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#12-5856 (Summit Home Respiratory Services, Inc. DBA Summit Home Healthcare Products)ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE Print on pink paper. Attach to original document. Original documents should be hand delivered to the Board Office. The completed routing slip and original documents are to be forwarded to the Board Office only after the Board has taken action on the item.) ROUTING SLIP Complete routing lines #1 through #4 as appropriate for additional signatures, dates, and/or information needed. If the document is already complete with the exception of the Chairman's sionan,re Ara_ a hna fMm...6 . ..*__ r....., u i a__.. L. _ _ __ _. _ .. ... . . _ Route to Addressee(s) ,,.,.,u a ,rte, a.vui -Lu um unuuutst, and Office forward to fan mitcrlell oine #5). List in routing order a ro riate. Initials Date 1. December 11, 2012 Agenda Item Number 16.13.26 2. signed by the Chairman, with the exception of most letters, must be reviewed and signed 3. #12-5856 – S rv'c s For Seniors Agreement Number of Original 2 1,� 4. Emily R. Pepin, Esq. County Attorney Office Documents Attached 5. BCC Office Board of County Commissioners Z Chairman and Clerk to the Board and possibly State Officials. 6. Minutes and Records Clerk of Court's Office C (W(3 PRIMARY CONTACT INFORMATION (The primary contact is the holder of the original document pending BCC approval. Normally the primary contact is the person who created/prepared the executive summary. Primary contact information is needed in the event one of the addressees above, including Ian Mitchell, need to contact staff for additional or missing information. All original documents needing the BCC Chairman's signature are to be delivered to the BCC office only after the BCC has acted to annrove the item.) Name of Primary Staff Diana DeLeon Phone Number 252 -8375 Contact a ro riate. Initial) A licable) Agenda Date Item was December 11, 2012 Agenda Item Number 16.13.26 Approved by the BCC signed by the Chairman, with the exception of most letters, must be reviewed and signed Type of Document #12-5856 – S rv'c s For Seniors Agreement Number of Original 2 1,� Attached V •� em. ` Documents Attached �mry iNWRTTIC''TIONC J& ('14F.VWT.1QT Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is Yes N/A (Not a ro riate. Initial) A licable) 1. Original document has been signed/initialed for legal sufficiency. (All documents to be signed by the Chairman, with the exception of most letters, must be reviewed and signed by the Office of the County Attorney. This includes signature pages from ordinances, resolutions, etc. signed by the County Attorney's Office and signature pages from contracts, agreements, etc. that have been fully executed by all parties except the BCC Chairman and Clerk to the Board and possibly State Officials. 2. All handwritten strike - through and revisions have been initialed by the County Attorney's Office and all other parties except the BCC Chairman and the Clerk to the Board L� N T t 3. The Chairman's signature line date has been entered as the date of BCC approval of the (� document or the final negotiated contract date whichever is applicable. 4. "Sign here" tabs are placed on the appropriate pages indicating where the Chairman's — signature and initials are required. 5. In most cases (some contracts are an exception), the original document and this routing slip should be provided to Ian Mitchell in the BCC office within 24 hours of BCC approval. N' P, Some documents are time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's actions are nullified. Be mare of your deadlines! 6. The document was approved by the BCC on I !Z(enter date) and all chap made during the meeting have been incorporated i the attached document. Th Coup Attorney's Office has reviewed the changes, if applicable. MEMORANDUM Date: January 4, 2013 To: Diana De Leon, Contracts Technician Purchasing Department From: Ann Jennejohn, Deputy Clerk Minutes & Records Department Re: Contract #12 -5856 "Services for Seniors" Contractor: Summit Home Healthcare Products Attached is an executed original copy of the contract referenced above, (Item #16D26) approved by the Board of County Commissioners on Tuesday, December 11, 2012. The second original contract will be held on file in the Minutes and Records Department for the Board's Official Record. If you have any questions, please contact me at 252 -8406. Thank you. Attachment ,._ Memorandum RECEIVED DEC 12 2012 RISK MANAGEMENT Date: December 11, 2012 From: Diana DeLeon, Purchasing Dept., for Joanne Markiewicz To: Ray Carter, Manager Risk Finance Subject: Contract 12 -5856 "Services for Seniors" The County is in the process of executing the following contracts with: Accu -Care Home Health Service, Inc. Gulf Coast Assisting Hands, Inc. Care Club of Collier County, Inc. Health Force NurseCore of Fort Myers Summit Home Healthcare Products VIP America of Southwest Florida, LLC Purchasing Department 3327 Tamiami Trail East Naples, Florida 34112 Telephone: (239) 252 -8375 FAX: (239) 252 -6597 Email: DianaDeLeon ()colliergov.net www.colliergov. neUpurchasing Always There Home Health Care, Inc. Bidwell Home Care Services, LLC First Care Home Services, Inc. Lifeline Systems Company Southern Home Care Services, Inc. Sunrise Community, Inc. Please review the Insurance Certificate(s) for the referenced Contract. • If the insurance is not in order. please contact the vendor /insurance company to obtain a proper certificate. Once you receive the proper certificate(s), please acknowledge your approval and send to the County Attorney's office via the attached Request for Legal Services. • If the insurance is in order please acknowledge your approval and send to the County Attorney's office via the attached Request for Legal Services. If you have any qu please Insur a pprov Manager k Finance Signature referenced information. (Please route to County Attorney via attached Request for Legal Services) G /Acquisitions /AgentFormsand Letters /RiskMgmtReviewofl nsu rance4 /15/2010/16/09 Summit Home Respiratory Services, Inc. d.b.a. Summit Home Healthcare Products 1467 Rail Head Blvd. Naples, Florida 34110 Phone (239) 596 -5000 Fax (239) 596 -5017 September 24, 2012 Effective immediately, Nancy Eckhardt is appointed Chief Financial Officer of Summit Home Respiratory Services, Inc. Additionally Ms. Eckhardt is authorized to execute any and all documents relative to the operation of Summit Home Respiratory Service, Inc. Keith E. Gli h President State of Florida County of Collier The foregoing instrument was signed and acknowledged before me this 24th day of September, 2012, by Keith E. Glisch personally known to me. (� JAMES E DODD Public Signature - Mr COMMISSION # EE058947 �•,,� EXPIRES January 26, 2015 (s07) 398 -0153 FWidallotarySmioa.com m cc Printed Name of Notary Public RECEIVE[ A G R E E M E N T 12-5856 DEC 12 2012 for RISK MANAGEMEN„ Services for Seniors THIS AGREEMENT, made and entered into on this day of &Cetn �U4 2012, by and between Summit Home Respiratory Services, Inc., d/b /a Summit Home Healthcare Products authorized to do business in the State of Florida, whose business address is 1467 Rail Head Boulevard, Naples, Florida 34110, hereinafter called the "Vendor" and Collier County, a political subdivision of the State of Florida, Collier County, Naples, hereinafter called the "County ": WITNESSETH: 1. COMMENCEMENT. This Agreement shall commence on .I% L)f (U MLO, 2012 and shall terminate on, Id bet- 2014. The Contract award is a two (2) year contract, with the possibility of two (2) additional two (2) year terms pending funding from grantors and acceptable performance by the awarded vendor. Any such renewals shall be mutually agreed upon in writing by the parties. The maximum duration for this Contract for CCE, HCE and ADI funding will not exceed six (6) years (through June 30, 2018). As outlined in RFP #12 -5856, the County requires the Vendor to contribute a cash or in -kind match of no less than ten (10) percent for all services related to the Community Care for the Elderly Program (CCE). 2. STATEMENT OF WORK. The Vendor shall provide Services for Seniors in accordance with the terms and conditions of RFP #12 -5856, the terms, conditions and requirements of the grant, 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 Attachment A, Contract Rates, attached hereto and made an integral part hereof. Payment will be made upon receipt of a proper invoice as per Attachment B, Invoice and Logs, attached herein and incorporated by reference, and upon approval by the Page 1 of 11 Contract Manager or his designee, and in compliance with Section 218.70, Fla. Stats., otherwise known as the "Local Government Prompt Payment Act ". 3.1 Payments will be made for services furnished, delivered, and accepted, upon receipt and approval of invoices submitted on the date of services or within six (6) months after completion of contract. Any untimely submission of invoices beyond the specified deadline period is subject to non - payment under the legal doctrine of "laches" as untimely submitted. Time shall be deemed of the essence with respect to the timely submission of invoices under this agreement. 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. 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: Summit Home Healthcare Products 1467 Rail Head Blvd., Naples, FL 34110 Attention: i�p4ocyA. ec V- *b Telephone: 239 - 596 -5000; Facsimile: 239 - 596- 5017n�{,i- i�tiu�oef E -mail: GtFO ncLnc- Aasummiti10me. rat 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 3327 Tamiami Trail, East Naples, Florida 34112 Attention: Joanne Markiewicz, Purchasing /GS Director Telephone: 239 - 252 -8407; Facsimile: 239 - 252 -6480 The Vendor and the County may change the above contact information 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.S., 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 Page 2 of 1 I 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 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: A. 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. B. 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. C. Workers' Compensation: Insurance covering all employees meeting Statutory Limits in compliance with the applicable state and federal laws. Page 3 of 11 Special Requirements: Collier County Government shall be listed as the Certificate Holder and included as an Additional Insured on the Comprehensive General Liability Policy. Current, valid insurance policies meeting the requirement herein identified shall be maintained by Vendor during the duration of this Agreement. The Vendor shall provide County with certificates of insurance meeting the required insurance provisions. Renewal certificates shall be sent to the County ten (10) days prior to any expiration date. Coverage afforded under the policies will not be canceled or allowed to expire until the greater of: ten (10) days prior written notice, or in accordance with policy provisions. Vendor shall also notify County, in a like manner, within twenty -four (24) hours after receipt, of any notices of expiration, cancellation, non - renewal or material change in coverage or limits received by Vendor from its insurer, and nothing contained herein shall relieve Vendor of this requirement to provide notice. 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. 12.1 The duty to defend under this Article 12 is independent and separate from the duty to indemnify, and the duty to defend exists regardless of any ultimate liability of the Vendor, County and any indemnified party. The duty to defend arises immediately upon presentation of a claim by any party and written notice of such claim being provided to Vendor. Vendor's obligation to indemnify and defend under this Article 12 will survive the expiration or earlier termination of this Agreement until it is determined by final judgment that an action against the County or an indemnified party for the matter indemnified hereunder is fully and finally barred by the applicable statute of limitations. 13. CONTRACT ADMINISTRATION. This Agreement shall be administered on behalf of the County by the Housing, Human and Veterans 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 Page 4 of I 1 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: Vendor's Proposal, Insurance Certificate, and RFP #12 -5856 Specifi- cations /Scope of Services, Attachment A Contract Rates and Attachment B Invoice and Logs. If a conflict arises between the documents, the order of precedence shall be: this Contract, the County's RFP #12 -5856, the terms and conditions of the grant, and the Vendor's proposal. 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 responsible for complying with the provisions of the Immigration Reform and Control Act of 1986 as located at 8 U.S.C. 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. Page 5 of 11 21. ADDITIONAL ITEMS /SERVICES Additional items and /or services may be added to this contract in compliance with the Purchasing Policy and Grantor Agency Requirements. 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. * * * * * * * * * * * * * * ** *Remainder of Page Intentionally Left Blank * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Page 6 of 11 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-` Dwight-. Brock, Clerk,of Courts jssr fU�fypj First Witness � ,vs,� &,e X-4N/4 TType /print witness nameT Second Witness �.a`!5 � r y� �s G�ry o ►'� TType /print witness nameT Approved as to form and legal sufficiency: l Assistant C unty A torney in Pr nt Name BOARD OF COUNTY COMMISSIO COLLIER COUNTY, FLORIDA Fred W. Coyle, Chairman Summit Horne Res iratoU Services, Inc dAb/a Summit Home Healthcare Products Vendor By: c/y ai r Signature DT Coo Typed signature and title Page 7 of 11 Agreement #12 -5856 "Services for Seniors" Attachment A Contract Rates Notes: 1. Services for Seniors grant includes Shopping Assistance under Homemaking and Escort under Personal Care. 2. The Total Cost per Service Unit will be used for HCE applied grants (no match is required). Total Cost Per Reimbursement Item Service Description Grant Service Unit Rate Per Unit to Service Unit Supplier 1. Adult Day Care CCE Per Hour $11.00 $9.90 2. Chore CCE Per Hour 19.57 17.61 3. Enhanced Chore CCE Per Hour 25.21 22.69 (Requires two (2) or more workers performing multiple tasks at the same time.) 4. Companion CCE Per Hour 19.60 17.64 5. Homemaker' (includes CCE Per Hour 18.56 16.70 Shopping Assistance (RFP #6 Shopping Assistance Service 6. Shopping Assistance See Item # 5 7. Personal Care (RFP #10 CCE Per Hour 21.46 19.31 Escort Service 8a. Respite In -Home CCE Per Hour 20.00 18.00 8b. Respite (In -Home) ADI Per Hour 20.00 20.00 9. Respite (In- Facility) ADI Per Hour 11.00 11.00 10. Escort See Item # 7 11. Skilled Nursing CCE Per Hour 35.26 31.73 12. Emergency Alert CCE Per Day 1.09 .98 Response System 13a. Specialized Medical CCE Per Episode Catalog in effect Catalog - ten (10) Equipment, Services, in September percent in effect in and Supplies 2012 September 2012 13b. Specialized Medical ADI Per Episode Catalog in effect Catalog in effect in Equipment, Services, in September September 2012 and Supplies 2012 Notes: 1. Services for Seniors grant includes Shopping Assistance under Homemaking and Escort under Personal Care. 2. The Total Cost per Service Unit will be used for HCE applied grants (no match is required). Attachment B Invoice and Logs (Minimum Standard Invoice Information) Vendor Name Invoice Number Vendor Address From Date and To Date County Purchasing Order Number Service Description (identified by line) Referenced Grant Total Cost Per Service Unit In Kind Match Amount Reimbursement Rate Per Unit to Supplier (Subtract In Kind Match Amount from Total Cost Per Service Unit) Unit Quantity TOTAL AMOUNT (Multiply the Reimbursement Rate Per Unit to Supplier x the, Unit Quantiq) I certify to the best of my knowledge and belief that this invoice, and attached service detail log, is complete and correct and all outlay herein are for the purposes set forth in the contract, and that services are ordered by the case manager as agreed on the Contract. Legible copies of the dated timesheet, signed by the client and the worker supporting this invoice must be available upon request. Collier County reserves the right to correct computation of errors to assure proper payment amount. Prepared by: Adjustments Reasons: Lead Agency Authorization: Date: Attachments: Weekly Service Log and Weekly Client Service Time Sheet Page 9 of I I O U r -a+ Q m m v v Z Q 0 � a W-4 ;-4 0 v cn v bA O H a.i V i-� O d) GJ G1 0 i-4 i� .'7 O V-1 � v O M ;l o � +� Q v � o "Q) w y V 0 ..V. vv as �° U U U t C w .y w x �z w c �z u W t 0 U W fYi W ,N a� v ai w u ri 43 L U en U y Ca L.U.. tw u O � : L C� �r U Qj C O RJ Oa 0 Ua O U U C ftf O CO CL � c `W O U „ s°. 'CS U U 0 .a O O U V a W dAU � 0 C V U U � dAU �z C � v b U G4 CA vz U U U t C w .y w �z c u W fYi W a� ri 43 L U en U L C� �r U C O Oa 0 Ua U U ftf O � c `W s°. 0 .a U dAU � C V U � �z W O 0 a a v W C� z 0 Ma 19 cu 3i v bA O H ti v v U) w O v v G 10 v 0 a� v v v � H^ v o V E"' G1 ctt CA v GJ A ti �u- O rj �4 w .N O OJ "�x+b .� O cu acu v A 0 H A 0 w w 0 a� on a 0 U c a� A c 0 'L w a a 3 H 0 s. _A C U v z w 0 a� on a n� Rb CERTIFICATE OF LIABILITY INSURANCE DATE(MIWDOIYYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. 101`17/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POL)CIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME;_ Davld R. Mettler Integrated ins. Services, Inc. _ PAICD,NM . E :1).(239) 549.5428 FAX 549_7905 tc. Nolt ( 239 a 1316 5E 46th Lane i1 _) ADORE as, integratedl7@earthlink.net Cape Coral, FL 33904 INSURER(SI AFFORDING COVERAGE NAIC A - - -- _ - INSURER A;., Hanover Insurance Company_ - INSURED _ LNSURE9 0 Technology Insurance Company Summit Home Respiratory Services, Inc. _ DBA: Summit Home Healthcare Products INSURER C ANY AUTO INSURER 0: 1467 Rail Head Blvd, INSURER E: Naples, FL 34110 BODILYINJURY(peracc�denq, $ • NON -OWNED HIREDAUTOS AUTOS INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMB £R. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - - T- _. INSRI TYPE OF INSURANCE 'ADDLSUBRI� POLICY EFF POLICY EXP I LIMITS _ -- LTR POLICY NUMBER GENERAL LIABILITY I I I EACH OCCURRENCE $ 1,- 000,000 A � � COMMERCIAL GENERAL LIABILITY � I I DAMAGE TO RENTED .X CLAIMS-MADE [ X !.00CUR '�. LHJ 9287527 PREMISES (En occurrence) _ - _3 100 000 03 9127012 9/2712013 ME EXP (Any one perscnl 35,000 X ProdUCtS /COmpi_ Ops. PERSONAL & AOV INJURY $ 1,000,0_00 X Professional Liability GENERAL AGGREGATE 32,300,000 GEN'L AGGREGATE OMIT APPLIES PER PRODUCTS - COMPIOP AGG $ 2,000,000 X POLICY PRO t.CC g AUTOMOBILE LIABILITY CCMBINED SINGLE LIMIT (Ea amdent) ANY AUTO BODILY INJURY (Per person) S ALL OWNED. SCHEDULED - -- 1I AUTOS ; AUTOS BODILYINJURY(peracc�denq, $ • NON -OWNED HIREDAUTOS AUTOS - -- - - - - - -- PROPERTY DAMAGE g . UMBRELLA LIAR I OCCUR l _ EXCBS$UA8 EACH OCCURRENCE g _ CLAIMS-MADE, AGGREGATE s DED R T N WORKERS COMPENSATION g AND EMPLOYERS' LIABILITY Y f N X WC STATU. 0TH -' - TORY LIMITS EIR ANY PROPRIETORIPARTNERIEXECUTIV B OFFICERIMEMBER EXCLUDED? I N IA TWC3315961 06)0512012 0610512013 IMandolory In NH) E L EwCH ACCIDENT g 500,000 I - Ue a vnoor assalba E L DISEASE - EA EMPLOYEE! 500 000 CWPTION OF OPERATIONS below E L DISEASE POLICY LIMIT ! S 500 000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 181, Additional Remarks Schedule, it more space Is raquiredl Sales of medical supplies. Certificate Holder is an an Additional Insured according to vendor agreement requirements. CERTIFICATE HOLDER Collier County Board of Commisioners 3327 Tamlami Trail East Naples, FL 34112 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ®1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Summit Home Respiratory Services, Inc. d.b.a. Summit Home Healthcare Products 1467 Rail Head Blvd. Naples, Florida 34110 Phone (239) 596-5000 Fax (239) 596-5017 November 21, 2012 Ms. Brenda Reaves Purchasing/Contract Technician Collier County Government 3327 Tamiami Trail East Naples, FL 34112 RE: Contract 12-58656 Services for Seniors/Automobile Insurance Dear Ms, Reaves, Pursuant to our contract with Collier County and Business Automobile Insurance Coverage: Please waive this insurance requirement, part I LB on page 3 of the contract, as it does not apply to Summit Home Respiratory Services, Inc. Summit does not own any vehicles and therefore we do not carry any Automobile Insurance Coverage. Thank you. ZHJ 9287527 03 5009448 COMMERCIAL GENERAL LIABILITY CG 02 20 03 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FLORIDA CHANGES - CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCT WITHDRAWAL COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART A. Paragraph 2. of the Cancellation Common Policy Condition is replaced by the following: 2. Cancellation Of Policies In Effect a. For 90 Days Or Less If this policy has been in effect for 90 days or less, we may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation, accompanied by the reasons for cancellation, at least: (1) 10 days before the effective date of cancellation if we cancel for nonpayment of premium; or (2) 20 days before the effective date of cancellation if we cancel for any other reason, except we may cancel immediately if there has been: (a) A material ' misstatement or misrepresentation; or (b) A failure to comply with the underwriting requirements established by the insurer. b. For More Than 90 Days If this policy has been in effect for more than 90 days, we may cancel this policy only for one or more of the following reasons: (1) Nonpayment of premium; (2) The policy was obtained by a material misstatement; (3) Failure to comply' with underwriting requirements established by the insurer within 90 days of the effective date of coverage; (4) A substantial change in the risk covered by the policy; or (5) The cancellation is for all insureds under such policies for a given class of insureds. If we cancel this policy for any of these reasons, we will mail or deliver to the first Named Insured written notice of cancellation, accompanied by the reasons for cancellation, at least: (a) 10 days before the effective date of cancellation if we cancel for nonpayment of premium; or (b) 45 days before the effective date of cancellation if we cancel for any of the other reasons stated in Paragraph 2.b. B. Paragraph 3. of the Cancellation Common Policy Condition is replaced by the following: 3. We will mail or deliver our notice to the first Named Insured at the last mailing address known to us. CG 02 20 03 12 0 Insurance Services Office, Inc., 2011 Page 1 of 2 C. Paragraph 5. of the Cancellation Common Policy Condition is replaced by the following: 5. If this policy is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rata. If the first Named Insured cancels, the refund may be less than pro rata. If the return premium is not refunded with the notice of cancellation or when this policy is returned to us, we will mail the refund within 15 working days after the date cancellation takes effect, unless this is an audit policy. If this is an audit policy, then, subject to your full cooperation with us or our agent in securing the necessary data for audit, we will return any premium refund due within 90 days of the date cancellation takes effect. If our audit is not completed within this time limitation, then we shall accept your own audit, and any premium refund due shall be mailed within 10 working days of receipt of your audit. ZHJ 9287527 03 5009448 The cancellation will be effective even if we have not made or offered a refund. D. The following is added and supersedes any other provision to the contrary: Nonrenewal 1. If we decide not to renew this policy, we will mail or deliver to the first Named Insured written notice of nonrenewal, accompanied by the reason for nonrenewal, at least 45 days prior to the expiration of this policy. 2. Any notice of nonrenewal will be mailed or delivered to the first Named Insured at the last mailing address known to us. If notice is mailed, proof of mailing will be sufficient proof of notice. Page 2 of 2 © Insurance Services Office, Inc., 2011 CG 02 20 03 12 >10 *1 a