Backup Documents 09/09/2025 Item #16F 1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 F 1
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
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.
ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with
the exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney's Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Risk Risk Management
2. County Attorney's Office County Attorney's Office
4. BCC Office Board of County
Commissioners ,I$ /
4. Minutes and Records Clerk of Court's Office ( /�
5. Procurement Services Procurement Services
PRIMARY CONTACT INFORMATION
Normally,the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event
One of the addressees above may need to contact staff for additional or missing information.
Name of Primary Staff Francheska Correa/Procurement Contact Information 239-252-6020
Contact/Department
Agenda Date Item was September 9,2025 Agenda Item Number 16.F.1
Approved by the BCC
Type of Document Amendment Number of Original 1
Attached Documents Attached
PO number or account N/A 11-5776 Medical Examiner
number if the Medical Examiner Services.
document is to be Services.
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 N/A
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
provide the Contact Information(Name,Agency,Address,Phone)on an attached sheet.
3. The original document has been signed/initialed for legal sufficiency. (All documents to FC
be 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 FC
document or the fmal negotiated contract date,whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's FC
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's 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 September 09,2025,and all changes N/A is not
made during the meeting have been incorporated into the attached document. The I'„"' an option for
County 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 r N/A is not
BCC,all changes directed by the BCC have been made,and the document is ready for the of Ap an option for
Chairman's signature. ((( this line.
1 6 F 1
FIFTEENTH AMENDMENT
11-5776 AGREEMENT FOR MEDICAL EXAMINER SERVICES
THIS AMENDMENT is made and entered into on this q day of Sepierrie025, by
and between Marta U. Coburn, M.D., Florida District Twenty Medical Examiner for Collier
County, Florida, doing business as District 20 Medical Examiner, Inc., a Florida for Profit
Corporation (hereinafter called "Medical Examiner") and the Board of County Commissioners
of Collier County, Florida(hereinafter called"County"), collectively referred to as the"Parties.":
WHEREAS, the Parties entered into an Agreement for Medical Examiner Services
("Agreement") dated September 27, 2011, a copy of which is attached hereto; and
WHEREAS,the Fourteenth Amendment to the Agreement was approved by the Board on
September 24, 2024 (Agenda Item 16.F.3); and
WHEREAS,the Parties wish to extend the term of the Agreement through September 30,
2026.
NOW, THEREFORE, in consideration of Ten Dollars ($10.00) and other good and
valuable consideration exchanged amongst the Parties, and in consideration of the covenants
contained herein, the Parties agree as follows:
1. All of the above RECITALS are true and correct and are hereby expressly
incorporated herein by reference as if set forth fully below.
2. Section I of the Agreement is hereby amended by extending the term of the
Agreement from October 1, 2025 through September 30, 2026.
3. Section III, Paragraph A of the Agreement is replaced in its entirety to now read as
follows:
"The County hereby agrees to compensate the Medical Examiner for services to be
performed for the term of this Agreement, beginning on October 1, 2025, in the amount of
Two Million Eighty-Three Thousand Dollars ($2,083,000) by semi-monthly payments
ending September 30, 2026. In addition, the County will make payments on behalf of the
Medical Examiner for County-allocated charges consisting of Information Technology
costs, as well as General, Property, and Liability insurances in the total amount of Eighty-
1
Amendment#15 to Contract 11-5776
CA°
1 6 F 1
One Thousand Five Hundred Dollars($81,500).Any modifications to this Contract shall
be in compliance with the County Procurement Ordinance and Procedures in effect at the
time such modifications are authorized."
4. Except as further modified by this Amendment,the Agreement shall remain in full
force and effect. If there is a conflict between the terms of this Amendment and the Agreement,
the terms of this Amendment shall prevail.
IN WITNESS WHEREOF, the executed have this Fifteenth Amendment by authorized
agent(s), as of the date first above written.
ATTEST: BOARD OF COUNTY COMMISSIONERS
Crystal IC Kinzel, Comptroller and COLLIER COUNTY, FLORIDA
Clerk of Cortrts ,
By: By: ,
• t i; =' ,Deputy Clerk u . Saunders, hairman
Attest as t M airman'8
signature only II
Approved as to Form and Legality:
By:
ott R. Teach, Deputy County Attorney
ME ICAL EXAMINER
B :
arta U. Coburn
M.D. Medical Examiner
Florida District Twenty
2
()
Amendment#15 to Contract 11-5776
1 6 F 1
AFFIDAVIT REGARDING LABOR AND SERVICES
AND CONTRACTING WITH ENTITIES OF FOREIGN COUNTRIES OF CONCERN PROHIBITED
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.
Effective January 1,2024,a governmental entity may not accept a bid on,a proposal for,or a reply to,or enter into,a contract with
an entity which would grant the entity access to an individual's personal identifying information unless the entity provides the
government with an affidavit signed by an officer or representative under penalty of perjury attesting that the entity does not meet
any of the following criteria: (a)the entity is owned by the government of a foreign country of concern;(b)the government of a
foreign country of concern has a controlling interest in the entity;or(c)the entity is organized under the laws of or has its principal
place of business in a foreign country of concern.
Effective July 1,2025,when an entity extends or renews a contract with a governmental entity which would grant the entity access
to an individual's personal identifying information,the entity must provide the governmental entity with an affidavit signed by an
officer or representative of the entity under penalty of perjury attesting that the entity does not meet any of the criteria in paragraphs
(2)(a)-(c),§287.138,Florida Statutes.
Nongovernmental Entity's Name: A.ST r 1'( t �ki, l�..�,( (,. xa.6ui�1
Address: 3 e�e D6)')1.(f '7L A. l )/E S, ii 3y(GS/-
Phone Number: 3 (� _ �/ 3 ;- c C `
Authorized Representative's Name: /L/ Q I lit ( ( - 0 t.•, /t/ 7w Lb
Authorized Representative's Title: -<)/'i1 i /e t 7l(t i(t?e. ( `- ,.Cc G s.& , ,el
Email Address: ►1 I A i f u (Y 4,, r i) K. c o%C ,,e. i/ e
1, Net• fa I . l/Y 4(- t 11I/1(1) (Name of Authorized Representative), as authorized representative attest under
penalty of perjury that U L O r,^// ("c..ro a./,/ Hi'it,i a( l K A iftqatitt of Nongovernmental Entity) does not: (1) use
coercion for labor or services as defined in§787.06,Florida Statutes, and(2)the nongovernmental entity is not(a)owned by
a government of a foreign country of concern,(b)that a foreign country of concern does not have a controlling interest in the
entity, and (c)that the entity is not organized under the laws of or has its principal place of business in a foreign country of
concern,all as prohibited under§287.138,Florida Statutes.
Under penalty of perjury,I declare that I have read the foregoing Affidavit and that the facts stated in it are true.
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Lc_itctlad,t
Signature of authorized representative) Date
STATE OF , tzt_
COUNTY OF ' C k'
Sworn to(or affirmed)and subscribed before me,by means of 0 physical presence or 0 online notarization this
-). day of ,20 5,by/92 &ki- (z,bu eyt (Name of Affiant),who produced his Florida Driver's License as
identification.
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Commission Expires EXPIRES 11 17 2028 ?
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Type of Identification Produced: FL ,1/ZIcJ-e-to !-„e.&- 4._ """',,,,,,,,""'",1
CONTRACT RENEWAL OR EXTENSION REQUEST FORM Version:2025.1