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#18-7470 (VIP America of South west Florida, LLC)
FOURTH AMENDMENT TO AGREEMENT#18-7470 FOR SERVICES FOR SENIORS THIS FOURTH AMENDMENT, made and entered into on this a7 day of MCA/ 2025, by and between VIP America of Southwest Florida, LLC (the "Contractor") and Collier County, a political subdivision of the State of Florida, (the "County"): 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; and WHEREAS, on March 26, 2019, the County administratively approved the First Amendment to the Agreement amending Exhibit B-Fee Schedule to include Older American's Act under the grant column of Skilled Nursing line item#1. WHEREAS, on July 19, 2019, the County administratively approved the Second Amendment to the Agreement to add additional grant pass through documents to the Agreement as required by the grantor agency, Area Agency on Aging of Southwest Florida; and WHEREAS, on January 24, 2023, the County administratively approved the Third Amendment to the Agreement to increase the Cost Per Service Unit for Skilled Nursing, Enhanced Chore, Respite (In-Home), Personal Care, Chore, and Homemaking by ten percent (10%) in consideration of the Contractor's agreement to exercise the available renewal term under the Agreement, and as supported by an analysis of market increases. 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 Fourth Amendment as if fully set forth herein. 2. Upon execution of this Fourth 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 the 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. Page 1 of 2 FOURTH AMENDMENT TO AGREEMENT#18-7470 VIP America of Southwest Florida,LLC CAO * * * * * IN WITNESS WHEREOF, the Parties hereto, have each, respectively, by an authorized person or agent,have executed this Fourth 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 By i1/4)„.,,..L.,-/-4:41-4,46.-AttIC By p,hest as to Chairman s At."/"Cee.0,104--- ' aunders, an 'Dated: �a5 signature only (SEAL) ' Contractor's Witnesses: CONTRACTOR: �' VIP America S t t Florida, LLC #4/ /.., By: First Witness ig ature Alidic.e1 Arc Ae A.l� Pa:G- ertr4-1) TType/print witness nameT Type rint ignature and titleT Second itness S/// r— Ti Z Date l( TT Type/print witness nameT Yp P rved a o F‘In and egality: e, r-- ___ Scott R. Teach Deputy County Attorney 74, Page 2 of 2 " ' AV FOURTH AMENDMENT TO AGREEMENT#18-7470 VIP America of Southwest Florida,LLC 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: ViP AM.o,- p514.,1L.s-vr ) 1 O-,dc. LL,C Address: /4Z/I0 P---nsg> S Ave_ S 103 Fb,^t J.,i41 cr,s FL.3 R5« Phone Number: ct_(ago.. 99 6 Authorized Representative's Name: A,SM LA.Ai s �-ems,• Authorized Representative's Title: Q efC4I�p Email Address: r�g�Q�, , �`k € Vl�/4r^�r1 cR.•cw�-�� AFFIDAVIT • I, 311(L� 2 (Name of Authorized Representative), as authorized representative attest that of 4!''t,cr/ic0.. kwt # (Name of Nongovernmental Entity)does not use coercion for labor or services as defined in§ 87.06, Florida Statutes. Un r pen y f p ju , declare that I have read the foregoing Affidavit and that the facts stated in it are true. s-1,/?-s� (Signature of a horized ere ntative) Date STATE OF COUNTY OF Ali Sworn to(or affirmed)and subscribed before me,by means of physical presence or 0 online notarization this ►s F day of /k�, , 20). ,by A. 4., J a JI'. (Name of Affiant),who produced his Florida Driver's License as identification. /7 i`/�� MICHAEL ASCHE Notary Public(not required when digital) MY COMMISSION#HH 435994 '•'.��o�'' EXPIRES:December 21,2027 Ai I /4117 Commission Expires Personally Known 0 OR Produced Identification iSf Type of Identification Produced: D, CONTRACT RENEWAL OR EXTENSION REQUEST FORM Version:2025.1 AC�® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 1/23/2025 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 have ADDITIONAL INSURED provisions or 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 GNP Brokerage US Inc. an ISU Network Member PHONE FAX 2001 57th Street wc.No.Ext): 718-851-5400 (A/c,No):718-853-0164 Brooklyn NY 11204 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# License#:1045961 INSURER A:PHILADELPHIA INDEMNITY CO. 18058 INSURED ALTECAR-01 INSURER B:BEAZLEY USA SERVICES INC VIP America, LLC INSURER C:CFC Underwriting Limited 2500 S. Kanner Hwy. Suite 3 Stuart FL 34994 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:603932280 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY PHPK2587080-003 8/1/2024 8/1/2025 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY PHPK2587080-003 8/1/2024 8/1/2025 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS ( X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) A X UMBRELLALIAB OCCUR PHPK2587080 8/1/2024 8/1/2025 EACH OCCURRENCE $5,000,000 EXCESS LIAB X CLAIMS-MADE AGGREGATE $5,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A -- (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under ---- - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Professional Liability PHPK2587080-003 8/1/2024 8/1/2025 Annual Aggregate 3,000,000 B Crime V35C69240201 9/1/2024 9/1/2025 Annual Aggregate 5,000,000 C Cyber Liability ESN0140097435 9/21/2024 9/21/2025 Annual Aggregate 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is listed as additional insured subject to written contact. Additional named insureds: VIP America of Southwest Florida, LLC VIP America of Central Florida, LLC CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Collier County Board of County Commissioners 3295 Tamiami Trail E. AUTHORIZED REPRESENTATIVE Naples FL 34112 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACoRL® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 1/12/2024 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may rsquire an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT GIGA Solutions, Inc. NAME: 101 Plaza Real South IAICCN o.Ext): 888-581-0807 FAX No): Ste 201 E-MAILDDR @gig ADDRESS: certs@gigasolves.com asolves.com Boca Raton FL 33432 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Ascendant Commercial Insurance Incorporated 13683 VIP AMERICA OF SOUTHWEST FLORIDA, LLC vIPAMER-01 INSURER B: 14440 METROPOLIS AVE#103 INSURER C: Fort Myers FL 33912 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:654580705 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 NAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR -""--""— --- LTR TYPE OF INSURANCE INSD wVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DO/YYYY) IMMIDD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE L J OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES°ER: li GENERAL AGGREGATE $ POLICY PRO- _ JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED r SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED I! NON-OWNED AUTOS ONLY 'L AUTOS CNLY PROPERTY DAMAGE (Per accident) UMBRELLA LIPS OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION WC-76407-4 11/10/2024 11/10/2025 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ANYPROPR;ETOR/PARTNERJEXECUT,:V= E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? N/A _.- (Mandatory in NH) i E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS bebw E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Collier County Board of County Commissioners,OR,Board of County Commissioners in Collier County,OR,Collier County Goverment,OR,Collier County is Additional Insured and Primary ar,d Non-contributory with respect to Workers Compensation and Employers'Liability as required by written contract for any and all work performed on behalf of Collier County. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Collier County Board of County Commissioners 3295 Tamiami Trail E. Naples FL 34112 AUTHORIZED REPRESENTATIVE ©4s..ce 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACOR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Collier County Board of County Commissioners 3295 Tamiami Trail E. AUTHORIZED REPRESENTATIVE Naples FL 34112 �# 1` 44 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • Greater • • • Companies October 30, 2023 To whom it may concern: Let this letter serve as full authorization for Ashley Skipper, VP of Operations of VIP America of Southwest Florida, LLC,to transact in any way with Collier County. Please feel free to contact me with any questions or concerns at mkochen@Rnyservices.com or at(914) 752-2117. Sincerely, 77/(>1// Michael Kochen Chief Executive Officer Greater Health Alliance LLC dba Greater Companies STATE OF TEXAS COUNTY OF TRAVIS ) The foregoing instrument was acknowledged before me by means of online notarization, this 301h day of October 2023, by Michael Kochen, as Chief Executive Officer of Greater Companies, who is personally known to me or who has produced a Driver's License as identification on behalf of Greater Health Alliance LLC d/b/a Greater Companies. Not ry blic State and County Aforesaid (NOTARIAL SEAL) Print Name:Jennifer Jo Thomasy My commission expires: 09/20/2025 at��'�'"1��i, My commission number: 133341819 Y Jennifer Jo Thomas a •(. Notarized online using audio-video communication 11. ID NUMBER 133341819 %ryg41FU1\t£ \\` CS September 20.2025OMMISSION 5 • •• Access •• • Access Greater - Pinnacle • •••• VIP • •• Concierge : • • Nursing NY Nursing HomeCare • .• America A GREATER COMPANY A GREATER COMPAN'. A GREATER_. .YA+- A GREATER_:xil ay+- n GaF4TER .:++-tN