#24-8280 (Southern Home Care Services, Inc d/b/a All Ways Caring Homecare) FIXED FEE PROFESSIONAL SERVICE AGREEMENT
# 24-8280
for
Services for Seniors
THIS AGREEMENT, made and entered into on this 'a-_day of `\ r L , 20 a--,
by and between Southern Home Care Services, Inc. d/b/a All Ways Caring Homecare ,
authorized to do business in the State of Florida, whose business address is
805 N. Whittington Parkway, Suite 400, Louisville, KY 40222 ,(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 ❑ 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 Procccd n Work-Order.
3. STATEMENT OF WORK. The Contractor shall provide services in accordance
with the terms and conditions of ❑■ Request for Proposal (RFP) ❑
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.
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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):
❑ Lump-Sum-(Fixed Price}--A-firm fixed total price offering fora project; the risks
offering for , risks
are transferred from the,County,,.t,e,.the.contractor,-and,,... �1._,c' ,,.k3uinessi practice there
I e III L �the contractor,-
are-no--hourly-of-material invoices presented,.rather,-the-contractor must perform
to thee-satisfaction of the County's project manager before-payment for thee. fixed
urine contract is authorized.
• 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-Prase:The--County--agrees _ts3-pay--.a--fir-e --total--fix-ed-price---(inclu-sive---of--atl
coslts;inclutl-irag_labor,_materials, equipmient.-overhead ...ete-)-four--a....repetitive-product
o.r....service-delivered+e,.installation----price---per„_ton;-deliver', --price per-package-or
carton;..._-etc.):_- The..-invoice......must-identify--the-unit number....of-units
received"{necon'tractor ini've'n'tory Eoostverifioaation)
4.2 Any County agency may obtain services under this Agreement, provided
sufficient funds are included in their budget(s).
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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{ .-ExpensV Travel- and Reimbursacb lle
Expenses must be"appr o Vied in advance in writing by the County. Travel'expenses
shall be reimbursed-as per-Section'"1r„'I.L:"v'61-Fla..:-Stets..
Reimbursements ments.,,shaH•b.e, at the following rates:"
Mileage $0:44.5_pe r„mile
Breakfast $6:00 1h
Lunch 81.1.00
Dinner $1-9:OQ
Aiffare Actual-ticket cost limited-to--tourist--or-c-®aoh
doss-fare
Rentalcar Actual---rentai cost limited-to- compact-or
standard-size-vehicles
Lodging Actual-cost-of-lodging-a-t-e-ingle occupancy
rate-with-a•cap of no rnore than$15,0.00 per
night
Parking >n\ctL}ul cost-of,:pa.rking.
Taxi-or.Airport Limousine. Actual,,,cost'"of either taxi-or-airport-limousine
Reimbursable-items Reimbursabl V'-items",other-"th•an-"triavool•""expe'n"�s"ha,ll--be limited-to the-following:.
telephone long distance charges,---fax--"charges,- photocopying- charges and
postage: _ Zeimbursable items will be'paid-only-after-Contractor-has provided-all
receipts. Contractor shall-be'" responsible-for-all-other costs-and expenses
associated-with"activities-and-solicitations undertaken-pursuant"to-thisi 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.
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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:
Southern Home Care Services, Inc. d/b/a All Ways Caring
Company Name: Homecare
Address: 805 N. Whittington Parkway, Suite 400
Louisville, KY 40222
Authorized Agent: Sherry Pemberton
Attention Name & Title:
Telephone: 502-272-3466
E-Mail(s): spemberton@brightspringhealth.com
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.
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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. El 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. 0 Workers' Compensation: Insurance covering all employees meeting
Statutory Limits in compliance with the applicable state and federal laws.
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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. ❑ Cyber..L abi!ity: f'ovrerage shCll..have...minimum limits ,of--$+,,,,,,,,,, ,,,,-----
per occurrence:
F. ❑ Technology Errors.and'Omissions:.Coverage...shall.,have...minimum-limits
of,w _,,,,..per occurrence.
G. ❑ Watercraft: Coverage shall have minimum limits Cf gi per
occuFFernice.
H. ❑ United States Longshoreman's and Harborworker's Act Coverage shall
be maintained where applicable--to the completion of the.-.work...$.... ....._ ._. ___
per occurrence.
I. ❑ Maritime Coverage (Jones Act): Coverage shall have minimum limits of
$ per occurrence.
j 0 Crime/Employee Dishonesty (other): Coverage shall have
minimum limits of$100,000 per occurrence.
K. n [other):--Co>erageeshall-have
minimum—limits of$ 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,
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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), 0 Exhibit
A Scope of Services, Exhibit B Fee Schedule, n RFP/ ❑ !TB/ ❑
Other Federal Grant Provisions ( ) #24-8280
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including Exhibits, Attachments and Addenda/Addendum, ❑ subsequent quotes,
and n Other Exhibit/Attachment: Affidavit Regarding Labor and Services
17. APPLICABILITY. Sections corresponding to any checked box (M ) 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 a(`�},colliercountyfl.gov
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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.
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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. I I •KEY-PERSONNEL: The Contractors-personnel and-management-to-be utilized far
this-•proje'ct---shafd- e-knowledg,ea',ble--in befr-•a-ream-of•-e •per-tise:-_-The-County....reserves
the-"right-te-perforrr....investigations as may be deemed- necessary-to-ensure-that
competent—persons-will-be-utiliz-ed in-the- perforrnanee--of- the"")Agreement--The
Contractor-shall-assign-as-many people-as necessary—to complete.,the_service-s--on,,,,,a
timely basis, and each person--assigned shall-be,available for an amount-of-timeadequate to...meet the required.....service dates.-The-Contractor shall not,•,change-Key
Personnel unless the following conditions are."met: (1)".'.Proposed replacements„„ a e
substantially or better qualifications and/or experience. (2) that the County
J a�d U.�Ala rr•ii..�i ,.,+,.
i.s-netified`..,,,li.n,.,"`.writing...as...far.. in..advance-as possible. The....Contractor make
commercially reasonable efforts to notify Collier County within__seven_(7) days_of.the
change...The 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. I I ORDER OF-PRP(`rnr^Ir.E:---ln--the",even of any conflict between or.among the
terms of any of the Contract-Dccuments; e-terms of solicitation-the-Contractor's
Proposal,- and/or the County's Board approved- xecutive Summary-,- 'the Contract
Documents shall take precedence
Documents IIV1 I�y,Y shall take-precedence.
n nVl...
❑■ 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
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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(ccolliercountyfl.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)
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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
l t
By: ,,,,;,,,.." 1:„. .: ,,,? By: ell441VtleZediree--
' ' ' ' Attest as to ChairmarA, B rt . Saunders , Chair
Dated: -` ,, , -.(SEAL) signature only.
Southern Home Care Services, Inc. d/b/a All
Contractor's Witnesses: Ways Caring Homecare
Contractor
Irlial\ - (%ritii By: p�1
Contractor's irst..pp Witness ��g��n�ture �m���n, �� C�r�i-rr�c--�
lI'I �l YI L I TType/prtdt signature and titleT
TType/ rint witness na
_.- 72 /i
ontract is cond Witness
T\mO+hU 1'10
TType/prir6 witness &ameT
A ov d a to F• a d Legality:
4 \ -4-,4 1 _
3 ep oli Counly Attorney
P nt Name
Page 12 0116 _
Fixed Price Professional Service Agreement
. [202 4_ver.31 >�/nt
Exhibit A
Scope of Services
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Fixed Price Professional Service Agreement
[2024_ver.3]
CAC
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 1 of 3
Exhibit A—Scope of Services
CPO
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 I 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 bepaying) 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
Item Services Grant Service company charges (Grant Amount County 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 N/A N/A N/A
1. Equipment,Services,
and Supplies
Page 1 of 1
Exhibit B-Fee Schedule
CAO
Other Exhibit/Attachment
Federal Contract Provisions
Description:
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❑ 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
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.
FCP-2
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,
FCP-3
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 siteLhttp://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
FCP-4
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
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-6
Cha
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://elderaffairs.orq/about- us/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 /or 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
CAO
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
FCP-9
EXHIBIT
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.
Sherry Pemberton Services for Seniors
Name Project Name
Vice President Contracts,Sales&Marketing M M D N KX3 KM 9S 1
Title SAM.gov Unique Entity ID(UEI)Number
orn liotraCaroSow..IntnbaAlWCW HaroCara 58-1408815
Firm Tax ID Number
025375809
DUNS Number
9696 Bonita Beach Rd. Suite 206, Bonita Springs, FL 34135
Street Address,City,State,Zip
Signature
Fct'-to
CA°
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.
SouPronMom.a,•sti,a..im:ea ai W.y.c.my Monts.
The Contractor, ,certifies or affirms the truthfulness and accuracy of each
statement of its certification and disclosure,if any.In addition,the Contractor understands 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
Sherry Pemberton.Vice President Contracts.Saiesa Marketing Name of Authorized Official and Title
8/6/2024 Date
FCP-i 1
cAo
EXHIBIT I
FEDERAL CONTRACT PROVISIONS AND ASUSRANCES
COLLIER COUNTY
Conflict of Interest Certification
24-8280
Collier County Solicitation No.
Sherry Pemberton , 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 certify 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.
Sherry Pemberton
Name Signature
Vice President Contracts,Sales&Marketing 8/6/2024
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.
rrr-12
C?O
EXHIBIT I
FEDERAL CONTRACT PROVISIONS AND ASUSRANCES
COLLIER COUNTY
ANTICIPATED DISADVANTAGED, MINORITY,WOMEN OR VETERAN PARTICIPATION STATEMENT
Status will be veriSed Unvenfable statuses will require the PRIME yo either prohide a revised statement or provide source documentation that validates a
status..
A. PRIME VENDOR/CONTRACTOR INFORMATION
PAINIE NAME PRIME FE D NUMBER CONTRACT DOLLAR AMOUNT
Southern Home Care Services,Inc.dba All Ways Caring HomeCare 58-1408815
IS THE PRIME 4 FLOPIDA.-CERT;NED DISADVANTAGED, VETERAN Y 0 S THE ACTIVITY OF THIS CONTRACT...
NIINOFIITt OR WON'EN BUSINESS ENTE PRISE?
DBE? Y CONSTRUCTION YC-17),1
iIDEEIMBEIWBEI OR HA"..1 4 smAtt DISADVANTAGED
BUSINESS SA CERTIFICATION FROM THE SMALL BUSINESS MBE? V CLL.) C ONSULTAT ON?
ADMINISTRATION? A SERVICE DISABLED VETERAN' WEE? 5 ( > OTHER? CD N
SOBBA? C )
IS THIS SUBMISS ON A REVISION? VNC7>F YES,REV SION 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 WORK OR ETHNICITY CODE SUB/SUPPLIER PERCENT OF CONTRACT
VETERAN NAME SPECIALTY (See Betowj DOLLAR AMOUNT DOLLARS
Not Applicable Not Applicable
TOTALS'
•
C. SECTION TO BE COMPLETED BY PRIME VENDOR/CONTRACTOR
NAME OF SLIBMITTER DATE TITLE OF SUBMITTER
Sherry Pemberton 10/25/2024 Vice President Contracts,Sales&Marketing
EMAIL ADDRESS OF PRIME ISUBMITTER) TELEPHONE NUMBER FAX NUMBER
AWCContracts@ brig htspringhealth.corn AND
(502) 272-3466 (502) 394-2901
spemberton@brightspringhealth.com
NOTE:This information is used to track and report anticipated DBE or MBE participation in federary-funciecl contracts. The anticipated DBE 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 when awarded a count,,contract,the prime will be asked to update the information for the grant compliance files.
ETHNICITY CODE
Black American BA
Hispanic American HA
Native American NA
Subcont.Asian American SAA
Asian-Pacific American SPA
Non-Miaceity'Women NMW
Other:not of any other group listed 0
D.SECTION TO BE COMPLETED BY COLLIER COUNTY
DEPARTMENT NAME COLLIER CONTRAtTe IIFB;RFT.or PCITREO, GRANT PROGRAM/CONTRACT
ACCEPTED BY: DATE
CM)
EXHIBIT I
FEDERAL CONTRACT PROVISIONS AND ASUSRANCES
COL:AP 7 tiAil,1-",f..,J,ANI.t:',','I,tINt7f:Fu",tt,,°
pID OPPORTUNITY LIST FOR COMMODITIES AND CONTRACTUAL SERVICES
AND PROFESSIONAL CONSULTANT SERVICES
il•is tqic pvicv of Calher County that disadvantaged businesses and rrinonty dors,as defined in the Code of Federal Peguiatwns(CFR)or
PiOridd statutes(FS),must have the opportunity to participate on contracts w,,th federal and/or state grant assistance.
Prime Contractor/Prime consultant 24-8280
Address and Phone Number: 1
Procurement NumberlAtNertisernent Number:
The list below is intended to be a listing of firms that are,or attempting to,participate an the project numbered above.The list must
include the firm bidding or quoting as prime,as well as subs and suppliers quoting for participation Prime contractors arid consultants must
provide information for Numbers 1,2,3,and 4;and,should provide any information they have for Numbers 5,6,7,and 5.This form must
be submitted with the bti package.
1. Feder.'Tax ID Number: 58-1408815 6. DBE 8, Annual Gross Receipts
2. Firm Name Southern Horne Care Services,Inc dba All Ways Caring HomeCare i Non-DBE 1 Less than$1 million
3. Phone Number Sherry Pemberton Beteeeen.3 1-5 million
4. Address 502-272-3466 Between$3-10 million
Bonita Springs,FL 34135 7.0 Subcontractor -Between$10-15 million
Subconsuttant -More than$13 million
—
5. year Firm Established 1975
--,
1. Federai Tax ID Number 6. DBE 0..Annual Gross Recetpts
2. Firm Marne Non-DBE Less than$1 million
3. Phone Number Between$1-5 million
4.Address Between$5-1G mullion
—.
7.EI Subcontractor Between 5 10-15 million
,—.
Sulocon.suttant More than 5 13 million
...--
5.Year RIM Established
1 Federal Tax ID Number 6 E DBE 3 Annual Gross Receipts
F. Firm Name, Non-DBE Less than$1 million
—
3. Phone Number: Between$14 million
—.
4.Address Between$5-10 million
7
EI 5J x sctractor Between$1G-13 million
511 XC MU teat . .....Mare then S IS Malkin
5
5. 'Year Firm Established,
1. Federal Tax ID Number 6 E DBE 0 Annual Gross Receipts
Z. Fin Name Non-DBE Less than$1 million
—
3. Phone Number Between S 14 million
4.Address Between$5-1G million
„ Subcontractor Between$10.15 million
—
Subconsultant More than 5 15 million
— —
5.Year Firm Established
FCP-14
Ch°
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). R //y�/�J (r{Ccsrthe:n;lame Care Sarvaa.'�nc. All Way.Canng:aameCare V/6/202�P"
Vendor/Contractor Name Date
Authorized Signature °}-2'`T-61-)-3jreArk—
Address 9696 Bonita Beach Rd. Suite 206, Bonita Springs, FL 34135
Solicitation/Contract# 24-8280
FCP-15
CA,C)
Other Exhibit/Attachment
Description:
Affidavit Regarding Labor and Services
n following this page (pages 1 through 1
l this exhibit is not applicable
Page 16 of 16
Fixed Price Professional Service Agreement
[2024_ver.3]
CAO
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: JV(\eYn �e Vv\CQS,
Address: -j A) Wh n n IN 1 x SvO to ti , yNA
Phone Number:
Authorized Representative's Name: Sh 1(� m Y- n
Authorized Representative's Title: VP `C ,—te
Email Address: e&C,(06I -}S 13h r-Spr) h ec W
pp I� AFFIDAVIT
t3\I, ' Yr t Nr' n (Name of Authorized Representative),as authorized representative attest
thatSfJt 1'\e }}Dint Cave serous (Name of Nongovernmental Entity)does not use coercion for labor or
services as defined in§787.06,Florida Statutes.
Under penalty of perjury, I declare that I have read the foregoing Affidavit and that the facts stated in it are true.
a go---
( i n uthorized representative)e) Date
�.�21/ 0
STATE OF \(--eniUGY1
COUNTY OF 3. 1 ,SOO
Sworn to(or affirmed)and subscribed before me,by means of(7hysical presence or❑online notarization this
'),k day ofF ik0-, by{}e(i'k \. \( \1500(Name of Affiant),who produced his Florida Driver's License
as identification. (iY&Y.IN
,'AER 11//4s,,,
otary Public �.�`• � R�OTAy`•. 02:
#
a a6 al _ COMM.N 909 _
A41 COMMISSION
EXPIRES
Commission Expires ;‹ • 7/292027
PersonallyKnown ( OR Produced Identification 0 ' BL�GF "�se
.Qe�
SIMI
Type of Identification Produced: hDC,I
CA()