Backup Documents 07/08/2025 Item #16D 8 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 D 8
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 7.8.25 BCC Mtg
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 Attomey Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Carolyn Noble Community and Human CN 7.8.25
Services
2. County Attorney Office— County Attorney Office
Uhkif►b 7/1
3. BCC Office Board of County
Commissioners BS , / 7/g
4. Minutes and Records Clerk of Court's Office /8745
`�V I y
f
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 Carolyn Noble Phone Number 239-450-5186
Contact/ Department
Agenda Date Item was 7.8.25 BCC Mtg Agenda Item Number 16.D.8
Approved by the BCC
Type of Document DAVID LAWRENCE OPIOID AMENDMENT Number of Original 3 DOCUMENTS
Attached #2 Documents Attached
PO number or account
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature STAMP OK CN
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 Yes
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 N/A
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's YES
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 above date and all changes made during N/A is not
the meeting have been incorporated in the attached document. The County 'M 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 Sp A an option for
Chairman's signature. this line.
16D8
CFSA Name: Opioid Settlement Fund
CFSA#: 60.355
OPIOID Settlement FY 2024-2028
:Agreement is 2024-01 DLC Opioid
Activity: Opioid Abatement Settlement
SUSRECIPIENT: David Lawrence Mental
Health Center, Inc.
Total Award Amount: 52,184,690.00
UEI#: PBE3LMASJ4YI
FEIN: 59-2206025
Period of Performance: 10/1/2024—
9/30/2028
Fiscal Year End: 6/30
Monitoring End: 12/2028
SECOND AMENDMENT TO AGREEMENT BETWEEN
COLLIER COUNTY
AND
DAVID LAWRENCE MENTAL HEALTH CENTER, INC.
dba
DAVID LAWRENCE CENTER
Opioid Settlement Funds
This Amendment, is made and entered into this 2}1 day of
2025, by and between Collier County, a political subdivision of the State f Florida,
("COUNTY") having its principal address as 3339 Tamiami Trail East,Naples, FL 34112, and the
DAVID LAWRENCE MENTAL HEALTH CENTER,INC.("SUBRECIPIENT"),authorized to do
business under the laws of the State of Florida, having its principal office at 6075 Bathey Lane,
Naples, Florida 34116.
WHEREAS, on June 22, 2021 (Agenda Item #16.K.8) meeting, the Board of County
Commissioners (Board) approved Resolution No. 2021-136 supporting the terms and conditions
of the Memorandum of Understanding (MOU)provided by the Office of Attorney General, which
set forth a framework of a unified plan for the proposed allocation and allowable uses of Settlement
Funds to mitigate the harmful effects of the opioid epidemic (the "Florida Plan"). Resolution No.
2021-136 further authorized the County to execute formal agreements to implement the Florida
Plan.
WHEREAS, on April 11, 2023, the Board approved the initial City/County allocation in
the amount of$289,151.06 (Agenda Item # 16.D.5) and the Regional Abatement fund allotment
in the amount of$2,628,842.15 on June 13, 2023, (Agenda Item #16.D.3). On June 25. 2024, the
Board approved its second year allocation (Agenda Item #16.D.7), in the amount$633,277.95 for
City/County and $1,241,219.04 for Regional Abatement received on January 1, 2024 and
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recognized and interest payment of$1,310.30 for Regional Abatement received on April 24,2024.
On April 22, 2025, the Board approved its third year allocation (Agenda Item #16.D.6) in the
amount of$399,277.79 for City/County and $1,542,962.85 for Regional Abatement, received on
February 14, 2025 and January 28, 2025, respectively.
RECITALS
WHEREAS, on December 10, 2024, Agenda Item #16.D.16. the COUNTY and
SUBRECIPIENT entered into an agreement for SUBRECIPIFNT to provide outreach services,
increase the utilization of medication assisted treatment (MAT), support crisis stabilization,
detoxification inpatient services and residential treatment beds and facilitate a centralized call
center ; and
WHEREAS, on February 25, 2025, Agenda Item #1 6.D.3, the Board approved
Amendment #1 to update language from contractor to subrecipicnt due to assignment of a Catalog
of State Financial Assistance (CFSA) number, clarified City/County. and Regional Abatement
funding amounts, removed the word `purchase from the agreement name, and clarified the
language of`target' on Exhibit E.
WHEREAS, the Parties desire to amend the Agreement update/add language in special
conditions, project details, agreement amount, records and documentation, agency
recognition/sponsorships, incident reporting,overpayment and offsets, general provisions, Exhibit
A, add Exhibits G, H, I and J and to renumber where applicable.
NOW, THEREFORE, in consideration of foregoing Recitals, and other good and
valuable consideration,the receipt and sufficiency of which is hereby mutually acknowledged,the
Parties agree to modify the Agreement as follows:
WordsStel—Through are deleted; Words Underlined are added.
WHEREAS, the State greement Florida Opioid Allocation and Statewide Response
Agreement set forth the amount and manner of distribution of City/County and Regional
Settlement funds within Florida, the requirements to receive and manage Regional Abatement
funds, and the purposes for which Regional Abatement funds may be used. The current Slate
n g ement : attached hereto as Exhibit n and Collier Counts: D es•olution 2021 1 36.dated
June 22. 2021-, approved in concept the State Agreement: and Collier County Resolution 2021-
136. dated June 22. 2021, including the Memorandum of Understanding between the State of
Florida and it's local governments (Florida Plan) approved in concept the State Agreement and is
attached hereto as Exhibit A: and
* * *
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1.1 SPECIAL CONDITIONS
A. Within sixty (60) calendar days of the execution of this Agreement, SUBRECIPIENT
must deliver to CHS for approval a detailed project schedule for the completion of the
project.
B. SUBRECIPIENT must submit the following resolutions and/or policies within sixty
(60)days of execution of this Agreement:
® Affirmative ActionlEqual Opportunity Policy
Conflict of Interest Policy (COI) and related COT Forms
Procurement Policy
Fraud, Waste, and Abuse Policy
,0 Language Assistance and Planning Policy (LAP)
Business Associate Agreement
HIPAA Policy
I®! Whistleblower Policy
®; Any Policies and Practices recommended by the Opioid Abatement
Taskforce or Council.
1.3 PROJECT DETAILS
C. Performance Deliverables
Program Deliverable Supporting Submission Schedule
Documentation
Policies & Procedures ' Policies as stated in this Within 60 days following
L(Section 1.2 B) AGREEMENT ; Agreement execution
Insurance Proof of coverage in Within 30 days following
accordance with Exhibit C Agreement execution and
annually within 30 days after
renewal
Detailed Project Schedule Project Schedule Within 60 days following
agreement execution
Progress Report Progress report, detailing 15 days after the end of the
accomplishments Exhibit E quarter
HIPAA and DCF Security Certificate of Training Within 30 days following
Training (per Section 2.5 of Agreement execution
this AGREEMENT)
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Program Deliverable Supporting Submission Schedule
Documentation
Florida Department of Exhibit I Annually,no more than 13
Children and Families months apart
Employment Screening
Affidavit
Annual Audit Monitoring Exhibit I' Annually, 60 days after FY end
Report
DCF Executive Compensation DCF Form PCMT-08 Annually on or before May 1
Annual_Report , (Exhibit J�
SUBRECIPIENI'Financial Audit report, Management Annually: 9 months after FY end
and Compliance Audit Letter, and Supporting for Single Audit OR one hundred
Documentation eighty (180)dyys after FY end.
DCF Electronic Data Professional Health Care 18 days after the end of each
Exchange (EDI) 837 File Claim files in FTP with month, using the DCF ShareFile
SSL
Business Associate Agreement Within 9(1 days following
Agreement execution of Agreement
Conflict of Interest Form Subrecipient/Developer/Ve Upon execution of the Agrecment
ndor Conflict of Interest for all employees who work on
Disclosure Form activities associated with the
project and upon hiring(fall new
employees
Labor and Services Affidavit Regarding Labor Within 60 days of execution of
(Trafficking) Form and Services Agreement
Whistleblowcr Protections - Exhibit H Upon execution of the Agreement
Affidavit for all employees who work on
activities associated with the
project and upon hiring of all new
employees
* * *
1.3 PROJECT DETAILS
A. Project Description/Budget
Description Year 1 1 Year 2 Year 3 Funding Year 4 TOTAL
Funding Funding (FY26/27) Funding AMOUNT
(FY24/25) (FY25/26) *contingent (FY27/28) AWARDED
*contingent upon allocation *contingent *contingent upon
upon availability upon allocation
allocation allocation availability
availability availability
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rr Project Component 1: $404. 7 2 $107,304.18 S110,523.31 ! $113,839.00
Staffing to include .5 FTE S 104,178.81
Nurse and .5 FTE Outreach
Specialist(Schedule A,
#A. #B and#E) Cost
Reimbursement I
Project Component 2: $70,777.28 $70,777.28 $99.524.82 $70.777.28
Detox and/or Crisis
Support Bed Days
(Schedule A, #A. Schedule
B,#A, B & #C). Fixed
Price/Unit Cost*
Project Component 3: $288.099.98 KA. -8.099.98 $384,133.30 $288.099.98
Crisis Hotline/Call Center S288.099.97 $288.099.97
Availability (Schedule B,
#A and #B). Fixed Price/
Unit Cost*
Project Component Four: $59,036.93 $55,818.57 $55,818.57 $17,880.75
Residential /Inpatient
Treatment Bed Days
(Schedule A, #A, Schedule
B,#A and#B) Fixed
Price/Unit Cost*
Total Funds $522,093.00 S522,000.00 $650.000.00 $490,597.00 $ 2,184,690.00
City/County S343,918.54 S384.133.30 $288.099.97 $1.538,244.81
Funds City County City-County City-County Total City-
Funds/ Funds/ Funds/ County Funds/
$178,081.46 $265,866.70 $202,497.03 $646,445.19
Regional Regional Funds Regional Total Regional
Funds Funds Funds
* * *
1.5 AGREEMENT AMOUNT
The COUNTY agrees to make available THREE MILLION ONE HUNDRED FIFTY
THOUSAND DOLLARS AND ZERO CENTS(S3,150,000.00),this agreement allows
for all costs incurred retroactive to May 1,2024 for use by SUBRECIPIENT, during the
term of the AGREEMENT (hereinafter, shall be referred to as the Funds).
Modifications to the Budget and Scope may only be made if approved by COUNTY, in
advance. Budgeted Cumulative Fund shifts among line items shall not be more than 10
and shall not signify a change in scope. may be
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approved administratively by CHS Director or designee for a total of up to 10 percent
(10%) of the total funding amount and shall not signify a change in scope. Fund shifts that
exceed 10 percent of the AGREEMENT amount shall only be made with Board of County
Commissioners (Board)approval.
The fixed price/unit cost for components 2, 3 and 4 are based on an agreed upon rate by
the State of Florida and the Department of Children and Families. This rate is determined
each year prior to the State's fiscal year (July 1). The SUI3REC1PIENT will provide the
COUNTY, in writing, of the new rate and the agreement will be modified to reflect the
new rate for billing purposes. This new fix price/unit cost does not change the amount of
the allocated budget for either the component or the agreement as a whole.
All services/activities specified in Part 1 Scope of Services shall be performed by
SUBRECIPIENT or its subcontractors who meet State requirements. SUBRECIPIENT
shall comply with, and ensurc its subcontractors, substrantecs, and others it arranges to
provide deliverables comply with:
• applicable laws. rules. codes. ordinances, certifications. licensing requirements.
and DCF's Operating Procedures
• Department of Financial Services' (DFS)'`Reference Gidc for State Expenditures"
and active DFS Comptroller or Chief Financial Officer Memoranda. If this
Agreement is funded by state financial assistance. those funds may only he used
for allowable costs during the Period of Performance. Absent DC'F's authorization.
unused state financial assistance funds must he returned to the Department.
The COUNTY shall reimhurse SUBRECIPIENT for the performance of this Agreement
upon completion or partial completion of the work tasks as accepted and approved by CHS.
SUBRECIPIENT may not request disbursement of OPIOID Funds until Funds arc needed
for eligible costs, and all disbursement requests must be limited to the amount needed at
the time of the request. SUBRECIPIENT may expend Funds only for allowable costs
resulting from obligations incurred during the term of this Agreement. Allowable costs
shall mean those necessary and proper costs identified in the SUBRECIPIENT application
and approved by the COUNTY, unless any or all such costs arc disallowed by the State of
Florida Attorney General or Department of Children and Families (DCF). Invoices for
work performed are required every month. If no work has been performed during the
month,or if SUBRECIPIENT is not yet prepared to send the required backup, a$0 invoice
is required. Explanations will be required if two consecutive months of$0 invoices are
submitted. Payments shall be made to SUBRECIPIENT when requested as work
progresses, but not more frequently than once per month. Reimbursement will not occur if
SUBRECIPIEN7' fails to perform the minimum level of service required by this
Agreement.
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No payment will be made until approved by CHS for compliance and adherence to any and
all applicable Local, State, or Federal requirements. including timely submission of
Performance Deliverables contained in Section 1.4.C. Late submission of deliverables may
cause payment suspension of any open pay requests until the required deliverables are
received by CHS. Except where disputed for noncompliance, payment will be made upon
receipt of a properly completed invoice, and in compliance with Section 218.70, Florida
Statutes, otherwise known as the "Local Government Prompt Payment Act."
Final invoices are due no later than 90 days after the end of the Agreement. Work
performed during the term of the program but not invoiced within 90 days after the end of
the Agreement may not be processed without written authorization from the Program
Manager.
Withholding or Cancellation of Funds. The COUNTY reserves the right to withhold
payments, pending timely delivery of program reports or documents as may be required
under this Agreement. SUBRECIPIENT agrees that funds determined by the COUNTY to
he surplus upon completion of the Project will he subject to cancellation by the COUNTY.
The COUNTY shall be relieved of any obligation for payment if funds allocated to the
COUNTY cease to be available for any cause other than misfeasance of the COUNTY
itself. Payment may be suspended by the COUNTY in the event of a default by
SUBRECIPIENT.
* *
1.6 OVERPAYMENTS AND OFFSETS
SUI3RFCIPIENT shall return erroneous payments.overpayments.or payments disallmN ed
by this Agreement (including payments made for services subsequently determined by the
COUNTY to not be in full compliance with this Agreement's requirements) or law,
including interest at a rate established per §55.03(1). F.S.. within 40 days after discovery
by the SUBRECIPIENT, audit, or COUNTY. The State or COUNTY may recover against
such payments by deduction from subsequent payments under this or any other Agreement
with SUBRECIPIENT, or any other lawful method. if this Agreement involves federal or
state financial assistance. the iollowintz applies:
a The SUBRECIPIE:NT shall return to the COUNTY unused funds.accrued interest
earned, and unmatched grant funds, as detailed in the Final Financial Report.
within 60 days of the Period of Performance end date.
* * *
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1.6-7 NOTICES
Notices required by this AGREEMENT shall be in writing and delivered via mail (postage
prepaid), commercial courier, or personal delivery, or sent by facsimile or other electronic
means. Any notice delivered or sent as aforesaid shall be effective on the date of delivery
or sending. All notices and other written communications under this AGREEMENT shall
be addressed to the individuals in the capacities indicated below, unless otherwise modified
by subsequent written notice.
COLLIER COUNTY ATTENTION: Carolyn Noble, Grant Coordinator
Collier County Community and Human Services Division
3339 Tamiami Trail East, Suite 213
Naples, FL 34112
Email to: Carolyn.Noble u colliercountyfl.gov
Telephone: 239-450-5186
CONTRACTOR ATTENTION: Marien Ruiz,General Accounting
Manager
Collier County Sheriff's Office
3319 Tamiami Trail East, Building J
Naples. FL 34112
Email to: Marien. Ruiz@colliersheriff.org
Telephone: 239-252-0852
* * *
2.2 RECORDS AND DOCUMENTATION
E. Upon completion of all work contemplated under this Agreement, copies of all
documents and records relating to this Agreement shall be surrendered to CHS, if
requested. In any event, SUBRECIPIENT shall maintain all documents and records in
an orderly fashion in a readily accessible, permanent, and secured location for six (6)
years after it ceases to receive OPIOID Funds. However, if any litigation, claim, or
audit is started before the expiration date of the six (6) year period, the records will be
maintained for six(6)years after all litigation, claim, or audit findings involving these
records are resolved. If SUBRFCIPIENT ceases to exist after the closeout of this
Agreement, it will notify the COUNTY in writing, of the address where the rccords are
to be kept, as outlined in Florida Statute Chapter 119. SUBRECIPIENT shall meet all
requirements for retaining public records and transfer, at no cost to COUNTY, all
public records in SUBRECIPIENT's possession upon termination of the Agreement,
and destroy any duplicate,exempt, or confidential public records that are released from
public records disclosure requirements. All records stored electronically must be
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provided to the COUNTY in a Format compatible with the COUNTY's information
technology systems.
IF SUBRECIPIENT HAS QUESTIONS REGARDING THE
APPLICATION OF CHAPTER 119, FLORIDA STATUTES,
TO THE SUBRECIPIENT'S DUTY TO PROVIDE PUBLIC
RECORDS RELATING TO THIS AGREEMENT, IT SHALL
CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT
239-
252-5837,Angel.Bates colliercountyfl.gov,3299 Tamiami Trail
East, Naples, FL 34112.
* * *
3.9 AGENCY RECOGNITION/SPONSORSHIPS
As required by §286.25. f .S.. SLBRECIPIENT agrees that all notices, informational
pamphlets, press releases, advertisements, descriptions of Program sponsorships, research
reports, and similar public notices, whether printed or digital, SUBRECIPIENT has
prepared and released for, on behalf of, and/or about the Program shall include the
statement:
"FINANCED SPONSORED IN PART BY ISUBRECIPIENT
NAMEI STATE OF FLORIDA DEPARTMENT OF CHILDREN
AND FAMILIES AND COLLIER COUNTY COMMUNITY AND
HUMAN SERVICES DIVISION"
and The words "State of Florida. Department of Children and Families" shall appear in the
same size letters or type as the SUBRECIPIENT's name. This design concept is intended
to disseminate key information to the general public regarding the development team as
well as Equal Housing Opportunity. Construction signs shall comply with applicable
COUNTY codes.
* * *
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3.18 INCIDENT REPORTING
If SUBRECIPIENT provides services to clients under this Agreement, SUBRECIPIENT
and any subcontractors shall report to the COUNTY any knowledge or reasonable
suspicion of abuse, neglect, or exploitation of a child, aged person, or disabled person.
During the term of this Agreement, SUBRECIPIENT must report to the COUNTY in
writing, within one business day of occurrence, any substantial, controversial, or
newsworthy incidents. The Collier County Standard Incident Report Form (Exhibit G)
shall be used to report all such incidents.
SUBRECIPIE.N1' and any subcontractor must comply with and inform its employees of
the following; mandatory reporting requirements. Each of the SUBREC II'lEN'l 'S
employes, and of any subcontractor. providing services in connection with this Agreement
who has knowledge of a reportable incident shall report such incident as follows:
• A reportable incident is defined in CLOP 180-4
• Reportable incidents that may involve an immediate or impending impact on the
health or safety of a client shall he immediately reported to DC Fs Office of
Inspector General and the COUNTY'S Program Manager
• Other reportable incidents shall be reported to DCF's Office of Inspector General
within two (2) business days of discovery.through the internet at:
hops://www.myflfamiles.com/about/additional-services-of iices!ofl ice-insnector-
general/investigations/inspector-general or by completing a
Notification/Investigation Request (Form Cl 1934) and mailing the request to the
Office of Inspector General at: IG.Complaints!a ntvflfatnilics.com. The
SUBRECIPIENT and subcontractor shall mail or fax the completed forms to the
Office of inspector General, 2415 North Monroe Street. Suite 400,Tallahassee. FL
32303-4190: or (850) 488-1428.
4.13 Unauthorized Aliens shall not be employed. Employment of unauthorized aliens shall be
cause for unilateral cancellation of this Agreement by the COUNTY for violation of
§274A of the Immigration and Nationality Act. SUBRECIPIENT and its subcontractors
will enroll in and use the E-Verify system estahlished by the U.S. Department of
Homeland Security to verify the employment eligibility of its employees, and its
subcontractors' employees performing under this Agreement. Employees assigned to this
Agreement means all persons employed or assigned (including subcontractors) by the
SUBRECIPIENT or subcontractor. during the Period of Performance, to perform work
p_ursuant to this Agreement within the United States and its territories.
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*
4.134 Florida Statutes section 119.021 Records Retention
Statutes &Constitution: View Statutes: Online Sunshine tstatt.fl.us)
4.145 Florida Statutes section 119.071, Contracts and Public Records
http:l/www.leg.state.fl.us/Statutes/index.cfm?App mode—I)isplav Statute&URL 0100-
0199/0119/Sections/01 19.07 I.httnl
4.156 2 CFR 200.15 Never contract with the enemy. Federal agencies, recipients, subrecipients,
and contractors arc subject to the guidance implementing Never Contract with the Enemy
in 2 CFR part 183.
https://ww1A.ecfr.gov/eurrent/title-2/subtitle-A/chapter- l!part-200/subpart-C!scction-
200.215
https://wti►w.ecfr.gov/current/title-2/subtitle-A/chapter-l!part-183
4.167 Trafficking in Persons: The SUBRECIPIENT agrees to, at any tier, comply with all
applicable requirements (including requirements to report allegations) pertaining to
prohibited conduct related to the trafficking of persons, whether on the part of the
SUBRECIPIENT and any employees of the SUBRECIPIENT. The details of the
SUBRECIPIENT'S obligations related to prohibited conduct related to the trafficking of
persons are posted at
https:/!oip.gov/funding.!Explore/ProhibitedConduct-'Taff icking.htm.
eCFR :: Appendix A to Part 175.Title 2 -- Award Term
Pursuant to Florida Statues 787.06,SPONSOR attests that it does not use coercion for labor
or services. SUBRECIPIENT shall provide an affidavit, under penalty of perjury. signed
by an officer or representative of the organization attesting that it does not use coercion for
labor services.
http:Pwww.le .state.11.us/Statutesiindex.cfm?App mode- Displav Statute&I"RL=0700-
0799,10787w'Scctions/0787.06.html
4.178 Whistleblower Protections:
a. In accordance with 2 CFR 200.217 and 41 U.S.C. § 4712, the SUBRECIPIENT may
not discharge, demote, or otherwise discriminate against an employee in reprisal for
disclosing to any of the list of persons or entities provided below, information that
the employee reasonably believes is evidence of gross mismanagement of a federal
contract or grant, a gross waste of federal funds, an abuse of authority relating to a
federal contract or grant, a substantial and specific danger to public health or safety,
or a violation of law, rule, or regulation related to a federal contract (including the
competition for or negotiation of a contract) or grant.
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b. The list of persons and entities referenced in the paragraph above includes the
following:
i. A member of Congress or a representative of a committee of Congress;
ii. An Inspector General;
iii. The Government Accountability Office;
iv. A Treasury employee responsible for contract or grant oversight or
management;
v. An authorized official of the Department of Justice or other law enforcement
agency;
vi. A court or grand jury; or
vii. A management official or other employee of Recipient, contractor, or
subcontractor who has the responsibility to investigate, discover, or address
misconduct.
The SUBRECIPIENT shall inform its employees in writing of whistleblower rights and
remedies provided under 2 CFR 200.217 and 41 U.S.C. 4712. in the predominant native
language of the workforce.
https://uscode.house.gov/view.xhtml?reel=(title:41%20section:47 l2%20edition:prelim)
All SUBRECIPIENT employees directly involved with activities associated with this
Agreement shall complete and submit to the COUNTY the Collier County Whisticblower
Protections Certification form (Exhibit H) prior to execution of this Agreement. Any new
employees hired during the period of performance of this Agreement shall also complete
and submit the form to the COUNTY.
4.19 Federal Whistleblower Requirements. Pursuant to 11(c) of the OSH Act of 1970 (29
U.S.C. §660(c)) and the subsequent federal laws expanding the act. the SUBRECIPIENT
is prohibited from discriminating against employees for exercising their rights under the
OS1-1 Act. Details of the OSH Act are located at:
http://www.whistleblowers.gov.
4.20 Employment Screening. As described in CFOP 60-25. Chapter 2 (implementing
110.1127. F.S.), as a condition of initial and continued employment. the SUBRECIPIENT
shall ensure all staff. whether employees or independent contractors. arc screened by lXT
in accordance with chapter 435. P.S.. are of good moral character, and meet the Level 2
Employment Screening standards in 435.04, 110.1127, and 39.001(2). F.S.. including:
• Employment history checks
• Fingerprinting for all criminal record checks
• Statewide criminal and juvenile delinquency records checks through Florida
Department of I.aw Enforcement (FDLE)
• Federal criminal records checks from the Federal Bureau of Investigation via the
Florida Department of Law l:nforecment
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• Security background investigation. which may include criminal record checks by
local law enforcement agencies: and
• Attestation by each employee, subject to penalty of perjury, to meeting the
requirements for qualifying for employment pursuant to Chapter 435, I .S.. and
agreeing to inform the employer immediately if arrested for any of the disqualifying
offenses while employed by the employer.
SUI3RECIPIENT shall sign the Florida Department of Children and Families Employment
Screening Affidavit each state fiscal year (no two such affidavits will he signed more than
13 months apart) for the term of this Agreement. stating that all required staff have been
screened or the SUBRECIPIENT is awaiting the results of screening.
4.21 Use of Funds for Diversity, Equity, and Inclusion Prohibited. No State funding under this
Agreement is being provided for, promoting, advocating for. or providing training or
education on "Diversity. Equity, and Inclusion" (UEI). DEI is any_program, activity, or
policy that classifies individuals on the basis of race, color. sex. national origin. gender
identity, or sexual orientation and promotes the position that a group or an individual's
action is inherently, unconsciously, or implicitly biased on the basis of such classification.
4.22 Health Insurance Portability and Accountability Act (HIPAA): Should this Agreement
involve SUBRECIPIFN'I' access to protected health information (Pill) the
StIIIRECIPIENT shall be a"Business Associate" limited to the following permissible uses
and disclosures. Reference to a section in the HIPAA Rules means the section as in effect
or as amended. The SUBRECIPIENT shall assist the COUNTY in amending this
Agreement to maintain compliance with l-IIPAA Rules and any other applicable law
requirements. Any ambiguity in this section will be interpreted to permit compliance with
the HIPAA Rules. Within the COUNTY, the Grant Manager has been designated the
I IIPAA privacy Officer.
• Catch-all Definitions. The following terms as used in this section have the same
meaning as those terms in the HIPAA Rules:Breach. Data Aggregation,Designated
Record Set. Disclosure, I realth Care Operations, Individual, Minimum Necessary,
Notice of Privacy Practices. Protected Health Information. Required by Law.
Security Incident. Unsecured Protected health Information. and Use.
• Specific Definitions:
o Business Associate has the same meaning as the term "business associate"
at 45 CFR ti l 60.l 03.
o Covered Entity has the same meaning as the term "covered entity" at 45
CFR §160.103. and for purposes of this Agreement includes the COUNTY.
o IIIPAA Rules will mean the Privacy. Security. Breach Notification and
Enforcement Rules at 45 CFR Parts 160 and 164.
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o Subcontractor has the same meaning as the term subcontractor at 45 CFR
,5160.103 and includes individuals to whom a Business Associate delegates
a function, activity. or service other than as a member of the workforce of
such Business Associate.
4.23 SUBRECIPIENT Obligations and Activities. The SUBRECIPIENT shall:
• Not use or disclose PHI except as permitted or required by section 4.22 above, or
by law.
• Use the appropriate administrative safeguards in 45 CFR § 164.308. physical
safeguards in 45 CFR § 164.310, and technical safeguards in 45 CFR § 164.312:
including policies and procedures regarding the protection of PI-II in 45 CFR
164.316 and the provisions of training on such policies and procedures to applicable
employees, independent providers. and volunteers, that reasonably and
appropriately protect the confidentiality. integrity. and availability of the Pill
Provider may crcatc, receive. maintain or transmit on the SUBRECIP1IN'1"S
behalf
• Acknowledge that the foregoing safeguards,policies, and procedures requirements
apply to the SUBRE:C'IPIFNT in the same manner as such requirements apply to
the COUNTY: and the SUBRECIPIENT and its subcontractors are directly liable
under the civil and criminal enforcement provisions § 13409 and 13410 of the
HITECH Act. 45 CFR § 164.500 and 164.502(E) of the Privacy Rule (42 U.S.C.
1320d-5 and 1320d-6). as amended, for failure to comply with the safeguards.
policies, and procedures requirements and resulting I...S. Health and Human
Services (HHS) guidance thereon.
• Report to the COUNTY any use or disclosure of PHI not permitted by section 4.22
above. including breaches of unsecured PHI as required at 45 CFR y 164.4 10. and
any security incident.
• Notify the COUNTY'S I IIPAA Security Officer, I11PAA Privacy Officer, and
Grant Manager within 120 hours after finding a breach or potential breach of
personal and confidential data.
• Notify the COUNTY'S I iIPAA Privacy Officer and Grant Manager within 24 hours
of HHS notification of any investigations, compliance reviews, or inquiries
concerning violations of 1 iIPAA.
• Provide additional information requested by the COUNTY for investigation of or
response to a breach.
• Provide, at no cost. notice to affected parties within 30 days of determination of
any potential breach of personal or confidential data of the Department (§ 501.171.
F.S.): implementation of the COUNTY'S prescribed measures to avoid or mitigate
potential injury to any person due to a breach or potential breach of personal and
confidential data of the COUNTY; and, immediate actions limiting or avoiding
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recurrence of any breach or potential breach and any actions required by applicable
federal and state laws and regulations regardless of the COUNTY'S actions,
• In accordance with 45 CFR § 164.502(c)(1)(ii) and 164.308(h)(2), as applicable.
ensure all entities creating. receiving, maintaining, or transmitting P111 on the
SUBRECIPIENT'S behalf are bound to the same restrictions. conditions. and
requirements as the SUBRECIPIENT by written contract or other written
agreement meeting the applicable requirements of 45 CFR § 164.504(c)(2) that the
entity will appropriately safeguard the P111. For prior contracts or other
arrangements, the SUBRECIPIENT shall provide written certification its
implementation complies with 45 CFR § 164.532(d).
• Make PHI available in a designated record set to the COUNTY as necessary to
satisfy the COUNTY'S 45 CFR § 164.524 obligations.
• Make any amendment to PHI in a designated record set as directed or agreed to by
the COUNTY. per 45 CFR § 164.526,or take other measures as necessary to satisfy
the COUNTY'S 45 CFR § 164.526 obligations.
• Maintain and make availahle the information required to provide an accounting of
disclosures to a covered entity as needed to satisfy the COUNTY'S 45 CFR §
164.528 obligations.
• To the extent the Si1BRECIPIENT carries any obligation under 45 CFR Subpart E.
comply with the requirement of Subpart E that apply to the COUNTY in the
performance of that obligation; and
• Make internal practices, books, and records available to HHS for determining
1-IIPAA rule compliance.
4.24 COUNTY Notifications Affecting SUBRECIPIENT Disclosure of PHI. The COUNTY
will notify the SUBRECIPIENT. to the extent it may affect SUBRECIPIENT'S use or
disclosure of P1II, of 45 CFR § 164.520 limitations in the Notice of Privacy Practices; of
changes in. or revocation oil an individual's permission to use or disclose PHI; or of any
restriction on the use or disclosure of PHI information the COUNTY has agreed to or is
required to abide hy under 45 CFR § 164.522.
4.25 Termination Regarding PHI.
• Termination for Cause. Upon the COUNTY'S know ledge of a material breach of the
SUBRECIPIENT'S duties under 4.20 above, the COUNTY may: (a) provide the
SUE3REC1PIEN'T opportunity to cure the breach within the COUNTY'S specified
timeframe; (h) immediately terminate the Agreement or discontinue access to PHI; or
(c) if termination or cure are not feasible, the COUNTY will report the breach to the
Secretary of HHS.
• SUBRECIPIENT obligations under Termination. Upon termination,
SUBRECIPIENT. with respect to PHI received From the COUNTY. or created.
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maintained, or received on behalf of the COUNTY, will: (a) retain on PHI necessary
to continue proper management and administration or to carry out legal
responsibilities: (b) return PHI not addressed in (a) to the COUNTY or its designee:
(c) upon the COUNTY'S permission,destroy PHI the SUBRECIPII?NT maintains in
any form: (d)continue to use appropriate safeguards and comply with Subpart C 0145
CFR 164 with respect to electronic PHI to prevent use or disclosure of PHI, other than
as provided for in (a) for retained Pi II: (e) not use or disclose retained PHI other than
for purposes for which PHI was retained and subject to the same conditions that
applied prior to termination: and (f) comply with(b) and (c) when retained PHI is no
longer needed under(a)
a Obligations in the preceding paragraph survive termination.
The SUBREC1P1ENT represents and warrants that no part of the funding under this
Agreement will be used in violation of any federal or state law. including but not limited
to. 8 U.S.C. §1324 or 8 U.S.C. §1325. or to aid or abet another in violating lederaI or state
law. The COUNTY may terminate this Agreement at any time if the SUBRECIPII_•:NT
violates or aids or abets another in violating any state or federal law.
4.26 Public Entity Crime and Discriminatory Contractors. Pursuant to §287.133 and 287.134.
F.S.. the following restrictions are placed on the ability of persons placed on the convicted
vendor list or the discriminatory vendor list. When a person or affiliate has been placed on
the convicted vendor list following,a conviction for a public entity crime. or any entity or
affiliate has been placed on the discriminatory vendor list, such person. entity, or affiliate
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 or real property to a public entity: may not he awarded or perfhrm work
as a contractor, su_pplier.subcontractor, or consultant under a contract with a public entity;
and may not transact business with any public entity: provided, however. that the
prohibition on persons or affiliates placed on the convicted vendor list is limited to business
in excess of the threshold amount provided in 287.017. F.S.. for CATEGORY TWO for
36 months from the date of being placed on the convicted vendor list.
4.27 PRIDE. it is expressly understood and agreed that any articles which are the subject of. or
required to carry out. this Agreement shall be purchased from the corporation identified
under Chapter 946, F.S., in the same manner and under the samc procedures set forth in
,;946.515(2) and (4). F.S.: and for purposes of this Agreement, the person. firm, or other
business entity carrying out the provisions of this Agreement shall be deemed to be
substituted for this agency insofar as dealings with such corporation are concerned.
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4.28 Continuing Oversight Teams. The SI.'RRECIPIENT shall comply with the provisions of
,`;287.057(26). F.S., as applicable;, establishing and governing conduct of Continuing
Oversight Teams for contracts of S5 million or more.
4.29 Major Disasters and Emergencies. The Stafford Act allows federal assistance for major
disasters and emergencies upon a declaration hy the President. Upon the declaration. the
COUNTY is authorized to apply for federal reimbursement from the Federal Emergency
Management Agency (FEMA) to aid in response and recovery from a major disaster. The
SUBRECIPIENT shall request reimbursement for eligible expenses through the COUNTY
with payment subject to FEMA approval and reimhursement.
4.30 Executive Compensation Reporting. Annually on or before May 1, SUBRECIPII N I shall
complete and return the Executive Compensation Annual Report (Form PCMT-08).
located at:
Itttps:1/n11 tlfain illes.eom/sites/default/files/2025-
03/Fxecuti ve°%o20Compensation%20Annual%2()Report (Lpdf.
In accordance with 216.1336. F.S., if the SUBRFCIP1ENT is a nonprofit as defined in
§215.97(2)(m). F.S.. SUBRECIPIENT must provide documentation to the COUNTY that
indicates the amount of state funds:
• Allocated to be used during the full term of the Agreement for remuneration to and
member of the Board of Directors or an officer of the contractor.
• Allocated under each payment by the COI IN'l'Y to he used for remuneration of ant•
member of the Board or Directors or an officer of the contractor. The
documentation must indicate the amounts and recipients of the remuneration.
If the SUBRECIPIENT maintains a website, information provided pursuant to the
statement above must he posted on the website.
4.31 Recycled Products. The SUBRECIPIENT shall procure any recycled products or materials.
which are the subject of or are required to carry out this Agreement, in accordance with
§403.7065, F.S.
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EXHIBIT A
(Sec Attachment)
COLLIER COUNTY RESOLUTION 2021436
(Florida Plan)
RESOLUTION NO. 2021-_Elf;
A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF
COLLIER COUNTY,FLORIDA,AUTHORIZING COLLIER COUNTY TO
JOIN WITH THE STATE OF FLORIDA AND OTHER LOCAL
GOVERNMENTAL UNITS AS A PARTICIPANT IN THE FLORIDA
MEMORANDUM OF UNDERSTANDING AND FORMAL AGREEMENTS
IMPLEMENTING A UNIFIED PLAN.
WHEREAS,Collier County has suffered harm from the opioid epidemic;and
WHEREAS,Collier County recognizes that the entire State of Florida has suffered harm
as a result from the opioid epidemic;and
WHEREAS,the State of Florida has filed an action pending in Pasco County,Florida,and
a number of Florida Cities and Counties have also filed an action In re: National Prescription
Opiate Litigation,MDL No.2804(N.D.Ohio)(the"Opioid Litigation')and Collier County is not
a litigating participant in that action;and
WHEREAS, the State of Florida and lawyers representing certain various local
governments involved in the Opioid Litigation have proposed a unified plan for the allocation and
use of prospective settlement dollars from opioid related litigation;and
WHEREAS,the Florida Memorandum of Understanding (the"Florida Plan") sets forth
sets forth a framework of a unified plan for the proposed allocation and use of opioid settlement
proceeds and it is anticipated that formal agreements implementing the Florida Plan will be entered
into at a future date;and
WHEREAS, participation in the Florida Plan by a large majority of Florida cities and
counties will materially increase the amount of funds to Florida and should improve Florida's
relative bargaining position during additional settlement negotiations;and
WHEREAS, failure to participate in the Florida Plan will reduce funds available to the
State,Collier County,and every other Florida City and County.
NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF
COMMISSIONERS OF COLLIER COUNTY,FLORIDA:
SECTION 1.That participation in the Florida Plan would be in the best interest of the
Collier County and its citizens in that such a plan ensures that almost all of the settlement funds
go to abate and resolve the opioid epidemic and each and every city and county receives funds for
the harm that it has suffered.
SECTION 2.That the Collier County Board of County Commissioners hereby expresses
its support of a unified plan for the allocation and use of opioid settlement proceeds as generally
described in the Florida Plan,attached hereto as Exhibit"A."
lzt 51- 2sa/t64I7s4/1;
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SECTION 3. That the Collier County Board of County Commissioners is hereby
expressly authorized to execute the Florida Plan in substantially the form contained in Exhibit"A."
SECTION 4. That the Collier County Board of County Commissioners is hereby
authorized to execute any formal agreements implementing a unified plan for the allocation and
use of opioid settlement proceeds that is not substantially inconsistent with the Florida Plan and
this Resolution.
SECTION S. That the Clerk be and hereby is instructed to record this Resolution in the
appropriate record book upon its adoption.
SECTION 6. The Clerk of the Collier County Board of County Commissioners is hereby
directed to furnish certified copies of this Resolution to:
Attorney General Ashley Moody Florida Association of Counties
clo John M.Guard 100 South Monroe Street
The Capitol, PL-0 I Tallahassee,FL 32301
Tallahassee,FL 32349-1050
SECTION 7.All resolutions inconsistent or in conflict herewith shall be and are hereby
repealed insofar as there is conflict or inconsistency.
SECTION 8. If any section,sentence,clause, or phrase of this Resolution is held to be
invalid or unconstitutional by any court of competent jurisdiction,then said holding shall in no
way affect the validity of the remaining portions of this resolution.
SECTION 9. This Resolution shall take effect immediately upon its adoption.
PASSED AND DULY ADOPTED by the Board of County Commissioners of Collier
County,Florida,this 22"4 day of Junc ,2021.
ATTEST: BOARD OF t c 1I I 1 COMMISSIONERS
Crystal K.Kiuiel.,Clerk of Courts C'01 I.IER i c t.,'%:`,.11 . 1 u iR l l l+y
d*//4
LJk43d.� CL' q e • By: -` (1.4411
�
By
-
AItem aS tb Clerk Penny 7 avli,r,Chair
S.:gn3ture only. .
1,pr$1).e4 a to form and legality:
1
Colhen A.Kerins u;a
Assistant County Attorney\ •ir•,f• C �h�,. jr.n '
�r� V `�-Y.• tJ"ASi rbp '��:.qr"h;
Wzdy eye.;
1
[2LiHr-00250/1M27M/11 `�- <<Elt C.O.
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' EXHIBIT
PROPOSAL
\11'MO11.1NDU11 t)1 l'NDFRSr1ND[Nt;
Whereas, the people of the State of Florida and its communities have been harmed by
misfeasance, nonfeasance and malfeasance committed by certain entities within the
Pharmaceutical Supply Chain;
Whereas, the State of Florida, through its Attorney General, and certain Local
Governments, through their elected representatives and counsel, are separately engaged in
litigation seeking to hold Pharmaceutical Supply Chain Participants accountable for the damage
caused by their misfeasance,nonfeasance and malfeasance;
Whereas,the State of Florida and its Local Governments share a common desire to abate
and alleviate the impacts of that misfeasance, nonfeasance and malfeasance throughout the State
of Florida;
Whereas, it is the intent of the State of Florida and its Local Governments 10 use the
proceeds front Settlements with Pharmaceutical Supply Chain Participants to increase the amount
of funding presently spent on opioid and substance abuse education,treatment and other related
programs and services, such as those identified in Exhibits A and B,and to ensure that the funds
are expended in compliance with evolving evidence-based"best practices";
Whereas, the State of Florida and its Local Governments. subject to the completion of
formal documents that will effectuate the Parties' agreements. enter into this Memorandum of
Understanding("MOU'')relating to the allocation and use of the proceeds of Senlements described
herein;and
Whereas, this MOU is a preliminary non-binding agreement between the Parties, is not
legally enforceable:and only provides a basis to draft formal documents which will effectuate the
Parties'agreements.
A. Definitions
As used in this MOU:
1. "Approved Purpose(s)" shall mean forward-looking strategies, programming and
services used to expand the availability of treatment for inuivid.!.ils impacted by substance use
disorders, to: (a) develop, promote, and provide evidence-based substance use prevention
strategies; (b) provide substance use avoidance and awareness education; (c) decrease the
oversupply of licit and illicit opioids;and(d)support recovery from addiction. Approved Purpose
shall include, hut are not limited to, the opioid abatement strategics listed on Exhibits A and H
which arc incorporated herein by reference.
2. "Local e'ovcrnlnents" shall mean all counties, cities, towns and villages located
within the geographic boundaries of the State.
3, "Managing Entities" shall mean the corporations selected by and under contract
with the Florida Department of Children and Families or its successor("DCF") to manage the
a04063Va112! t
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daily operational delivery of behavioral health services through a coordinated system of care.The
singular"Managing Entity"shall refer to a singular of the Managing Entities.
4, "County" shall mean a political subdivision of the state established pursuant to s
I,Art.VIII of the State Constitution.
5. ..Municipalities"cha;l mean cries.towns,or villages of: ["nun,v-within 'he State
with a I't pulation treater than I(r,000 :nd:vtduals and shall also inc:ude cities. tnwnc or villages
within the State with a Population equal to or les,(Lan 1.1.17pi1 indi iduals which tiled a Complaint
:n this Iitrgation against I'hatniucculic:ll S'uppi1 Clain "tlri,cipattt fltc singular Municipality-
shall refer to a singular of the Vtiltticipa:itics_
6. "Negotiating Committee" shall mean a three-member group comprised by
representatives of the following: (1)the Stale; and(2)two representatives of Local Governments
of suhtch one rcprcu'ttative will be from a Municipality and one shall be from a County
t collect ive.y.-\lrnthcrs")within the State. The State shall be represented by the Attorney General
or her designee.
7. "Negotr,rt;on Class Metrics"shall mean those county and city settlement allocations
which come from the official wcbsite of the Negotiation Class of counties and cities certified nn
September 11, 2019 by the U.S. District for the Northern District of Ohio in in re National
Prescription Opiate Litigation, MDI_ No. 2804 (N.D. Ohio). The website is located at
https://allocationmap.iclaimsonline.com.
8. "Opioid Funds"shall mean monetary amounts obtained through a Settlement as
defined in this MOU.
9. "Opioid Related"shall have the same meaning and breadth as in the agreed Opioid
Abatement Strategies attached hereto as Exhibits A or D.
10. "Parties"shall mean the State and Local Governments.The singular word'`Party"
shall mean either the State or Local Governments.
11. "PEG"shall mean the Plaintiffs'Executive Committee of the National Prescription
Opiate Multidistrict Litigation pending in the United States District Court for the Northern District
of Ohio.
12, "Pharmaceutical Supply Chain"shall mean the process and enamel.:ih:nigh which
Controlled Substances are manufactured,marketed,promoted,distributed o:,:r.l'rn s d.
13. "Pharmaceutical Supply Chain Participant"shall meant any entity that engages in,
or has engaged in the:n u:t:ts cture, marketing, promotion,distribution or dispensing of an opioid
analgesic.
14. "Population"shall refer to puhir:heri I S t-rncu: Bureau popu:atirn estimates as
of July 1,2019,released .lurch 2020.and shalt rema,n :incharge,1 during the term of this MOU
These estimates can currently he f-oarri at Mips:''w vuu censns.en\
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15. Qualified County shall mean a charter or non-chartered county within the State
that:has a Population of at least 300,000 individuals and(a)has an opinid taskforcc of which it is
a member.or operates in.onnccti,tt t+itit its burn:cip;tlitics or others nit a local or regional basis:
th1 has an abatement plan that has been either nd,yxed or is being utilized to respond to theopicid
epi,lernre:(c)rs currenti>.ctther pros ientg lir is rontrac•ting with others to pus ide .uhstance abuse
prexention.recovery,and treatment services to its citizens;and tilt has or enters into an agreement
with a majority of Municipalities (4lajorin is more than 5Y' of the Municipa.itic,:' total
population)related to the expenditure of Onioid Funds.The Opioid Funds to he n:.d to a Qualified
County will only include Orroid Funds for Municipalities whose claims arc released by the
Municipality or Opioid Funds for Municipalities whose claims are otherwise barred.
16. "SAMHSA" shall mean the U.S Department of I)earth & Human Services,
Substance Abuse and Mental Health Services.Administration.
17, "Settlement" shall mean the negotiated resolution of legal or equ.table claims
against a Pharmaceutical Stipp: Chain Participant when that resolution has been inrrt.y entered
into by the State and Local(internments or c settlement class as described in(lilt 1) heiott.
18. "State"shall mean the State of Florida.
B. Terms
1. Only Abatement-()titer tiitan, fords used for the Administrative Costs teal f:x,:•ense
fund as hereinatller described In paragraph 6 and paragraph`).respecttselyl.all Unit)d 1't.ftds shall
he tit i;ized lot Approve'hurpo:•Ls. To arcomnlislt ill:s purpi c,lire State will either Ili,-a•:ew.;tenon
with Local Government;a. Parties or add ;.o,ai Governments:,, t'.exist;ne se:t.m. setcr settic•c
defendants, and seek entry of a consent order or other order holding h,i:h the State. l_ueal
Governments,and Pharmaceutical Supply Chain Participator-ct ("aide(": f'hc Il:_in :tree, Ise 1-urr
of a class action settlement or similar device. the Order shall pros ide:or continuing jnrisdi:tiort of
a state court to address non-performance by any par'. nader the Older. Any l vial(rover entent that
objects to or refuses to be included under the Order or entry of documents necessary to effectuate a
Settlement shall not be entitled to any Opioid Funds and its portion of Opioid.Funds shall he
distributed to,and for the benefit of, the other Local Governments.
2. Avnid C law Bark and Recoupment-Both the State and Local Governments wish
to maximize any Settlement and C(pined Funds. In addition to committing to only using funds for
the Expense Funds,Atlminrstnc:ne Costs and Approved Purposes,both Parties It ell agree to utilize
a perct.ntage of funds for the cote strategies huh tghted in Exhibit A- Exhrr,: A contains the
programs and strategics pnortrtzed bs the t .S. Department of Justice and%or the U S. Department
of Health& human Services t`Corc Strategies"), The State is trying to obtain the United States'
agreement to limit or reduce the l:nued States'ability to recoscr cc recoup monies from the state
and Local Government in exchange for prioritization of funds to certain pu'cects, lino agreement
is reached with the United States,then there will be no requirement that a percentage be utilized
for Core Strategies.
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3. Distribution Scheme-AU Opioid Funds will to the State,and then be
distributed according to the following distribution scheme, The Funds will be divided into
three funds after deducting costs of the Expense Fund detailed in paragraph 9 below:
(a) C'a C:oun I und- The city/county fund will receive 15%of ail Opioid Funds to
drrcct:y her..cli•u;l C:at.ta}es and Municipalities, The amounts to be distributed to
each Col iwy.and tllu}:ieipality shall be determined by the Negotiation Class Metrics
or other metrics agreed upon,in writing.1w ;IC:oue:tydnr y;uu}rr,a'r I"or[.oral
Governments that are not within the octin}tian of Count) or !.t;rrc:iplilit}. tliuee
Local Governments may receive that gn1'er:uncnt•s sharc of the t }rs Count. F'r:n,l
under the Negotiation Class}Metrics, if that government e\ccutes a release as pal
of a Settlement. Any Local Government that is not..i:hin the definition(If t.,hint)
or Municipality and that does not exc:,ate n rel;a,,c par of a Settlement sl:ell
have its share of the City/County Fund go to the County in which it is located
(b) Revional Fund•The regional fund will be subdivided into two parts.
(i) The State will annually calculate the share of each County within the Sta:c
of the regional fund utilizing the sliding scale in section 4 ol•the allocation
contained in the Negotiation Class Metrics or other metrics that the Parties
agree upon.
(ii) Fur[Qualified Counties,:he Qualifies t'r+ur-rv's t-hurc sill be paid to the
Qualified County an,-; expended on :\pprnlcd Purunes, including the
Core Strategies :den';led in Exhibit A.it ai+pltcahle.
(iii) For,i.l n;;ret l •ant:C .::1c'rci:on.11 :i1,11C for Cash("paw. ..ill 1•C['Aid to
rho\l.rt.r,2i'=1; i.-m::ti.s hr• ric:ag sc,.tern t;rr that lbu::t\. 1 he \i;lr;.}gu}
I•ntitres r':;Il he require.: to mnl:icy o r' \ppru.
•ncl:ulini the Con- strategies Inc \Lra,i itr Ft;t}::ec shall e'idcacor to
the greatest e\tcut pos>rhle to expend these monies on counties within
the State that are non-Qualified Counties and to ensure that there arc
services in every County.
(c) State Fund - The remainder of Opioid Funds after deducting the costs of the
Expense Fund detailed in paragraph 9,the City/County Fund and the Regional Fund
will be expended by the State on Approved Purposes, including the provisions
related to Core Strategies,if applicable.
(d) To the extent that Opioid Funds are not appropriated and expended in a year by the
State, the State shall identify the investments where settlement funds will be
deposited. Any gains, profits, or interest accrued from the deposit of the Opioid
Funds to the extent that any funds are not appropriated and expended within a
calendar year,shall be the sole property of the Party that was entitled to the initial
deposit.
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4. Regional Fund Sliding Scale-The Regional Fund shall be calculated by utilizing
the following sliding scale of the Opioid Funds available in any year:
A. Years 1-6: 40%
R. Years 7-9: 35%
C. fears 10-12: 34%
D. Years 13-15: 33%
L. Years 16-18: 30%
i Opurid Abatement l:l:•itforce +;r i'or.nLil - cic;r'e ;IF O:11,:u,1
ah,ttentent '?'askfnrcc.or Council t.nntelancs hcrc neiicr"1a4, tree-or"Council-) to adtise the
(rovcrnnr. the Legiclature. 1 iorid_t's Department of ('hiid:cr. .l
Ci01 etnrrentsen the prior:Ites tha'sI'o:tld be:odres;ed as p.trt of th.irp:t+:c cpldctnic and to ret
hots totin:es have beer spent anal the:e of;;';ra[hive been orh:ctcd tt ira Opit'ld l .ad
(a) Size-The Taskforce or Grn,i;shall have ten Members equally balanced between
the State and the Local(i ter::nutnts.
11) -1,•_uinilnents I.or. lr.•tenrnenr. - .ttn ,l?;r,;:ciha'ity represert.iI;ve, trill 're
appointed by of th:i'ur l: 1 i +::d i I.e ootie t )( trees 'v.+'coiintt reptc.,ental inc
t;oin a Qualified ('non:v and. ,Fete fren: co.r;tt v.-thin the State that nu: a
Curt]:lied Ceutrt). tvt ; ht arpuin'ed in ,t 'nrnutit the t,.i+riti.r r\:,+t,iation �t
Counties The fin.i: rcpresent:tl.ve ui:1 alternate even ttto ve.rrs her ecn hcinfr a
county representative(.rpp.tinmod by or Borough Florida Aisocia+ion r;'.('tuaties)or
a Municipality rcprctentativc ?arpoin[ed b? to *roagl the 1-luraia I :ague
( 11te:), Ot'e Nitinlclpa.1:1 rei'rta�ntrult'i. ;*iwit be from a ui 1C:s than 50.0(10
pc„p:c One counts represenlalivc most he from a c'.,'-t:1:� .c s il'.►n'_fl.i i)I:C+pcu is
and the other count!: rol'•r,orta;tvo n;;i:st h: From ;t count:. w1 ose poplation
,,,,ccrd. 1)Il,rN tO Jk,,ltlt.
(c) Apnoini n:uti, State-
(i) The Governor shall appoint two Members
(ii) The Speaker of the House shall appoint one Member,
(iii) 7 he Senate President shall appoint one Member.
(iv) The Attorney General.or her designee shall be a Member
(d) Chair-The Attorney General or designee shall be the chair of the Taskforce or
Council.
(e) Term-Members will be appointed to serve a two-year term.
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(f) Support-DC17shall support the Taskforce or Council and the Taskforce or Council
shall be administratively housed in DCF.
(g) Alec:in_s Ti.'Taskforce or Council shall meet quarterly in person or virtually
using communications media technology as defined in section I20.54(5)(b)(2),
I:i rind Statutes,
(h) Re.poniiag-The Taskforce or Council shall provide and publish a report annually
no iatcr than November 30th or the first business day after November 30th, if
November 30th fails on a weekend or is r•.rlt;Ir:tsc ran: ;:husinec.ti day. The report
ci'rl!1 nrttain anforma1 •n on ',+ monies were _meta fite tares i,'us.fiscal year its the
State,c,tell r•f tar(,tu,t'Itied i ;n ttie ,each r; the \I Irrat:i'Ig I angles,and ercn rd
the L.ne,:I t;a.cr'tt+:,oi:,, It shall also .infant :<<r a'r:ri:,::,:i, .s to the Goven; m.
ix i e,i'lat:::e, and Local Govern-rents !',n plot: .e ,.ct,',ng the Appi i c.?
Par-pose:: for itos( monies should he-peat the e mlrr_ i +e,tl e.ir to respond', tl•c
.ptuici epidemic
(i) lccot:nla:alit. - Prior to i,aly I s; of edit sear. ti r ,S;ate .'id each r1 the ; (near
(Joveramc rats steal. provide iltf'r'taaaurt to 0( I- drioir how the\ intend ,o expene
Opioid Funds r d:c upce'rnintt fiscal year 1 he State au.1 each of the l_ncat
Government shall report Its expendi'urcc to l:)C'! rat later t'.t<,n:\ut_mt 111 st !err the
previous fiscal)ear Hie I alk'brce or Council will set other data sets that reed II,
be repn:ted to I)t'I- to ecr•a,nsttau the e:'Itectiveness of \pprr•e Purposes -1'I
programs and :'\pendita:es shad he :tan itcd annually in a similar faslaton
SA\•1HIA program-. Local (iosernments shall respond and provide documents to
any reasonable requests from the State for data or information about programs
receiving Opioid Funds.
U) C:oniTn..of!nlerest -All Me'nbers shall ad:ere h,'.;r(:ties,leeulahons:a::e:.aws of
1 orid.a including, but not hntite l to, §11.' Ti s I cotLerlling the
discln,urc of conflicts of intcrc'•', and rccusal firm disc.rssinns or \rates on
conllrcted mattes.
G Admini+Irati%c Cost.-.I I',: State rats take III mole than a 5% administrative fee
from the State Fund i'Aclminis:rativc Co:-I.-1 and tam Rezi,rr.aI i urn that it a.lrainisters for
counties that arc not (irt a'.iti.(l t onnrI S. l•act.: Ot.i:dlied C'uunt', :nay take no It;are than a 5%
administrative fee from its chore of Mc Region it I ,tndF.
7. Negotiation of Non-Multistate Settlements-lithe State begins negotiations with
a Plltarntaeeuti,:al Suppl)('nail]I'.rii.;pa;a that Iti tiers^ratc and apart tr<t❑a n't..ti-stale negnt atir•n.
sane State sLali include Local Gus:nown's Ih.tl are s hnrl •,f the 1c•t,atalan Committee ;a
negotiations. No Seakntenl lh.lt: tie reconanaendeut o; ae.epted\satlI'icit the ,Iiirma'ive s, le, of
both the State:Ind I oral[noel-omen:rip tescrtaiiscs of the Negotiating Committee.
8. Negotiation of Multistate or Local Government Settlements - To the extent
practicable and atloswd by other parties to a negotiation,both Parties agree to communicate with
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members of the Negotiation Committee regarding the terms of any other Pharmaceutical Supply
Chain Participant Settlement.
9. Expense Fund-The Parties agree that in any negotiation every efton shall he made
to cause Pharmaceutical Supply Chain Participants to pay costs of litigation, including attorneys'
fees. in addition to any agreed to Opioid Funds in the Settlement. To the extent that a fund
sufficient to pay the entirety of all contingency tee contracts fut Local Governments in the State
of Horida is not created as part of a Settlement by a Pharmaceutical Supply Chain Participant,the
Parries agree that an additional expense fund for attorneys who represent Local Governments
(herein"Expense Fund")shall be created out of the City'County Fund For the purpose of paying
the hard costs of a litigating Local Government and then paying attorneys'fees.
(a) The Source of.Funds for the Fxt'ense 1 mid-Money for the Expense Fund shall be
sourced exclusively from the City:County Fund.
(b) The Arm-mint of the(expense Fund-The State recognizes the value litigating Local
Covenunents bt:nr to the State of Florida in connection with the Settlement
because their participation increases the amount incentive Payments due from each
Pharmaceutical Supply Chain Participant. in recogniimit of that value.the amount
of fiords that shall be deposited into the Expense fund shall he contingent upon on
the percentage of litigating Local Governoicnt participation in the Settlement.
according to the following table
Litigating Local Government Amount that shall be paid
Participation in the into the Expense Fund
Settlement(by percentage of from(and as a percentage
the population of i the Cih/Count; fund
96 io 100% _ 10%
91 to 95% 7.5%
86 to 90% 5%
85% 2.5%
Less than 85% 0%
If fewer than 85% percent of the litigating Local Governments (by population)
participate,then the Expense Fund shall not be funded,and this Section of the MOU
shall be null and void.
(c) The Timin_ of Pa,ments into the Exi'cnse Fund- Although the amount of the
Expense Fund shall he calculated based on the entirety of pay nients due to the
City!('ounty fund over a ten to eighteen year period, the Expense Fund shall be
funded entirely from payments made by Pharmaceutical Supply Chain Participants
during the first two years of the Settlement Accordingly, to offset the amounts
being paid from the City.County to the Expense Fund in the first two years.
Counties or Municipalities may borrow from the Regional Fund during the first two
years and pay the borrowed amounts back in the Regional Blind during years three.
I'rur.and five,
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For the avoidance of doubt. the following provides an illustrative example regarding the
calculation of payments and amounts that may be borrowed under the terms of this MOU,
consistent with she provisions of this Section:
Opioid Funds due to State of Florida and Local Governments(over 10 in 18 years): S 1,000
Litigating Local Government Participation: 100%
City/County Fund(over 10 to 18 years): $150
Expense Fund(paid over 2 years): $15
Amount Paid to Expense Fund in 1st year: $7.5
Amount Paid to Expense Fund in 2nd year $7 5
Amount that may be borrowed from Regional Fund in 1st year: $7.5
Amount that ntay be borrowed from Regional Fund in 2nd year: $7.5
Amount that must be paid hack to Regional Fund in 3rd year: 55
Amount that must he paid back to Regional Fund in 4th year: $5
Amount that must he paid hack to Regional Fund in 5th year. $5
(d) Creation of ancl,Jtlriscliction over the Expense Fund- The Expense Fund shall be
established,consistent with the provisions of this Section of the MOL!, by order of
the Circuit Court of the Sixth Judicial Circuit in and for Pasco County,West Pasco
Division New Port Richey,Florida,in the matter of The Stale of Florida. (JJJice of
the Attorney General, Deparunent q/Legal 4frir, r Purdue Phca'rnu 1,P., et al..
Case No. 2018-CA-001438 (the"CourC). The Court shall have jurisdiction over
the Expense Fund, including authority to allocate and disburse amounts from the
Expense Fund and to resolve any disputes concerning the Expense Fund.
(e) Allocation of PaY menus to Counsel from the Expense Fund- As part of the order
establishing the Expense Fund,counsel for the litigating Local Governments shall
seek to have the Court appoint a third neutral to serve as a special master for
purposes of allocating the Expense Fund. Within 30 days of entry of the order
appointing a special master for the Expense Fund,any counsel who intend to seek
an award from the Expense Fund shall provide the copies of their contingency fee
contracts to the special master. The special master shall then build a mathematical
model,which shall he based on each litigating local Government's share under the
Negotiation Class Metrics and the rate set forth in their contingency contracts, to
calculate a proposed award for each litigating Local Government who timely
provided a copy of its contingency contract.
10. Dispute resolution-Any one or more of the Local Governments or the State may
object to an allocation or expenditure of Opioid Funds solely on the basis that the allocation or
expenditure at issue(a) is inconsistent with the Approved Purposes; (h) is inconsistent with the
distribution scheme as provided in paragraph 3,or(c)violates the limitations set forth herein with
respect to administrative costs or the Expense Fund.There shall be no other basis for bringing an
objection to the approval of an allocation or expenditure of Opioid Funds.
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Collier County
Community & Human Services Division
EXHIBIT IG
INCIDENT REPORT FORM
Organization Name: j David Lawrence Mental Health Center
Organization Address: 6075 Bathey Lane,Naples,FL 34116
Project No: R024-01 DLC Opioid
Grant Coordinator:
Date of Incident —1 Time of Incident: 1
Report Submitted By: (Name
& Phone)
Description of Incident:
Location/Address of Incident.
Was Police Report Filed? j❑ Yes 0 No
if Yes,Police Report Number: Jurisdiction:
Were there any warning signs that this type of Incident could occur? ❑Yes .❑No
If Yes,Explain:
What actions will be taken to prevent a recurrence of a similar incident?
I certify under penalty of perjury under F.S. 837.06 that the contents of this affidavit are true and correct.
Signature of Person Making Report Date
Printed Name
Title
Return completed form to: Kristi Sonntag, Director,CHS
Collier County Community and Human Services Division
3339 Tamiami Trail East, Bldg. H,Suite 213
Napit., FL 34112 Fax: r_,ot 252-2638
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EXHIBIT H
COLLIER COUNTY COMMUNITY &HUMAN SERVICES
WHISTLEBLOWER PROTECTIONS AFFIDAVIT
SUBRECIPIENT Name: David Lawrence Mental Health Center, Inc
SUBRECIPIENT Address: 6075 Bathey Lane,Naples, FL 341 16
Project Name: Opioid Abatement Funds
Project No: 2024-0I DLC Opioid
In accordance with 2 CFR200.217 and 41 U.S.C. § 4712, SUBRECIPIENT may not discharge, dcmotc, or
otherwise discriminate against an employee in reprisal for disclosing to any oldie list of persons or entities
provided below, information that the employee reasonably believes is evidence of gross mismanagement
of a federal contract or grant, a gross waste of federal funds, an abuse of authority relating to a federal
contract or grants, a substantial and specific danger to public health or safety, or a violation of law, rule,or
regulation related to a federal contract(including the competition for or negotiation of a contract) or grant.
The list of persons and entities referenced in the paragraph above includes the following:
• A member of Congress or a representative of a committee of Congress
• An Inspector General
• The Government Accountability Office
• A Treasury employee responsible for contract or grant oversight or management
• An authorized official of the Department of Justice or other law enforcement agency
• A court or grand jury
• A management official or other employee of SUBRECIPIENT, contractor, or subcontractor who
has the responsibility to investigate, discover,or address misconduct
SUBRECIPIENT shall inform its employees in writing of whistleblower rights and remedies provided
under section 41 U.S.C. §4712, in the predominant native language of the workforce.
By signing this affidavit, I certify that Subcontractor Name will comply with all Whistleblower rights and
protections for its employees.
Name:
Signature:
Title:
N'oui_ttyped name here represents your electronic signature
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David Lawrence Mental I Iealth
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Opioid Settlement
I6P8
EXHIBIT I
DEPARTMENT OF ELDER AFFAIRS
BACKGROUND SCREENING
ATTESTATION OF COMPLIANCE - EMPLOYER
AUTHORITY:ALL EMPLOYERS are required to annually submit this form attesting to
clanplianrce with the provisions of chapter 435 and section 430.0402 of the Florida Statutes.
The term employs"means any person or entity myurrc•d he lan to conduct background screenings,rnaudinp
but not limited to,Area Agencies on AgingiAging and Disability Resource Courts,Lead Agencies,and Service
Providers that contract directly or indirectly with the Department of Elder Affairs(DOE A),and any other person
or entity which hires employees or has volunteers in service who meet the definition of a direct service provider.
See§§435,02,430.0402,Fla.Stat.
A direct service provider is"a person 18 years of age or older who,pursuant to a program to provide services to
the elderly,has direct,face-to-face contact with a client while providing services to the client and has access to
the client's living areas,funds.personal property,or personal identification information as defined in s.817.568.
The term also includes,but is not limited to,the administrator or a similarly titled person who is responsible for
the day-to-day operations of the provider,the financial officer or similarly titled person who is responsible for the
financial operations of the provider, coordinators, managers, and supervisors of residential facilities, and
volunteers,and any other person seeking employment with a provider who is expected to,or whose responsibilities
may require him or her to,provide personal care or services directly,to clients or have acccws to client funds,
financial matters,legal matters,personal property,or living areas."§430.04.02(1)(b),Fla.Stat.(2023).
ATTESTATION
As the duly authorized representative of: _
(Name of Employer)
Located at _
Street address City State Zip Code
Under penally of perjury, I. _
(Name of Representative)
hereby swear or affirm that the above-named employer is in compliance with the provisions of chapter
433 and section 430.0402 of the Florida Statutes,regarding level 2 background screening.
Signature of Representative Date
DOEAForm 235,Anestation of Compliance-Employer,Effective October 2023,F.S
Form available at:https •elde rat bon ere at.u;.u:bul}round-screerrn_l:>ut mind strernirv_LI,.rrineliou. teunrrr -
.r,:ecsrvrR-the-c fannghou,c
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David Lawrence Mental Health
2024-0 1 Amendment 42
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EXHIBIT.'
Dept.of Children and Families Executive Compensation Report
Executive Compensation Annual Report
Instructions:Upon entering into a contract with the Department of Children and Families(Department),and
annually by May 1 of each year,providers in a contract with the Department must complete Sections 1 and 2 of
this form, and Section 3 if required.Completion of this document is required to comply with the Federal
Funding Accountability and Transparency Act(FFATA)and Executive Order 20-44.All references to entity or
contract(s) in Sections 2 and 3 shall refer to the Entity and Contract(s)identified in Section 1. Upon completion
submit this form to the relevant Department Contract manager(s)
Section 1:Attestation
I swear(or affirm)to my authority to make binding representations on behalf of the entity listed below,the
information contained in this document is accurate and complete to the best of the below-listed entity's
knowledge,and both I and the below-listed entity intend the Department rely upon the information contained in
this document
Entity Name
Department Contract Numbers UEID Number
Printed Name of Authorized Person
Signature of Authorized Person Date
STATE OF FLORIDA
CDUNTYOF
Sworn to (or affirmed)before me by means of❑physical presence or❑online notarization,this day
of ,20_,by
Signature of Notary Public-State of Florida
Personally Known OR Produced Identification
Type of Identification Produced:
Section 2:Qualifying Questions
1) Did one or more of the contract(s) result from the Entity being named in federal law or Florida Statutes
(substantive or appropriation)as the required recipient of a single source,public-private agreement?
❑Yes ❑No
2) During the preceding fiscal year,did the Entity receive 50%or more of its budget from either the State of
Florida or from a combination of State and Federal funds?
❑Yes G No
3) During the preceding fiscal year,did the Entity: (a)receive more than$25 million in total federal funding,(b)
the federal funds so received accounted for mere than 80%of the Provider's annual gross revenue,and (c)was
the compensation of top five executives for the preceding fiscal year not available publicly?
G Yes ❑No
If the answer to any question in this section is Yes,you must proceed to and complete Section 3 Otherwise,
submit this form to your relevant Department Contract Manager.
PCMT-08
Effective February 15. 2023
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David Lai;rencc Menial Health
2024-0 I Amendment 42
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Section 3:Annual Executive Compensation Report
Attach the latest copy of the Entity's most recent IRS Form 990 and complete the following lithe IRS 990
form is unavailable for the last fiscal year, please explain why
List the Entity's current directors,board members,chief executive officer,chief financial officer,chief operating
officer,and any other person performing equivalent functions by their title,total annual compensation,and the
percentage of compensation from state(FL%)or federal (Fed%)allocations.If any executive compensation
changes prior to the next annuai report,the Entity must submit an updated version of this report with those
changes,and their total annual compensation. Total annual compensation includes salary, bonuses,cashed-
in-leave,cash equivalents,paid personal leave,severanco pay,retirement benefits,deferred compensation,
real-property gifts,and any other payout[see also 17 CFR 229 402(c)(2)J Include the percentage of the total
compensation directly from the state or federal allocations to the contracted entity. If any of the above-listed
persons also receive compensation from organizations that:(a)created or were created by the Entity;(b)that
were created by any of the above-listed persons whose compensation therefrom also derives from state or
federal allocations;or(c)contract with the Entity,then identify the organization(s),their relationship with the
Entity or the above listed person,and that person's annual compensation from each such organization,and
the percentage of that compensation from state(FL%)or federal(Fed%)allocations.The Entity is not
required to disclose the additional compensation a person receives from organizations that contract with the
Entity if the above listed person was identified solely upon the person's status as an uncompensated member
of the Entity's board of directors,whatever the person's actual title in the organization.
Name Title Total Annual FL% Fed% FL&Fed
Compensation %(Total)
PCMT•0.9
Effective Feb 15 2023 2
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IN WITNESS WHEREOF, the SUBRECIPIENT and the COUNTY, have each,
respectively, by an authorized person or agent,hereunder set their hands and seals on the date first
written above.
ATTEST: AS TO COUNTY:
CRYSTAL_K. I L, CLERK
;� ' BOARD OF COUNTY COMMISSIONERS OF
' COLLIER COUNTY, FLORIDA
f:.: Deputy Clerk
tte# o h i ta' n's By: i
*nati4_141404--
ure
B RT L. SA DERS, CHAIRPERSON
Dated:_ _7 0�
al
(SEAL) Date: 7/3 ( 25
AS TO SUBRECIPIENT:
W TNESS S:
DAVID LAWRENCE MENTAL HEALTH
CENTER, INC.
li ess #1 Signature
ke ut w B
' ess#1 P inted Name SC T URGES' , PRESIDENT& CEO
Witness#2 ignature Date: / ;cif
t2el•i l ' 4NA5T,(Zoki [Please provide evidence of signing authority]
Witness#2 Printed Name
If
Approv: . to ) i and legality:
I
-..re i if iiya,
Jeffrey A 1 4 Iatz ow
County l orne
Date: _ i S _
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David Lawrence Mental Health
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