Backup Documents 10/10/2017 Item #16E2 1
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 c
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE +�
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney
Office at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney
Office no later than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with
the exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Risk Risk Management 13/A N�
2. County Attorney Office County Attorney Office51)2 /0 7
P�
4. BCC Office Board of County
Commissioners V14l IcA,kz_V-1
4. Minutes and Records Clerk of Court's Office
—1 I��y /1)/1414.I'� a`"110\
5. Procurement Services Procurement Services
PRIMARY CONTACT INFORMATION
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,may need to contact staff for additional or missing information.
Name of Primary Staff Barbara Lance Contact Information 239-252-8998
Contact/ Depai tment
Agenda Date Item was 10/10/17 / Agenda Item Number 16.E.2✓
Approved by the BCC ✓
Type of Document Amendment Number of Original 02
Attached Documents Attached
PO number or account N/A 14-6293 Collier County Millenium Physician
number if document is On-Site Medical Clinic Group,LLC V/
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature STAMP OK > 0 1 -
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be BL
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the N/A
document or the fmal negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's BL
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip N/A
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 10/10/2017 and all changes made during
the meeting have been incorporated in the attached document. The Countyakk .r Vtnzigt
Attorney's Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the L
BCC,all changes directed by the BCC have been made,and the document is ready for th- + .
Chairman's signature.
16E2
MEMORANDUM
Date: October 12, 2017
To: Barbara Lance,
Procurement Services
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Amendment to Contract #14-6293 "Collier County On-Site
Medical Clinic"
Contractor: Millennium Physician Group, LLC
Attached for your records is one (1) original of the referenced contract above,
(Item #16E2) adopted by the Board of County Commissioners on Tuesday,
October 10, 2017.
The Board's Minutes & Records Department has kept an original as part of the
Board's Official Records.
If you have any questions, please feel free to contact me at 252-8411.
Thank you.
Attachment
FIRST AMENDMENT TO AGREEMENT#14-6293 1 V E 2
"COLLIER COUNTY ON-SITE MEDICAL CLINIC"
BETWEEN COLLIER COUNTY
AND
MILLENNIUM PHYSICIAN GROUP,LLC
THIS AGREEMENT, made and entered into on this 1(Y4m day of ultdoRr 2017, by and
between Millennium Physician Group, LLC,authorized to do business in the State of Florida, whose
business address is 6321 Daniels Parkway, Suite 201, Fort Myers, Florida 33921 (the "Provider" and
"Millennium") and Collier County, a political subdivision of the State of Florida, (the "County" or
"Owner").
WHEREAS,on September 9,2014,Item 16.E.7,the County entered into an Agreement with
Provider to provide on-site primary care health services; and
WHEREAS,the parties desire to amend the Agreement to expand services under all four(4)
clinic model options to provide onsite limited pharmacy services for the disbursement of commonly
prescribed medications and flu shot vaccinations through the Med Center; and
WHEREAS, by amending the current clinic Model Option 1 to include limited pharmacy
services, the future exercise of any of the other three (3) expanded clinic options will automatically
include those services;and
WHEREAS, the Provider will request reimbursement from the County for the actual cost
paid by Provider with no additional markup to the County.
NOW, THEREFORE, in consideration of the mutual promises and covenants herein
contained, it is agreed by the parties as follows:
Words Struek-Through are deleted; Words Underlined are added
**Remainder of this page left blank intentionally**
Page 1 of 3
1 6 E 2
Agreement#14-6293 Collier County On—Site Medical Clinic
Exhibit A
Scope of Services
* * * * *
3. CLINIC OPTIONS—BRIEF DESCRIPTIONS
This Agreement provides for four (4) clinic options. Option 4 is not anticipated at this time, but
may be considered for implementation in the future. These options are:
Option 1: Current Clinic—The current clinic services, along with the provision of onsite limited
pharmacy services as further set forth in Section 4, Clinic Options—Detailed Descriptions.
* * * * *
4. CLINIC OPTIONS—DETAILED DESCRIPTIONS
Option 1 —Current Clinic Model—Duplicate the current clinic model, including the provision of
on-site limited pharmacy services to be provided under all clinic model options under this
Agreement, which will stock and dispense medications to treat acute episodic illness and chronic
disease to include but not limited to: Flu Vaccine, antibiotics, and Steroid packs.
Millennium will purchase medications directly from supplier and the County will reimburse Provider
at actual cost paid with no additional markup to County.
Staffing to match what is in the pricing sheet in Exhibit B.
* * * * *
(SIGNATURE PAGE TO FOLLOW)
Page 2 of 3
1bE2
IN WITNESS WHEREOF,the parties hereto,have each,respectively,by an authorized person or
agent,have executed this Amendment on the date and year first written above.
ATTEST:
Dwight E. Brock, Clerk of Courts BOARD OF COUNTY COMMISSIONERS
COLLIE' I„1y Y, FLORIDA
/& ,
By: A
Penny Taylor airman O
Dated: ` 1610-114-
'
(SEAL) Attest as to Chairman's
signature only.
Providerr'tnesses P •vider
Mille ium Ph sician Grou t LLC
Fit ►;ip_ ess —or By: I
Sia .tore
TT Al e/print 'tn nameT
467 c — TType/print signature and title
: cond W. nes•'
,v(/`t // z. � �ppi712 ti0e � a(ti<`t
TType/phnt witness nameT Date
Afficacl,,,as to Fioy d Legality:
dC
Deputy County Attorney
\14..) if 42 - 4
Prin ame
# 14oEc9-,
/ends
I/D��Rec'dDTD
Page 3 of 3 ! ty Clerk