Backup Documents 10/28/2014 Item #16D11 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT T( D I 1
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGN
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 signature,draw a line through routing lines#1 through#4,complete the checklist,and forward to Sue Filson(line#5).
Route to Addressee(s) Office Initials Date
(List in routing order)
1. Jennifer Belpedio Attorney's office
gat' %o /a 1114-
2. BCC Office BCC
/
A\
3. H d. �i` oma- Puub�licc Serviiik- �ces Office '�PM tot-5004 3:3gpin
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 Executive Manager,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 approve
the item.)
Name of Primary Staff Hailey Alonso Phone Number 252-8468
Contact
Agenda Date Item was 10/28/14 J Agenda Item Number 16D11
Approved by the BCC
Type of Document Annual Core Contract Number of Original 1
Attached Documents Attached
Does Nd-r iuQtRC ittcoQb t G
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
i appropriate. (Initial)_ /Applicable)
1. Original document has been signed/initialed for legal sufficiency.(All documents to be HMA V
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 NA
Office and all other parties except the BCC Chairman and the Clerk to the Board
3. The Chairman's signature line date has been entered as the date of BCC approval of the HMA
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 HMA
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 the Executive Manager in the BCC office within 24 hours of BCC N IA
approval. Some documents are time sensitive and require forwarding to Tallahassee within
a certain time frame or the BCC's actions are nullified.Be aware of your deadlines!
6. The document was approved by the BCC on_enter date)and all changes made 10/28/14 'ts n t
during the meeting have been incorporated in the attached document.The Coun Q_JC'� option for
Attorney's Office has reviewed the changes,if applicable. e 6____
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SVQGgON 6ENEgt. ALi-s OFFICE .
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Coir-nty of Collier 1 6 0 1 1
CLERK OF THE CIRCUIT COURT
COLLIER COUNTY,,COUR1 HOUSE
3315 TAMIAMI TRL E STE 102 Dwight E. Brock-G`1e k of Circuit Court P.O.BOX 413044
NAPLES,FL 34112-5324 NAPLES,FL 34101-3044
Clerk of Courts • Comptroller • Auditor ustgdian of County Funds
Dr. John H. Armstrong, MD, FACS
Surgeon General & Secretary
Florida Department of Health
Office of the State Surgeon General
4052 Bald Cypress Way, Bin A-00
Tallahassee, Florida 32399-1701
Re: Contract between the State of Florida Department of Health and
Collier County Board of County Commissioners for the operation of
the Collier County Health Department (Contract Year 2014-2015)
Dr. Armstrong,
Attached for further processing is the original contract referenced above, approved
by the Collier County Board of County Commissioners on October 28, 2014.
After the agreement has been signed, please return the original to the Collier
County Minutes and Records Department, that serves as Clerk to the Board, for
the Official Record. I have included a mailing label to facilitate processing.
Upon our office's receipt of the contract, I will provide a certified copy to staff
within the Collier County Health Department.
If your office requires further information or you have questions, please do not
hesitate to contact me at 239-252-8406.
Respectfully,
DWIGHT E. BROCK, CLERK
Ann Jennejohn, Deputy Clerk
Attachment
Phone- (239) 252-2646 Fax- (239) 252-2755
Website- www.CollierClerk.com Email- CollierClerk(Tcollierclerk.com
DWIGHT E. BROCK
1 6 0 11
CLERK OF THE CIRCUIT COURT
COLLIER COUNTY COURTHOUSE COMPLEX
3301 TAMIAMI TRAIL EAST
P.O. BOX 413044
NAPLES, FLORIDA 34101-3044
Florida Department of Health
Office of the State Surgeon General
Attn: Dr. John H. Armstrong, MD, FACS
Surgeon General & Secretary
4052 Bald Cypress Way, Bin A-00
Tallahassee, Florida 32399-1701
County of Collier 16011
CLERK OF THE CJRC1 .IT COURT
COLLIER COUNTY OUR HOUSE
.fr 5
3315 TAMIAMI TRL E STE 102 Dwight E.Brock- k of Circuit Court P.O.BOX 413044
NAPLES,FL 34112-5324 NAPLES,FL 34101-3044
Clerk of Courts • Comptroller • Auditor ustgdian of County Funds
Dr. John H. Armstrong, MD, FACS
Surgeon General & Secretary @=
Florida Department of Health
Office of the State Surgeon General
4052 Bald Cypress Way, Bin A-00
Tallahassee, Florida 32399-1701
Re: Contract between the State of Florida Department of Health and
Collier County Board of County Commissioners for the operation of
the Collier County Health Department (Contract Year 2014-2015)
Dr. Armstrong,
Attached for further processing is the original contract referenced above, approved
by the Collier County Board of County Commissioners on October 28, 2014.
After the agreement has been signed, please return the original to the Collier
County Minutes and Records Department, that serves as Clerk to the Board, for
the Official Record. I have included a mailing label to facilitate processing.
Upon our office's receipt of the contract, I will provide a certified copy to staff
within the Collier County Health Department.
If your office requires further information or you have questions, please do not
hesitate to contact me at 239-252-8406.
Respectfully,
DWIGHT E. BROCK, CLERK 0 Ag
sima
Ann Jennejohn, Deputy Clerk
LC :Zi Wd AON 4IOZ
Attachment '' ' -' i`i n 3 J
G1!J
Phone- (239) 252-2646 Fax- (239) 252-2755
Website- www.CollierClerk.com Email- CollierClerk@collierclerk.com
l6Dii
MEMORANDUM
Date: November 25, 2014
To: Alan Portis, Business Manager
State of Florida Department of Health
From: Ann Jennejohn, Sr. Deputy Clerk
Minutes & Records Department
Re: FY 14-15 Contract with State of Florida's Department of
Health for the operation of Collier County's Health Department
Attached for your records is a certified copy of the contract referenced above,
(Item #16D11) approved by the Board of County Commissioners October 28, 2014.
The original contract will be held in the Minutes and Records Department for
the Board's Official Record.
If you have any questions, please feel free to contact me at 252-8406.
Thank you.
Attachment
1 6 0 1 1
CONTRACT BETWEEN
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
AND
STATE OF FLORIDA DEPARTMENT OF HEALTH
FOR OPERATION OF
THE COLLIER COUNTY HEALTH DEPARTMENT
CONTRACT YEAR 2014-2015
This agreement ("Agreement") is made and entered into between the State of Florida,
Department of Health ("State") and the Collier County Board of County Commissioners
("County"), through their undersigned authorities, effective October 1, 2014.
RECITALS
A. Pursuant to Chapter 154, Florida Statutes, the intent of the legislature is to
"promote, protect, maintain, and improve the health and safety of all citizens and visitors of
this state through a system of coordinated county health department services."
B. County Health Departments were created throughout Florida to satisfy this
legislative intent through "promotion of the public's health, the control and eradication of
preventable diseases, and the provision of primary health care for special populations."
C. Collier County Health Department ("CHD") is one of the County Health
Departments created throughout Florida.
D. It is necessary for the parties 'hereto to enter into this Agreement in order to
ensure coordination between the State and the County in the operation of the CHD.
NOW THEREFORE, in consideration of the mutual promises set forth herein, the
sufficiency of which are hereby acknowledged, the parties hereto agree as follows:
1. RECITALS. The parties mutually agree that the forgoing recitals are true and
correct and incorporated herein by reference.
2. TERM. The parties mutually agree that this Agreement shall be effective from
October 1, 2014, through September 30, 2015, or until a written agreement replacing this
Agreement is entered into between the parties, whichever is later, unless this Agreement
is otherwise terminated pursuant to the termination provisions set forth in paragraph 8,
below.
3. SERVICES MAINTAINED BY THE CHD. The parties mutually agree that the CHD
shall provide those services as set forth on Part Ill of Attachment II hereof, in order to
maintain the following three levels of service pursuant to Section 154.01(2), Florida
Statutes, as defined below:
a. "Environmental health services" are those services which are organized and
operated to protect the health of the general public by monitoring and regulating activities
in the environment which may contribute to the occurrence or transmission of disease.
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Environmental health services shall be supported by available federal, state and local
funds and shall include those services mandated on a state or federal level. Examples of
environmental health services include, but are not limited to, food hygiene, safe drinking
water supply, sewage and solid waste disposal, swimming pools, group care facilities,
migrant labor camps, toxic material control, radiological health, and occupational health.
b. "Communicable disease control services" are those services which protect the
health of the general public through the detection, control,, and eradication of diseases
which are transmitted primarily by human beings. Communicable disease services shall
be supported by available federal, state, and local funds and shall include those services
mandated on a state or federal level. Such services include, but are not limited to,
epidemiology, sexually transmissible disease detection and control, HIV/AIDS,
immunization, tuberculosis control and maintenance of vital statistics.
c. "Primary care services" are acute care and preventive services that are made
available to well and sick persons who are unable to obtain such services due to lack of
income or other barriers beyond their control. These services are provided to benefit
individuals, improve the collective health of the public, and prevent and control the spread
of disease. Primary health care services are provided at home, in group settings, or in
clinics. These services shall be supported by available federal, state, and local funds and
shall include services mandated on a state or federal level. Examples of primary health
care services include, but are not limited to: first contact acute care services; chronic
disease detection and treatment; maternal and child health services; family planning;
nutrition; school health; supplemental food assistance for women, infants, and children;
home health; and dental services.
4. FUNDING. The parties further agree that funding for the CHD will be handled as
follows:
a. The funding to be provided by the parties and any other sources are set forth in Part
II of Attachment II hereof. This funding will be used as shown in Part I of Attachment II.
i. The State's appropriated responsibility (direct contribution excluding any state fees,
Medicaid contributions or any other funds not listed on the Schedule C) as provided in
Attachment II, Part II is an amount not to exceed $ 5,491,305 (State General
Revenue, State Funds, Other State Funds and Federal Funds listed on the Schedule C). The
State's obligation to pay under this contract is contingent upon an annual
appropriation by the Legislature.
ii. The County's appropriated responsibility (direct contribution excluding any fees,
other cash or local contributions) as provided in Attachment II, Part II is an amount not
to exceed $ 1,289,500 (amount listed under the "Board of County Commissioners Annual
Appropriations section of the revenue attachment).
b. Overall expenditures will not exceed available funding or budget authority,
whichever is less, (either current year or from surplus trust funds) in any service category.
Unless requested otherwise, any surplus at the end of the term of this Agreement in the
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County Health Department Trust Fund that is attributed to the CHD shall be carried
forward to the next contract period.
c. Either party may establish service fees as allowed by law to fund activities of the
CHD. Where applicable, such fees shall be automatically adjusted to at least the
Medicaid fee schedule.
d. Either party may increase or decrease funding of this Agreement during the term
hereof by notifying the other party in writing of the amount and purpose for the change in
funding. If the State initiates the increase/decrease, the CHD will revise the Attachment II
and send a copy of the revised pages to the County and the Department of Health, Office
of Budget and Revenue Management. If the County initiates the increase/decrease, the
County shall notify the CHD. The CHD will then revise the Attachment II and send a copy
of the revised pages to the Department of Health, Office of Budget and Revenue
Management.
e. The name and address of the official payee to who payments shall be made is:
County Health Department Trust Fund
Collier County
3339 E. Tamiami Trail, Suite 145
Naples, FL 34112
5. CHD DIRECTOR/ADMINISTRATOR. Both parties agree the director/administrator
of the CHD shall be a State employee or under contract with the State and will be under
the day-to-day direction of the Deputy Secretary for Statewide Services. The
director/administrator shall be selected by the State with the concurrence of the County.
The director/administrator of the CHD shall ensure that non-categorical sources of funding
are used to fulfill public health priorities in the community and the Long Range Program
Plan. A report detailing the status of public health as measured by outcome measures
and similar indicators will be sent by the CHD director/administrator to the parties no later
than October 1 of each year (This is the standard quality assurance "County Health Profile" report
located on the Division of Public Health Statistics and Performance Management Intranet site).
6. ADMINISTRATIVE POLICIES AND PROCEDURES. The parties hereto agree that
the following standards should apply in the operation of the CHD:
a. The CHD and its personnel shall follow all State policies and procedures, except to
the extent permitted for the use of county purchasing procedures as set forth in
subparagraph b., below. All CHD employees shall be State or State-contract personnel
subject to State personnel rules and procedures. Employees will report time in the Health
Management System compatible format by program component as specified by the State.
b. The CHD shall comply with all applicable provisions of federal and state laws and
regulations relating to its operation with the exception that the use of county purchasing
procedures shall be allowed when it will result in a better price or service and no statewide
Department of Health purchasing contract has been implemented for those goods or
services. In such cases, the CHD director/administrator must sign a justification therefore,
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and all county-purchasing procedures must be followed in their entirety, and such
compliance shall be documented. Such justification and compliance documentation shall
be maintained by the CHD in accordance with the terms of this Agreement. State
procedures must be followed for all leases on facilities not enumerated in Attachment IV.
c. The CHD shall maintain books, records and documents in accordance with those
promulgated by the Generally Accepted Accounting Principles (GAAP) and Governmental
Accounting Standards Board (GASB), and the requirements of federal or state law. These
records shall be maintained as required by the Department of Health Policies and
Procedures for Records Management and shall be open for inspection at any time by the
parties and the public, except for those records that are not otherwise subject to disclosure
as provided by law which are subject to the confidentiality provisions of paragraph 6.i.,
below. Books, records and documents must be adequate to allow the CHD to comply with
the following reporting requirements:
i. The revenue and expenditure requirements in the Florida Accounting
System Information Resource (FLAIR).
ii. The client registration and services reporting requirements of the
minimum data set as specified in the most current version of the Client
Information System/Health Management Component Pamphlet;
iii. Financial procedures specified in the Department of Health's Accounting
Procedures Manuals, Accounting memoranda, and Comptroller's
memoranda;
iv. The CHD is responsible for assuring that all contracts with service
providers include provisions that all subcontracted services be reported
to the CHD in a manner consistent with the client registration and
service reporting requirements of the minimum data set as specified in
the Client Information System/Health Management Component
Pamphlet.
d. All funds for the CHD shall be deposited in the County Health Department Trust
Fund maintained by the state treasurer. These funds shall be accounted for separately
from funds deposited for other CHDs and shall be used only for public health purposes in
Collier County.
e. That any surplus/deficit funds, including fees or accrued interest, remaining in the
County Health Department Trust Fund account at the end of the contract year shall be
credited/debited to the state or county, as appropriate, based on the funds contributed by
each and the expenditures incurred by each. Expenditures will be charged to the program
accounts by state and county based on the ratio of planned expenditures in the core
contract and funding from all sources is credited to the program accounts by state and
county. The equity share of any surplus/deficit funds accruing to the state and county is
determined each month and at contract year-end. Surplus funds may be applied toward
the funding requirements of each participating governmental entity in the following year.
However, in each such case, all surplus funds, including fees and accrued interest, shall
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remain in the trust fund until accounted for in a manner which clearly illustrates the amount
which has been credited to each participating governmental entity. The planned use of
surplus funds shall be reflected in Attachment II, Part I of this contract, with special capital
projects explained in Attachment V.
f. There shall be no transfer of funds between the three levels of services without a
contract amendment unless the CHD director/administrator determines that an emergency
exists wherein a time delay would endanger the public's health and the Deputy Secretary
for Statewide Services has approved the transfer. The Deputy Secretary for Statewide
Services shall forward written evidence of this approval to the CHD within 30 days after an
emergency transfer.
g. The CHD may execute subcontracts for services necessary to enable the CHD to
carry out the programs specified in this Agreement. Any such subcontract shall include all
aforementioned audit and record keeping requirements.
h. At the request of either party, an audit may be conducted by an independent CPA
on the financial records of the CHD and the results made available to the parties within
180 days after the close of the CHD fiscal year. This audit will follow requirements
contained in OMB Circular A-133 and may be in conjunction with audits performed by
county government. If audit exceptions are found, then the director/administrator of the
CHD will prepare a corrective action plan and a copy of that plan and monthly status
reports will be furnished to the contract managers for the parties.
i. The CHD shall not use or disclose any information concerning a recipient of
services except as allowed by federal or state law or policy.
j. The CHD shall retain all client records, financial records, supporting documents,
statistical records, and any other documents (including electronic storage media) pertinent
to this Agreement for a period of five (5) years after termination of this Agreement. If an
audit has been initiated and audit findings have not been resolved at the end of five (5)
years, the records shall be retained until resolution of the audit findings.
k. The CHD shall maintain confidentiality of all data, files, and records that are
confidential under the law or are otherwise exempted from disclosure as a public record
under Florida law. The CHD shall implement procedures to ensure the protection and
confidentiality of all such records and shall comply with sections 384.29, 381.004, 392.65
and 456.057, Florida Statutes, and all other state and federal laws regarding
confidentiality. All confidentiality procedures implemented by the CHD shall be consistent
with the Department of Health Information Security Policies, Protocols, and Procedures.
The CHD shall further adhere to any amendments to the State's security requirements and
shall comply with any applicable professional standards of practice with respect to client
confidentiality.
I. The CHD shall abide by all State policies and procedures, which by this reference
are incorporated herein as standards to be followed by the CHD, except as otherwise
permitted for some purchases using county procedures pursuant to paragraph 6.b. hereof.
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m. The CHD shall establish a system through which applicants for services and current
clients may present grievances over denial, modification or termination of services. The
CHD will advise applicants of the right to appeal a denial or exclusion from services, of
failure to take account of a client's choice of service, and of his/her right to a fair hearing to
the final governing authority of the agency. Specific references to existing laws, rules or
program manuals are included in Attachment I of this Agreement.
n. The CHD shall comply with the provisions contained in the Civil Rights Certificate,
hereby incorporated into this contract as Attachment Ill.
o. The CHD shall submit quarterly reports to the county that shall include at least the
following:
i. The DE385L1 Contract Management Variance Report and the DE580L1
Analysis of Fund Equities Report;
ii. A written explanation to the county of service variances reflected in the
DE385L1 report if the variance exceeds or falls below 25 percent of the planned
expenditure amount. However, if the amount of the service specific variance
between actual and planned expenditures does not exceed three percent of the
total planned expenditures for the level of service in which the type of service is
included, a variance explanation is not required. A copy of the written
explanation shall be sent to the Department of Health, Office of Budget and
Revenue Management.
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p. The dates for the submission of quarterly reports to the county shall be as follows
unless the generation and distribution of reports is delayed due to circumstances beyond
the CHD's control:
i. March 1, 2015 for the report period October 1, 2014 through
December 31, 2014;
ii. June 1, 2015 for the report period October 1, 2014 through
March 31, 2015;
iii. September 1, 2015 for the report period October 1, 2014
through June 30, 2015; and
iv. December 1, 2015 for the report period October 1, 2014
through September 30, 2015.
7. FACILITIES AND EQUIPMENT. The parties mutually agree that:
a. CHD facilities shall be provided as specified in Attachment IV to this contract and
the county shall own the facilities used by the CHD unless otherwise provided in
Attachment IV.
b. The county shall ensure adequate fire and casualty insurance coverage for County-
owned CHD offices and buildings and for all furnishings and equipment in CHD offices
through either a self-insurance program or insurance purchased by the County.
c. All vehicles will be transferred to the ownership of the County and registered as
county vehicles. The county shall ensure insurance coverage for these vehicles is
available through either a self-insurance program or insurance purchased by the County.
All vehicles will be used solely for CHD operations. Vehicles purchased through the
County Health Department Trust Fund shall be sold at fair market value when they are no
longer needed by the CHD and the proceeds returned to the County Health Department
Trust Fund.
8. TERMINATION.
a. Termination at Will. This Agreement may be terminated by either party without
cause upon no less than one-hundred eighty (180) calendar days notice in writing to the
other party unless a lesser time is mutually agreed upon in writing by both parties. Said
notice shall be delivered by certified mail, return receipt requested, or in person to the
other party's contract manager with proof of delivery.
b. Termination Because of Lack of Funds. In the event funds to finance this
Agreement become unavailable, either party may terminate this Agreement upon no less
than twenty-four (24) hours notice. Said notice shall be delivered by certified mail, return
receipt requested, or in person to the other party's contract manager with proof of delivery.
c. Termination for Breach. This Agreement may be terminated by one party, upon no
less than thirty (30) days notice, because of the other party's failure to perform an
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obligation hereunder. Said notice shall be delivered by certified mail, return receipt
requested, or in person to the other party's contract manager with proof of delivery.
Waiver of breach of any provisions of this Agreement shall not be deemed to be a waiver
of any other breach and shall not be construed to be a modification of the terms of this
Agreement.
9. MISCELLANEOUS. The parties further agree:
a. Availability of Funds. If this Agreement, any renewal hereof, or any term,
performance or payment hereunder, extends beyond the fiscal year beginning July 1,
2015, it is agreed that the performance and payment under this Agreement are contingent
upon an annual appropriation by the Legislature, in accordance with section 287.0582,
Florida Statutes.
b. Contract Managers. The name and address of the contract managers for
the parties under this Agreement are as follows:
For the State: For the County:
Stephanie Vick, M.S.,B.S.N., R.N. Steve Carnell
Name Name
Administrator, Florida Department of Public Services Division Administrator
Health in Collier County
Title Title
3339 E. Tamiami Trail, Suite 145 3339 E. Tamiami Trail, Suite 217
Naples, Florida 34112 Naples, Florida 34112
Address Address
(239) 252-5332 (239) 252-8468
Telephone Telephone
If different contract managers are designated after execution of this Agreement, the name,
address and telephone number of the new representative shall be furnished in writing to
the other parties and attached to originals of this Agreement.
c. Captions. The captions and headings contained in this Agreement are for
the convenience of the parties only and do not in any way modify, amplify, or give
additional notice of the provisions hereof.
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16011
In WITNESS THEREOF, the parties hereto have caused this 20 page agreement to be
executed by their undersigned officials as duly authorized effective the 17-day of October, 2014.
BOARD OF COUNTY COMMISSIONERS STATE OF FLORIDA
FOR COLLIER COUNTY DEPARTMENT OF HEALTH
7/1
SIGNED B(a(;, SIGNED BY:
NAME: To 1.1 G NAME: John H. Armstrong, MD
TITLE: CH A r . rvA TITLE: Surgeon General/Secretary of Health
DATE: OGTOS E K 2$1 Q01.4 DATE: //49/''//17
ATTESTED TO:
SIGNED BY: .1,(,l,( Q SIGNED BY: , _ A, v
NAME: l V'J1 ife✓ /r(N, NAME: Stephanie Vick, M.S., B.S.N., R.N.
TITLE: �p(,(411 C4€/v- TITLE: CHD Administrator
DATE: T,\OVQIYot 3 , c 4`t DATE: IC ) �G
ATTEST: Approved as to form and legality
DWIGHT E. ar4OCK. Clerk
By: F�;. 10 �. Assistant County rney
A
Attest astoy u,
signature only.
9
ATTACHMENTI 1 6 0 1 1
COLLIER COUNTY HEALTH DEPARTMENT I
PROGRAM SPECIFIC REPORTING REQUIREMENTS AND PROGRAMS REQUIRING
COMPLIANCE WITH THE PROVISIONS OF SPECIFIC MANUALS
Some health services must comply with specific program and reporting requirements in addition to the Personal Health
Coding Pamphlet(DHP 50-20), Environmental Health Coding Pamphlet (DHP 50-21) and FLAIR requirements because
of federal or state law, regulation or rule. If a county health department is funded to provide one of these services, it
must comply with the special reporting requirements for that service. The services and the reporting requirements are
listed below:
Service Requirement
1. Sexually Transmitted Disease Requirements as specified in F.A.C. 64D-3, F.S. 381 and
Program F.S. 384.
2. Dental Health Periodic financial and programmatic reports as specified by
the program office.
3. Special Supplemental Nutrition Service documentation and monthly financial reports as
Program for Women, Infants specified in DHM 150-24* and all federal, state.and county
and Children (including the WIC requirements detailed in program manuals and published
Breastfeeding Peer Counseling procedures.
Program)
4. Healthy Start/ Requirements as specified in the 2007 Healthy Start
Improved Pregnancy Outcome Standards and Guidelines and as specified by the Healthy
Start Coalitions in contract with each county health
department.
5. Family Planning Requirements as specified in Public Law 91-572, 42 U.S.C.
300, et seq., 42 CFR part 59, subpart A, 45 CFR parts 74&
92, 2 CFR 215 (OMB Circular A-110) OMB Circular A-102,
F.S. 381.0051, F.A.C. 64F-7, F.A.C. 64F-16, and F.A.C. 64F-
19. Requirements and Guidance as specified in the Program
Requirements for Title X Funded Family Planning Projects
(Title X Requirements)(2014) and the Providing Quality
Family Planning Services (QFP): Recommendations of CDC
and the U.S. Office of Population Affairs published on the
Office of Population Affairs website. Programmatic annual
reports as specified by the program office as specified in the
annual programmatic Scope of Work for Family Planning and
Maternal Child Health Services, including the Family Planning
Annual Report(FPAR), and other minimum guidelines as
specified by the Policy Web Technical Assistance Guidelines.
6. Immunization Periodic reports as specified by the department pertaining to
immunization levels in kindergarten and/or seventh grade
pursuant to instructions contained in the Immunization
Guidelines-Florida Schools, Childcare Facilities and Family
Daycare Homes (DH Form 150-615)and Rule 64D-3.046,
F.A.C. In addition, periodic reports as specified by the
department pertaining to the surveillance/investigation of
reportable vaccine-preventable diseases, adverse events,
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ATTACHMENT I (Continued)
vaccine accountability, and assessment of immunization
levels as documented in Florida. SHOTS and supported by
CHD Guidebook policies and technical assistance guidance.
7. Environmental Health Requirements as specified in Environmental Health Programs
Manual 150-4*and DHP 50-21*
8. HIV/AIDS Program Requirements as specified in F.S. 384.25 and
F.A.C. 64D-3.030 and 64D-3.031. Case reporting should be
on Adult HIV/AIDS Confidential Case Report CDC Form
DH2139 and Pediatric HIV/AIDS Confidential Case Report
CDC Form DH2140.
Requirements as specified in F.A.C. 64D-2 and 64D-3, F.S.
381 and F.S. 384. Socio-demographic and risk data on
persons tested for HIV in CHD clinics should be reported
on Lab Request DH Form 1628 in accordance with the Forms
Instruction Guide. Requirements for the HIV/AIDS Patient
Care programs are found in the Patient Care Contract
Administrative Guidelines.
9. School Health Services Requirements as specified in the Florida School Health
Administrative Guidelines (May 2012). Requirements as
specified in F.S. 381.0056, F.S. 381.0057, F.S. 402.3026 and
F.A.C. 64F-6.
10. Tuberculosis Tuberculosis Program Requirements as specified in F.A.C.
64D-3 and F.S. 392.
11. General Communicable Disease Control Carry out surveillance for reportable communicable and other
acute diseases, detect outbreaks, respond to individual cases
of reportable diseases, investigate outbreaks, and carry out
communication and quality assurance functions, as specified
in F.A.C. 64D-3, F.S. 381, F.S. 384 and the CHD
Epidemiology Guide to Surveillance and Investigations.
12. Refugee Health Program Programmatic and financial requirements as specified by the
program office.
*or the subsequent replacement if adopted during the contract period.
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1
ATTACHMENT
H. 1 6 0 1 1
COLLIER COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County Health Department
October 1,2014 to September 30,2015
State CUD County Total CHD
Trust Fund CIID Trust Fund Other
(cash) Trust Fund (cash) Contribution Total
1. GENERAL REVENUE-STATE
015040 AIDS PATIENT CARE 140,000 0 140,000 0 140,000
015040 AIDS PREVENTION&SURVEILLANCE-GENERAL REVENUE 69,571 0 69,571 0 69,571
015040 CHD-TB COMMUNITY PROGRAM 147,173 0 147,173 0 147,173
015040 DENTAL SPECIAL INITIATIVE PROJECTS 7,076 0 7,076 0 7,076
015040 DOH RESPONSE TO TERRORISM 73,643 0 73,643 0 73,643
015040 FAMILY PLANNING GENERAL REVENUE 57,217 0 57,217 0 57,217
015040 HEPATITIS AND LIVER FAILURE PREVENTION&CONTROL 89,286 0 89,286 0 89,286
015040 MIGRANT LABOR CAMP SANITATION 74,533 0 74,533 0 74,533
015040 PRIMARY CARE PROGRAM 313,432 0 313,432 0 313,432
015040 SCHOOL HEALTH SERVICES-GENERAL REVENUE 218,073 0 218,073 0 218,073
015050 CHD GENERAL REVENUE NON-CATEGORICAL 1,820,944 0 1,820,944 0 1,820,944
GENERAL REVENUE TOTAL 3,010,948 0 3,010,948 0 3,010,948
2. NON GENERAL REVENUE-STATE
015010 CHD GENERAL REVENUE NON-CATEGORICAL 46,606 0 46,606 0 46,606
015010 ENVIRONMENTAL BIOMEDICAL WASTE PROGRAM 13,759 0 13,759 0 13,759
015010 STATE UNDERGROUND PETROLEUM RESPONSE ACT 3,200 0 3,200 0 3,200
015010 TOBACCO STATE AND COMMUNITY INTERVENTIONS 224,230 0 224,230 0 224,230
NON GENERAL REVENUE TOTAL 287,795 0 287,795 0 287,795
3. FEDERAL FUNDS-State
007000 AIDS DRUG ASSISTANCE PROGRAM ADMIN 77,946 0 77,946 0 77,946
007000 AIDS PREVENTION 239,788 0 239,788 0 239,788
007000 BIOTERRORISM HOSPITAL PREPAREDNESS 20,243 0 20,243 0 20,243
007000 COASTAL BEACH WATER QUALITY MONITORING 16,874 0 16,874 0 16,874
007000 COMPREHENSIVE COMMUNITY CARDIO-PHBG 22,586 0 22,586 0 22,586
007000 FAMILY PLANNING TITLE X-GRANT 100,722 0 100,722 0 100,722
007000 IMMUNIZATION ACTION PLAN 76,761 0 76,761 0 76,761
007000 IMPROVING STD PROGRAMS 2,812 0 2,812 0 2,812
007000 MCH SPECIAL PRJCT UNPLANNED PREGNANCY 32,618 0 32,618 0 32,618
007000 MCH SPECIAL PROJECTS DENTAL 3,200 0 3,200 0 3,200
007000 PHP PUBLIC HEALTH PREPAREDNESS BASE ALLOC 133,593 0 133,593 0 133,593
007000 RADON INDOOR AIR EPA FUNDNG ASSISTANCE 630 0 630 0 630
007000 TB CONTROL PROJECT 74,062 0 74,062 0 74,062
007000 TOBACCO PREVENTION AND CONTROL PROGRAM 12,000 0 12,000 0 12,000
007000 WIC BREASTFEEDING PEER COUNSELING PROG 55,442 0 55,442 0 55,442
007000 WIC PROGRAM ADMINISTRATION 1,385,416 0 1,385,416 0 1,385,416
015075 INSPECTIONS OF SUMMER FEEDING PROGRAM-DOE 1,500 0 1,500 0 1,500
015075 REFUGEE HEALTH SCREENING EXPENSE REIMBURSEMENT 450,000 0 450,000 0 450,000
015075 SUPPLEMENTAL SCHOOL HEALTH 33,690 0 33,690 0 33,690
FEDERAL FUNDS TOTAL 2,739,883 0 2,739,883 0 2,739,883
4. FEES ASSESSED BY STATE OR FEDERAL RULES-STATE
001020 CHD STATEWIDE ENVIRONMENTAL FEES 403,770 0 403,770 0 403,770
001092 CHD STATEWIDE ENVIRONMENTAL FEES 102,300 0 102,300 0 102,300
001206 DRINKING WATER PROGRAM OPERATIONS 1,000 0 1,000 0 1,000
001206 MOBILE HOME&RV PARK FEES 2,095 0 2,095 0 2,095
Version: Page 1 of 3�
'Y
ATTACHMENT II. 1 6 0 1 1
COLLIER COUNTY HEALTH DEPARTMENT
Part H. Sources of Contributions to County Health Department
October 1,2014 to September 30,2015
State CIID County Total CIID
Frust Fund CIID Trust Fund Other
(cash) 4,Trust Fund (cash) Contribution Total
4. FEES ASSESSED BY STATE OR FEDERAL RULES-STATE
001206 ON SITE SEWAGE DISPOSAL PERMIT FEES 7,000 0 7,000 0 7,000
001206 ONSITE SEWAGE TRAINING CENTER 1,000 0 1,000 0 1,000
001206 PUBLIC SWIMMING POOL PERMIT FEES10%HQ TRANSFER 27,000 0 27,000 0 27,000
001206 REGULATION OF BODY PIERCING SALONS 30 0 30 0 30
001206 SANITATION CERTIFICATES(FOOD INSPECTION) 3,500 0 3,500 0 3,500
001206 SEPTIC TANK RESEARCH SURCHARGE 500 0 500 0 500
001206 TANNING FACILITIES 375 0 375 0 375
001206 TATTO PROGRAM ENVIRONMENTAL HEALTH 1,000 0 1,000 0 1,000
FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 549,570 0 549,570 0 549,570
5. OTHER CASH CONTRIBUTIONS-STATE
OTHER CASH CONTRIBUTIONS TOTAL 0 0 0 0 0
6. MEDICAID-STATE/COUNTY
001061 HEALTH START MEDICAID WAIVER DIRECT-AHCA 0
001069 CHD CLINIC FEES 0 22,516 22,516 0 22,516
001076 CHD CLINIC FEES 0 25,000 25,000 0 25,000
001078 CHD CLINIC FEES 0 1,000 1,000 0 1,000
001087 CHD CLINIC FEES 0 6,500 6,500 0 6,500
001079 CHD CLINIC FEES 0 20,000 20,000 0 20,000
001082 CHD CLINIC FEES 0 22,000 22,000 0 22,000
001089 CHD CLINIC FEES 0 30,000 30,000 0 30,000
001193 CHD CLINIC FEES 0 1,500 1,500 0 1,500
001192 CHD CLINIC FEES 0 6,500 6,500 0 6,500
MEDICAID TOTAL 0 135,016 135,016 0 135,016
7. ALLOCABLE REVENUE-STATE
ALLOCABLE REVENUE TOTAL 0 0 0 0 0
8. OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND-STATE
ADAP 0 0 0 2,018,679 2,018,679
PHARMACY DRUG PROGRAM 0 0 0 127,266 127,266
WIC PROGRAM 0 0 0 5,768,474 5,768,474
BUREAU OF PUBLIC HEALTH LABORATORIES 0 0 0 86,356 86,356
IMMUNIZATIONS 0 0 0 821,672 821,672
OTHER STATE CONTRIBUTIONS TOTAL 0 0 0 8,822,447 8,822,447
9. DIRECT LOCAL CONTRIBUTIONS-BCC/TAX DISTRICT
008034 CHD LOCAL REVENUE&EXPENDITURES 0 1,289,500 1,289,500 0 1,289,500
DIRECT COUNTY CONTRIBUTION TOTAL 0 1,289,500 1,289,500 0 1,289,500
10. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION-COUNTY
001077 CHD CLINIC FEES 0 158,650 158,650 0 158,650
001077 GENERAL CLINIC RABIES SERVICES&DRUG PURCHASES 0 750 750 0 750
001114 VITAL STATISTICS CERTIFIED RECORDS 0 50,000 50,000 0 50,000
Version: Page 2 of
O
ATTACHMENT IL
6 1 1 1
COLLIER COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County Health Department
October 1,2014 to September 30,201.5
State CUD County Total CHD
frust Fund CUD Trust Fund Other
' ', "�'v (cash) Trust Fund (cash) Contribution Total
10. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION-COUN"I'Y
001094 CHD STATEWIDE ENVIRONMENTAL FEES 0 572,700 572,700 0 572,700
001115 VITAL STATISTICS CERTIFIED RECORDS 0 255,000 255,000 0 255,000
FEES AUTHORIZED BY COUNTY TOTAL 0 1,037,100 1,037,100 0 1,037,100
11. OTHER CASH AND LOCAL CONTRIBUTIONS-COUNTY
001029 CHD CLINIC FEES 0 942,775 942,775 0 942,775
001029 GENERAL CLINIC RABIES SERVICES&DRUG PURCHASES 0 6,250 6,250 0 6,250
001029 RYAN WHITE 0 243,000 243,000 0 243,000
001090 CHD CLINIC FEES 0 38,400 38,400 0 38,400
010303 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 0 200 200 0 200
011000 CHD LOCAL REVENUE&EXPENDITURES 0 246,440 246,440 0 246,440
011000 EARLY LEARNING COALITION OF SOUTHWEST FLORIDA 0 60,900 60,900 0 60,900
011001 CHD HEALTHY START COALITION CONTRACT 0 465,096 465,096 0 465,096
010500 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 0 2,000 2,000 0 2,000
011007 CHD CLINIC FEES 0 500 500 0 500
090002 DRAW DOWN FROM PUBLIC HEALTH UNIT 0 486,973 486,973 0 486,973
OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 0 2,492,534 2,492,534 0 2,492,534
12. ALLOCABLE REVENUE-COUNTY
COUNTY ALLOCABLE REVENUE TOTAL 0 0 0 0 0
13. BUILDINGS-COUNTY
ANNUAL RENTAL EQUIVALENT VALUE 0 0 0 525,048 525,048
IT ALLOCATION&GOLDEN GATE RENTAL 0 0 0 76,200 76,200
UTILITIES 0 0 0 196,000 196,000
GROUNDS MAINTENANCE 0 0 0 195,149 195,149
BUILDINGS TOTAL 0 0 0 992,397 992,397
14. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND-COUNTY
EQUIPMENT/VEHICLE PURCHASES 0 0 0 48,000 48,000
VEHICLE INSURANCE 0 0 0 15,900 15,900
OTHER COUNTY CONTRIBUTIONS TOTAL 0 0 0 63,900 63,900
GRAND TOTAL CHD PROGRAM 6,588,196 4,954,150 11,542,346 9,878,744 21,421,090
Version: Page 3 oft)
ATTACHMENT H
COLLIER COUNTY HEALTH DEPARTMENT
Part III.Planned Staffing,Clients,Services,And Expenditures By Program Service Area Within Each Level Of Service
October 1,2014 to September 30,2015
Quarterly Expenditure Plan
V1'E's Clients Services/ 1st 2nd 3rd 4th Grand
(0,00) UnitsVisits (Whole dollars only) State County Total
A. COMMUNICABLE DISEASE CONTROL:
IMMUNIZATION(101) 12.04 9,540 12,709 192,068 164,588 192,068 191,994 305,086 435,632 740,718
STD(102) 5.26 1,211 1,924 75,520 64,715 75,520 75,490 107,040 184,205 291,245
HIV/AIDS PREVENTION(03A1) 5.62 1,559 1,853 82,906 71,044 82,906 82,874 319;730 0 319,730
HIV/AIDS SURVEILLANCE(03A2) 1.19 17 17 17,299 14,824 17,299 17,294 66,716 0 66,716
HIV/AIDS PATIENT CARE(03A3) 7.50 388 2,218 149,512 128,120 149,512 149,454 219,213 357,385 576,598
ADAP(03A4) 1.99 31 68 31,221 26,754 31,221 31,208 120,404 0 120,404
TB CONTROL SERVICES(104) 6.39 657 3,570 117,391 100,595 117,391 117,345 321,202 131,520 452,722
COMM.DISEASE SURV.(106) 6.19 0 4,443 120,125 102,937 120,125 120,078 197,656 265,609 463,265
HEPATITIS PREVENTION(109) 1.61 1,652 2,120 28,741 24,628 28,741 28,729 110,839 0 110,839
PUBLIC HEALTH PREP AND RESP(116) 4.95 0 8 96,356 82,570 96,356 96,320 327,916 43,686 371,602
REFUGEE HEALTH(118) 6.34 840 2,756 166,073 142,312 166,073 166,010 615,346 25,122 640,468
VITAL STATISTICS(180) 2.71 8,235 30,219 35,537 30,452 35,537 35,522 0 137,048 137,048
COMMUNICABLE DISEASE SUBTOTAL 61.79 24,130 61,905 1,112,749 953,539 1,112,749 1,112,318 2,711,148 1,580,207 4,291,355
B. PRIMARY CARE:
CHRONIC DISEASE SERVICES(210) 1.47 146 109 27,375 23,458 27,375 27,364 63,507 42,065 105,572
TOBACCO PREVENTION(212) 4.88 0 4,457 70,336 60,272 70,336 70,309 271,253 0 271,253
WIC(21W1) 30.43 11,153 85,917 425,806 364,882 425,806 425,641 1,607,374 34,761 1,642,135
WIC BREASTFEEDING PEER COUNSELING(21W2) 3.17 0 5,538 34,055 29,183 34,055 34,043 89,840 41,496 131,336
FAMILY PLANNING(223) 3.76 3,087 3,494 86,615 74,223 86,615 86,582 229,274 104,761 334,035
IMPROVED PREGNANCY OUTCOME(225) 0.18 39 258 87,578 75,047 87,578 87,544 0 337,747 337,747
HEALTHY START PRENATAL(227) 10.89 1,088 6,575 162,245 139,031 162,245 162,182 158,508 467,195 625,703
COMPREHENSIVE CHILD HEALTH(229) 1.23 217 491 20,721 17,756 20,721 20,712 0 79,910 79,910
HEALTHY START INFANT(231) 4.93 778 4,955 78,332 67,124 78,332 78,302 53,578 248,512 302,090
SCHOOL HEALTH(234) 7.62 0 371,926 106,391 91,169 106,391 106,350 332,906 77,395 410,301
COMPREHENSIVE ADULT HEALTH(237) 7.97 8,151 13,864 146,487 125,528 146,487 146,430 236,837 328,095 564,932
COMMUNITY HEALTH DEVELOPMENT(238) 1.15 0 431 19,045 16,320 19,045 19,036 12,526 60,920 73,446
DENTAL HEALTH(240) 16.43 4,297 8,268 310,862 266,385 310,862 310,743 167,507 1,031,345 1,198,852
PRIMARY CARE SUBTOTAL 94.11 28,956 506,283 1,575,848 1,350,378 1,575,848 1,575,238 3,223,110 2,854,202 6,077,312
C. ENVIRONMENTAL HEALTH:
Water and Onsite Sewage Programs
COASTAL BEACH MONITORING(347) 0.15 321 321 5,732 4,912 5,732 5,729 22,105 0 22,105
LIMITED USE PUBLIC WATER SYSTEMS(357) 0.23 208 1,102 3,766 3,227 3,766 3,766 5,154 9,371 14,525
PUBLIC WATER SYSTEM(358) 0.00 0 0 20 17 20 19 35 41 76
PRIVATE WATER SYSTEM(359) 0.01 0 9 237 203 237 236 0 913 913
INDIVIDUAL SEWAGE DISP.(361) 6.02 2,083 4,046 99,903 85,609 99,903 99,864 158,795 226,484 385,279
Group Total 6.41 2,612 5,478 109,658 93,968 109,658 109,614 186,089 236,809 422,898
Facility Programs
FOOD HYGIENE(348) 1.26 176 761 19,598 16,794 19,598 19,590 75,580 0 75,580
BODY PIERCING FACILITIES SERVICES(349) 0.01 2 3 327 280 327 327 1,261 0 1,261
GROUP CARE FACILITY(351) 0.54 184 304 8,435 7,228 8,435 8,431 0 32,529 32,529
MIGRANT LABOR CAMP(352) 2.91 184 1,095 49,515 42,430 49,515 49,496 132,989 57,967 190,956
Version: Page 1 of 2
C. O
ATTACHMENT IL
COLLIER COUNTY HEALTH DEPARTMENT
Part III.Planned Staffing,Clients,Services,And Expenditures By Program Service Area Within Each Level Of Service
October 1,2014 to September 30,2015
Quarterly Expenditure Plan
FTE's Clients Services/ 1st 2nd 3rd 4th Grand
(0.00) Units Visits (Whole dollars only) State County Total
C. ENVIRONMENTAL HEALTH:
Facility Programs
HOUSING,PUBLIC BLDG SAFETY,SANITATION(353)0.00 0 0 0 0 0 0 0 0 0
MOBILE HOME AND PARKS SERVICES(354) 0.40 80 243 6,121 5,245 6,121 6,119 23,606 0 23,606
SWIMMING POOLSBATHING(360) 3.64 1,663 18,050 70,804 60,673 70,804 70,776 112,875 160,182 273,057
BIOMEDICAL WASTE SERVICES(364) 1.07 631 660 22,349 19,151 22,349 22,339 56,182 30,006 86,188
TANNING FACILITY SERVICES(369) 0.09 15 46 1,312 1,124 1,312 1,311 4,559 500 5,059
Group Total 9.92 2,935 21,162 178,461 152,925 178,461 178,389 407,052 281,184 688,236
Groundwater Contamination
STORAGE TANK COMPLIANCE(355) 0.00 0 0 0 0 0 0 0 0 0
SUPER ACT SERVICE(356) 0.06 40 64 1,001 858 1,001 1,000 3,860 0 3,860
Group Total 0.06 40 64 1,001 858 1,001 1,000 3,860 0 3,860
Community Hygiene
TATTOO FACILITIES SERVICES 0.18 0 45 3,162 2,710 3,162 3,161 12,195 0 12,195
COMMUNITY ENVIR HEALTH(345) 0.00 0 0 15 13 15 14 28 29 57
INJURY PREVENTION(346) 0.02 0 0 556 476 556 556 1,000 1,144 2,144
LEAD MONITORING SERVICES(350) 0.00 0 0 9 8 9 9 17 18 35
PUBLIC SEWAGE(362) 0.00 0 0 29 25 29 29 50 62 112
SOLID WASTE DISPOSAL(363) 0.00 0 0 9 8 9 9 15 20 35
SANITARY NUISANCE(365) 0.00 0 0 52 45 52 52 100 101 201
RABIES SURVEILLANCFICONTROL SERVICES(366)0.00 0 0 0 0 0 0 0 0 0
ARBOVIRUS SURVEILLANCE(367) 0.00 0 0 89 76 89 88 0 342 342
RODENT/ARTHROPOD CONTROL(368) 0.00 0 0 0 0 0 0 0 0 0
WATER POLLUTION(370) 0.00 0 0 0 0 0 0 0 0 0
INDOOR AIR(371) 0.00 0 0 0 0 0 0 0 0 0
RADIOLOGICAL HEALTH(372) 0.00 0 0 8 7 8 9 16 16 32
TOXIC SUBSTANCES(373) 0.00 0 0 8 7 8 9 16 16 32
Group Total 0.20 0 45 3,937 3,375 3,937 3,936 13,437 1,748 15,185
ENVIRONMENTAL HEALTH SUBTOTAL 16.59 5,587 26,749 293,057 251,126 293,057 292,939 610,438 519,741 1,130,179
D. NON-OPERATIONAL COSTS:
NON-OPERATIONAL COSTS(599) 0.00 0 0 0 0 0 0 0 0 0
ENVIRONMENTAL HEALTH SURCHARGE(399) 0.00 0 0 11,280 9,666 11,280 11,274 43,500 0 43,500
MEDICAID BUYBACK(611) 0.00 0 0 0 0 0 0 0 0 0
NON-OPERATIONAL COSTS SUBTOTAL 0.00 0 0 11,280 9,666 11,280 11,274 43,500 0 43,500
TOTAL CONTRACT 172.49 58,673 594,937 2,992,934 2,564,709 2,992,934 2,991,769 6,588,196 4,954,150 11,542,346
Version: Page 2 of 2
S
1 6 D 1 1
ATTACHMENT III
COLLIER COUNTY HEALTH DEPARTMENT
CIVIL RIGHTS CERTIFICATE
The applicant provides this assurance in consideration of and for the purpose of obtaining federal grants, loans,
contracts (except contracts of insurance or guaranty), property, discounts, or other federal financial assistance to
programs or activities receiving or benefiting from federal financial assistance. The provider agrees to complete
the Civil Rights Compliance Questionnaire, DH Forms 946 A and B (or the subsequent replacement if adopted
during the contract period), if so requested by the department.
The applicant assures that it will comply with:
1. Title VI of the Civil Rights Act of 1964, as amended, 42 U.S.C., 2000 Et seq., which prohibits
discrimination on the basis of race, color or national origin in programs and activities receiving or
benefiting from federal financial assistance.
2. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794, which prohibits discrimination
on the basis of handicap in programs and activities receiving or benefiting from federal financial
assistance.
3. Title IX of the Education Amendments of 1972, as amended, 20 U.S.C. 1681 et seq., which prohibits
discrimination on the basis of sex in education programs and activities receiving or benefiting from
federal financial assistance.
4. The Age Discrimination Act of 1975, as amended, 42 U.S.C. 6101 et seq., which prohibits discrimination
on the basis of age in programs or activities receiving or benefiting from federal financial assistance.
5. The Omnibus Budget Reconciliation Act of 1981, P.L. 97-35, which prohibits discrimination on the basis
of sex and religion in programs and activities receiving or benefiting from federal financial assistance.
6. All regulations, guidelines and standards lawfully adopted under the above statutes. The applicant agrees
that compliance with this assurance constitutes a condition of continued receipt of or benefit from federal
financial assistance, and that it is binding upon the applicant, its successors, transferees, and assignees
for the period during which such assistance is provided. The applicant further assures that all contracts,
subcontractors, subgrantees or others with whom it arranges to provide services or benefits to
participants or employees in connection with any of its programs and activities are not discriminating
against those participants or employees in violation of the above statutes, regulations, guidelines, and
standards. In the event of failure to comply, the applicant understands that the grantor may, at its
discretion, seek a court order requiring compliance with the terms of this assurance or seek other
appropriate judicial or administrative relief, to include assistance being terminated and further assistance
being denied.
18
1 6 0 1 1
ATTACHMENT IV
COLLIER COUNTY HEALTH DEPARTMENT
FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT
Facility
Description Location Owned By
Collier County Health 3339 E. Tamiami Trail Collier County
Department & Public Building H, Naples
Services Building H
Immokalee Satellite 419 North First Street Collier County
Immokalee
Golden Gate WIC Office 4945 Golden Gate Parkway Benderson
Unit 102 , Naples Development
CCHD Annex 3205 Beck Blvd Florida Department
Naples of Environmental
Protection
G
1 6 0 1 1
ATTACHMENT V
COLLIER COUNTY HEALTH DEPARTMENT
SPECIAL PROJECTS SAVINGS PLAN
CASH RESERVED OR ANTICIPATED TO BE RESERVED FOR PROJECTS
CONTRACT YEAR STATE COUNTY TOTAL
2013-2014* $ $ $
2014-2015** $ 0 $ 0 $ 0
2015-2016*** $ $ $
2016-2017*** $ $ $
PROJECT TOTAL $ 0 $ 0 $ 0
SPECIAL PROJECT CONSTRUCTION/RENOVATION PLAN
PROJECT NUMBER:
PROJECT NAME:
LOCATION/ADDRESS:
PROJECT TYPE: NEW BUILDING ROOFING
RENOVATION PLANNING STUDY
NEW ADDITION OTHER
SQUARE FOOTAGE:
PROJECT SUMMARY: Describe scope of work in reasonable detail.
START DATE (initial expenditure of funds):
COMPLETION DATE:
DESIGN FEES: $
CONSTRUCTION COSTS: $
FURNITURE/EQUIPMENT $
TOTAL PROJECT COST: $ -
COST PER SQ FOOT: $ #DIV/0!
Special Capital Projects are new construction or renovation projects and new furniture or equipment
associated with these projects and mobile health vans.
*Cash balance as of 9/30/14.
**Cash to be transferred to FCO account.
***Cash anticipated for future contract years.
20