Backup Documents 11/10/2025 Item #16A 4 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 D 4
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 11.10.25 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 Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Carolyn Noble Community and Human CN 10.30.25
Services
2. County Attorney Office— County Attorney Office D
3. BCC Office Board of County (,
Commissioners /S J,/j /715
4. Minutes and Records Clerk of Court's Office l (tI r3r g‘
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is n ded 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 10.28.25 BCC Mtg Agenda Item Number 16.D.4
Approved by the BCC
Type of Document 3 CAC AGREEMENTS Number of Original 3
Attached Documents Attached Cy;GS
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 CO
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 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 Ci-AD an option for
Chairman's signature. this line.
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State Mandated: CAC
Agreement#: SM25-01
Activity: Medical Exams and Consultations
RECIPIENT: Collier County Child
Advocacy Council,Inc.d/b/a Children's
Advocacy Center of Collier County
Total Award Amount: S80,000.00
UEI#: E6WMNP33EWMS
FEIN: 65-0049492
Period of Performance: 10/1/2025-9/30/2026
Fiscal Year End: 6/30
Monitoring End 3/30/2027
AGREEMENT BETWEEN COLLIER COUNTY
AND
COLLIER COUNTY CHILD ADVOCACY COUNCIL,INC.
d/b/a CHILDREN'S ADVOCACY CENTER OF COLLIER COUNTY
STATE MANDATED SERVICES PROGRAM
THIS AGREEMENT, is made and entered into on this day of /10‘-e ,i elr ,
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 the Collier County
Child Advocacy Council, Inc., d/b/a Children's Advocacy Center of Collier County
(RECIPIENT), a private not-for-profit corporation, under agreement with the State of Florida,
Department of Children and Families, providing coordination of the Child Protection Team of
Collier County(CPT),authorized to do business in the State of Florida,whose business address is
5405 Park Central Court,Naples,Florida 34109.
WHEREAS, COUNTY believes it to be in the public interest to provide initial forensic
physical examination and medical consultation services for abused, abandoned, or neglected
children who are residents of Collier County in accordance with this Agreement,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 SCOPE OF SERVICES
The RECIPIENT shall, in a satisfactory and proper manner and in accordance with Florida
Statute §39.304, Appendix A and any other 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 conduct the program as follows:
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Project Name: State Mandated Services Program
Description of project: Provide initial forensic physical examination and medical
consultation services for abused, abandoned, or neglected children who are residents of
Collier County, pursuant to Section 39.304(5), Florida Statutes; or conduct a medical
records review in cases where such a review can serve in place of an initial forensic
physical examination.
Project Component One: Initial forensic physical examinations for abused, abandoned, or
neglected children.
Project Component Two: Medical consultations/reviews where such a consultation/review
can serve in place of an initial forensic physical examination.
Project Tasks:
1. Possess, maintain, and keep current all necessary medical license(s) required by
governmental authorities.
2. Possess, maintain, and keep current all agreements between CAC and ARNP's,
physician assistants,and physicians.
A. Project Description/Budget
Description Fixed Unit Rate Cost
Project Component 1: Initial forensic physical examinations for $350.00
abused,abandoned,or neglected children.
Project Component 2: Medical consultations/reviews where such $125.00
a consultation/review can serve in place of an initial forensic
physical examination.
TOTAL FUNDS AVAILABLE $80,000.00
B. Performance Deliverables
Program Deliverable Deliverable Supporting Submission Schedule
Documentation
Insurance Insurance Certificate, Within 30 days of Agreement
Exhibit A execution and annually within thirty
(30)days of renewal
Physician Agreements Agreements between Within sixty(60)days of Agreement
CAC and physicians execution,and 30 days prior to
execution of any renewal, for
approval
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Licenses Physician, Physician Within sixty (60)days of Agreement
Assistants execution and upon renewal of each
license
Quarterly Progress Report Exhibit C Quarterly by the 30th of the month
following quarter end.
CPT/Medical Provider Agreements between Within thirty (30)days of Agreement
Agreements CPT and CAC medical execution
providers
Children's Advocacy Agreements between Within thirty(30)days of Agreement
Center/Florida Department CAC and DCF relating execution
of Children & Families to CPT
Agreements
Financial and Compliance Audit, Management Annually: nine (9)months after FY
Audit Letter, and Supporting end for Single Audit OR one hundred
Documentation eighty(180)days after FY end
Annual Audit Monitoring Exhibit D Annually,within 60 days after FY
Report end.
Florida Department of Attestation of Annually,no more than 13 months
Children and Families Compliance— apart.
Employment Background Employer(Exhibit G)
Screening Attestation
Conflict of Interest Form RecipientNendor/ Upon execution of the Agreement for
Developer Conflict of all employees who work on activities
Interest Disclosure associated with the Project and upon
Form hiring of all new employees.
Whistleblower Protections Exhibit F Upon execution of the Agreement for
Affidavit all employees who work on activities
associated with the Project and upon
hiring of all new employees.
Business Associate Business Associate Within 60 days of Agreement
Agreement Agreement execution.
C. Payment Deliverables
Payment Deliverable Payment Supporting Documentation Submission
Schedule
Project Component 1: Initial Exhibit B along with supporting Quarterly invoices
forensic physical documents,as evidenced by CAC cover due by the 30th of 1
examinations for abused, sheet, invoice, exam services provided the month following
abandoned, or neglected list, monthly summary log,cancelled quarter end.
children. check or bank statements,and any other
additional documentation as requested.
Project Component 2: Medical Exhibit B along with supporting Quarterly invoices
consultations/reviews where documents,as evidenced by CAC cover due by the 3091 of
such a consultation/review sheet, invoice,exam services provided the month following
can serve in place of an list, monthly summary log,cancelled quarter end.
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initial forensic physical check or bank statements,and any other
examination, additional documentation as requested.
D. RECIPIENT shall receive reimbursement for medical examinations and medical
consultation/review services pursuant to Section 39.304(5), Florida Statutes, in
accordance with Section 1.4, Compensation, of this Agreement.
E. The RECIPIENT shall pay, from its own account,the costs for initial forensic physical
examination and medical consultations to the providers of medical diagnosis and
evaluation services for each child abuse or neglect case. RECIPIENT shall seek
reimbursement from the COUNTY in accordance with the Compensation section of
this Agreement.
F. The county in which the child is a resident shall bear the initial costs of the examination
of the allegedly abused, abandoned, or neglected child; however, the parents or legal
custodian of the child shall be required to reimburse the county for the costs of such
examination,other than an initial forensic physical examination,as provided in Section
39.304(5), Florida Statutes, as well as reimburse the Department of Children and
Families for the cost of the photographs taken pursuant to this section. A medical
provider shall not bill a child victim directly, or indirectly for the cost of an initial
forensic physical examination.
G. Within 30 days of execution of this Agreement, the RECIPIENT shall furnish the
COUNTY with copies of its current contracts between the Child Protection Team
(CPT) and its medical provider(s),and copies of its contracts with Florida Department
of Children and Families (DCF) relating to the CPT. Any amendments or new
agreements executed during the term of this Agreement between CPT and its medical
provider(s)or DCF shall be immediately forwarded to the COUNTY.
H. Allow inspection, review, or audit of these records by COUNTY personnel upon
reasonable notice, subject to the confidentiality requirements of Chapter 39, Florida
Statutes. RECIPIENT will provide the COUNTY with privacy, security, and audit
protocol agreement forms from the Department of Health (DH) and DCF. The
COUNTY will execute said forms.
1.2 PERIOD OF PERFORMANCE
RECIPIENT's services shall start on October 1,2025,and end on September 30,2026(Term
of Agreement), unless terminated as specified in Section 3.6 Defaults, Remedies, and
Termination. The services/activities of the RECIPIENT shall be undertaken and completed
in light of the purposes of this Agreement. Any funds not obligated by the expiration date of
this Agreement shall automatically revert to the COUNTY.
The COUNTY may, at its discretion and with the consent of the RECIPIENT, renew this
agreement under all the terms and conditions contained in this Agreement for three (3)
additional one (1) year terms. The COUNTY shall give the RECIPIENT written notice of
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the COUNTY's intent to renew the Agreement 45 days prior to the end of each one year
term. The RECIPIENT will have 10 days to accept or reject the renewal and provide written
notice to the COUNTY's Grant Coordinator.
1.3 AGREEMENT AMOUNT
The COUNTY agrees to make available EIGHTY THOUSAND DOLLARS AND ZERO
CENTS ($80,000.00) for use by the RECIPIENT, during the Term of the Agreement (the
Funds).
Modifications to the Budget and Scope may only be made if approved by COUNTY in
advance. Cumulative Fund shifts among line items may be 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 (10%) of the
Agreement amount shall only be made with Board of County Commissioners (Board)
approval.
The COUNTY shall reimburse RECIPIENT for the performance of this Agreement upon
completion or partial completion of the work tasks, as accepted and approved by CHS.
RECIPIENT may not request disbursement funds until funds are needed for eligible costs,
and all disbursement requests must be limited to the amount needed at the time of the request.
Invoices for work performed are required every quarter.RECIPIENT may expend funds only
for allowable costs resulting from obligations incurred during the term of this Agreement. If
no work has been performed during that quarter,or if RECIPIENT is not yet prepared to send
the required backup, a $0 invoice is required. Explanations may be required if two
consecutive quarters of$0 invoices are submitted. Payments shall be made to RECIPIENT
when requested as work progresses, but not more frequently than once per quarter.
Reimbursement will not occur if RECIPIENT fails to perform the minimum level of service
required by this Agreement.
Final invoices are due no later than 90 days after the end of the Agreement. Work performed
during the term of the Agreement but not invoiced within 90 days after the end of the
Agreement may not be processed without written authorization from the Grant Coordinator.
No payment will be made until approved by CHS for compliance and adherence to all
applicable Local, State, or Federal requirements, including timely submission of
Performance Deliverables contained in Section 1.1.B. 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 Ch. 218, Part VII, Florida
Statutes,otherwise known as the"Local Government Prompt Payment Act."
1.4 COMPENSATION
The COUNTY shall reimburse RECIPIENT for initial forensic physical examinations
services for abused, abandoned, or neglected children and administrative costs. The
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COUNTY shall also reimburse the RECIPIENT for medical consultations/reviews where
such a consultation/review can serve in place of an initial forensic physical examination.
However, the COUNTY shall in no instance be required to pay for both an initial forensic
physical examination and a medical consultation/review.A medical consultation/review may
be provided when a physical evaluation has already been performed by a non-CPT medical
provider. A medical consultation/review involves situations where the child protective
investigator (or court) requests CPT to assist with a medical opinion. A medical
consultation/review must result in a typed report that references all the pertinent history,
examination findings,and laboratory/imaging studies used to reach the medical conclusions.
The CPT medical record must include copies of the relevant records and reports used to
arrive at the medical opinion.
During the term of this Agreement, should any of the forensic physician examinations or
medical consultation/review prices increase, the RECIPIENT shall notify the COUNTY
immediately. The COUNTY will determine if an amendment is allowable and acceptable
and may require Board approval.
A. RECIPIENT shall bill Crimes Victim's Services for all situations covered under 2019
Florida Statutes Section 960.28, see Appendix B. If denied, the invoice will include
documentation of denial. The COUNTY will be billed at the time denial is received by
RECIPIENT. If reimbursement from Crimes Victim's Services is received by
RECIPIENT at any time after the COUNTY has paid RECIPIENT invoices,
RECIPIENT shall reimburse the COUNTY for any Crimes Victim's Services monies
received. Said reimbursement shall reference the case number for which the
reimbursement is being provided.
B. RECIPIENT shall submit a quarterly invoice that references an invoice number,
invoice date, and a CPT case number for each initial forensic physical examination
and/or medical consultation/review.
C. Quarterly payments will be made upon receipt of a proper invoice and in compliance
with Chapter 218 Florida Statutes,otherwise known as the"Local Government Prompt
Payment Act." COUNTY reserves the right to withhold and/or reduce an appropriate
amount of any payment for work not performed or for unsatisfactory performance of
RECIPIENT requirements. The COUNTY shall pay RECIPIENT for the performance
of this Agreement.
1.5 NOTICES
Notices required by this Agreement shall be in writing and delivered via mail (postage
prepaid), commercial courier, 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.
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COLLIER COUNTY ATTENTION: Carolyn Noble, Grants Coordinator
Collier County Community& Human Services Division
2671 Airport Pulling Road, Suite 202
Naples, Florida 34112
Email: Carolyn.Noble'collier.gov
Telephone: (239) 252-5321
RECIPIENT ATTENTION: Jacqueline Griffith Stephens,CEO
Collier County Child Advocacy Council, Inc.d/b/a
Children's Advocacy Center of Collier County
5405 Park Central Court
Naples,Florida 34109
Email:jstephens@caccollier.org
Telephone: (239)263-8383
RECIPIENT and the COUNTY may change the above mailing address at any time upon
giving the other party written notification. All notices under this Agreement must be in
writing.
PART II
CONTROL REQUIREMENTS
2.1 AUDITS
During the term of this Agreement, RECIPIENT shall submit an annual audit monitoring
report(Exhibit D) to the COUNTY no later than nine (9)months after the Single Audit(or
one hundred eighty (180) days for Recipients exempt from Single Audit), after
RECIPIENT's fiscal year end. The COUNTY will conduct an annual financial and
programmatic review.
RECIPIENT must fully clear any deficiencies noted in audit reports within 30 days after its
receipt of the report. RECIPIENT's failure to comply with the above audit requirements will
constitute a violation of this Agreement and may result in the withholding of future
payments. RECIPIENT hereby agrees to obtain an annual agency audit conducted in
accordance with current COUNTY policy concerning Contractor audits and if applicable,
Florida Statutes, section 215.97(Florida Single Audit Act).
2.2 RECORDS AND DOCUMENTATION
The RECIPIENT shall maintain sufficient records, in accordance with Florida Statute, to
determine compliance with the requirements of this Agreement, the DCF agreement,and all
other applicable laws and regulations. This documentation shall include, but is not limited
to,the following:
A. All records required by Florida Statute, as directed by DCF, in its contract with
RECIPIENT.
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B. RECIPIENT shall establish and maintain books,records,and documents(including
electronic storage media) sufficient to reflect all income and expenditures of State
Funds. Upon demand,at no additional cost to the State or COUNTY, RECIPIENT
will facilitate the duplication and transfer of any records or documents during the
term that it receives any State Funds and the required retention period for the State
or COUNTY. These records shall be made available at all reasonable times for
inspection,review, copying. transfer, or audit by Federal, State, or other personnel
duly authorized by the State or COUNTY.
C. RECIPIENT shall maintain public records that ordinarily and necessarily would be
required by the COUNTY in order to perform the service.
D. All reports, plans, surveys, information, documents, maps, books, records, and
other data procedures developed, prepared, assembled, or completed by the
RECIPIENT for this Agreement shall be made available to the COUNTY, by the
RECIPIENT, at any time, upon request by the COUNTY or CHS. Materials
identified in the previous sentence shall be in accordance with generally accepted
accounting principles (GAAP), procedures, and practices, which sufficiently and
properly reflect all revenues and expenditures of funds provided directly or
indirectly by this Agreement. These records shall be maintained to the extent of
such detail as will properly reflect all net costs,direct and indirect labor,materials,
equipment,supplies and services,and other costs and expenses of whatever nature
for which reimbursement is claimed under the provisions of this Agreement.
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, RECIPIENT shall keep all documents and records in an
orderly fashion, in a readily accessible,permanent,and secured location for six(6)
years after the date of submission of the final progress report., However, if any
litigation, claim, or audit is started before the expiration date of the six (6) year
period, the records will be maintained until all litigation, claim, or audit findings
involving these records are resolved. If RECIPIENT ceases to exist after the
closeout of this Agreement, the COUNTY shall be informed, in writing, of the
address where the records are to be kept. The RECIPIENT shall meet all
requirements for retaining public records and transfer, at no cost to COUNTY, all
public records in possession of the RECIPIENT upon termination of the
Agreement,and destroy any duplicate public records that are exempt or confidential
and exempt from public records disclosure requirements. All records stored
electronically must be provided to the COUNTY in a format that is compatible with
the COUNTY'S information technology systems.
IF THE RECIPIENT HAS QUESTIONS REGARDING THE
APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE
RECIPIENT'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO
THIS AGREEMENT, CONTACT THE CUSTODIAN OF PUBLIC
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RECORDS AT 239-252-5837, Angel.Bates@collier.gov, 3299 Tamiami
Trail E, Naples FL 34112.
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 CFR 200.303(e). This includes
information that DCF 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 public records that are
exempt or confidential and exempt from public records disclosure requirements are
not disclosed.
2.3 MONITORING
RECIPIENT agrees that CHS may carry out no less than one (1) annual on-site monitoring
visit and evaluation activities, as determined necessary. At the COUNTY's discretion, a
desktop review of the activities may be conducted in lieu of an on-site visit.The continuation
of this Agreement is dependent upon satisfactory evaluations.
At any time during normal business hours and as often as the COUNTY (and/or its
representatives) may deem necessary, RECIPIENT shall make available all records,
documentation, and any other data relating to all matters covered by this Agreement for
review, inspection,or audit.
Deferred Payment/Return of Funds: If,as a result of monitoring or audit,clients counted are
not properly documented, payment may be deferred. If RECIPIENT cannot provide
appropriate documentation to determine the accuracy of the number of qualifying clients
submitted by RECIPIENT, no future payment will be made until the full amount of
overpayment is remitted to the COUNTY or a repayment agreement is accepted by the
COUNTY.The overpayment will be calculated on a pro rata basis. If the monitoring or audit
occurs after the term of this Agreement, RECIPIENT will be required to remit funds to the
COUNTY in accordance with the repayment conditions below.
RECIPIENT agrees to return to the COUNTY any overpayments due to funds disallowed,
pursuant to the terms of this Agreement and/or Local, State, or Federal requirements.
RECIPIENT will be required to reimburse the COUNTY for any acts of noncompliance
resulting in disallowed costs or fines.
COUNTY will monitor RECIPIENT's performance to mitigate fraud, waste, abuse, or
nonperformance based on goals and performance standards, as stated with all other
applicable laws, regulations, and policies governing the funds provided under this
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Agreement, further defined by Florida Statute Section 215.85. Substandard Performance, as
determined by the COUNTY, will constitute noncompliance with this Agreement. If
RECIPIENT does not take corrective action within a reasonable time period after being
notified by the COUNTY,Agreement suspension or termination procedures may be initiated.
2.4 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 Agreement,and provide proper and effective management of all Program
and Fiscal activities of the Agreement. RECIPIENT's internal control systems and all
transactions and other significant events shall be clearly documented and readily available
for monitoring by COUNTY.
RECIPIENT shall provide COUNTY with complete access to all its records,employees,and
agents for the purpose of monitoring or investigating the performance of this Agreement.
RECIPIENT shall fully cooperate with 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 Agreement or any law or regulation to the COUNTY, or any
appropriate law enforcement authority, if the report is made in good faith.
2.5 REPORTS
Reimbursement may be contingent upon the timely receipt of complete and accurate
reports required by this Agreement,and on the resolution of monitoring findings identified
pursuant to this Agreement, as deemed necessary by the County Manager or designee.
Reports showing lack of project activity may result in the withholding of payment or
issuance of a Notice of Non-Compliance.
During the term of this Agreement,RECIPIENT shall submit quarterly progress reports to
the COUNTY on the 30th day of January, April, July, and October, respectively, for the
prior quarter period end. Exhibit C contains the reporting form to be used to fulfill this
requirement. Other reporting requirements may be required by the County Manager or
designee if the Program changes, the need for additional information or documentation
arises,and/or legislative amendments are enacted. Reports and/or requested documentation
not received by the due date shall be considered delinquent and may be cause for default
and termination of this Agreement.
2.6 CONFIDENTIAL CLIENT AND OTIIE R INFORMATION
Except as provided in this Agreement, RECIPIENT 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 or regulations, that is obtained or accessed by
RECIPIENT or its subcontractor's incidental to performance under this Agreement.
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2.7 HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
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 created, received, maintained, or transmitted by RECIPIENTS or its
subcontractors incidental to performance under this Agreement.
PART III
TERMS AND CONDITIONS
3.1 SUBCONTRACTS
Any work or services subcontracted by the RECIPIENT shall be by written contract or
agreement, and such subcontracts shall be subject to each provision of this Agreement and
applicable County, State, and Federal guidelines and regulations. RECIPIENT must submit
such subcontracts to the COUNTY for review and approval 30 days prior to execution. If
medical provider agreements are already in place at the time of this Agreement execution,
approval by the COUNTY is not required until such time as those agreements are renewed.
None of the work or services covered by the Agreement, including but not limited to
consultant work or services,shall be subcontracted by the RECIPIENT or reimbursed by the
COUNTY,without prior written approval of the CHS Director or designee.
3.2 GENERAL COMPLIANCE
RECIPIENT agrees to comply with all applicable State and Local laws, regulations, and
policies governing the Funds provided under this Agreement. RECIPIENT is prohibited from
using Funds provided herein, or personnel employed in the administration of the program,
for political activities, inherently religious activities, lobbying, political patronage, and/or
nepotism activities.
3.3 INDEPENDENT CONTRACTOR
Nothing contained in this Agreement is intended to,or shall be construed in any manner, as
creating or establishing the relationship of employer/employee between the parties. The
RECIPIENT shall always remain an"independent contractor"with respect to the services to
be performed under this Agreement. The COUNTY shall be exempt from payment of all
Unemployment Compensation, FICA, retirement, life and/or medical insurance, and
Workers' Compensation Insurance as RECIPIENT is an independent contractor.
3.4 AMENDMENTS
The COUNTY or RECIPIENT may amend this Agreement, at any time, provided that such
amendments make specific reference to this Agreement, and are executed in writing, signed
by a duly authorized representative of each organization, and approved by the COUNTY's
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Board. Such amendments shall not invalidate this Agreement, nor relieve or release the
COUNTY or RECIPIENT from its obligations under this Agreement.
The COUNTY may,at its discretion, amend this Agreement to conform with Federal, State,
or governmental guidelines,policies,available funding amounts,or for other reasons. If such
amendments result in a change in the funding, the scope of services, or schedule of the
activities to be undertaken as part of this Agreement,such modifications will be incorporated
only by written amendment signed by both COUNTY and RECIPIENT.
3.5 INDEMNIFICATION
To the maximum extent permitted by Florida law, RECIPIENT shall indemnify and hold
harmless Collier County, its officers, agents, and employees from any and all claims,
liabilities, damages, losses, costs, and causes of action which may arise out of an act or
omission,including but not limited to, reasonable attorneys' fees and paralegals' fees, to the
extent caused by the negligence, recklessness, or intentionally wrongful conduct of
RECIPIENT or any of its agents, officers, employees, contractors, patrons. guests, clients,
licensees, invitees, or any persons acting under the direction, control, or supervision of
RECIPIENT, in the performance of this Agreement.
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 pay all claims and losses of any nature
whatsoever in connection therewith and shall defend all suits in the name of the COUNTY
and shall pay all costs(including attorney's fees)and judgments which may issue thereon.
This Indemnification shall survive the termination and/or expiration of this Agreement. This
section does not pertain to any incident arising from the sole negligence of COUNTY. The
foregoing indemnification shall not constitute a waiver of sovereign immunity beyond the
limits set forth in Section 768.28, Florida Statutes. This section shall survive the expiration
or termination of this Agreement.
3.6 DEFAULTS, REMEDIES AND TERMINATION
This Agreement may be terminated for convenience by either the COUNTY or RECIPIENT,
in whole or in part, with a thirty(30)day written notice, 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 Agreement may also be
terminated by the COUNTY if the award no longer effectuates the program goals or agency
priorities.
The following actions or inactions by RECIPIENT shall constitute a Default under this
Agreement:
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A. Failure to comply with any of the rules, regulations, or provisions referred to
herein, or such statutes, regulations, executive orders, and State of Florida
guidelines,policies, or directives as may become applicable at any time
B. Failure, for any reason, to fulfill in a timely and proper manner its obligations
under this Agreement
C. Ineffective or improper use of funds provided under this Agreement
D. Submission of reports to the COUNTY 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 Agreement
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 Agreement, the COUNTY may seek
any combination of one or more of the following remedies:
A. Require specific performance of the Agreement, in whole or in part
B. Require the use of or change in medical services provider
C. Require RECIPIENT to immediately repay to the COUNTY all funds received
under this Agreement
D. Apply sanctions, if determined by the COUNTY to be applicable
E. Stop all payments until identified deficiencies are corrected
F. Terminate this Agreement, by giving written notice to RECIPIENT and
specifying the effective date of such termination.If the Agreement is terminated
by the COUNTY, as provided herein, RECIPIENT shall have no claim of
payment or claim of benefit for any incomplete project activities undertaken
under this Agreement.
3.7 CORRECTIVE ACTION
Corrective action plans may be required for noncompliance, nonperformance, or
unacceptable performance under this Agreement. Penalties may be imposed for failure to
implement or to 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. CHS's escalation policy for noncompliance is as
follows:
A. Initial noncompliance may result in Findings or Concerns being issued to the
RECIPIENT and will require a corrective action plan be submitted 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.
• CHS will be available to provide Technical Assistance (TA) to RECIPIENT, as
needed, in order to correct the noncompliance issue.
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B. If RECIPIENT fails to submit the corrective action plan in a timely manner, CHS may
require RECIPIENT to return a portion of the awarded grant amount to the COUNTY.
• The COUNTY may require RECIPIENT to return upwards of 5 percent(5%) of
the award amount to the COUNTY,at the discretion of the Board.
• The RECIPIENT may be denied future consideration, as set forth in Resolution
No. 2013-228.
C. If RECIPIENT remains noncompliant or repeats an issue that was previously corrected
and has been informed by CHS of its substantial noncompliance by certified mail,CHS
may require RECIPIENT to return a portion of the awarded amount to the COUNTY.
• The COUNTY may require RECIPIENT to return upwards of 10 percent(10%)
of the award amount to the COUNTY,at the discretion of the Board.
• The RECIPIENT will be in violation of Resolution No. 2013-228.
D. If after repeated notification, RECIPIENT continues to be substantially noncompliant,
CHS may recommend the Agreement or award be terminated.
• CHS will make a recommendation to the Board to immediately terminate the
Agreement.The RECIPIENT will be required to repay all funds disbursed by the
COUNTY for the project that was terminated. This includes the amount invested
by the COUNTY for the initial acquisition of properties or other activities, if
applicable.
• The RECIPIENT will be in violation of Resolution No. 2013-228.
If RECIPIENT has multiple agreements with CHS and is found to be noncompliant,
the above sanctions may be imposed across all awards, at the Board's discretion.
3.8 AGENCY RECOGNITION/SPONSORSHIPS
As required by§286.25,F.S.,RECIPIENT agrees that all notices,informational pamphlets,
press releases,advertisements,descriptions of Program sponsorships,research reports,and
similar public notices, whether printed or digital, RECIPIENT has prepared and released
for,on behalf of, and/or about the Program shall include the statement:
"SPONSORED IN PART BY COLLIER COUNTY
COMMUNITY AND HUMAN SERVICES DIVISION"
The statement shall appear in the same size letters or type as the RECIPIENT'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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3,9 PURCHASING
RECIPIENT is required to follow Collier County's Procurement Ordinance #2025-34, as
amended. Current COUNTY purchasing thresholds are:
Range: Competition Required
$0-$10,000 Single Quote
$10,001 -$50,000 3 Written Quotes in writing
$50,001 - $250,000 3 Quotes through COUNTY'S bidding platform
$250,001+ Formal Solicitation(ITB, RFP,etc.)
All project tasks specified in Part I Scope of Work shall be performed by RECIPIENT
employees,or put out to competitive bidding,under a procedure acceptable to the COUNTY
and State requirements. RECIPIENT shall enter contracts with the lowest, responsible, and
qualified bidder. RECIPIENT shall manage and CHS shall monitor contract administration.
CHS shall have access to all records and documents related to the Project.
Per Section 287.057(3)(e), Florida Statutes, RECIPIENT is exempt from competitive
solicitation of health services.
As provided in Section 287.133, Florida Statutes, by entering into this Agreement or
performing any work in furtherance hereof, 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.
3.10 INSURANCE
RECIPIENT shall not commence any work and/or services pursuant to this Agreement,until
all required insurance, as outlined in Exhibit A has been obtained. Said insurance shall be
carried continuously during RECIPIENT's performance under the Agreement. RECIPIENT
shall furnish a Certificate of Insurance naming Collier County as an additional insured with
general liability limits of at least$1,000,000 per occurrence in accordance with Exhibit A.
3.11 DEBARMENT
RECIPIENT certifies that none of its officers or agents have been debarred from bidding,
proposing, or contracting for Federal, State, or Local government programs. RECIPIENT
assures that all its subcontractors who will participate in activities,subject to this Agreement,
are eligible and have not been debarred.
3.12 CIVIL RIGHTS COMPLIANCE
The RECIPIENT agrees that no person shall be excluded from the benefits of,or be subjected
to,discrimination based on race,creed,color,religion,national origin,sex,handicap,familial
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status,marital status or age under any activity carried out by RECIPIENT in performance of
this Agreement. Upon receipt of evidence of such discrimination, the COUNTY shall have
the right to terminate this Agreement. RECIPIENT will take affirmative action to ensure that
all employment practices are free from such discrimination. Such employment practices
include but are not limited to hiring, upgrading, demotion, transfer, recruitment or
recruitment advertising, layoff,termination,rate of pay or other forms of compensation,and
selection for training, including apprenticeship. RECIPIENT agrees to post notices setting
forth the provisions of this nondiscrimination clause in conspicuous places available to
employees and applicants for employment.
3.13 OPPORTUNITIES FOR SMALL AND MINORITY/WOMEN-OWNED BUSINESS
ENTERPRISES
The RECIPIENT will use its best efforts to afford small businesses, minority and women's
business enterprises the maximum practicable opportunity to participate in the performance
of this Agreement. As used in this Agreement, the terms"small business"means a business
that meets the criteria set forth in section 3(a) of the Small Business Act, as amended (15
U.S.C. 632); and "minority and women's business enterprise" means a business at least 51
percent owned and controlled by minority group members or women. For the purpose of this
definition, "minority group members" are Afro-Americans, Spanish-speaking, Spanish
surnamed, or Spanish-heritage Americans, Asian-Americans, and American Indians.
RECIPIENT may rely on written representations by businesses regarding their status as
minority and female business enterprises in lieu of an independent investigation.
3.14 PROHIBITED ACTIVITY
RECIPIENT, or personnel employed in the administration of the program, are prohibited
from using Funds provided herein, for political activities, sectarian or religious activities,
lobbying,political patronage,and/or nepotism activities.
3.15 CONFLICT OF INTEREST
The RECIPIENT covenants that no person under its employ, who presently exercises any
functions or responsibilities in connection with the Program, has any personal financial
interest, direct or indirect, which would conflict in any manner or degree with the
performance of services, required in this Agreement. RECIPIENT further agrees that it will
not employ or subcontract with any person having any conflict of interest. The RECIPIENT
agrees that it will comply with all provisions of Florida Statute Section 287.057 and any
additional State and County statutes, regulations, ordinances, or resolutions governing
conflicts of interest.All RECIPIENT employees who work on activities associated with this
Agreement shall complete the Subrecipient/DeveloperNendor Conflict of Interest
Disclosure Form prior to execution of this Agreement.Any employees hired later during the
period of performance for this Agreement who will work on activities associated with this
Agreement shall also complete and submit to the COUNTY the Conflict-of-Interest
Disclosure Form.
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The 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 subrecipient is qualified and that 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.
3.16 SUBJECT TO APPROPRIATION
It is further understood and agreed by and between the parties herein that this Agreement is
subject to appropriation by the Board of County Commissioners.
3.17 ASSIGNMENT
RECIPIENT shall not assign this Agreement or any part thereof, without the prior written
consent of the COUNTY. Any attempt to assign or otherwise transfer this Agreement or any
part herein, without the COUNTY's consent, shall be void. If RECIPIENT does, with
approval,assign this Agreement or any part thereof,it shall require that its assignee be bound
to it and to assume toward RECIPIENT all the obligations and responsibilities that
RECIPIENT has assumed toward the COUNTY. If an assignment of this Agreement is
approved by the COUNTY, RECIPIENT shall be relieved of all obligations under this
Agreement arising after any assignment.
3.18 INCIDENT REPORTING
If RECEIPIENT provides services to clients under this Agreement,the RECIPIENT 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, 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.
3.19 SEVERABILITY
Should any provision of the Agreement be determined to be unenforceable or invalid, such
a determination shall not affect the validity or enforceability of any other section or part
thereof.
3.20 MISCELLANEOUS
RECIPIENT and COUNTY each binds itself, its partners, successors, legal representatives,
and assigns of such other party in respect to all covenants of this Agreement.
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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 RECIPIENT.
RECIPIENT understands that client information collected under this Agreement 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 Agreement, is prohibited unless written consent is obtained from such
person receiving service and, in case of a minor,that of a responsible parent/guardian.
RECIPIENT certifies that it has the legal authority to receive the Funds under this Agreement
and its governing body has authorized the execution and acceptance of this Agreement.
RECIPIENT also certifies that the undersigned person has the authority to legally execute
and bind RECIPIENT to the terms of this Agreement.
The section headings and subheadings contained in this Agreement are included for
convenience only and shall not limit or otherwise affect the terms of this Agreement.
The Agreement Documents shall be construed in accordance with and governed by the laws
of the State of Florida, without giving effect to its provisions regarding choice of laws.
All activities authorized by this Agreement shall be subject to and performed in accordance
with the provisions of the terms and conditions of this Agreement, the Regulations, all
applicable Federal. State, and Municipal laws, ordinances, regulations, orders, and
guidelines, including but not limited to any applicable regulations issued by the COUNTY.
Electronic Signatures. This Agreement, and related documents, entered into in connection
with this Agreement, are signed when a party's signature is delivered by facsimile, e-mail,
or any other electronic medium. These signatures must be treated in all respects as having
the same force and effect as original written signatures.
PART IV
GENERAL PROVISIONS
4.1 PERMITS, LICENSES, TAXES: In compliance with Section 218.80, Florida Statues, all
permits necessary for the performance of the Work shall be obtained by RECIPIENT.
Payment for all such permits issued by the COUNTY shall be processed internally by the
COUNTY. All non-COUNTY permits necessary for the performance of the Work shall be
procured and paid for by RECIPIENT. The RECIPIENT shall also be solely responsible for
payment of all taxes levied on the RECIPIENT. In addition, RECIPIENT shall comply with
all rules, regulations, and laws of Collier County, the State of Florida, or the U. S.
Government now in force or hereafter adopted. The RECIPIENT agrees to comply with all
laws governing the responsibility of an employer with respect to persons employed by
RECIPIENT.
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4.2 NO IMPROPER USE: The RECIPIENT will not use, nor offer or permit any person to use
in any manner whatsoever, COUNTY facilities for any improper, immoral, or offensive
purpose or for any purpose in violation of any federal,state,county,or municipal ordinance,
rule.order,or regulation,or of any governmental rule or regulation now in effect or hereafter
enacted or adopted. In the event of such violation by the RECIPIENT,or if the COUNTY or
its authorized representative shall deem any conduct on the part of the RECIPIENT to be
objectionable or improper,the COUNTY shall have the right to suspend the Agreement with
the RECIPIENT. Should RECIPIENT fail to correct any such violation,conduct,or practice
to the satisfaction of the COUNTY within twenty-four (24) hours after receiving notice of
such violation,conduct,or practice,such suspension will continue until the violation is cured.
The RECIPIENT further agrees not to commence operation during the suspension period
until the violation has been corrected to the satisfaction of the COUNTY.
4.3 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/executi ve-order-11246/as-amended
EO 11375 and 12086: see item#8 below
4.4 Title VII of the 1968 Civil Rights Act as amended by the Equal Employment Opportunity
Act of 1972, 42 U.S.C. §2000e, et. seq. RECIPIENT will, in all solicitations or
advertisements for employees placed by or on behalf of RECIPIENT,state that it is an Equal
Opportunity or Affirmative Action employer.
Title VII of the Civil Rights Act of 19641 U.S.Equal Employment Opportunity Commission
(eeoc.gov)
4.5 RECIPIENT shall not assign or transfer any interest in this Agreement without the prior
written consent of the COUNTY thereto; provided, however, that claims for money due or
to become due to RECIPIENT from CHS under this Agreement may be assigned to a bank,
trust company, or other financial institution without such approval. Notice of any such
assignment or transfer shall be furnished promptly to CHS.
4.6 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
4.7 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. RECIPIENT and its subcontractors will enroll in
and use the E-Verify system established 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 RECIPIENT or
subcontractor, during the Period of Performance, to perform work pursuant to this
Agreement within the United States and its territories.
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4.8 False Claim; Criminal, or Civil Violation: RECIPIENT must promptly refer to COUNTY
any credible evidence that a principal, employee, agent, contractor, subcontractor, or other
person has either(i)submitted a false claim for Settlement 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
4.9 Political Activities Prohibited: None of the Funds provided directly or indirectly under this
Agreement shall be used for any political activities or to further the election or defeat of any
candidates for public office. Neither this Agreement 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.
4.10 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.cam/law/state/florida/statutes/florida statutes chapter 112 part iii
Collier County-
http://www.colliergov.net/home/showdoc ument?id=3 513 7
4.11 Order of Precedence- In the event of any conflict between or among the terms of any of the
Contract Documents,the terms of the Agreement shall take precedence over the terms of all
other Contract Documents, except that the terms of any Supplemental Conditions shall take
precedence over the Agreement. To the extent any conflict in the terms of the Contract
Documents cannot be resolved by application of the Supplemental Conditions, if any,or the
Agreement, the conflict shall be resolved by imposing the more strict or costly obligation
under the Contract Documents upon the RECIPIENT at Owner's discretion.
4.12 Venue-Any suit of action brought by either party to this Agreement against the other party,
relating to or arising out of this Agreement, must be brought in the appropriate federal or
state courts, in Collier County, FL which courts have sole jurisdiction on all such matters.
(No reference required for this item).
4.13 Dispute Resolution - Prior to the initiation of any action or proceeding permitted by this
Agreement to resolve disputes between the parties, the parties shall make a good faith effort
to resolve any such disputes by negotiation. Any situations when negotiations, litigation,
and/or mediation shall be attended by representatives of RECIPIENT with full decision-
making authority and by COUNTY'S staff person who would make the presentation of any
settlement reached during negotiations to COUNTY for approval. Failing resolution, and
prior to the commencement of depositions in any litigation between the parties arising out of
this Agreement, the parties shall attempt to resolve the dispute through Mediation before an
agreed-upon Circuit Court Mediator certified by the State of Florida. Should either party fail
to submit to mediation as required hereunder, the other party may obtain a court order
requiring mediation under section 44.102, Florida Statutes. The litigation arising out of this
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Agreement shall be adjudicated in Collier County, Florida, if in state court; and the US
District Court, Middle District of Florida, if in federal court. BY ENTERING INTO THIS
AGREEMENT,COLLIER COUNTY AND THE RECIPIENT EXPRESSLY WAIVE ANY
RIGHTS EITHER PARTY MAY HAVE TO A TRIAL BY JURY OF ANY CIVIL
LITIGATION RELATED TO,OR ARISING OUT OF, THIS Agreement.
https://www.flsenate.gov/Laws/Statutes/2012/44.102
4.14 As provided in § 287.133, Florida Statutes, by entering into this Agreement 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 § 287.133 (3)(a),Florida Statutes.
http://wwrw.leg.state.fl.us/Statutes/index.cfm?App mode=Display Statute&Search String=
&URL=0200-0299/0287/Sections/0287.133.html
4.15 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.
http://www.leg.state.fl.us/statutes/index.cfm?App mode=Displav 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
contractor)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 award 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-
Verifyrdhs.gov. E-Verify employer agents can email E-Verify at E-
VerifyEmployerAgent®dhs.gov.
4.16 Florida Statutes section 119.021 Records Retention
Statutes& Constitution: View Statutes: Online Sunshine(state.fl.us)
4.17 Florida Statutes section 119.071, Contracts and Public Records
http://www.leg.state.tl.us/Statutes/index.cfm?App mode=Displav Statute&URL=0100-
0199'0119/Sections/0119.071.html
4.18 2 CFR §200.15 Never contract with the enemy. Federal agencies, recipients, subrecipients,
and contractors are subject to the guidance implementing Never Contract with the Enemy in
2 CFR part 183.
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https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-C/section-
200.215
https://www.ec fr.gov/current/title-2/subtitle-A/chapter-I/part-I 83
4.19 Trafficking in Persons: The 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
employees of the RECIPIENT. The details of the RECIPIENT's obligations related to
prohibited conduct related to the trafficking of persons are posted at
https://oip. ov/funding/Explore/Prohi bitedConduct-Trafficking.htm.
eCFR :: Appendix A to Part 175. Title 2 --Award Term
Pursuant to Florida Statues Section 787.06, SPONSOR 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.
http://www.leg.state.fl.us/Statutes/index.cfm?App mode=Display Statute&URL=0700-
0799/0787/Sections/0787.06.html
4.20 Whistleblower Protections:
a. In accordance with 2 CFR §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 CFR §200.217 and 41 U.S.C. §4712, in the predominant native language
of the workforce.
https://uscode.house.gov/view.xhtml?req=(title:4I%20section:47 12%20edition prelim)
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All RECIPIENT employees directly involved with activities associated with this Agreement
shall complete and submit to the COUNTY the Collier County Whistleblower 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.
Federal Whistleblower Requirements. Pursuant to §11(c) of the Occupational Safety and
Health Act of 1970 (OSH Act) (29 U.S.C. §660(c)) and the subsequent federal laws
expanding the act,the RECIPIENT is prohibited from discriminating against employees for
exercising their rights under the OSH Act. Details of the OSH Act are located at:
http://www.whistleblov;ers.gov.
4.21 Employment Screening. As described in CFOP 60-25 Chapter 2 (implementing §110.1127,
F.S.), as a condition of initial and continued employment, the RECIPIENT shall ensure all
staff, whether employees or independent contractors, are screened by DCF in accordance
with Chapter 435, F.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 Law Enforcement(FDLE);
• Federal criminal records checks from the Federal Bureau of Investigation via the
Florida Department of Law Enforcement;
• 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, F.S., and
agreeing to inform the employer immediately if arrested for any of the disqualifying
offenses while employed by the employer.
RECIPIENT shall sign the Florida Department of Children and Families Employment
Screening Affidavit each state fiscal year (no two such affidavits will be signed more than
13 months apart) for the term of this Agreement, stating that all required staff have been
screened or the RECIPIENT is awaiting the results of screening.
4.22 Use of Funds for Diversity, Equity, and Inclusion Prohibited. No funding under this
Agreement is being provided for, promoting, advocating for, or providing training or
education on "Diversity, Equity, and Inclusion" (DEI). 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.
4.23 Health Insurance Portability and Accountability Act (HIPAA): Should this Agreement
involve RECIPIENT access to protected health information(PHI) the RECIPIENT shall be
a`Business Associate"limited to the following permissible uses and disclosures. Reference
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to a section in the HIPAA Rules means the section as in effect or as amended. The
RECIPIENT shall assist the COUNTY in amending this Agreement to maintain compliance
with HIPAA 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 HIPAA 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, Health 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 §160.103.
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 HIPAA Rules will mean the Privacy, Security, Breach Notification and
Enforcement Rules at 45 CFR Parts 160 and 164.
o Subcontractor has the same meaning as the term subcontractor at 45 CFR
§160.103 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.
4.24 RECIPIENT Obligations and Activities. The RECIPIENT shall:
• Not use or disclose PHI except as permitted or required by section 4.23 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 PHI 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 PHI
Provider may create, receive, maintain or transmit on the RECIPIENT'S behalf.
• Acknowledge that the foregoing safeguards,policies,and procedures requirements
apply to the RECIPIENT in the same manner as such requirements apply to the
COUNTY;and the RECIPIENT and its subcontractors are directly liable under the
civil and criminal enforcement provisions §13409 and §13410 of the Heath
Information Technology for Economic and Clinical Health Act ("HITECH Act"),
45 C.F.R. §164.500 and 164.502(E) of the Privacy Rule(42 U.S.C. §1320d-5 and
§I320d-6), as amended, for failure to comply with the safeguards, policies, and
procedure requirements and resulting U.S. Health and Human Services (HHS)
guidance thereon.
• Report to the COUNTY any use or disclosure of PHI not permitted by section 4.23
above, including breaches of unsecured PHI as required at 45 CFR §164.410, and
any security incident.
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• Notify the COUNTY's HIPAA Security Officer, HIPAA Privacy Officer, and
Grant Manager within 120 hours after finding a breach or potential breach of
personal and confidential data.
• Notify the COUNTY's HIPAA Privacy Officer and Grant Manager within 24 hours
of HHS notification of any investigations, compliance reviews, or inquiries
concerning violations of HIPAA.
• 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,
ES.); 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
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(e)(1)(ii) and §164.308(b)(2), as applicable,
ensure all entities creating, receiving, maintaining, or transmitting PHI on the
RECIPIENT'S behalf are bound to the same restrictions, conditions, and
requirements as the RECIPIENT by written contract or other written agreement
meeting the applicable requirements of 45 CFR §164.504(e)(2)that the entity will
appropriately safeguard the PHI. For prior contracts or other arrangements, the
RECIPIENT shall provide written certification that 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 available 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 RECIPIENT 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
HIPAA rule compliance.
4.25 COUNTY Notifications Affecting RECIPIENT Disclosure of PHI. The COUNTY will
notify the RECIPIENT, to the extent it may affect RECIPIENT's use or disclosure of PHI,
of 45 CFR §164.520 limitations in the Notice of Privacy Practices; of changes in, or
revocation of, 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 by
under 45 CFR §164.522.
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4.26 Termination Regarding PHI.
• Termination for Cause. Upon the COUNTY's knowledge of a material breach of
the RECIPIENT's duties under 4.24 above, the COUNTY may: (a) provide the
RECIPIENT opportunity to cure the breach within the COUNTY's specified
timeframe; (b)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.
• RECIPIENT obligations under Termination. Upon termination, RECIPIENT, with
respect to PHI received from the COUNTY,or created,maintained,or received on
behalf of the COUNTY, will: (a) retain only 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 RECIPIENT maintains in any form; (d) continue to
use appropriate safeguards and comply with 45 CFR Part 164, Subpart C with
respect to electronic PHI to prevent use or disclosure of PHI,other than as provided
for in (a) for retained PHI; (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).
• Obligations in the preceding paragraph survive termination of this Agreement.
The RECIPIENT 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 federal or state law. The
COUNTY may terminate this Agreement at any time if the RECIPIENT violates or aids or
abets another in violating any state or federal law.
4.27 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 be awarded or perform work as a contractor,
supplier, 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.
4.28 Continuing Oversight Teams. The RECIPIENT shall comply with the provisions of
§287.057(26), F.S., as applicable, establishing and governing conduct of Continuing
Oversight Teams for contracts of$5 million or more.
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4.29 Recycled Products.The RECIPIENT 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.
ENTIRE AGREEMENT. This Agreement constitutes the entire Agreement between COUNTY
and RECIPIENT for the use of Funds received under this Agreement and it supersedes all prior or
contemporaneous communications and proposals, whether electronic, oral, or written, between
COUNTY and RECIPIENT with respect to this Agreement.
Signature 1'age to Follow
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IN WITNESS WHEREOF,RECIPIENT and COUNTY.have each respectively,by an authorized
person or agent.hereunder set their hands and seals on the date first written above.
ATTEST: � • ?<''A 90 • AS TO COUNTY:
CRYSTAJ' `" _L.,C RK BOARD OF COUNTY COMMISSIONERS OF
. COLLIER COUNTY,FLORIDA
• Duty rk
<, yr •
By. L.S ,CHAIRMAN
Dated: � W(SEAL Date: i t f 10('z.5
Attest as to Chairman's
signature only
I ESSES: AS TO RECIPIENT:
COLLIER COUNTY CHILD ADVOCACY
COUNCIL,INC.,d/b/a CHILDREN'S
i s#1 nature ADVOCACY CENTER OF COLLIER
• COUNTY
Witness# Printed ame
By:
1A UEL R FFI STEPHENS,CEO
Witness#2 Signature
l,.)a a Date: (C)j3f�
o 2S
Witness#2 Printed Name I'
Approved as to form and legality:
Ca )
Courtney L.DaSilva� +�
Collier Assistant County
/Attorney g1512
Date: \ I 10 /Z�
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EXHIBIT A
INSURANCE REQUIREMENTS
The RECIPIENT shall furnish to Collier County Board of County Commissioners,do Community
and Human Services Division, 3339 E. Tamiami Trail, 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 Agreement, 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 Agreement. 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 one hundred (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 and maintained.
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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 Agreement:
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 Agreement 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 one hundred
(100%) 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 B
COLLIER COUNTY COMMUNITY& HUMAN SERVICES
SECTION I: REQUEST FOR PAYMENT
RECIPIENT Name: Collier County Child Advocacy Council, Inc. d/b/a Children's
Advocacy Center of Collier County
RECIPIENT Address: 5405 Park Central Court, Naples, FL 34109
Project Name: Forensic Physical Examinations& Medical Consultation Services
Project No: SM25-01 Payment Request#
Total Payment Requested:
Period of Availability: through
Period for which the Agency has incurred the indebtedness through
SECTION II: STATUS OF FUNDS
Recipient CHS Approved
1. Amount Awarded $
2.Total Amount of Previous Requests $ $
3. Amount of Today's Request $ $
4.Current Balance(Initial Amount Award request) $ $
Description Fixed Unit Number of Total for
Rate Cost Exam/ this period
Consultations
Initial forensic physical examinations $350.00
Medical consultations/reviews. $125.00
By signing this report, I certify to the best of my knowledge and belief that this request for payment is true,complete
and accurate, and the expenditures, disbursements and cash receipts are for the purposes and objectives set forth in
the term and conditions of the State award. I am aware that any false, fictitious, or fraudulent information, or the
omission of any material fact,may subject me to criminal,civil,or administrative penalties for fraud,false statements,
false claims or otherwise(U.S.Code Title 18,Section 1001 and Title 31,Sections 3729-3730 and 3801-3812;and/or
Title VI, Chapter 68, Sections 68.081-083, and Title XLVI Chapter 837, Section 837-06)or Florida Statutes, Title
XLVI,817.155.
Signature Date
I itle
Authorizing Grant Coordinator Authorizing Grant Accountant
Supervisor(Approval required S 14.999 and below) Division Director(Approval Required S 15,000 and above)
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EXHIBIT C
QUARTERLY PERFORMANCE REPORT
Report Period:
Fiscal Year:
Agreement Number: SM25-01
Collier County Child Advocacy Council, Inc. d/b/a
Recipient Name: Children's Advocacy Center of Collier County
Contact Name: Jacqueline Stephens
Contact Telephone Number: 239-263-8383
Characteristics Report
I Report Selection Criteria:
Ethnicity
Non-
Race Hispanic Hispanic
White
Black/African American
Asian
American Indian/Alaskan Native
Native Hawaiian/Other Pacific
Islander
Other/Multi-Racial
2 Number of individuals served:
Age Male Female Male Female
Quarter Quarter YTD YTD
Children aged 5 or younger
Children aged 6— 12
Children aged 13— 18
Total
3 Type of Services Delivered:
Service _ Quarter YTD
Medical Examinations
Medical Consultations
Total
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4 Project Progress:
Describe your progress, during the reporting period,and any impediments, if applicable.
By signing this report, I certify to the best of my knowledge and belief that the information
contained in this report is true, complete and accurate. I am aware that any false, fictitious, or
fraudulent information,or the omission of any material fact, may subject me to criminal, civil, or
administrative penalties for fraud, false statements, false claims or otherwise(U.S. Code Title 18,
Section 1001 and Title 31, Sections 3729-3730 and 3801-3812).
Signature: Date:
Printed Name:
Title:
Your typed name here represents your electronic signature.
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EXHIBIT I)
A\\1- At, :A1i1)IT MONITORING REPORT
If RECIPIENT 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 RECIPIENT 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, RECIPIENT
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.
RECIPIENT Name Collier Child Advocacy Council, d/b/a Children's Advocacy Center of Collier County
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
El 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 separate from the written response provided within the audit report. 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
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Community & Human Servics Division
EXHIBIT E
INCIDENT REPORT FORM
Organization Name: Collier County Child Advocacy Council, Inc.,d/b/a Children's
Advocacy Center of Collier County
Organization Address: 5405 Park Central Court,Naples,FL 64109
Project No: SM25-01
Grant Coordinator: Carolyn Noble
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 Jurisdiction:
Number:
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 form are true and correct.
Signature of Person Making Report Date
Printed Name
Title
Return completed form to: Kristi Sonntag,Director,CHS
Collier County Communith and Human Services Division
3339 Tam iami Trail East, Bldg. H.Suite 213
Naples, FL 34112 Far:(239)252-2638 CAO
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EXHIBIT F
COLLIER COUNTY COMMUNITY& HUMAN SERVICES
WHISTLEBLOWER PROTECTIONS CERTIFICATION
RECIPIENT Name: Collier County Child Advocacy Council, Inc.,d/b/a Children's Advocacy Center
of Collier County
RECIPIENT Address: 5405 Park Central Court,Naples,FL 34109
Employee Name:
Project Name: State Mandated Services—Forensic Physical Examinations& Medical Consultations
Project No: SM25-01
In accordance with 2 CFR 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
• 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 form, I certify that I have reviewed and understand my Whistleblower rights and
protections as stated above.
Name:
Signature:
Date:
Title:
Your typed name here represents your electronic signature
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EXHIBIT G
DEPARTMENT OF ELDER AFFAIRS
BACKGROUND SCREENING
ATTESTATION OF COMPLIANCE - EMPLOYER
AUTIHORITY:ALL EMPLOYERS are required to annually submit this form attesting to
compliance with the provisions of chapter 435 and section 430.0402 of the Florida Statutes.
The tarn"employer"means any person or entity required by law to conduct background screenings,including
but not limited to,Area Agencies on Aging.Aging and Disability Resource Centers,Lead Agencies,and Service
Providers that contract directly or indirectly with the Department of Elder Affairs(DOEA),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 access to client funds,
financial matters,legal matters,personal property.or living areas."§430.0402(1 xb).Fla.Stat.(2023).
ATTESTAT ION
As the duly authorized representative of:
(Name of Employer)
Located at
Street address City State Zip Code
Under penalty of perjury,1•
(Name of Representative)
hereby swear or affirm that the above-named employer is in compliance with the provisions of chapter
435 and section 430.0402 of the Florida Statutes,regarding level 2 background screening.
Signature of Representative Date
DOEA Form 235.Attestation of Compliance-Employer.Effective October 2023.F.S.
Form available at:huos:'etderatTairs oraahout-uc'hackgrnund-s rtrninc hsckground-screaniru:-cleartnahousetrainrnE-
accessing-the-clearinghouse
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APPENDIX A
Florida Statute 39.304(5)
(5) The county in which the child is a resident shall bear the initial costs of the examination of
the allegedly abused, abandoned, or neglected child; however, the parents or legal
custodian of the child shall be required to reimburse the county for the costs of such
examination, other than an initial forensic physical examination as provided in Section
960.28, and to reimburse the department for the cost of the photographs taken pursuant to
this section. A medical provider may not bill a child victim, directly or indirectly, for the
cost of an initial forensic physical examination.
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APPENDIX B
Florida Statute §960.28 Payment for victims' initial forensic physical examinations.
(1) A medical provider who performs an initial forensic physical examination may not bill a
victim or the victim's parent or guardian if the victim is a minor directly or indirectly for
that examination.
(2) The Crime Victims' Services Office of the department shall pay for medical expenses
connected with an initial forensic physical examination of a victim of sexual battery as
defined in chapter 794 or a lewd or lascivious offense as defined in chapter 800. Such
payment shall be made regardless of whether the victim is covered by health or disability
insurance and whether the victim participates in the criminal justice system or cooperates
with law enforcement. The payment shall be made only out of moneys allocated to the
Crime Victims' Services Office for the purposes of this section,and the payment may not
exceed $500 with respect to any violation. The department shall develop and maintain
separate protocols for the initial forensic physical examination of adults and children.
Payment under this section is limited to medical expenses connected with the initial
forensic physical examination, and payment may be made to a medical provider using an
examiner qualified under part I of chapter 464, excluding Section 464.003(16); chapter
458; or chapter 459. Payment made to the medical provider by the department shall be
considered by the provider as payment in full for the initial forensic physical examination
associated with the collection of evidence. The victim may not be required to pay,directly
or indirectly, the cost of an initial forensic physical examination performed in accordance
with this section.
(3) The department may allow, deny, controvert, or litigate claims made against it under this
section.
(4) Information received or maintained by the department identifying an alleged victim who
seeks payment of medical expenses under this section is confidential and exempt from the
provisions of Section 119.07(1).
(5) A defendant or juvenile offender who pleads guilty or nolo contendere to, or is convicted
of or adjudicated delinquent for,a violation of chapter 794 or chapter 800 shall be ordered
by the court to make restitution to the Crimes Compensation Trust Fund in an amount equal
to the compensation paid to the medical provider by the Crime Victims' Services Office
for the cost of the initial forensic physical examination. The order may be enforced by the
department in the same manner as a judgment in a civil action.
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