Agenda 11/10/2025 Item #16D 6 (The Chair to sign a MOU between Collier County and Collier Health Services, Inc. (CHSI) d/b/a Healthcare Network of Southwest Florida)11/10/2025
Item # 16.D.6
ID# 2025-4490
Executive Summary
Recommendation to approve and authorize the Chair to sign a MOU between Collier County and Collier Health
Services, Inc. (CHSI) d/b/a Healthcare Network of Southwest Florida, to support the low-income pool program for health
prevention and medical services for uninsured and underinsured low-income Collier residents. General Fund (0001).
OBJECTIVE: To deliver health care and preventive services to uninsured and underinsured low-income residents of
Collier County, while supporting the County’s strategic goal of enhancing access to health, wellness, and human
services for the benefit of all residents.
CONSIDERATIONS: The Agency for Health Care Administration (AHCA) is a state entity that provides Medicaid
services in Florida and operates the Medicaid Low Income Pool (LIP) Program. The LIP Program leverages local funds
to obtain federal matching dollars. The County participates in the LIP Program as outlined in the attached LIP Letter of
Agreement between Collier County and AHCA, as approved by the Board on September 9, 2025, Agenda Item #16.D.9.
Collier Health Services, Inc. will utilize the total funds under the LIP Program to provide healthcare services for
uninsured and underinsured low-income individuals in Collier County. The proposed MOU requires that CHSI provide
health care and prevention services and medical payments on behalf of income eligible citizens 18-64 who do not
qualify for Medicaid. Since the funds were provided directly to AHCA, it is necessary for the County to ensure
compliance thus necessitating a MOU to ensure that the dollars being provided are providing the necessary services to
the required population. The MOU period is from October 1, 2025, through September 30, 2026. The MOU requires
CHSI to report the number of residents served each quarter and their corresponding service units.
The local LIP contribution will provide CHSI $979,619.46 in federal matching dollars to be utilized under the LIP
program. Collier Health Services will receive a total of $1,712,022.73 in LIP funding to support health care and
prevention services for uninsured and underinsured low-income individuals in Collier County.
Supports the County’s strategic goal of enhancing access to health, wellness, and human services for the benefit of all
residents.
FISCAL IMPACT: There is no new fiscal impact associated with this item. Funding in the amount of $732,403.27 is
available within the Community & Human Services (CHS) Fiscal Year 2026 General Fund (0001), Community Mental
Health and Low-Income Pool (LIP) Support Cost Center 156010. The County's contribution payment to the State of
Florida Agency for Health Care Administration (AHCA) will be processed through an Intergovernmental Transfer (IGT)
upon receipt of an invoice.
GROWTH MANAGEMENT IMPACT: There is no Growth Management impact associated with this action.
LEGAL CONSIDERATIONS: This item has been reviewed by the County Attorney, is approved as to form and
legality and requires a majority vote for Board approval. -JAK
RECOMMENDATION(S): To approve and authorize the Chair to sign a MOU between Collier County and Collier
Health Services, Inc. (CHSI) d/b/a Healthcare Network of Southwest Florida, to support the low-income pool program
for health prevention and medical services for uninsured and underinsured low-income Collier residents. General Fund
(0001).
PREPARED BY: Carolyn Noble, Grant Coordinator, Community and Human Services
ATTACHMENTS:
1. CHSI LIP LOA ES from CIVIC 9.9.25 16D9
2. LIP LOA Collier County.Healthcare Network CM Signed
Page 4514 of 6525
11/10/2025
Item # 16.D.6
ID# 2025-4490
3. CHSI-LIP MOU FINAL SR Signed 10.30.25
Page 4515 of 6525
9/9/2025
Item # 16.D.9
ID# 2025-2809
Executive Summary
Recommendation to approve the Low Income Pool Letter of Agreement with the Agency for Health Care
Administration, in the amount of $732,403.27 to participate in the Medicaid Low Income Pool Program, (b) authorize an
additional allocation of $111,592.27 to allow for the maximum allocation of federal matching funds, (c) authorize the
County Manager to execute and submit the Low Income Pool agreement and the required Provider Questionnaire and (d)
authorize the necessary Budget Amendment. (Fiscal Impact $732,403.27)
OBJECTIVE: To provide additional health care services to the low-income citizens of Collier County and further the
County’s strategic plan focus area of supporting access to health, wellness and human services.
CONSIDERATIONS: The Agency for Health Care Administration (AHCA) is a State entity that provides Medicaid
services in Florida and operates the Medicaid Low Income Pool (LIP) Program. The LIP Program leverages local funds
to obtain federal matching dollars. The County's participation in the LIP Program is outlined in the attached LIP Letter
of Agreement between Collier County and AHCA. AHCA requested that the County execute the LIP Letter of
Agreement using DocuSign; therefore, staff is requesting that the Board of County Commissioners (Board) authorize the
County Manager to execute and submit the agreement and IGT Provider Questionnaire.
Healthcare Network of Southwest Florida (Healthcare Network) desires and is qualified to administer the LIP Program
with AHCA using County ad valorem tax dollars. These funds may only be allocated to those Federally Qualified
Health Centers (FQHC). In FY 25 Healthcare Network provided $6,162,500 in charity care.
Currently, FY 26 has budgeted $620,811 to support the LIP program and this would yield a federal match of
$830,360.21, with the additional $111,592.27 the federal match would increase the funds made available to Collier
County residents by $260,851.52.
The allocation of County and matching funds is as follows:
Collier
County FY
26 Budget
Allocation
FY 26
Additional
Funds
Requested
Collier County
Proposed LIP
IGT
Federal Matching Funds
Provided to CHSI as Program
Administrator
Total Funds
Benefiting Collier
County Residents
$ 620,811 N/A N/A $830,360.21 $1,451,171.21
$ 620,811 $111,592.27 $732,403.27 $979,619.46 $1,712,022.73
Healthcare Network will utilize the total funds under the LIP Program to provide additional healthcare services for low-
income individuals in Collier County. An agreement that outlines the contractual arrangement between Collier County
and Healthcare Network will be presented at a future board date. Healthcare Network will make payments in an amount
not to exceed $200,000 for eligible medical services to eligible residents authorized by County staff.
Furthers the County’s strategic plan focus area of supporting access to health, wellness and human services
FISCAL IMPACT: In FY 2026, a budget amendment is required to reallocate funding in the amount of $111,592.27
within the General Fund from Contributions to Grants cost center (969010-0001) to Community & Human Services
(CHS) Mental Health cost center (156010-0001) to cover the full IGT amount of $732,403.27 for the County’s
contribution payment to the State of Florida Agency for Healthcare by October 31, 2025. The County funds will
generate $979,619.46 in federal matching funds for the benefit of Collier Health Services to assist in meeting the state
match obligation.
GROWTH MANAGEMENT IMPACT: There is no Growth Management impact associated with this action.
Page 4516 of 6525
9/9/2025
Item # 16.D.9
ID# 2025-2809
LEGAL CONSIDERATIONS: This item has been reviewed by the County Attorney, is approved as to form and
legality, and requires majority vote for Board approval. -JAK
RECOMMENDATIONS: Approve the Low Income Pool Letter of Agreement with the Agency for Health Care
Administration, in the amount of $732,403.27 to participate in the Medicaid Low Income Pool Program, (b) authorize an
additional allocation of $111,592.27 to allow for the maximum allocation of federal matching funds, (c) authorize the
County Manager to execute and submit the Low Income Pool agreement and the required Provider Questionnaire and
(d) authorize the necessary Budget Amendment. (Fiscal Impact $732,403.27)
PREPARED BY: Carolyn Noble. Grant Coordinator, Community & Human Services Division
ATTACHMENTS:
1. LIP LOA Healthcare Network 8.26.25 CAO Signed
2. LIP IGT_Provider_Questionnaire CNkf
3. BA 156010
Page 4517 of 6525
Low Income Pool Letter of Agreement
1
THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the 1
day of 5epfc4v 2025, by and between Collier County BoCC (the "IGT Provider") on behalf
of Healthcare Network and the State of Florida, Agency for Health Care Administration
the "Agency''). for good and valuable consideration, the receipt and sufficiency of which is
acknowledged.
DEFINITIONS
Charity care" or "uncompensated charity care" means that portion of hospital charges reported
to the Agency for which there is no compensation, other than restricted or unrestricted revenues
provided to a hospital by local governments or tax districts, regardless of the method of
payment. Uncompensated care includes charity care for the uninsured but does not include
uncompensated care for insured individuals, bad debt. or Medicaid and Children's Health
Insurance Program (CHIP) shortfall. The state and providers that are participating in the Low
Income Pool (LIP) will provide assurance that LIP claims include only costs associated with
uncompensated care that is furnished through a charity care program and that adheres to the
principles of the Healthcare Financial Management Association (HFMA) operated by the
provider.
Intergovernmental Transfers (IGTs)" means transfers of funds from a non-Medicaid
governmental entity (e.g., counties, hospital taxing districts, providers operated by state or local
government) to the Medicaid agency. IGTs must be compliant with 42 CFR Part 433 Subpart B.
Low Income Pool (LIP)" means providing government support for safety-net providers for the
costs of uncompensated charity care for low-income individuals who are uninsured.
Uncompensated care includes charity care for the uninsured but does not include
uncompensated care for insured individuals, "bad debt." or Medicaid and CHIP shortfall,
Medicaid" means the medical assistance program authorized by Title XIX of the Social Security
Act, 42 U.S.C. §§ 1396 et seq., and regulations thereunder, as administered in Florida by the
Agency.
A. GENERAL PROVISIONS
1. Per Senate Bill 2500, the General Appropriations Act of State Fiscal Year 2025-
2026, passed by the 2025 Florida Legislature. the IGT Provider and the Agency agree
that the IGT Provider will remit IGT funds to the Agency in an amount not to exceed the
total of$732,403.27.
a. The IGT Provider and the Agency have agreed that these IGT funds will only be
used to increase the provision of health services for the charity care of the IGT
Provider and the State of Florida at large.
b. The increased provision of charity care health services will be accomplished
through the following Medicaid programs:
i LIP payments to hospitals, federally qualified health centers, Medical
School Physician Practices, community behavioral health providers, and
Collier County BoCC_Healthcare Network_LIP LOA SFY 2025-26
Page 4518 of 6525
rural health centers pursuant to the approved Centers for Medicare &
Medicaid Services Special Terms and Conditions,
2. The IGT Provider will return the signed LOA to the Agency no later than October 1,
2025.
3. The IGT Provider will pay IGT funds to the Agency in an amount not to exceed the total
of$732,403.27.
a. Per Florida Statute 409.908. annual payments for the months of July 2025 through
June 2026 are due to the Agency no later than October 31, 2025, unless an
alternative plan is specifically approved by the agency.
b. The Agency will bill the IGT Provider when payment is due.
4. The IGT Provider and the Agency agree that the Agency will maintain necessary records
and supporting documentation applicable to health services covered by this LOA.
a. Audits and Records
i. The IGT Provider agrees to maintain books, records, and documents
including electronic storage media) pertinent to performance under this
LOA in accordance with generally accepted accounting procedures and
practices, which sufficiently and properly reflect all revenues and
expenditures of funds provided.
ii. The IGT Provider agrees to ensure that these records shall be subject at
all reasonable times to inspection, review, or audit by state personnel and
other personnel duly authorized by the Agency, as well as by federal
personnel.
iii. The IGT Provider agrees to comply with public record laws as outlined in
section 119.0701. Florida Statutes.
b. Retention of Records
i. The IGT Provider agrees to retain all financial records, supporting
documents, statistical records, and any other documents (including
electronic storage media) pertinent to performance under this LOA for a
period of six (6) years after termination of this LOA, or if an audit has been
initiated and audit findings have not been resolved at the end of six (6)
years, the records shall be retained until resolution of the audit findings.
ii. Persons duly authorized by the Agency and federal auditors shall have full
access to and the right to examine any of said records and documents.
Collier County BoCC_Healthcare Network_LIP LOA SFY 2025-26
Page 4519 of 6525
iii. The rights of access in this section must not be limited to the required
retention period but shall last as long as the records are retained.
c. Monitoring
i. The IGT Provider agrees to permit persons duly authorized by the
Agency to inspect any records, papers. and documents of the IGT
Provider which are relevant to this LOA.
d. Assignment and Subcontracts
i. The IGT Provider agrees to neither assign the responsibility of this LOA
to another party nor subcontract for any of the work contemplated under
this LOA without prior written approval of the Agency. No such approval
by the Agency of any assignment or subcontract shall be deemed in any
event or in any manner to provide for the incurrence of any obligation of
the Agency in addition to the total dollar amount agreed upon in this
LOA. All such assignments or subcontracts shall be subject to the
conditions of this LOA and to any conditions of approval that the Agency
shall deem necessary.
5. This LOA may only be amended upon written agreement signed by both parties.
The IGT Provider and the Agency agree that any modifications to this LOA shall be in
the same form, namely, the exchange of signed copies of a revised LOA.
6. The IGT Provider confirms that there are no pre-arranged agreements (contractual or
otherwise) between the respective counties, taxing districts, and/or the providers to
redirect any portion of these aforementioned charity care supplemental payments in
order to satisfy non-Medicaid, non-uninsured, and non-underinsured activities.
7. The IGT Provider agrees the following provision shall be included in any agreements
between the IGT Provider and local providers where IGT funding is provided pursuant
to this LOA: "Funding provided in this Agreement shall be prioritized so that designated
IGT funding shall first be used to fund the Medicaid program (including LIP or DSH) and
used secondarily for other purposes."
8. This LOA covers the period of July 1, 2025, through June 30. 2026, and shall
be terminated September 30. 2026. which includes the state's certified forward
period
9. This LOA may be executed in multiple counterparts, each of which shall constitute an
original, and each of which shall be fully binding on any party signing at least one
counterpart.
Collier County BoCC_Healthcare Network_LIP LOA SFY 2025-26
Page 4520 of 6525
LIP Local Intergovernmental Transfers (IGTs)
Program /Amount State Fiscal Year 2025-2026
Estimated IGTs
732,403.27
Total Funding Not to Exceed
732,403.27
WITNESSETH:
IN WITNESS WHEREOF, the parties have caused this (4) page Letter of Agreement
to be executed by their undersigned officials as duly authorized.
COLLIER COUNTY BOCC STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION
SIGNED SIGNED
BY: BY:
NAME: f____ NAME: Stephanie Scanlon
TITLE: TITLE: Chief of Medicaid Programbbit1411kanAPrFinance
DATE:al [ f( IZdZc DATE:
A1 Ltirt4rm and legality
Ili k
Jeffrey •I ' Iat•.'ow,County Attorney
Collier County BoCC_Healthcare Network_LIP LOA SFY 2025-26
Page 4521 of 6525
1
Collier Health Services
MOU- State Mandated/Low Income Pool 25-26
LIP25-01
MEMORANDUM OF UNDERSTANDING BETWEEN
COLLIER COUNTY
AND
COLLIER HEALTH SERVICES, INC., d/b/a HEALTHCARE NETWORK OF
SOUTHWEST FLORIDA
THIS MEMORANDUM OF UNDERSTANDING (MOU) is made and entered
into on this day of 2025 by and between Collier County, a political
subdivision of the State of Florida (COUNTY), having its principal address as 3339 E.
Tamiami Trail, Naples, FL 34112, and Collier Health Services, Inc., d/b/a Healthcare
Network of Southwest Florida (RECIPIENT) a Florida not-for-profit corporation having its
principal address at 1454 Madison Ave West, Immokalee, FL 34142.
WHEREAS, Section 125.01(1)(e), Florida Statutes, authorizes the COUNTY to
provide health welfare programs for the residents of Collier County to the extent not
inconsistent with general or special law; and
WHEREAS, the establishment and maintenance of such programs are in the common
interest of the people of Collier County; and
WHEREAS, The COUNTY desires the RECIPIENT to become a community health
partner to assist in providing services for uninsured and underinsured Collier County residents
with medical and health prevention services; and
NOW THEREFORE, in consideration of the mutual benefits contained herein, it is
agreed by the Parties as follows:
PART I
SCOPE OF SERVICES
1.1. The RECIPIENT shall in a satisfactory and proper manner and consistent with any
standards required as a condition of providing services as provided herein and as
determined by Collier County Community and Human Services (CHS) Division,
perform the tasks necessary to provide:
A. Women’s health services for pregnant and postpartum women.
B. Medical payments to providers as approved by Collier County.
C. Health prevention services to eligible residents of Collier County.
D. Medical services to the uninsured and underinsured residents of Collier County.
Page 4522 of 6525
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MOU- State Mandated/Low Income Pool 25-26
LIP25-01
1.2. The RECIPIENT and/or its approved subcontractor shall provide timely responses to all
requests by the COUNTY.
1.3. RECIPIENT must submit to the COUNTY the following policies and procedures within
60 days of execution of this MOU.
Conflict of Interest Policy (COI) and related COI Forms
Fraud, Waste, and Abuse Policy
Limited English Proficiency Policy
HIPPA Policy
1.4. Performance Deliverables
A. Clients Served
The RECIPIENT will serve the following:
i. Women’s Health Program: deliver services to a minimum of 250 non-
duplicated pregnant and/or post-partum women (Collier County residents)
with at least one (1) unit of service. Clients may receive duplicated services;
only one unit of service will be applied to a minimum number of clients served.
ii. Medical payments: the RECEPIENT will pay all invoices for referred
treatment received by the COUNTY within sixty (60) days of receipt of
complete and accurate invoice at the Medicaid rate.
iii. Health prevention and medical services: a minimum of 7,000 non-duplicated
underinsured/uninsured Collier County residents with at least one (1) unit of
service. Clients may receive duplicated services; only one unit of service will
be applied to a minimum number of clients served.
B. Performance Deliverables
Program Deliverable Supporting Documentation Submission Schedule
Insurance
Proof of coverage in
accordance with Exhibit B
Within 30 days following
MOU execution and
annually thereafter
Quarterly Performance
Report
Exhibit C Quarterly by 30th of the
month following quarter end
Accreditation Agencies
and/or Audit Reports
Final Audit/Monitoring
Reports including any plans of
corrective action
Within 30 days of receipt
Single Audit Audit report and management Within 9 months of end of
Page 4523 of 6525
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Collier Health Services
MOU- State Mandated/Low Income Pool 25-26
LIP25-01
Program Deliverable Supporting Documentation Submission Schedule
letter fiscal year
Annual Audit Monitoring
Report
Exhibit D Annually, within 60 days
after fiscal year end.
Conflict of Interest
Disclosure Form
Subrecipient/Vendor/Developer
Conflict of Interest Disclosure
Form
Upon execution of the
MOU, for all employees
who work on activities
associated with the MOU
and upon hiring of all new
employees.
Whistleblower Protections
Certification
Exhibit F Upon execution of the
MOU, for all employees
who work on activities
associated with the MOU
and upon hiring of all new
employees.
Affidavit Regarding Labor
and Services (Trafficking)
Affidavit Upon execution of the
MOU.
Business Associate
Agreement
Business Associate Agreement Within 60 Days of
Agreement Execution
PART II
PAYMENTS
The COUNTY shall make intergovernmental transfers (IGT) on behalf of the RECIPIENT, in
connection with the Low Income Pool (LIP) program, to the State of Florida (State) in
accordance with the Letter of Agreement between the COUNTY and the Agency for Health
Care Administration (AHCA).
2.1. The COUNTY will remit to AHCA an amount not to exceed SEVEN HUNDRED
THIRTY-TWO THOUSAND FOUR HUNDRED THREE DOLLARS AND TWENTY
SEVEN CENTS ($732,403.27). The COUNTY will transfer payment to the AHCA in
the following manner:
A. The payments for the months July 2025 – June 2026 are subject to the Centers for
Medicare and Medicaid Services (CMS) approval of the LIP reimbursement and
funding methodology document. Once approved, IGT invoices will be sent out.
When payments are received, one payment will be made to Collier Health Services,
Page 4524 of 6525
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Collier Health Services
MOU- State Mandated/Low Income Pool 25-26
LIP25-01
Inc. by AHCA. This timeframe has not yet been determined.
B. The COUNTY is providing a local contribution amount of $732,403.27 for eligible
services.
2.2 The following document is hereby incorporated by reference as Exhibit A to this MOU:
Low Income Pool Agreement (LIP) with the State of Florida Agency for Healthcare
Administration (AHCA) reflecting the anticipated annual distributions for State Fiscal
Year 2025-2026.
PART III
TERMS OF MOU AND TERMINATION
3.1. The term of this MOU shall be October 1, 2025, through September 30, 2026, with no
renewal.
3.2. Either party may terminate this MOU thirty (30) calendar days after receipt of written
notice of intent to terminate from the other party and should the RECIPIENT choose to
terminate, the RECIPIENT is obligated to return the pro-rated share of the COUNTY’S
funds paid on the RECIPIENT’S behalf to AHCA.
3.3. Upon breach of this MOU, the aggrieved party may, by written notice of breach to the
breaching party, terminate the whole or any part of this MOU. Termination shall be
upon no less than 24 hours’ notice, in writing, delivered by certified mail, or in person.
Waiver by either party of breach of any provisions of this MOU shall not be deemed to
be a waiver of any other or subsequent breach and shall not be construed to be a
modification of the terms of this MOU.
3.4 It is further agreed that in the event general funds to finance all or part of the AHCA
LIP agreement do not become available, the obligations of each party hereunder may
be terminated upon no less than 24 hours’ notice in writing to the other party. Said
notice shall be delivered by certified mail, or in person.
3.5 It is further agreed that the RECIPIENT shall set aside funds for the benefit of
COUNTY-supported health programs, allocating $100,000 for the Collier County
Community and Human Services (CHS) Medical Program and $320,000 for the
Women’s Health Program. The COUNTY shall refer uninsured persons to medical
Page 4525 of 6525
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Collier Health Services
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LIP25-01
providers for services, and all invoices shall be paid by the RECIPIENT within sixty
(60) days of receipt at the Medicaid rate.
PART IV
NOTICES
Notices required by this MOU shall be in writing and delivered via mail (postage prepaid),
commercial courier, personal delivery, or sent by facsimile or other electronic means. Either party
may change the address to which notices are to be sent to it by giving written notice of such change
to the other party in the manner herein provided for giving notice. Any notice, request, instruction,
or other document delivered or sent as aforesaid shall be effective on the date of delivery or
sending. All notices and other written communications under this MOU 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 Government
Community and Human Services Division
2671 Airport Pulling Road, Suite 202
Naples, Florida 34112
Email: carolyn.noble@collier.gov
Telephone: (239) 450-5186
RECIPIENT ATTENTION: Tami Raznoff, CFO
Collier Health Services
1454 Madison Ave West
Immokalee, FL 34142
Email: traznoff@healthcareSWFL.org
Telephone: (239)658-3137
PART V
ASSIGNMENT
The RECIPIENT and/or its subcontractors shall not assign or transfer this MOU, or any
interest, right, or duty herein, without the prior written consent of the COUNTY.
Page 4526 of 6525
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LIP25-01
PART VI
SUBCONTRACTING
The parties agree that, upon approval by the COUNTY, the RECIPIENT shall be permitted to
execute subcontracts for the purchase of such services, articles, supplies, and equipment that
are both necessary and incidental to the performance of the work required under this MOU.
However, the RECIPIENT expressly understands that it shall assume the primary
responsibility for performing the services outlined in Part I of this MOU.
PART VII
INSURANCE, SAFETY, AND INDEMNIFICATION
7.1. Indemnity: To the maximum extent permitted by Florida law, the RECIPIENT and/or
its subcontractors shall indemnify and hold harmless the COUNTY against any claims,
damages, losses, and expenses, including reasonable attorney’s fees and costs, arising
out of or resulting from the RECIPIENT’S failure to pay for services or performance
under this MOU. This indemnification obligation shall not be construed to negate,
abridge, or reduce any other rights or remedies which otherwise may be available to
an indemnified party or person described in this paragraph.
The RECIPIENT shall jointly and severally indemnify and hold harmless the COUNTY
for all claims demands, actions, suits, losses, costs, charges, expenses, damages, and
liabilities whatsoever which the COUNTY may pay, sustain, suffer, or incur by reason
of or in connection with this MOU, including payment of all legal costs, including but
not limited to attorney’s fees paid by the COUNTY.
7.2. Insurance Required: The RECIPIENT shall not commence any work and/or services
pursuant to this MOU, until all required insurance, as outlined in Exhibit B has been
obtained. Said insurance shall be carried continuously during the RECIPIENT’s
performance under this MOU.
PART VIII
RECORDS
The RECIPIENT and/or its subcontractors shall keep orderly and complete records of its accounts
and operations related to the services provided under this MOU for the entire term of the MOU
plus six (6) years. The RECIPIENT and/or its subcontractors shall keep these records open to
Page 4527 of 6525
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LIP25-01
inspection by COUNTY personnel at reasonable hours during the entire term of this MOU. If any
litigation, claim, or audit is commenced prior to the expiration of the six (6) year period and
extends beyond this period, the records must remain available until any litigation, claim, or audit
has been resolved. Any person duly authorized by the COUNTY shall have full access to, and the
right to examine any of said records during said period. Access to Protected Health Information
(PHI) shall comply with federal laws and the Health Insurance Portability and Accountability Act
(HIPAA).
RECIPIENT shall take reasonable cybersecurity and other measures to safeguard information including
protected personally identifiable information (PII) and other types of information in accordance with 2
C.F.R. §200.303(e). This includes information that the State of Florida or the COUNTY designates as
sensitive, or other information the COUNTY considers sensitive and is consistent with applicable federal,
state, and local laws regarding privacy and responsibility over confidentiality.
RECIPIENT shall provide the public with access to public records on the same terms and
conditions that the COUNTY would provide the records, and at a cost that does not exceed the
cost provided in Chapter 119, Florida Statutes or as otherwise provided by law. RECIPIENT shall
ensure that exempt or confidential public records that are free from public records disclosure
requirements are not disclosed, except as authorized by 2 C.F.R. §200.337 and 2 C.F.R. §200.338.
IF RECIPIENT HAS QUESTIONS REGARDING THE
APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO
RECIPIENT’S DUTY TO PROVIDE PUBLIC RECORDS
RELATING TO THIS MOU, IT SHALL CONTACT THE
CUSTODIAN OF PUBLIC RECORDS AT 239-252-5837,
Angel.Bates@colliercountyfl.gov, 3299 Tamiami Trail East, Naples,
FL 34112.
PART IX
CIVIL RIGHTS
9.1. In the performance of this MOU, there will be no discrimination against any employee or
person served based on race, color, sex, age, religion, ancestry, national origin, handicap, or
marital status.
9.2. It is expressly understood that, upon receipt of evidence of such discrimination, the
COUNTY shall have the right to terminate this MOU for breach of MOU.
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LIP25-01
9.3. The RECIPIENT and/or its subcontractors shall comply with Title VI of the Civil Rights
Act of 1964 (42 USC 2000(d)) regarding persons served.
9.4. The RECIPIENT and/or its subcontractors shall comply with Title VII of the Civil Rights
Act of 1964 (42 USC 2000(c)) regarding employees or applicants for employment.
9.5. The RECIPIENT and/or its subcontractors shall comply with Section 504 of the
Rehabilitation Act of 1973 regarding employees or applicants for employment and clients
served.
PART X
MONITORING
RECIPIENT agrees that CHS may carry out no fewer than one (1) annual on-site monitoring visit
and evaluation of project activities, as determined necessary. Such site visits may be scheduled or
unscheduled, as determined by CHS. At the COUNTY’s discretion, a desktop review may be
conducted in lieu of an on-site visit. The continuation of this MOU is dependent upon satisfactory
evaluations. Upon request by CHS, RECIPIENT shall submit information and status reports
required by CHS to enable it to evaluate said progress and allow for completion of CHS’s required
reports.
At any time during normal business hours and as often as the COUNTY (and/or its representatives)
may deem necessary, RECIPIENT shall make available for review, inspection, or audit all records,
documentation, and any other data relating to all matters covered by the MOU.
COUNTY will monitor RECIPIENT’S performance in an attempt to mitigate fraud, waste, abuse,
or non-performance, based on goals and performance standards as stated with all other applicable
laws, regulations, and policies governing the Funds provided under this MOU. Substandard
performance, as determined by CHS, will constitute noncompliance with this MOU. If
RECIPIENT does not take corrective action within a reasonable time period after being notified
by CHS, MOU suspension or termination procedures will be initiated.
PART XI
PREVENTION OF FRAUD, WASTE, AND ABUSE
RECIPIENT shall establish, maintain, and utilize internal control systems and procedures
necessary to prevent, detect, and correct incidents of fraud, waste, and abuse in the performance
of this MOU, and provide proper and effective management of all Program and Fiscal activities of
the MOU. RECIPIENT’S internal control systems and all transactions and other significant events
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shall be clearly documented, and the documentation shall be readily available for monitoring by
the COUNTY.
RECIPIENT shall provide the COUNTY with complete access to all of its records, employees,
and agents for the purpose of monitoring or investigating the performance of this MOU.
RECIPIENT shall fully cooperate with the COUNTY’s efforts to detect, investigate, and prevent
fraud, waste, and abuse.
RECIPIENT may not discriminate against any employee or other person who reports a violation
of the terms of this MOU or any law or regulation to the COUNTY or any appropriate law
enforcement authority, if the report is made in good faith.
PART XII
DEFAULTS, REMEDIES, AND TERMINATION
This MOU may be terminated for convenience by either the COUNTY or RECIPIENT, in whole
or in part, by setting forth the reasons for such termination, the effective date, and in the case of
partial terminations, the portion to be terminated. However, in the case of a partial termination, if
the COUNTY determines that the remaining portion of the award will not accomplish the purpose
for which the award was made, the COUNTY may terminate the award in its entirety. This MOU
may also be terminated by the COUNTY if the award no longer effectuates the program goals or
grantor agency priorities.
The following actions or inactions by RECIPIENT shall constitute a Default under this MOU:
A. Failure to comply with any of the rules, regulations, or provisions referred to herein; or
such statutes, regulations, executive orders, policies, or directives as may become
applicable at any time.
B. Failure, for any reason, to fulfill its obligations under this MOU in a timely and proper
manner.
C. Ineffective or improper use of Funds provided under this MOU.
D. Submission of reports that are incorrect or incomplete in any material respect.
E. Submission of any false certification.
F. Failure to materially comply with any terms of this MOU.
G. Failure to materially comply with the terms of any other agreement between the
COUNTY and RECIPIENT relating to the project.
In the event of any default by RECIPIENT under this MOU, the COUNTY may seek any
combination of one or more of the following remedies):
A. Require specific performance of the MOU in whole or in part.
B. Require the use of, or change in, professional property management, if applicable.
C. Require RECIPIENT to immediately repay to the COUNTY all Funds received under
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this MOU.
D. Apply sanctions, if COUNTY determines them to be applicable.
E. Stop all payments until identified deficiencies are corrected.
F. Terminate this MOU by giving written notice to RECIPIENT specifying the effective
date of such termination. If the MOU is terminated by the COUNTY, as provided
herein, RECIPIENT shall have no claim of payment or benefit for any incomplete
project activities undertaken under this MOU.
PART XIII
CORRECTIVE ACTIONS
Corrective action plans may be required for noncompliance, nonperformance, or unacceptable
performance under this MOU. Penalties may be imposed for failure to implement or make
acceptable progress on such corrective action plans.
To effectively enforce COUNTY Resolution No. 2013-228, CHS has adopted an escalation policy
to ensure continued compliance by Recipients, Subrecipients, Developers, or any entity receiving
grant funds from CHS. The escalation policy for noncompliance is as follows:
1. Initial noncompliance may result in the COUNTY issuing Findings or Concerns to
RECIPIENT, which requires RECIPIENT to submit a corrective action plan to CHS
within 10 business days following issuance of the report.
• Any pay requests that have been submitted to CHS for payment will be held
until the corrective action plan has been submitted and accepted.
• CHS will be available to provide Technical Assistance (TA) to RECIPIENT,
as needed, in order to correct the noncompliance issue.
2. If RECIPIENT fails to submit the corrective action plan to CHS in a timely manner,
CHS may require RECIPIENT to return a portion of the awarded Funds to the
COUNTY.
• CHS may require RECIPIENT to return upwards of 5 percent of the award
amount to the COUNTY, at the discretion of the Board.
• RECIPIENT may be denied future consideration, as set forth in COUNTY
Resolution No. 2013-228.
3. If RECIPIENT remains noncompliant or repeats an issue that was previously
corrected, and has been informed by CHS of their substantial noncompliance by
certified mail, CHS may require RECIPIENT to return to the COUNTY a portion of
the awarded Funds.
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• CHS may require RECIPIENT to return upwards of 10 percent of the award
amount to the COUNTY, at the discretion of the Board.
• RECIPIENT will be considered in violation of COUNTY Resolution No. 2013-
228.
4. If after repeated notification, RECIPIENT continues to be substantially
noncompliant, CHS may recommend termination of the MOU or awarded Funds.
• CHS will make a recommendation to the Board to immediately terminate the
MOU. RECIPIENT will be required to repay all awarded Funds disbursed by
CHS for the terminated project.
• RECIPIENT will be considered in violation of COUNTY Resolution No. 2013-
228.
If RECIPIENT has multiple agreements with the COUNTY, and is found to be noncompliant, the
above sanctions may be imposed across all awards, at the Board’s discretion.
PART XIV
INDEPENDENT CONTRACTOR
Nothing contained in this MOU is intended to, or shall be construed in any manner, as creating or
establishing the relationship of employer/employee between the parties. RECIPIENT shall always
remain an “independent contractor” with respect to the services to be performed under this MOU.
The COUNTY shall be exempt from payment of all Unemployment Compensation, FICA,
retirement, life and/or medical insurance, and Workers’ Compensation Insurance, as the
RECIPIENT is independent from the COUNTY.
PART XV
CONFLICT OF INTEREST
RECIPIENT covenants that no person under its employ, who presently exercises any functions or
responsibilities in connection with the project, has any personal financial interest, direct or indirect,
in the project, which would conflict in any manner or degree with the performance of this MOU;
and that RECIPIENT shall not employ or subcontract with any person having any conflict of
interest. The RECIPIENT covenants that it will comply with all provisions of 24 C.F.R §570.611
“Conflict of Interest,” 2 C.F.R. §200.318, and the State and County statutes, regulations,
ordinances, or resolutions governing conflicts of interest. All RECIPIENT employees who work
on activities associated with this MOU shall complete the Subrecipient/Developer/Vendor Conflict
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of Interest Disclosure Form prior to execution of this MOU. Any employees hired later during the
period of performance for this MOU who will work on activities associated with this MOU shall
also complete and submit to the COUNTY the Conflict of Interest Disclosure Form.
RECIPIENT will notify the COUNTY in writing and seek COUNTY approval, prior to entering
into any contract with an entity owned in whole or in part by a covered person, or an entity owned
or controlled in whole or in part by RECIPIENT. The COUNTY may review the proposed contract
to ensure that the contractor is qualified and the costs are reasonable. Approval of an identity of
interest contract will be in the COUNTY’s sole discretion. This provision is not intended to limit
RECIPIENT’S ability to self-manage the projects using its own employees.
RECIPIENT shall establish Conflict of Interest reporting requirements for its board members and
staff to report their participation as a beneficiary in the program supported by this MOU. Such
reporting shall also incorporate reporting the participation of their family members who include a
spouse or civil union partner, member of the same household, parent (including step- and in-law)
grandparent (including step- and in-law), child (including step-) or grandchild (including step-),
sibling (including step- and in-law), cousin, aunt, or uncle.
Any possible conflict of interest on the part of RECIPIENT, its employees, or its contractors shall
be disclosed to CHS in writing.
PART XVI
INCIDENT REPORTING
If RECIPIENT provides services to clients under this MOU, RECIPENT and any subcontractors
shall report knowledge or reasonable suspicion of abuse, neglect, or exploitation of a child, aged
person, or disabled person to the COUNTY.
During the term of this MOU, RECIPIENT must report to the COUNTY in writing, within one
business day of occurrence, any substantial, controversial, or newsworthy incidents. The Collier
County Incident Report Form (Exhibit E) shall be used to report all such incidents.
PART XVI
OTHER CONDITIONS
16.1 The COUNTY or the RECIPIENT may amend this MOU at any time, provided that
such amendments make specific reference to this MOU, are executed in writing, signed
by a duly authorized representative of each organization, and approved by the
COUNTY’S Board. Such amendments shall not invalidate this MOU, nor relieve or
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release the COUNTY or the RECIPIENT from its obligations under this MOU.
The COUNTY may, in its discretion, amend this MOU to conform with Federal, State,
or Local governmental guidelines, policies, available funding amounts, or other
reasons. If such amendments result in a change in the funding, scope of services, or
schedule of the activities to be undertaken as part of this MOU, such modifications
will be incorporated only by written amendment, signed by both COUNTY and
RECIPIENT.
16.2 This MOU contains all the terms and conditions agreed upon by the parties. All items
incorporated by reference are as though physically attached. No other agreements, oral
or otherwise, regarding the subject matter of this MOU, shall be deemed to exist or to
bind any of the parties hereto.
16.3 The RECIPIENT and/or its subcontractors shall obtain and possess throughout the term
of this MOU all licenses and permits applicable to its operations under federal, state,
and local laws, and shall comply with all fire, health, and other applicable regulatory
codes.
16.4 The RECIPIENT and/or its subcontractors agree to comply with all applicable
requirements and guidelines prescribed by the COUNTY for recipients of funds.
16.5 The RECIPIENT and/or its subcontractors shall not use or disclose but shall protect and
maintain the confidentiality of any client information and any other information made
confidential by State or Federal laws, including Health Insurance Portability, incidental
to performance under this Agreement, and agree to safeguard the privacy of information
pursuant to HIPAA regulations. In compliance with 45 CFR 164,504(e), RECIPIENT
shall comply with the provisions of this Agreement, governing the safeguarding, use
and disclosure of Protected Health Information.
16.6 RECIPIENT understands that client information collected under this MOU is private
and the use or disclosure of such information, when not directly connected with the
administration of the COUNTY’S or RECIPIENT’S responsibilities with respect to
services provided under this MOU, is prohibited unless written consent is obtained from
such person receiving service and, in case of a minor, that of a responsible
parent/guardian.
16.7 RECIPIENT and COUNTY each binds itself, its partners, successors, legal
representatives, and assigns of such other party in respect to all covenants of this MOU.
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16.8 RECIPIENT represents and warrants that the financial data, reports, and other
information it furnished to the COUNTY regarding the Project are accurate and
complete, and financial disclosures fairly represent the financial position of the
RECIPIENT.
16.9 RECIPIENT certifies that it has the legal authority to receive the Funds under this
MOU, and its governing body has authorized the execution and acceptance of this
MOU. RECIPIENT also certifies that the undersigned person has the authority to
legally execute and bind RECIPIENT to the terms of this MOU.
16.10 The section headings and subheadings contained in this MOU are included for
convenience only and shall not limit or otherwise affect the terms of this MOU.
16.11 All activities authorized by this MOU shall be subject to and performed in accordance
with the provisions of the terms and conditions of the MOU, the Regulations, all
applicable federal, state, local and municipal laws, ordinances, regulations, orders, and
guidelines, including but not limited to any applicable regulations issued by the
COUNTY.
16.12 Electronic Signatures: This MOU, and related documents entered into in connection
with this MOU, are signed when a party’s signature is delivered by facsimile, email, or
any other electronic medium. These signatures must be treated in all respects as having
the same force and effect as original signatures.
PART XVII
GENERAL PROVISIONS
17.1 Executive Order 11246 (“Equal Employment Opportunity”), as amended by Executive
Orders 11375 and 12086 - which establishes hiring goals for minorities and women on
projects assisted with federal funds and as supplemented in Department of Labor
regulations. EO 11246:
https://www.dol.gov/agencies/ofccp/executive-order-11246/as-amended
EO 11375 and 12086:
17.2 Age Discrimination Act of 1975, Executive Order 11063, and Executive Order 11246 as
amended by Executive Orders 11375, 11478, 12107, and 12086.
Age Discrimination Act of 1975
https://www.govinfo.gov/content/pkg/USCODE-1996-title42/pdf/USCODE-1996-title42-
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chap76.pdf
11246: https://www.dol.gov/ofccp/regs/statutes/eo11246.htm
11375: Amended by EO 11478
11478:https://www.archives.gov/federal-register/codification/executive-order/11478.html
12107:https://www.archives.gov/federal-register/codification/executive-order/12107.html
12086:https://www.archives.gov/federal-register/codification/executive-order/12086.html
17.3 Contract Work Hours and Safety Standards Act, 40 U.S.C. §327-332.
https://www.dol.gov/whd/regs/statutes/safe01.pdf
17.4 Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. §776(b) (5), 24 C.F.R. §570.614
Subpart K.
Section 504: https://www.hud.gov/sites/dfiles/documents/504compliance.pdf
29 USC 776: https://www.govinfo.gov/content/pkg/USCODE-2010-
title29/html/USCODE-2010-title29-chap16.htm
24 C.F.R. 570.614: https://www.ecfr.gov/current/title-24/subtitle-B/chapter-V/subchapter-
C/part-570/subpart-K?toc=1
17.5 The Americans with Disabilities Act of 1990:
https://www.hug.gov/program_offices/fair_housing_equal_opp
Americans with Disabilities Act of 1990, As Amended | ADA.gov
17.6 Immigration Reform and Control Act of 1986:
S.1200 - 99th Congress (1985-1986): Immigration Reform and Control Act of 1986 |
Congress.gov | Library of Congress
17.7 Florida Statutes Section 448.095 Employment Eligibility. Per Florida Statute Section
448.095(3), all Florida private employers are required to verify employment eligibility for
all new hires beginning January 1, 2021. Eligibility determination is not required for
continuing employees hired prior to January 1, 2021. See:
http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-
0499/0448/0448.html
For purposes of satisfying the requirement of this condition regarding verification of
employment eligibility, the RECIPIENT shall participate in, and use, E-Verify (www.e-
verify.gov), provided an appropriate person authorized to act on behalf of the RECIPIENT
(or subrecipient) uses E-Verify (and follows the proper E-Verify procedures, including in
the event of a "Tentative Non-confirmation" or a "Final Non-confirmation") to confirm
employment eligibility for each hiring for a position in the United States that is or will be
funded (in whole or in part) with awarded Funds.
Questions about E-Verify should be directed to DHS. For more information about E-Verify
visit the E-Verify website (https://www.e-verify.gov/) or email E-Verify at E-
Verify@dhs.gov. E-Verify employer agents can email E-Verify at E-
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VerifyEmployerAgent@dhs.gov.
17.8 RECIPIENT must certify that it will provide drug-free workplaces, in accordance with the
Drug-Free Workplace Act of 1988 (41 U.S.C. §701).
https://www.gpo.gov/fdsys/granule/USCODE-2009-title41/USCODE-2009-title41-
chap10-sec701
17.9 RECIPIENT certifies that neither it, nor its principals, is presently debarred, suspended,
proposed for debarment, declared ineligible, or voluntarily excluded from participation in
this transaction by any Federal Department or agency; and the RECIPIENT shall not
knowingly enter into any lower tier contract, or other covered transaction, with a person
who is similarly debarred or suspended from participating in this covered transaction as
outlined in 24 C.F.R. §570.609, Subpart K.
See 24 C.F.R. §570.609, Subpart K at: https://www.ecfr.gov/current/title-24/subtitle-
B/chapter-V/subchapter-C/part-570/subpart-K
https://www.archives.gov/federal-register/codification/executive-order/12549.html
17.10 Limited English Proficiency: RECIPIENT agrees to take reasonable steps to provide
meaningful access to the program/project and activities funded under this MOU for persons
with limited English proficiency pursuant to information located at http://www.lep.gov.
17.11 Arrest and Conviction Records: Federal and state laws restrict use of arrest and conviction
records in the employment context, except when specifically authorized. RECIPIENT
agrees to avoid the misuse of arrest or conviction records to screen applicants for
employment or employees for retention or promotion that may have a disparate impact
based on race or national origin, resulting in unlawful employment discrimination unless
use is otherwise specifically authorized by law. See:
https://ojp.gov/about/ocr/pdfs/UseofConviction_Advisory.pdf for more details.
17.12 False Claim; Criminal, or Civil Violation: RECIPIENT must promptly refer to the
COUNTY any credible evidence that a principal, employee, agent, contractor, subgrantee,
subcontractor, or other person has either (i) submitted a false claim for grant funds under
the False Claims Act or (ii) committed a criminal or civil violation of laws pertaining to
fraud, conflict of interest, bribery, gratuity, or similar misconduct involving subaward
agreement funds. See:
18 U.S. Code § 1001 - Statements or entries generally | U.S. Code | US Law | LII / Legal
Information Institute (cornell.edu)
Beneficiaries are subject to this False Claims Act that include the following: 31 U.S.C.
3729 - False claims - Document in Context - USCODE-2010-title31-subtitleIII-chap37-
subchapIII-sec3729 (govinfo.gov)
31 U.S. Code § 3729 - False claims | U.S. Code | US Law | LII / Legal Information Institute
(cornell.edu)
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17.13 Political Activities Prohibited: None of the Funds provided directly or indirectly under this
MOU shall be used for any political activities or to further the election or defeat of any
candidates for public office. Neither this MOU nor any Funds provided hereunder shall be
utilized in support of any partisan political activities or activities for or against the election
of a candidate for an elected office.
17.14 Trafficking in Persons: RECIPIENT 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 RECIPIENT and
any of its employees. The details of RECIPIENT’S obligations related to prohibited
conduct related to the trafficking of persons are posted at:
https://ojp.gov/funding/Explore/ProhibitedConduct-Trafficking.htm.
Pursuant to Florida Statues Section 787.06, RECIPIENT attests that it does not use
coercion for labor or services. RECIPIENT 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. See:
http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0700-
0799/0787/Sections/0787.06.html
17.15 Prohibition of Gifts to COUNTY Employees - No organization or individual shall offer or
give, either directly or indirectly, any favor, gift, loan, fee, service, or other item of value
to any COUNTY employee, as set forth in Chapter 112, Part III, Florida Statutes, Collier
County Ethics Ordinance No. 2004-05, as amended, and County Administrative Procedure
5311.
Florida Statutes:
https://www.lawserver.com/law/state/florida/statutes/florida_statutes_chapter_112_part_i
ii
Other possible site:
http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0100-
0199/0112/0112PartIIIContentsIndex.html&StatuteYear=2021&Title=%2D%3E2021%2
D%3EChapter%20112%2D%3EPart%20III
Collier County Administrative Procedures:
http://www.colliergov.net/home/showdocument?id=35137
17.16 As provided in Section 287.133, Florida Statutes, by entering into this MOU or performing
any work in furtherance hereof, the RECIPIENT certifies that it, its affiliates, suppliers,
subcontractors, and consultants who will perform hereunder, have not been placed on the
convicted vendor list maintained by the State of Florida Department of Management
Services within the 36 months immediately preceding the date hereof.
This notice is required by Section 287.133 (3) (a), Florida Statutes:
http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_Strin
g=&URL=0200-0299/0287/Sections/0287.133.html
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17.17 Whistleblower Protections:
a. In accordance with 2 C.F.R. §200.217 and 41 U.S.C. §4712, the RECIPIENT 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.
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 RECIPIENT shall inform its employees in writing of whistleblower rights and
remedies provided under 2 C.F.R. §200.217 and 41 U.S.C. §4712, in the predominant
native language of the workforce. See:
https://uscode.house.gov/view.xhtml?req=(title:41%20section:4712%20edition:prelim)
All RECIPIENT employees directly involved with activities associated with this MOU
shall complete and submit to the COUNTY the Collier County Whistleblower Protections
Certification form (Exhibit F) prior to execution of this MOU. Any new employees hired
during the period of performance of this MOU shall also complete and submit the form to
the COUNTY.
ENTIRE MOU. This MOU constitutes the entire agreement between COUNTY and RECIPIENT
for the use of funds received under this MOU and it supersedes all prior or contemporaneous
communications and proposals, whether electronic, oral, or written between COUNTY and
RECIPIENT with respect to this MOU.
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EXHIBIT A
LOW INCOME POOL AGREEMENT
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EXHIBIT B
INSURANCE REQUIREMENTS
The RECIPIENT shall furnish to Collier County Board of County Commissioners, c/o Community
and Human Services Division, 3339 Tamiami Trail East, Suite 213, Naples, Florida 34112,
Certificate(s) of Insurance evidencing insurance coverage that meets the requirements as outlined
below:
1. Workers’ Compensation as required by Chapter 440, Florida Statutes.
2. Commercial General Liability, including products and completed operations insurance,
in the amount of $1,000,000 per occurrence and $2,000,000 aggregate. Collier County
Board of County Commissioners must be shown as an additional insured with respect
to this coverage.
3. Automobile Liability Insurance covering all owned, non-owned and hired vehicles
used in connection with this MOU, in an amount not less than $1,000,000 combined
single limit for combined Bodily Injury and Property Damage.
DESIGN STAGE (IF APPLICABLE)
In addition to the insurance required in 1 – 3 above, a Certificate of Insurance must be provided as
follows:
4. Professional Liability Insurance, in the name of the RECIPIENT or the licensed design
professional employed by the RECIPIENT, in an amount not less than $1,000,000 per
occurrence/$1,000,000 aggregate providing for all sums which the RECIPIENT and/or
the design professional shall become legally obligated to pay as damages for claims
arising out of the services performed by the RECIPIENT or any person employed by
the RECIPIENT in connection with this MOU. This insurance shall be maintained for
a period of two (2) years after the Certificate of Occupancy is issued.
CONSTRUCTION PHASE (IF APPLICABLE)
In addition to the insurance required in 1 – 4 above, the RECIPIENT shall provide, or cause its
Subcontractors to provide, original certificates indicating the following types of insurance
coverage prior to any construction:
5. Completed Value Builder’s Risk Insurance on an “All Risk” basis, in an amount not
less than 100 percent of the insurable value of the building(s) or structure(s). The policy
shall be in the name of Collier County Board of County Commissioners and the
RECIPIENT.
6. In accordance with the requirements of the Flood Disaster Protection Act of 1973 (42
U.S.C. 4001), the RECIPIENT shall assure that for activities located in an area
identified by the Federal Emergency Management Agency (FEMA) as having special
flood hazards, flood insurance under the National Flood Insurance Program is obtained
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and maintained, as a condition of financial assistance for acquisition or construction
purposes (including rehabilitation).
OPERATION/MANAGEMENT PHASE (IF APPLICABLE)
After the Construction Phase is completed and occupancy begins, the following insurance must be
kept in force throughout the duration of the loan and/or MOU:
7. Workers’ Compensation as required by Chapter 440, Florida Statutes.
8. Commercial General Liability including products and completed operations insurance
in the amount of $1,000,000 per occurrence and $2,000,000 aggregate. Collier County
Board of County Commissioners must be shown as an additional insured with respect
to this coverage.
9. Automobile Liability Insurance covering all owned, non-owned and hired vehicles
used in connection with this MOU in an amount not less than $1,000,000 combined
single limit for combined Bodily Injury and Property Damage.
10. Property Insurance coverage on an “All Risk” basis, in an amount not less than 100
percent of the replacement cost of the property. Collier County Board of County
Commissioners must be shown as a Loss payee, with respect to this coverage
A.T.I.M.A.
11. Flood Insurance coverage for those properties found to be within a flood hazard zone,
for the full replacement values of the structure(s) or the maximum amount of coverage
available through the National Flood Insurance Program (NFIP). The policy must show
Collier County Board of County Commissioners as a Loss Payee A.T.I.M.A.
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EXHIBIT C
PROGRESS REPORT
Recipient Name: Collier Health Services
Report Period:
Fiscal Year: 2024-2025
Program: State Mandated/LIP
Contact Name: Tami Raznoff
Contact Number: LIP25-01
Performance
Measures
Women’s Health
Services
1st
Quarter
10/1-12/31
2nd
Quarter
1/1-3/31
3rd
Quarter
4/1-6/30
4th
Quarter
7/1-9/30
Cumulative
To
Date
Target
Number to
be served
Annually
Number of Individual
Served (unduplicated) 250
Number of Service
Units
Medical Program
1st
Quarter
10/1-12/31
2nd
Quarter
1/1-3/31
3rd
Quarter
4/1-6/30
4th
Quarter
7/1-9/30
Cumulative
To
Date
Number of CHS Referred Clients
Number of Services Authorized
CHS Expenditure Amount Incurred
Expenditures Paid to Date
Page 4547 of 6525
Health Prevention and
Medical Services
1st
Quarter
10/1-12/31
2nd
Quarter
1/1-3/31
3rd
Quarter
4/1-6/30
4th
Quarter
7/1-9/30
Cumulative
To
Date
Target
Number to
be served
Annually
Number of Clients
Served 7,000
Number of Service Units
I hereby certify the above information is true and accurate.
Name: Date:
Signature:
Title:
Your typed name here represents your electronic signature
Page 4548 of 6525
EXHIBIT D
ANNUAL AUDIT MONITORING REPORT
If SUBRECIPIENT expends $750,000 or more in State financial assistance during its fiscal year, it must have
a State Single or Project Specific audit conducted in accordance with Section 215.97, Florida Statutes;
applicable rules of the Department of Financial Services; and Chapters 10.550 (local governmental entities)
or 10.650 (nonprofit and for-profit organizations), and Rules of the Auditor General. If SUBRECIPIENT
expends less than $750,000 in State financial assistance during its fiscal year, it shall provide certification to
the COUNTY that single audit was not required. In determining State financial assistance expended,
SUBRECIPIENT must consider all sources of State financial assistance, including assistance received from
Department of Children & Families, other State agencies, and other nonstate entities. This form may be used
to monitor Florida Single Audit Act (Florida Statutes Section 215.97) requirements.
Subrecipient Name Collier Health Services
First Date of Fiscal Year (MM/DD/YY) Last Date of Fiscal Year (MM/DD/YY)
Total State Financial Assistance Expended
during most recently completed Fiscal Year $
Check A. or B. Check C if applicable
A. The state expenditure threshold for our fiscal year ending as indicated above has been met
and a Single Audit as required by Section 215.97, Florida Statutes has been completed or will
be completed by ______________. Copies of the audit report and management letter are
attached or will be provided within 30 days of completion.
B. We are not subject to the requirements of Section 215.97, Florida Statutes because we:
Did not exceed the expenditure threshold for the fiscal year indicated above
Are exempt for other reasons – explain _________________________________
An audited financial statement is attached and if applicable, the independent auditor’s
management letter.
C. Findings were noted, a current Status Update of the responses and corrective action plan is
included.
While we understand that the audit report contains a written response to the finding(s), we are
requesting an updated status of the corrective action(s) being taken. Please do not provide just
a copy of the written response from your audit report, unless it includes details of the actions,
procedures, policies, etc. implemented and when it was or will be implemented.
Certification Statement
I hereby certify that the above information is true and accurate.
Signature Date:
Print Name and Title:
07/24/24
Page 4549 of 6525
Community & Human Services Division
Return completed form to: Kristi Sonntag, Director, CHS
Collier County Community and Human Services Division
3339 Tamiami Trail East, Bldg. H, Suite 213
Naples, FL 34112 Fax: (239) 252-2638
EXHIBIT E
INCIDENT REPORT FORM
Organization Name: Collier Health Services
Organization Address: 1454 Madison Ave West, Immokalee, FL 34142
Project No: LIP25-01
Grant Coordinator:
Date of Incident
Time of Incident:
Report Submitted By:
(Name & Phone)
Description of Incident:
Location/Address of Incident:
Was Police Report Filed? ☐ Yes ☐ 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 report are true and correct.
Signature of Person Making Report Date
Printed Name
Title
Page 4550 of 6525
EXHIBIT F
COLLIER COUNTY COMMUNITY & HUMAN SERVICES
WHISTLEBLOWER PROTECTIONS CERTIFICATION
RECIPIENT Name: Collier Health Services
RECIPIENT Address: 1454 Madison Ave West, Immokalee, FL 34142
EMPLOYEE NAME:
Project Name: MOU State Mandated/LIP
Project No: LIP 25-01
In accordance with 2 C.F.R. §200.217 and 41 U.S.C. §4712, RECIPIENT 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 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; or
• A management official or other employee of RECIPIENT, contractor, or subcontractor who has
the responsibility to investigate, discover, or address misconduct.
RECIPIENT 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 certification, I certify that Recipient Name will comply with all Whistleblower rights and
protections for its employees.
Name:
Signature:
Title:
Your typed name here represents your electronic signature
Page 4551 of 6525