#09-5227 (Executive Healthcare Solutions, LLC d/b/a Brightstar Healthcare)
A G R E E MEN T 09-5227
for
Services for Seniors
THIS AGREEMENT, made and entered into on this 23rd day of June, 2009, by and between
Executive Healthcare Solutions, LLC d/b/ a Brightstar Healthcare, authorized to do business
in the State of Florida, whose business address is 9001 Highland Woods Boulevard, Suite 5,
Bonita Springs, Florida, 34135, hereinafter called the "Vendor" and Collier County, a political
subdivision of the State of Florida, Collier County, Naples, hereinafter called the "County":
WIT N E SSE T H:
1. COMMENCEMENT. This Agreement shall commence on July 1, 2009 and shall
terminate on June 30, 2012.
2. STATEMENT OF WORK. The Contractor shall provide Services for Seniors in
accordance with the terms and conditions of ITQ #09-5227 and the Vendor's proposal
referred to herein and made an integral part of this agreement. This Agreement contains
the entire understanding between the parties and any modifications to this Agreement
shall be mutually agreed upon in writing by the Vendor and the County Contract
Manager or his designee, in compliance with the County Purchasing Policy and
Administrative Procedures in effect at the time such services are authorized.
3. COMPENSATION. The County shall pay the Vendor for the performance of this
Agreement the aggregate of the units actually ordered and furnished at the unit price,
together with the cost of any other charges/ fees submitted in the proposal as set forth
in Appendix I, Contract Rate Caps, attached hereto and made an integral part hereof.
Payment will be made upon receipt of a proper invoice and upon approval by the
Contract Manager or his designee, and in compliance with Section 218.70, Fla. Stats.,
otherwise known as the "Local Government Prompt Payment Act".
4. SALES TAX. Vendor shall pay all sales, consumer, use and other similar taxes
associated with the Work or portions thereof, which are applicable during the
performance of the Work.
Page 1 of7
5. NOTICES. All notices from the County to the Vendor shall be deemed duly served if
mailed or faxed to the Vendor at the following Address:
Executive Healthcare Solutions, LLC d/b/ a Brightstar Healthcare
9001 Highland Woods Blvd., Suite 5
Bonita Springs, FL 34135
Attention: John Botsko, Jr.
Telephone: 239-992-4779
Facsimile: 239-992-4764
All Notices from the Vendor to the County shall be deemed duly served if mailed or
faxed to the County to:
Collier County Government Center
Purchasing Department - Purchasing Building
3301 Tamiami Trail, East
Naples, Florida 34112
Attention: Steve Carnell, Purchasing/ GS Director
Telephone: 239-252-8371
Facsimile: 239-252-6584
The Vendor 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.
6. NO PARTNERSHIP. Nothing herein contained shall create or be construed as creating
a partnership between the County and the Vendor or to constitute the Vendor as an
agent of the County.
7. PERMITS: LICENSES: TAXES. In compliance with Section 218.80, F.5., all permits
necessary for the prosecution of the Work shall be obtained by the Vendor. Payment for
all such permits issued by the County shall be processed internally by the County. All
non-County permits necessary for the prosecution of the Work shall be procured and
paid for by the Vendor. The Vendor shall also be solely responsible for payment of any
and all taxes levied on the Vendor. In addition, the Vendor 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 Vendor agrees to comply with all laws
governing the responsibility of an employer with respect to persons employed by the
Vendor.
8. NO IMPROPER USE. The Vendor will not use, nor suffer 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
Page 2 of7
effect or hereafter enacted or adopted. In the event of such violation by the Vendor or if
the County or its authorized representative shall deem any conduct on the part of the
Vendor to be objectionable or improper, the County shall have the right to suspend the
contract of the Vendor. Should the Vendor 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 to continue until the
violation is cured. The Vendor further agrees not to commence operation during the
suspension period until the violation has been corrected to the satisfaction of the
County.
9. TERMINATION. Should the Vendor be found to have failed to perform his services in
a manner satisfactory to the County as per this Agreement, the County may terminate
said agreement for cause; further the County may terminate this Agreement for
convenience with a thirty (30) day written notice. The County shall be sole judge of
non-performance.
10. NO DISCRIMINATION. The Vendor agrees that there shall be no discrimination as to
race, sex, color, creed or national origin.
11. INSURANCE. The Vendor shall provide insurance as follows:
fA. Commercial General Liability: Coverage shall have minimum limits of $1,000,000
Per Occurrence, Combined Single Limit for Bodily Injury Liability and Property
Damage Liability. This shall include Premises and Operations; Independent
Vendors; Products and Completed Operations and Contractual Liability.
,~.
Business Auto Liability: Coverage shall have minimum limits of $1,000,000 Per
Occurrence, Combined Single Limit for Bodily Injury Liability and Property
Damage Liability. This shall include: Owned Vehicles, Hired and Non-Owned
Vehicles and Employee Non-Ownership.
~
Workers' Compensation: Insurance covering all employees meeting Statutory
Limits in compliance with the applicable state and federal laws.
Special Requirements: Collier County Government shall be listed as the
Certificate Holder and included as an Additionalrlnsured on the Comprehensive
General Liability Policy. V
Current, valid insurance policies meeting the requirement herein identified shall
be maintained by Vendor during the duration of this Agreement. Renewal
certificates shall be sent to the County thirty (30) days prior to any expiration date.
There shall be a thirty (30) day notification to the County in the event of
cancellation or modification of any stipulated insurance coverage.
Page 3 of7
Vendor shall insure that all subVendors comply with the same insurance
requirements that he is required to meet. The same Vendor shall provide County
with certificates of insurance meeting the required insurance provisions.
12. INDEMNIFICATION. To the maximum extent permitted by Florida law, the Vendor
shall indemnify and hold harmless Collier County, its officers and employees from any
and all liabilities, damages, losses and costs, including, but not limited to, reasonable
attorneys' fees and paralegals' fees, to the extent caused by the negligence, recklessness,
or intentionally wrongful conduct of the Vendor or anyone employed or utilized by the
Vendor 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.
This section does not pertain to any incident arising from the sole negligence of Collier
County.
13. CONTRACT ADMINISTRATION. This Agreement shall be administered on behalf
of the County by the Housing and Human Services Department.
14. CONFLICT OF INTEREST: Vendor represents that it presently has no interest and
shall acquire no interest, either direct or indirect, which would conflict in any manner
with the performance of services required hereunder. Vendor further represents that no
persons having any such interest shall be employed to perform those services.
15. COMPONENT PARTS OF THIS CONTRACT. This Contract consists of the attached
component parts, all of which are as fully a part of the contract as if herein set out
verbatim: Vendor1s Proposal, Insurance Certificate, and ITQ #09-5227 Specifi-
cations/Scope of Services.
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.
17. 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, and County Administrative
Procedure 5311. Violation of this provision may result in one or more of the following
consequences: a.) Prohibition by the individual, firm, and/ or any employee of the firm
from contact with County staff for a specified period of time; b.) Prohibition by the
individual and/ or firm from doing business with the County for a specified period of
time, including but not limited to: submitting bids, RFP, and/or quotes; and, c.)
immediate termination of any contract held by the individual and/ or firm for cause.
18. IMMIGRATION LAW COMPLIANCE. By executing and entering into this agreement,
the Vendor is formally acknowledging without exception or stipulation that it is fully
Page 4 of7
responsible for complying with the provisions of the Immigration Reform and Control
Act of 1986 as located at 8 U.s.e. 1324, et seq. and regulations relating thereto, as either
may be amended. Failure by the Vendor to comply with the laws referenced herein shall
constitute a breach of this agreement and the County shall have the discretion to
unilaterally terminate this agreement immediately.
19. OFFER EXTENDED TO OTHER GOVERNMENTAL ENTITIES. Collier County
encourages and agrees to the successful proposer extending the pricing, terms and
conditions of this solicitation or resultant contract to other governmental entities at the
discretion of the successful proposer.
20. AGREEMENT TERMS. If any portion of this Agreement is held to be void, invalid, or
otherwise unenforceable, in whole or in part, the remaining portion of this Agreement
shall remain in effect.
21. ADDITIONAL ITEMS/SERVICES. Additional items and/ or services may be added to
this contract upon satisfactory negotiation of price by the Contract Manager and
Vendor.
22. 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. The negotiation shall be
attended by representatives of Vendor 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. The mediation
shall be attended by representatives of Vendor with full decision-making authority and
by County's staff person who would make the presentation of any settlement reached at
mediation to County's board for approval. 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, Fla. Stat.
Any suit or 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, Florida, which courts have sole and exclusive
jurisdiction on all such matters.
Page 5 of7
IN WITNESS WHEREOF, the Vendor and the County, have each, respectively, by an
authorized person or agent, hereunder set their hands and seals on the date and year first above
written.
ATTEST:
Dwi htE;,Bfd<<lq,<;lerk of Courts
"". ..., ::. ,)
BOARD OF COUNTY COMMISSIONERS
COLLIER CO NTY, FLORIDA
By: t., .
Dated: '1..
::(SEAU . ./-
,~::.= ~,~(~ ,
, "'..':"~
By:
Donna Fiala, Chairman
Executive Healthcare Solutions, LLC
d/b/a Bright Star Healthcare
Vendor
Signature
/
~a~vf?-O
First Witness
By:
'JJ l q *",-c\. ~Le.e Y'\
1
tType/print witness namet
~IC
~w/-+~ J> cr,uQ~
Second Witness
J n0\~p--I. Chi Il:)
tTypejprint witness namet
Approved as to form and
legal sufficiency:
~ae<<-~
,
Assistant County Attorney
Co/leef\ 6reen-e-
Print Name
Page 6 of7
APPENDIX 1
CONTRACT RATE CAPS
SERVICE
MAXIMUM FEEIUNIT OF SERVICE
Total Cost Reimbursement
Adult Day Care (CCE) $10.00 per Hour $ 9.00
CHORE $20.00 per Hour $18.00
Enhanced CHORE* $30.00 per Hour $27.00
Emergency Alert Response System $ 1.11 per Day $ 1.00
Homemaker $20.00 per Hour $18.00
Personal Care $22.22 per Hour $20.00
Respite (In-Home) $20.00 per Hour $18.00
Respite (In- Facility)ADI $10.00 per Hour $ 10.00
Skilled Nursing $38.89 per Hour $35.00
Specialized Med Equipment 100% cost 90% of cost
Facility Respite (24 Hours) $138.90 per 24hr. $125.00 per 24hr.
* Enhanced Chore requires two (2) or more workers performing multiple tasks at the same time.
Page 70f7
Jul 06 2009 1:43PM
BrightStar Healthcare
239-992-4764
p.2
ACQRD... CERTIFICATE OF LIABILITY INSURANCE
Saba1 Insurance Group, Inc.
B05 E Broward Boulevard, Ste 303
Port Laudercla1e, FL 33301
THIS CERTIFICATE IS ISSUEDAS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICAte
HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXlEND OR
ALTER THE coveRAGE AFFORDED BY THE POUCIES BELOW.
F'ROOOCER
IN8URERSAFFORDING COVERAGE
Exeoutive H.a~thoare Solutions, LLC
DBA Brighbtar Hea1t:hcar6/24-'7Bzi\JMur
9001 Hiqh1and Woods Blvd, Suite #S
Bonita Springe, I'L 34135
INSURER A'
INSURER B:
INSURER C;
INSURER 0:
INSURER E:
COVERAGES
THE POLICIES OF I~ USTEDElElOWHAVE BEEN ISSUED TO THE INSURED NAMED AIlO\/E FOR THE POUCY PERIOD INDICATED. NOTWTHSTANOING
Al<V REClJIREMENT. TERl! OR CONDrTlON OF AllY CONTRACT OR OTHER DOCUMENT VolTH RESPECT TO IM-IICH THIS CERTIFICATe MAY BE ISSUED OR
MAY PERTAI". 1l1EIN5VRANCE AFFORCED BY THE POUCIESDeSCRIBED HEREIN ISSUBJECT TO ALL THETEFlIoAS, I!)(CLUSIONS AND CONDITIONS OF SlJCH
POLICIES. AGGREGATE UNlTS SHOV\N MAY HAIlE BEEN REDUCED B'f PAID CUIIAS.
I'::';; r= TYPE OF .....J RANCE POLICY NUMBER T1VE TION LIMITS
D
GENERAL UASILITY EfooCH OCCURRENCE $ 1 nnnnnn
-
.x. COMM ERCIA L GENERAL LIASILITY PREMl6E.s EtI ~J S Innn nnn
_ :xJ C1.AIMSMADE D OCCUR M ED EXP (N'I on'!*'Ion) S ~n .OOt)
A X Prof.8.~ona1~lab VHRG 3051715-03 07/01/09 07/01/10 PER80N.'".L &. AOVINJ~V S Innn nnn
y RAtro Dat.* *06/01/06 GENERAL. ^G~!GATE , ~ .Rnnnon
GeN'\. AGC3REGATe UMIT APPUE1lPER PRODUCTS - COMPIOP AGG S ":I nnn nnn
-I roUCY n ~~ II LOG 1l!~ 1=l.n #t~,i:o nnn
AUTO"'OIlILE UAI3IL1TY COI.lBlNEO SINGLe LIMIT
- lEa acCi~ $ 1,000,000
- AN'fAUTO
ALL01MlEO AUTOS IlODILY Ii'lJURv
- (Per penal) $
SCHEDULED AUTOS
A :i HIRED AUTOS VHHG 3051715-03 07/01/09 07/01/10 SODIL.V li'lJURY
$
.x. NON-O'MlED AUTOS (P... oecldenl)
PROI'ERTY DAMAGE $
~Per oecldonC)
GARAGE UA81UTY AUTO ONLY, El'\ACCIDENT S
=J ANYAUTO OTHER THAN EAACG $
AUTO ONLY: AGG ,
I!XCI;llSNMBRaLA LIAIlIUTY EACH OCCURRENCE ,
:JOCClJR [] CLAlMSMAOE AGGREGo'oTE $
$
R DEDUCTIBLE $
RETeNTION $ $
\/lQ"'KER5 COIolPENSATION AIlD X ITORYLMTS livER'
EMPLOYERS" UABIUTY E,L EACH ACCIDEIfT' $ 1nO,00n
AN'( 1IIAOPRIET0000ARtNEf.ttEXECUTIVE
B OFFlCE'fWlIEMIER EXCLUDEC1 CPW002528 01/0/09 01/01/10 E,L DlSEASE- EAe~OVEE $ 1nn nnn
Ityee,..._...... E,L OISEASI!!. POUCYUMlT $ !;OQ .ann
SProAL PROVI5IONS lItO....
OTHER
C Crime Bond LFMOO02970 07/01/09 07/01/10 $25,000 Limit
DESCRIPTION OF OPERATlONS I LOCATIONS IveHlCI.ES IEXC"USlONS ADDED BveNDORseMENT ISPECIAL.PROV'SIONS
Certificate Holder is named additional insured in respect to General Liability
CERTIFICATE HOLDER
CANCELLATION
Collier County Government
3301 Tami.1IDi Trail, East
Naples, FL 34112
SHOULD ANY OF THE AeOVEDESCRI9EO POLICIES BE CANCEu.ED BSFORETHE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAl" 30 DAYS 'hR!TT1;N
NOTICE TO THE CERTIFICATE HOLDER NMIED TO THE LEFT, BUT FAILURE TO DO so SHML
IMPOSE NO OBLIGATION OR LIABlLITV OF ANY I<lND UPON THe INSURER. rTS AGENTS OR
I'lEPRESENTATlVe;s
AUTI-IORIz!;D REPRESENTATIVE;
C> ACORD CORPORATION 1988
ACORD2I (2001Xl81
ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (UMlDDIYYYY)
TM. 05.12812009
PROOUCER Phone: (847) 82~ Fu: (847) 623-5600 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
WESrSINSURANCEAGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1733 W WASHINGTON STREET ~?;;>;R. THIS CERTIFICATE DOES ~~T AMEND, ~?,~
WAUKEGAN IL 60085
INSURERS AFFORDING COVERAGE NAlC..
INSURED INSURER A: Insurance Co of the State of PA ,.." ...1..,
EXECUTIVE HEAL THCARE SOLUTIONS LLC INSURER B: ~
DBA BRlGHTSTAR HEAL THCARE INSURER C:
9001 HIGHLAND WOODS BLVD, STE 5
BONITA SPRINGS FL 34135 INSURER 0:
INSURER E:
COVERAGES
rt
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
At<< REQUIREMENT. TERM OR CONDITION OF At<< CONTRACT OR OTHER DOCUMENT WTH RESPECT TOWHICH THIS CERTIACATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOI/IN MAY HAVE BEEN REDUCED BY PAID ClAIMS.
INSR = TYPE OF INSURANCE POUCY NUMBER ~~~ ~~~ LIMITS
LtR
~ERAL LIABILITY EACH OCCURRENCE $
- COMMERCIAl GENERAl LIABILITY ~~.:=...., $
,-- :=J ClAIMS MADE 0 OCCUR MED. EXP (Any one person) $
f-- PERSONAL & ADV IN.JURY $
GENERAL AGGREGATE $
~N'lAGGREGATE LIMIT APPLIES PER: PROOUCT5-COMPIOP AGG. $
"I nPRO. n!
POLICY JECT LOC
~OMOBlLE LIABILITY COMBINED SINGLE LIMIT
At<< AUTO (E. lICdctenl) $
-
ALL OWNED AUTOS BODILY INJURY
- (Per person) $
- SCHEDULED AUTOS
HIRED AUTOS BODILY INJURY
- (Per IICCldent) $
- NON-OWNED AUTOS
- !we~~ $
GARAGE LlABIUTY AUTO ONLY. EA ACCIDENT $
~ At<< AUTO OTHER THAN EAACC $
AUTO ONLY: AGG $
5CESS I UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR 0 ClAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
02101/10 I~STATU- 1 I OTHER
WORKERS COMPENSATION AND WC006783007 02101/09 TORY UNlT8
EMPLOYERS' UABlUTY E.L. EACH ACCIDENT $ 500,000
A AI<< PlIOl'RlETOIIIPAIlTIWIIt!XECUTI
OFFlCEMIEMlIEIt UCLUDED7 E.L DlSEASE-EA EMPLOYEE $ 500,000
----- E.L DlSEASE-POlICY LIMIT $ 500,000
lIPEClAL r_OHS...1ow
OTHER:
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS
CERTIFICATE HOLDER
Collier County
Board of County Commissioners
Naples, Florida
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POlICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WLLENOEAVORTO MAIL 30 DAYS
WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAIlURE TO
00 so SHALL IMPOSE NO OBLIGATION OR LIABILITY OF AN'( KINO UPON THE INSURER, ITS
AGENTS OR REPRESENTATIveS.
AUTHORIZED REPRESENTATIVE
~
ACORD 25 (2001108)
Certificate #
8903
Brent es
C> ACORD CORPORATION 1988
Attention:
ISSUED BY THE STOCK IrJSURA'\JCE COMPANY HEREIN CAllED THE COfllPANY
AGENT NUMBER
POLICY NUWBER
THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA
13889
0026814-00 we 006-78-300
--------------------------------------
013-82-020g-oC
. .
~~,CUTIVE HEALTHCARE SOLUTIONS. LLC DBA
(SEE WC990013 FOR COMPLETE NAME)
9001 HIGRLAND WOODS BLVD
SUITE 5
BON ITA SPRI NGS. FL 34135-0000
~ra Member Companies of
,.IL ., American Intemational Group
EXECUTIVE OFFICES:
70 PINE STREET, NEW VORK, N.V. 10270
SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE - WC990610
1.0#
PRODUCEHS t,AME ~ND ADDRESS
WORKERS COMPENSATION AND EMPLOYERS
LIABILITY POLICY INFORMATION PAGE
SMITH BELL & THOMPSON INC.
40 MA I N STREET
SUITE 500
INSURED IS PREVIOUS POLICY NUMBER
LIMITED LIABILITY COMPANY NEW
OTHER WORKPLACES NOT SHOWN ABOVE: SEE EXTENSION OF ITEM 1. OF THE INFORMAnON PAGE - WC990610
ITEM 2 POLICY PERIOD 12:01 A.M. standard 11me stthe Insured"
mailing add_
ITEM 3
FROM 02/01/09 TO 02/01/10
A. Worker. Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed
here:
FL
B. Employers Uablllty Insurance: Part Two of the policy applies to the work In each state listed In Item 3.A.
The limits of our liability under Part Two are: Bodily Injury by Accident S 1500.000 each accldent
Bodily Injury by Disease S 'i00. 000 policy limit
Bodily Injury by Disease S 'i00. 000 each employee
C. Other States Insurance: Part Three of the policy applies to the states, If any. listed here:
AK AL AR AZ CO CT DC DE GA HilA lOlL IN KS KY LA MA MD ME MI HN MO MS KT NC NE NH NJ
NM NV NY OK OR PA RI SC SO TN TX UT VA VT WI WV
D. This polley Includes these
SEE EXTENSION OF ITEM 3.D. OF THE INFORMATION PAGE - WC990612
ITEM 4 The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans.
All Information required below Is subject to verification and change by audit.
Classlfic.tlons
Cod. Number
3 Vear
flate Per
$100 OF R.
muneratlon
3"t
SEE EXTENSION OF ITEM 4. OF THE INFORMATION PAGE - WC7754
EXPENSE CONSTANT (EXCEPT WHERE APPLICABLE BY STATE)
MINIMUM PREMIUM S 383 F L
If Indlc.ted below. Interim .dju.t....nts 01 premium Mell b. m.d.:
o Seml-Annu.lly .
200 F L
TOTAL ESTIMATED PREMIUM
S 13. Oe
02/16/09 PARSIPPANY
. Monthly
DEPOSIT PREMIUM
82
we 00 00
Issue Oate
39967 (Rev'd 04/08)
Issuing Office
INSURED'S COPY
ITEM NO.:
. ,[1- L'r fl1, E);:.-RE~EIVED:
--- 1\-" \.'1 - ln'
(\rd 1~ r....' , ,...:.._ 4-.
\ A\.j, : 'I' , I,' IJr:J~ Ir"\i
. ", I ,'. II \ I:, I
FILE NO.:
ROUTED TO:
'i" '.
.:.. ~ ~';j
DO NOT WRITE ABOVE THIS LINE
REQUEST FOR LEGAL SERVICES
Date: June 25, 2009
To: Office of the County Attorney
Jeff Klatzkow
From: Lyn M. Wood, C.P.M., Contract Specialist
Purchasing Department, Extension 2667
Re: Contract: #09-5227 "Services for Seniors"
Contractor: Executive Healthcare Solutions, LLC d/b/a Brightstar
Healthcare
BACKGROUND OF REQUEST:
This Contract was approved by the BCC on June 23, 2009, Agend
Item 16.E.10
This item has not been previously submitted.
Contract review and approval.
J.~.O~
CrYl G-
rl~.dD~
ACTION REQUESTED:
OTHER COMMENTS:
Please forward to BCC for signature after approval. If there are any
questions concerning the document, please contact me. Purchasing would
appreciate notification when the documents exit your office. Thank you.
C: Terri Daniels, Housing & Human Services
RLS # or-/~t!..- /) J .:111'1
CHECKLIST FOR REVIEWING CONTRACTS
Entity Name: E Xf('urlv€"" ffell-L ,IU!A.e.'i. SOL Lt "t"IVS, t.t.(!
d/; {It. BIC.I"#T.srA~ HtAL-rHC!Atf!.E
Entity name correct on contract?
Entity registered with FL Sec. of State?
Insurance
Insurance Certificate attached?
Insured registered in Florida?
Contract # &/or Project referenced on Certificate?
Certificate Holder name correct (BCC)?
Commercial General Liability
General Aggregate Required $ l"Vv\l L-
Products/CompI/Op Required $
Personal & Advert Required $
Each Occurrence Required $
Fire/Prop Damage Required $
Automobile Liability
Bodily Inj & Prop Required $ l ~t L-
Workers Compensation
Each accident Required $ $rl\r. I-.!fI.{IT5.
Disease Aggregate Required $
Disease Each Empl Required $
Umbrella Liability
Each Occurrence Provided $
Aggregate Provided $
Does Umbrella sufficiently cover any underinsured portion?
Professional Liability
Each Occurrence Required $
Per Aggregate Required $
Other Insurance
Each Occur Type: Q ~_\M~
../' Yes
~Yes
Yes
~Yes
.3 MIL
t (
MIL
II
Provided $
Provided $
Provided $
Provided $
Provided $
p
Provided $ r M..l L
Provided $ .100) Df) ()
Provided $ S"oc?, OIl?
Provided $5110', dDO
,
Exp Date
Exp Date
Yes
Provided $
Provided $
Required $
V'Yes
~Yes
No
No
No
No
v" No
No
Exp. Date
Exp. Date
Exp. Date
Exp. Date
Exp. Date
Exp Date
f] It '''1
Exp Date~1 ( I/o
Exp Date I / ,
Exp Date I ,
No
Exp. Date
Exp. Date
Provided $ z.s; ~o
Exp Date ~q
County required to be named as additional insured? /Yes No
County named as additional insured? ~Yes - No
Indemnification
Does indemnification meet County standards? -L- Yes - No
Is County indemnifying other party? Yes ~No
Performance Bond
Bond requirement referenced in contract? Yes No
Ifattached, expiration date of bond
Does dollar amount match contract? Yes No
Agent registered in Florida? - Yes No
Signature Blocks
Correct executor name in signature block? --1L.. Y es - No
Correct title of executor? ~Yes No
Executor authorized to sign for entity? ~Yes No
Proper number of witnesses/notary? Yes ~o
Authorization for executor to sign, if necessary:
Chairman's signature block? ~Yes - No
Clerk's attestation signature block? ~Yes No
County Attorney's signature block? ~Yes No
Attachments V'Yes
Are all required attachments included?
MEMORANDUM
FROM: Lyn M. Wood, C.P.M., Contract Specialist
Purchasing Department
~
.Y
}L/ 1<
TO: Ray Carter
Risk Management Department
DATE: June 25, 2009
RE: Review Insurance for Contract: #09-5227 "Services for Seniors"
Contractor: Executive Healthcare Solutions, LLC d/b/a
Brightstar Healthcare
This Contract was approved by the BCC on June 23, 2009, Agenda Item
16.E.10
Please review the Insurance Certificates for the above referenced contract. If
everything is acceptable, please forward to the County Attorney for further
review and approval. Also, will you advise me when it has been forwarded.
Thank you. If you have any questions, please contact me at extension 2667.
C: Terri Daniels, Housing & Human Services
RECE\VED
JUN 2 6 2009
NT
RISK MANAG '
dod/LMW
~rtr
&2?}lcJ~
mausen_g
From:
Sent:
To:
Cc:
Subject:
RaymondCarter
Monday, June 29, 2009 1:17 PM
LynWood; DeLeonDiana
DanielsTerri; mausen_g
Contract 09-5227 "Services for Seniors"
All, I have reviewed and approved the certificate(s) for the following vendors under contract 09-5227:
1. Arcadia Health services, Inc. d/b/a Arcadia Health Care
2. Executive Healthcare Solutions, LLC d/b/a Brightstar Healthcare
3. Eleven Ash, Inc. d/b/a Health Force
The contract s will now be forwarded to the county attorney's office for their review.
Thank you,
Ray
~~
Manager Risk Finanace
Office 239-252-8839
Cell 239-821-9370
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Florida Limited Liability Company
EXECUTIVE HEAL THCARE SOLUTIONS, LLC
Filing Information
Document Number L06000013155
FEI/EIN Number 204870885
Date Filed 02/06/2006
State FL
Status ACTIVE
Effective Date 02/06/2006
Principal Address
9001 HIGHLAND WOODS BLVD
SUITE # 5
BONITA SPRINGS FL 34135 US
Changed 04/14/2009
Mailing Address
9001 HIGHLAND WOODS BLVD
SUITE # 5
BONITA SPRINGS FL 34135 US
Changed 04/14/2009
Registered Agent Name & Address
BOTSKO, JOHN JR.
9001 HIGHLAND WOODS BLVD, SUITE 5
BONITA SPRINGS FL 34135 US
Address Changed: 09/03/2008
Manager/Member Detail
Name & Address
Title MGR
BOTSKO, JOHN JR.
9001 HIGHLAND WOODS BLVD, SUITE 5
BONITA SPRINGS FL 34135
Title MGR
BOTSKO, MARLA J
9001 HIGHLAND WOODS BLVD
BONITA SPRINGS FL 34135 US
Annual Reports
http://www.sunbiz.org/scripts/cordet.exe?action=DETFIL&inCL doc _ number=L060000 131... 6/25/2009
www.sunbiz.org - Department of State
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Report Year Filed Date
2007 OS/22/2007
2008 09/03/2008
2009 04/14/2009
Document Images
Q411412QQ9=ANNLJAL,RI;,PORT
Q9L0312QQ$..=="f',1'-l.NJJAloEEPORT
QEil2212QQ7 =ANNLJAl,.REPORT
Q2/Q()12QQ()=EIQrida Limited Liability
Note: This is not official record. See documents if question or conflict
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