 Federal Register(pages 21681-21691). Equal Employment Opportunity: (Appendix II, 2 CFR Part 200) The Contractor shall not discriminate against any employee or applicant for employment because of race,age,creed,color,sex or national origin. The Agency will take affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to their race, age, creed, color, sex, or national origin. Such action shall include, but not be limited to, the following: Employment upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. Contractors must insert a similar provision in all subcontracts,except subcontracts for standard commercial supplies or raw materials. No Government Obligation to Third Parties: The Federal Government is not a party to this contract and is not subject to any obligations or liabilities to the non-Federal entity, contractor, or any other party pertaining to any matter resulting from the contract." Procurement of Recovered Materials: (2 CFR§ 200.323) Contractor and subcontractor agree to comply with Section 6002 of the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act, and the regulatory provisions of 40 CFR Part 247. (1) In the performance of this contract, the Contractor shall make maximum use of products containing recovered materials that are EPA designated items unless the product cannot be acquired (i) Competitively within a timeframe providing for compliance with the contract performance schedule;(ii) Meeting contract performance requirements; or(iii) At a reasonable price. (2) Information about this requirement is available at EPA's Comprehensive Procurement Guidelines web site_http://www.epa.gov/. The list of EPA-designate items is available at https://www.epa.gov/smm/comprehensive-procurement-guideline-cpg-program. Program Fraud and False or Fraudulent Statements of Related Acts: The contractor acknowledges that 31 U.S.C. Chap. 38 (Administrative Remedies for False Claims and Statements) applies to the contractor's actions pertaining to this contract. Prohibition on Certain Telecommunications and Video Surveillance Services or Equipment: (2 CFR § 200.216) The Federal awarding agency prohibits the County to enter into a contract to procure or obtain equipment, services or systems that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. As described in Public Law 115-232, section 889, covered telecommunications equipment is telecommunications equipment produced by Huawei Technologies Company or ZTE Corporation (or any subsidiary or affiliate of such entities). (i) For the purpose of public safety, security of government facilities, physical security surveillance of critical infrastructure, and other national security purposes, video surveillance and telecommunications equipment produced by Hytera Communications Corporation, Hangzhou Hikvision Digital Technology Company, or Dahua Technology Company (or any subsidiary or affiliate of such entities). (ii)Telecommunications or video surveillance services provided by such entities EXHIBIT I FEDERAL CONTRACT PROVISIONS AND ASUSRANCES or using such equipment.(i)(iii)Telecommunications or video surveillance equipment or services produced or provided by an entity that the Secretary of Defense, in consultation with the Director of the National Intelligence or the Director of the Federal Bureau of Investigation, reasonably believes to be an entity owned or controlled by, or otherwise connected to, the government of a covered foreign country. (b) In implementing the prohibition under Public Law 115-232, section 889, subsection(f), paragraph (1), heads of executive agencies administering loan, grant, or subsidy programs shall prioritize available funding and technical support to assist affected businesses, institutions and organizations as is reasonably necessary for those affected entities to transition from covered communications equipment and services, to procure replacement equipment and services, and to ensure that communications service to users and customers is sustained. (c) See Public Law 115-232,section 889 for additional information. Rights to Inventions: If the Federal award meets the definition of"funding agreement" under 37 CFR § 401.2 (a) and the recipient or subrecipient wishes to enter into a contract with a small business firm or nonprofit organization regarding the substitution of parties, assignment or performance of experimental, developmental,or research work under that"funding agreement,"the recipient or subrecipient must comply with the requirements of 37 CFR Part 401,"Rights to Inventions Made by Nonprofit Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative Agreements," and any implementing regulations issued by the awarding agency. Termination for Cause and Convenience: (2 CFR§ 200 Appendix II) See County's Standard Terms and Conditions. Trafficking in Persons: The Contractor and subcontractors shall comply with Title 2 CFR Part 175 and 2 CFR§175.15 provisions applicable to a private entity, as defined in 2 CFR 175.25. Transparency Act: Unless exempt under 2 CFR§ 170.11 0(b),the Contractor shall comply with the reporting requirements of the Transparency Act as expressed in 2 CFR Part 170. Unauthorized Aliens: (Reference Immigration and Nationality Act(8 U.S.C.§ 1324a)and the Immigration Reform and Control Act of 1986 (8 U.C. § 1101) (a) Making Employment of Unauthorized Aliens Unlawful (1) In General It is unlawful for a person or other entity— (A) to hire, or to recruit or refer for a fee, for employment in the United States an alien knowing the alien is an unauthorized alien (as defined in subsection(h)(3))with respect to such employment. (2)Continuing Employment It is unlawful for a person or other entity,after hiring an alien for employment in accordance with paragraph(1),to continue to employ the alien in the United States knowing the alien is (or has become) an unauthorized alien with respect to such employment. FCP-5 CAO EXHIBIT I FEDERAL CONTRACT PROVISIONS AND ASUSRANCES STATE GENERAL PROVISIONS Discriminatory Vendors List, Section 287.134, F.S.: In accordance with Section 287.134, Florida Statutes, an entity or affiliate who has been placed on the discriminatory vendor list may not submit a bid on a contract to provide any goods or services to a public entity,may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to a public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity,and may not transact business with any public entity. Equal Employment Opportunity:The Contractor shall not discriminate against any employee or applicant for employment because of race, age, creed, color, sex or national origin. The Agency will take affirmative action to ensure that applicants are employed, and that employees are treated during employment,without regard to their race, age, creed, color, sex, or national origin. Such action shall include, but not be limited to,the following:Employment upgrading,demotion,or transfer;recruitment or recruitment advertising;layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. Contractors must insert a similar provision in all subcontracts, except subcontracts for standard commercial supplies or raw materials. Interest of Members of Congress: No member of or delegate to the Congress of the United States shall be admitted to any share or part of this contract or to any benefit arising therefrom. Interest of Public Officials: No member, officer, or employee of the public body or of a local public body during his tenure or for two years thereafter shall have any interest, direct or indirect, in this contract or the proceeds thereof. For purposes of this provision, public body shall include municipalities and other political subdivisions of States; and public corporations, boards, and commissions established under the laws of any State. No member, officer, or employee of the MPO or of a local public body during his tenure or for two years thereafter shall have any interest, direct or indirect, in this contract or the proceeds thereof. Inspector General Cooperation:The Parties agree to comply with Section 20.055(5), Florida Statutes,for the inspector general to have access to any records,data and other information deemed necessary to carry out his or her duties and incorporate into all subcontracts the obligation to comply with Section 20.055(5), Florida Statutes. Lobbying: No funds received pursuant to this Agreement may be expended for lobbying the Legislature, the judicial branch or a state agency. Public Entity Crime: Pursuant to Section 287.133, F.S., a person or affiliate who has been placed on the Convicted Vendor List following a conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity;may not submit a bid, proposal, or reply on a contract with a public entity for the construction or repair of a public building or public work; may not submit bids, proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a Contractor, Supplier, Subcontractor, or Consultant under a contract with any public entity; and may not transact business with any public entity in excess of the threshold amount 7.017, F.S., for CATEGORY TWO for a period of thirty six (36) months following the date of being placed on the Convicted Vendor List. FCP-G CAO EXHIBIT I FEDERAL CONTRACT PROVISIONS AND ASUSRANCES DIRECT SERVICE PROVIDER PROVISIONS Background Screening: The Contractor shall ensure that the requirements of Section 430.0402 and Chapter 435, F.S., as amended, are met regarding background screening background screening for all employees,volunteers,and persons seeking employment who are"direct service providers"as that term is defined in Section 430.0402(1)(b)and who are not exempted from Level 2 background screening by Section 430.0402(2). The Contractor and its direct service providers must also comply with any applicable rules promulgated by the Area Agency on Aging for Southwest Florida, Inc. (AAASWFL) and the Agency for Health Care Administration regarding implementation of Section 430.0402 and Chapter 435, F.S. Contractor shall submit the Background Screening Attestation of Compliance-Employer(Screening Form) to the AAASWFL within thirty (30) days of execution of this contract. Should the AAASWFL have a completed Screening Form on file for the Contractor, a new Screening Form shall be submitted to the AAASWFL every twelve(12) months, and the Contractor shall also maintain copies of the new screening forms for its direct service providers as required herein. The Contractor hereby agrees to correct all background screening deficiencies identified by the AAASWFL's Contract Manager within thirty(30) days upon notification. Further information concerning the procedures for background screening may be found at https ifelderaffa;r s orq?about-usJJ'background-screening Social Media and Personal Cell Phone Use: Inappropriate use of social media and personal cell phones may pose risks to Agency's confidential and proprietary information and may jeopardize compliance with legal obligations. By signing this contract, Contractor agrees to the following social media and personal cell phone use requirements. The term Social Media and for personal cellular communication includes, but is not limited to, social networking websites, blogs, podcasts, discussion forums, RSS feeds, video sharing, SMS(including Direct Messages (DMs), iMessages, text messages, etc.); social networks like Instagram, TikTok, Snapchat, Google Hangouts,WhatsApp, Signal,Facebook, Pinterest, and Twitter;and content sharing networks such as Flickr and YouTube. This includes the transmission of social media through any cellular or online transmission via any electronic, internet, intranet, or other wireless communication.This contract applies to any Agency or other state business conducted on any of the Contractor's, Subcontractor's, or their employees' social media accounts or through personal cellular communication. This contract applies regardless of whether the social media is accessed using Agency's IT facilities and equipment or equipment belonging to Contractor, Subcontractor, or their respective employees. Equipment includes, but is not limited to,personal computers,cellular phones,personal digital assistants,smart watches,or smart tablets. Prohibited or Restricted Postings: Any social media posts which include photos, videos, or names of clients, volunteers, staff, or other affiliates of DOEA may only be posted when authorized by law and when any required HIPAA authorizations and any other consents or authorizations required pursuant to federal or state law are on file with the contractor's records. Florida Government in the Sunshine, Florida Public Records Law, and HIPAA: Contractor acknowledges that any DOEA or other state business conducted by social media or through personal cellular communication is subject to Florida's Government in the Sunshine Law, Florida's Public Records Law(Chapter 119, Florida Statutes), and the Health Insurance Portability and Accountability Act (HIPAA). Compliance with these laws and other applicable laws are further detailed in the contract. Data Integrity and Safeguarding Information: Uniform Electronic Transaction Act, Section 668.50, F.S.; Public Records Law, Chapter 119, Section 29, F.S.The Contractor shall ensure an appropriate level of data security for the information the Contractor is collecting or using in the performance of this contract. An appropriate level of security includes approving and tracking all Contractor employees that request system or information access and ensuring that user access has been removed from all terminated employees. The Contractor, among other requirements, must anticipate and prepare for the loss of information processing capabilities. All data and software shall be routinely backed up to ensure recovery from losses or outages of the computer system.The security over the backed-up data is to be as stringent as the protection required FCP-7 EXHIBIT I FEDERAL CONTRACT PROVISIONS AND ASUSRANCES of the primary systems. The Contractor shall ensure all Subcontractors maintain written procedures for computer system backup and recovery.The Contractor shall complete and sign the Certification Regarding Data Integrity Compliance for Agreements, Grants, Loans, and Cooperative Agreements prior to the execution of this contract. Grievance Procedures:The Contractor shall develop,implement,and ensure that its Subcontractors have established grievance procedures to process and resolve client dissatisfaction with, or denial of,service(s) and to address complaints regarding the termination, suspension or reduction of services, as required for receipt of funds. These procedures, at a minimum, will provide for notice of the grievance procedure and an opportunity for review of the Subcontractor s determination(s). Inspections (Meals): The Contractor must agree to notify the Nutrition Provider within 24 hours of any sanitation inspection and provide a copy of the report. Information Technology Resources: The Contractor must adhere to the AAASWFL's procedures and standards when purchasing Information Technology Resources (ITR) as part of any agreement(s) incorporating this contract by reference.An ITR worksheet is required for any computer related item costing $1,000.00 or more, including data processing hardware, software, services, supplies, maintenance, training, personnel, and facilities. The completed ITR worksheet shall be maintained in the LAN administrator's file and must be provided to the AAASWFL upon request. The Contractor has the responsibility to require any Subcontractors to comply with the AAASWFL's ITR procedures. FCP-8 CA 0 EXHIBIT I FEDERAL CONTRACT PROVISIONS AND ASUSRANCES GRANT CERTIFICATIONS AND ASSURANCES RETURN DOCUMENTS BY SOLICIATION DEADLINE 1. Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions 2. Certification regarding Lobbying 3. Conflict of Interest 4. Anticipated DBE, M/WBE or VETERAN Participation Statement 5. Opportunity List for Commodities and Contractual Services and Professional Consultant Services 6. Acknowledgement of Grant Terms and Conditions FC P-9 CA0 EXHIBIT I FEDERAL CONTRACT PROVISIONS AND ASUSRANCES COLLIER COUNTY Certification Regarding Debarment, Suspension,and Other Responsibility Matters Primary Covered Transactions (1) The prospective primary participant certifies to the best of its knowledge and belief, that it and its principals: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; (b) Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction;violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local)with commission of any of the offenses enumerated in paragraph (I)(b) of this certification; and (d) Have not within a three-year period preceding this application/proposal had one or more public transactions(Federal, State or local)terminated for cause or default. (2) Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. C ,‘,1e.-;2 ki l ,/ Sev\ cry Name Project Name dwti,n,s% ate— w 7 \I h G t a.-1 itle SAM.gov Unique Entity ID(U I) Number S—o1bCOS— Firm Tax ID Number S'4 3oti 333 DUNS Number 11 1v Sv v+.ti+n\eA 1 � v1 C o oo,S Wa 7 d �--� sa _ Street Address, City, State,Zip Signature PCP-to CAO EXHIBIT I FEDERAL CONTRACT PROVISIONS AND ASUSRANCES COLLIER COUNTY Certification Regarding Lobbying The undersigned certifies,to the best of his or her knowledge, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any Federal grant,the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract,grant,loan,or cooperative agreement,the undersigned shall complete and submit Standard Form- LLL,"Disclosure Form to Report Lobbying,"in accordance with its instructions. (3)The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements)and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31, U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). Any person who fails to file the required certification shall be subject to a civil penalty of not less than$10,000 and not more than$100,000 for each such failure. The Contractor, ' -a\' V-1 ctn. --,certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition,the Contractor understards and agrees that the provisions of 31 U.S.C.§ 3801 et seq., apply to this certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 11.062, Florida Statutes., apply to this certification and disclosure, if any. Signature of Contractor's Authorized Official C' i--- •‘`C/1ti.Q_ (ii\k`,` A---,— Name of Authorized Official and Title Date id,-I I C A 0 EXHIBIT I FEDERAL CONTRACT PROVISIONS AND ASUSRANCES COLLIER COUNTY Conflict of Interest Certification Collier County Solicitation No. , hereby certify that to the best of my knowledge, neither I nor my spouse,dependent child, general partner, or any organization for which I am serving as an officer, director, trustee, general partner or employee, or any person or organization with whom I am negotiating or have an arrangement concerning prospective employment has a financial interest in this matter. I further certity to the best of my knowledge that this matter will not affect the financial interests of any member of my household.Also,to the best of my knowledge, no member of my household; no relative with whom I have a close relationship; no one with whom my spouse, parent or dependent child has or seeks employment; and no organization with which i am seeking a business relationship nor which I now serve actively or have served within the last year are parties or represent a party to the matter. I also acknowledge my responsibility to disclose the acquisition of any financial or personal interest as described above that would be affected by the matter,and to disclose any interest I,or anyone noted above, has in any person or organization that does become involved in,or is affected at a later date by,the conduct of this matter. D,XN, Nk\VILA— _.)\t\A Name Signature VA A 53C \ •:), 4 Position Date Privacy Act Statement Title I of the Ethics in Government Act of 1978 (5 U.S.C. App.), Executive Order 12674 and 5 CFR Part 2634, Subpart I require the reporting of this information. The primary use of the information on this form is for review by officials of The Justice Department to determine compliance with applicable federal conflict of interest laws and regulations.Additional disclosures of the information on this report may be made:(1)to a federal, state or local law enforcement agency if the Justice Department becomes aware of a violation or potential violation of law or regulations;(2)to a court or party in a court or federal administrative proceeding if the government is a party or in order to comply with a judge-issued subpoena; (3) to a source when necessary to obtain information relevant to a conflict of interest investigation or decision; (4)to the National Archives and Records Administration or the General Services Administration in records management inspections; (5) to the Office of Management and Budget during legislative coordination on private relief legislation; and(6) in response to a request for discovery or for the appearance of a witness in a judicial or administrative proceeding, if the information is relevant to the subject matter. This confidential certification will not be disclosed to any requesting person unless authorized by law. See also the OGE/GOVT-2 executive branch-wide Privacy Act system of records. FCP-12 CA f EXHIBIT I FEDERAL CONTRACT PROVISIONS AND ASUSRANCES ...... _.___. COLLIER COUNTY ANTICIPATED DISADVANTAGED,MINORITY,WOMEN OR VETERAN PARTICIPATION STATEMENT Status will be verified. Unverifiable statuses'r6Jl require the PR ME to either prc"evde a revised statement or provide source documentation that validates a status, A. PRIME VENDOR/CONTRACTOR INFORMATION PRIME NAM! PRIME FED NUMBER CONTRACT DOLLAR AMOUNT t in kr)G 10 5.O(79,6 SZ S- ISTHE PRIME A FLORIDA-CERTIFIED DISADVANTAGED, VETERAN Y N %S THE ACTIVITY OF THIS CONTRACT... MINORITY OR WOMEN BUSINESS ENTERPRISE? DBE? Y N CONSTRUCTION? Y N PEEN BEIWBE)OR HAVE A SMALL DISADVANTAGED MBE, V N CONSULTAT;Otd? Y N BUSINESS SA CERTIFICATION FROM THE SMALL BUSINESS ADMINISTRATION? A SERV CE DISABLED VETERAN? WEE? P N OTHER? N SDB CAR V N IS TTi:-S.SUBMISS'Orr A REVISION? Y N iF YES,REV-iSION NUMBER B. IF PRIME HAS SUBCONTRACTOR OR SUPPLIER WHO IS A DISADVANTAGED MINORITY,WOMEN-OWNED,SMALL BUSINESS CONCERN OR SERVICE DISABLED VETERAN,PRIME IS TO COMPLETE THIS NEXT SECTION DBE M/WBE SUBCONTRACTOR OR SUPPLIER TYPE OF WORX OR ETHNICITY CODE SUB/SUPPLIER PERCENT OF CONTRACT VETERAN NAME SPECIALTY (See Below) DOLLAR AMOUNT DOLLARS I3 C. AM/e Ale ailh N TOTAL`: C. SECTION TO BE COMPLETED BY PRIME VENDOR/CONTRACTOR NAME OF SUBMITTER DATE TITLE OF SUBMITTER ,1\ \14\.\ \RA, 1 - �3 - �-' w.„n,N\--p thn, EMAIL ADDRESS OF PRIME(SUBMITTER TELEPHONE NUMBER FAX NUMBER CW` ►�\ ,,, \nea ec 471'17 t NOTE:This information is used to track and report anticipated DBE of MBE participation in federallyfunded contracts. The anticipated OBE or MBE amount is voluntary and will not become part of the contractual terms. This form must be submitted at time of response to a solicitation_if and vrhen a,carded a County contract,the prime will be asked to update the information for the grant compliance fi°es, ETHNICITY CODE Black American BA Hispanic American HA Native American NA Subccnt.Asian American 5AA Asian-Pacific American APA Non-Minor Women NAM Other:not of any other group Fisted O D.SECTION TO BE COMPLETED BY COLLIER COUNTY DEPARTMENT NAME COLLIER CONTRACT (IFBIRfP or PO/PEO) GRANT PP.OGRAMICONTR.ACT ACCEPTED BY: DATE CA() EXHIBIT I FEDERAL CONTRACT PROVISIONS AND ASUSRANCES CGLLIEB CO...;NT'r GRANT COM LILt10E FOF:,',t )3ID OPPORTUNITY LIST FOR COMMODITIES AND CONTRACTUAL SERVICES AND PROFESSIONAL CONSULTANT SERVICES T is the policy of Collor County that disadvantaged businesses and minority vendors,as defined in the Code of Federal Regulations(CM)or flarida Statutes(FS),must hose the opportunity to participate on contracts with federal one}/or state grant assistance. Prime Contractor/Prime Consultant: \�tJ 1 I- `1 1 c_e.—__ ck.t c 1 1t ♦ .LS Address and Phone Number. . (�GS 0 me/f \ C Vk(1.� '11 Procurement Plumber/Advertisement Number: as L\~ ,PS% The list below is intended to be a listing of firms that are,or attempting to,participate on the project numbered abcrre.The list must include the firm bidding or quoting as prince,as well as subs and suppliers quoting for participation.Prime contractors and consultants must provide information for Numbers 1,2,3,and 4;and,should provide any information they hays for Numbers 5,6,7,and B.This form must be submitted with the bid package. 1. Federal Tax ID Number: (..0 "Q�,.b56s- 6. DBE B.Annual Gross Receipts 2. Firm Name: ll� 1(ate�5I EI . Nan-DBE less than 51 million 3. Phone Number. aC --a-'15-"-k)0(7 ♦ Between 5 1-5 million S,Address Between 5 5.10 million San VSJ 4,,tymcAlk rx 7. Subcontractor etweenS 10-15 million C-0 v'414 bh l'2,49 J3 -j Subconsuitant More than 5 15 million VJG 5. Year Firm Established: �C �� _ . 1. Federal Tax ID Plumber: 6.— DBE B.Annual Gross Receipts 2. Firm Name: Non-DBE _Less than 51 million S. Phone Number. Between$1-5 million S.Address ~•Between 5 5-10 million 7.—, • SubcontractorBetween 5 10-15 million Subconsultant More than$15 ntil lion 5.Year firm Established: Ei 1. Federal Tax ID Number 6. DOE C.Annual Gross Receipts 2. Firm Name: Non-DBE __less than 51 million S. Phone Number: Between$1-5 million 1.Address _Between 5 5-10 million 7.E Subcontractor .—Between S 10-15 million Subconsuitant More than 515 million 5.Year Firm Established: 1. Federal Tax ID Number: 6. DBE B.Annual Gross Receipts 2. Firm Name: Non-DBE1��.,. _Less than S 1 million w_ 3. Phone Number. Between$1-5 million 4.Address E Between S 5-10 mullion 7. Subcontractor 4�Between$10.15 million Subconsulant More than 5 15 million 5.Year Firm Established: FCP-14 CA EXHIBIT I FEDERAL CONTRACT PROVISIONS AND ASUSRANCES COLLIER COUNTY Acknowledgement of Terms, Conditions and Grant Clauses Flow Down of Terms and Conditions from the Grant Agreement Subcontracts: If the vendor subcontracts any of the work required under this Agreement, a copy of the signed subcontract must be available to the Department for review and approval. The vendor agrees to include in the subcontract that (1) the subcontractor is bound by the terms of this Agreement, (ii) the subcontractor is bound by all applicable state and federal laws and regulations, and (iii) the subcontractor shall hold the Department and Recipient harmless against all claims of whatever nature arising out of the subcontractor's performance of work under this Agreement, to the extent allowed and required by law. The recipient shall document in the quarterly report the subcontractor's progress in performing its work under this agreement. For each subcontract, the Recipient shall provide a written statement to the Department as to whether the subcontractor is a minority vendor as defined in Section 288,703, Fla. Stat. Certification On behalf of my firm, I acknowledge, and agree to perform all of the specifications and grant requirements identified in this solicitation document(s).Vendor/Contractor Name `vQ.\ ‘'\ Zee '-0 Date t "a3 r�� Authorized Signature_ sa 1 c� 5 F MN)Eg-S Address �tlY1YY\�PJ\� t� � Ow1v�h.Q fly �y �� c�.- t- Solicitation/Contract# a.V\ 9 7 P CP-15 CAO Other Exhibit/Attachment Description: Affidavit Regarding Labor and Services 1 1 • following this page (pages through ) this exhibit is not applicable Page 16 of 16 Fixed Price Professional Service Agreement [2024 ver.3] '.FAO 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: E`c u e v., (Ash (1. h a Q `��v t�-Grl C-�— Address: 6a16 Fy Owtwtc4S lJl„tly 1oa-11-6M toll+ 33707 Phone Number: p'Z �e) -3-15- +-1 4 Authorized Representative's Name: /\cyst levy e V'k t ( \- Authorized Representative's Title: L-Ac, vtil i (ski a kr\--- Email Address: C wt .a en. L kca (tom c_ • t) � AFFIDAVIT I, LJVZc�f\ehe- ``�n\ (Name of Authorized Representative),as authorized representative attest that \'kv cc C_ (Name of Nongovernmental Entity)does not use coercion for labor or services as defined in§787.06,Florida Statutes. Under penalty of perjury re that I have read the foregoing Affidavit and that the facts stated in it are true. t Aca (Signature of authorized representative) Date STATE OF CVS� COUNTY OF Sworn to(or a rmed)and subscribed before me,by means of E ysical presence or 0 online notarization this day of �1rV1Gby Cr\Q.JL (Name of Affiant),who produced his Florida Driver's License as identification. M \\er Notary Public : ,�., CHRIS.E:TCRC ?' .;;•��:\\ Notary auoiic•State or%%cnca My Comm,� Commission;HMar H r03is5 '�cF Expires 13. 2028 Commission Expires Bonded through National Notary Assn, Personally Known 0 OR Produced Identification Type of Identification Produced: CY\\ t,(*- CAO