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Backup Documents 05/27/2025 Item #16D 8 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 16 Q 8 4 THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later than Monday preceding the Board meeting. **NEW** ROUTING SLIP Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office. Route to Addressee(s) (List in routing order) Office Initials Date 1. Risk Risk Management 2. County Attorney Office County Attorney Office 5 '7 a.. 4. BCC Office Board of County Commissioners 135 �r `/ S12 7 4. Minutes and Records Clerk of Court's Office trr <-7 • 1.)-y ii' 6 5. Procurement Services Procurement Services PRIMARY CONTACT INFORMATION Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees above,may need to contact staff for additional or missing information. Name of Primary Staff Cole Chandler/Procurement Contact Information 239-252-8407 Contact/Department Agenda Date Item was May 27,2025 Agenda Item Number 16.D.8 Approved by the BCC Type of Document Amendment Number of Original 1 Attached Documents Attached PO number or account N/A 18-7470 Summit Home number if document is Summit Home Respiratory Services,Inc to be recorded Respiratory Services,Inc INSTRUCTIONS & CHECKLIST Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not appropriate. (Initial) Applicable) 1. Does the document require the chairman's original signature STAMP OK N/A 2. Does the document need to be sent to another agency for additional signatures? If yes, N/A provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. 3. Original document has been signed/initialed for legal sufficiency. (All documents to be CC signed by the Chairman,with the exception of most letters,must be reviewed and signed by the Office of the County Attorney. 4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A Office and all other parties except the BCC Chairman and the Clerk to the Board 5. The Chairman's signature line date has been entered as the date of BCC approval of the CC document or the fmal negotiated contract date whichever is applicable. 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's CC signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip N/A should be provided to the County Attorney Office at the time the item is input into SIRE. Some documents are time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's actions are nullified. Be aware of your deadlines! 8. The document was approved by the BCC on May 27,2025,and all changes made /A is not during the meeting have been incorporated in the attached document. The County S I,r,� an option for Attorney's Office has reviewed the changes,if applicable. this line. 9. Initials of attorney verifying that the attached document is the version approved by the N/A is not BCC,all changes directed by the BCC have been made,and the document is ready for the in an option for Chairman's signature. this line. 16Q8 SECOND AMENDMENT TO AGREEMENT#18-7470 FOR SERVICES FOR SENIORS THIS SECOND AMENDMENT, made and entered into on this day of Ofv.44 2025, by and between Summit Home Respiratory Services, Inc. d/b/a Summit Home Healthcare Products(the "Contractor")and Collier County, a political subdivision of the State of Florida, (the "County" or"Owner"): WHEREAS, on December 11, 2018 (Agenda Item 16.D.13), the County entered into an Agreement with the Contractor to provide comprehensive in-home and out of home services to the elderly in Collier County with an annual estimated cost of$550,000; and WHEREAS, on July 19, 2019, the County administratively approved the First Amendment to the Agreement amending Exhibit B-Fee Schedule with Exhibit B-1 Products List and added additional grant pass through documents to be included in the Agreement as required by the grantor agency, Area Agency on Aging of Southwest Florida; and WHEREAS, the Parties have exhausted all renewals, and the term of the Agreement is operating under an administrative extension and currently set to expire on June 9, 2025; and WHEREAS,the Parties desire to extend the term of the Agreement for one additional year to provide continued services while the County is soliciting a new contract. NOW, THEREFORE, in consideration of the mutual promises and covenants herein contained, it is agreed by the Parties as follows: 1. The above recitals are hereby incorporated into this Second Amendment as if fully set forth herein. 2. Upon execution of this Second Amendment,the term of the Agreement shall be extended for one year,through and including June 9, 2026,unless terminated earlier as authorized under the terms of t l he Agreement. 3. All fees will remain the same during the extension period. 4. Except as amended herein,all other terms and conditions of the Agreement,which is incorporated herein by reference, shall remain unchanged. * * * * * (SIGNATURE PAGE TO FOLLOW) Page 1 of 2 SECOND AMENDMENT TO AGREEMENT# 18-7470 Summit Home Respiratory Services,Inc.d/b/a Summit Home Healthcare Products 1 6 a 8 IN WITNESS WHEREOF,the Parties hereto, have each,respectively,by an authorized person or agent, have executed this Second Amendment on the date and year first written above. ATTEST: Crystal K. Kinzel, Clerk of the Circuit BOARD OF COUNTY COMMISSIONERS Court and Comptroller COLLIER COUNTY, FLORIDA r, r,, ifro T : �. irs By: Attest as to Chairman's ut L. Saunders, airman ate .,,'ra ?.$ ..,)-61.. signature only y'T. a°1r i",)\ Contractor's Witnesses: CONTRACTOR: Summit Home Respiratory Services, Inc. I 14 vkat ,'* d/b/a Summit Home Healthcare Products By: F rst Witness D — L Si ure 4nonk TType/print witness namet '3—ft f Pafoopewt CED TType/print signature and titleT /i its` - r Second Witness ��I,`/� �ELsoi y `te/2 5/2°2C- / Date TType/print witness name proved as t F an Legality: .4_,....4_______ Scott R.Teach Deputy County Attorney Page 2 of 2 SECOND AMENDMENT TO AGREEMENT# 18-7470 OD*/ Summit Home Respiratory Services, Inc.d/b/a Summit Home Healthcare Products 16D8 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: (}Q�ESPLBKCoco sT Q`��S,Iw� pgA 5�,1.n,. Epf �..+ ,� Address: IOSS 130yiN`ss LH 1Tfi . N A?t.& FL 34110 Phone Number: 239 596 9*v Authorized Representative's Name: 'SME" '-CYD I Authorized Representative's Title: Fees/De r t a0 Email Address: jdb e sonwi n..t AFFIDAVIT I, JAa IJnDrD (Name of Authorized Representative), as authorized representative attest that Sunurtr NprE Reassume' SErask SAP& (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. (Si ture of authorized representative) Date STATE OF FLoRTDA COUNTY OF COtLjEie-- Sworcto(or affi me )and subscribed before me, by means of CYphysical presence or❑online notarization this 125—day of rI) ,2061 ,by 1rh1-5 tlew. (Name of Affiant),who produced their as identification o are personarty known to m Aviekte„ Notary Public iP`�:'•••" RAMONACORT *AOn.°, * Commiselon#HH 228116 Commission Expires ExOlreeJune 13,2028 Personally Known Q' R Produced Identification CA Type of Identification Produced: CONTRACT,RENEWAL,OR EXTENSION REQUEST FORM Version:2025.1 ti CERTIFICATE OF LIABILITY INSURANCE 6 /1C R DATE(MM/DDYYYY) L.- 09/13/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is'an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT David R.Mettler A,S,ME• Integrated Insurance Services,Inc. PHONE (239)549-5420 ff FAX .lnt.NrL F:r)• I(p/c.Nol:(239)549-7905 1639 Cape Coral Parkway E,#203 ppDRIFss, dave a@integratedinsfl.com Cape Coral,FL 33904 INSURER(S)AFFORDING COVERAGE NAIL# INSURER A: Hanover Insurance Company INSURED INSURER B: Technology Insurance Company Summit Home Respiratory Services,Inc. INSURER C: DBA:Summit Home Healthcare Products INSURER D: 1085 Business Lane,Unit 2 INSURER E: Naples,FL 34110 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POUCY EXP LTR TYPE OF INSURANCE �Nsrt,wvn POLICY NUMBER IMM/DDIYYYYI IMM/➢D YYYY1, LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERAL LIABILITY PRFM SFPCFRa EoNc ante) $100,000 CLAIMS-MADE I X l OCCUR X ZHJ 9287527 15 09/27/2024 9/27/2025 MED EXP(Any one person) $5,000 X PI'OCIUCtS/COmpl.Ops. PERSONAL&ADV INJURY $1,000,000 X Professional Liability GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $3,000,000 $ PI POLICY PRO- GE 1FCT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT_(Fa accidentt g 1,000,000 A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED X ZHJ 9287527 15 09/27/2024 09/27/2025 BODILY INJURY(Per accident) $ AUTOS AUTOS X AUT HIRED AUTOS X NONOS- WNED PROPERTY DAMAGE O _leeLaccide0U $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $2,000,000 _ A EXCESS LIAB CLAIMS-MADE X UHJ D534845 07 09/27/2024 09/27/2025 AGGREGATE $2,000,000 DED RETENTION$ WORKERS COMPENSATION X WC STATU• OTH AND EMPLOYERS'LIABILITY Tr1Rv1 IMITR FR B OFFICER/MEMBEREXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE N N N/A E.L.EACH ACCIDENT $1,000,000 TWC4475642 09/27/2024 09/27/2025 (Mandatory In NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A Crime/Employee Dishonesty X ZHJ 9287527 15 09/27/2024 09/27/2025 Per Occurrence $100,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Sales of Medical Supplies. Collier County Board of County Commisioners,OR,Board Of County Commissioner in Collier County,OR Collier County Government,OR,Collier County included as an additional Insured under the captioned Comercial General Liability and AutomobileLiability Policies on a primary and non-contributory basis if and to the extent required by written contract foray and all work performed on behalf of Collier County. Sales of medical supplies. Collier County Services for Seniors,Solicitaton/Contract No.18-7470 CERTIFICATE HOLDER CANCELLATION Collier County Board of County Commisioners SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 3295 Tamiami Trail East THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Naples,FL 34112 AUTHORIZED REPRESENTATIVE r♦1 • '-` .^ � _ > I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD