Backup Documents 10/12/2010 Item #16E 1
MEMORANDUM
Date:
March 17, 2011
To:
Brenda Reaves, Contract Technician
Purchasing Department
From:
Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re:
Contract Number #10-5407R: Employment
Physicals and Drug Testing
Contractor: Dr. Julia K. Harris
Attached is the original contract, referenced above (Item #16E1)
approved by the Board of County Commissioners on October 12, 2010.
The second original document will be held 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
16E 1
16E 1
Colt,. County
--- -
Adminisllalive Seniioes Division
Purchasing
Purchasing Department
3327 Tamiami Trail East
Naples, Florida 34112
Telephone: (239) 252-6020
FAX: (239) 252-6592
Email: BrendaReavesavcollieroov.net
www.collieroov.neUDurchasino
Memorandum
Subject:
Solicitation # 10-5407R "Employment Physicals and Drug Testing"
Date:
March 8, 2011
"
Brenda Reaves P~ontracUPurChaSing Technician- For Joanne Markiewicz
From:
To:
Ray Carter, Risk Manager
This Contract was approved by the BCC on October 12, 2010, Agenda Item 16.E.1
The County is in the process of executing this contract with Dr. Julia Harris. The insurance requirements are listed
in Section 12.
Please review the Insurance Certificate(s) for the referenced Contract.
. If the insurance is not in order. please contact the vendorlinsurance 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 questions, please contact me at the above referenced information.
Risk Management Signature
~
Date
(Please route to County Attorney via attached Request for Legal Services)
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16E 1
A G R E E MEN T #10-5407R
Employment Physicals and Drug Testing
THIS AGREEMENT, made and entered into on this Q day of jdc:?Vr ~ ,201L,
by and between Dr. Julia K. Harris, whose address is 8803 Tamiami Trail East,
Naples, Florida 34113, hereinafter called the "Consultant" and Collier County, a political
subdivision of the State of Florida, Collier County, Naples, hereinafter called the "County":
WIT N E SSE T H:
1. COMMENCEMENT. The contract shall be for a one (1) year period, commencing on
execution of this agreement and upon issuance of a purchase order on or after October
1,2010 and terminating on September 30, 2011.
2. STATEMENT OF WORK. The Consultant shall provide Employment Physicals and
Drug Testing Services in accordance with the terms and conditions of this Agreement
and Exhibit A, attached hereto and incorporated herein by reference. This Agreement
contains the entire understanding between the parties and any modifications to this
Agreement shall be mutually agreed upon in writing by the Consultant and the County
project manager or his designee, in compliance with the County Purchasing Policy and
Administrative Procedures in effect at the time such services arc authorized.
3. THE CONTRACT SUM. The County shall pay the Consultant for the performance of
this Agreement an estimated maximum annual amount of Eleven Thousand Dollars
($11,000.00) for the performance of this Agreement, based on the pricing identified in
Exhibit B, attached hereto and incorporated by reference. Payment will be made upon
receipt of a proper invoice and upon approval by the Project Manager or his designee,
and in compliance with Chapter 218, Florida Statutes, otherwise known as the "Local
Government Prompt Payment Act".
4. SALES TAX. Consultant 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.
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5. NOTICES. All notices from the County to the Consultant shall be deemed duly served
if mailed to the Consultant at the following Address:
Dr. Julia K. Harris
8803 Tamiami Trail E
Naples, Florida 34113
Telephone: 239-732-1050
FAX: 239-430-7828
Email: drjulhar@aol.com
All Notices from the Consultant to the County shall be deemed duly served if mailed or
faxed to the County to:
Collier County Government Center
Purchasing Department
3327 Tamiami Trail, East
Naples, Florida 34112
Attention: Steve Carnell, Purchasing/GS Director
Telephone: 239-252-8371
Facsimile: 239-252-6584
The Consultant and the County may change the above mailing address at any time
upon giving the other party written notification. All notices under this Agreement must
be in writing.
6. NO PARTNERSHIP. Nothing herein contained shall create or be construed as creating
a partnership between the County and the Consultant or to constitute the Consultant 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 Consultant. Payment
for all such permits issued by the County shall be processed internally by the County.
All nonCounty permits necessary for the prosecution of the Work shall be procured and
paid for by the Consultant. The Consultant shall also be solely responsible for payment
of any and all taxes levied on the Consultant. In addition, the Consultant 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 Consultant agrees to comply with
all laws governing the responsibility of an employer with respect to persons employed
by the Consultant.
8. NO IMPROPER USE. The Consultant 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
Page 2 of 11
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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 Consultant
or if the County or its authorized representative shall deem any conduct on the part of
the Consultant to be objectionable or improper, the County shall have the right to
suspend the contract of the Consultant. Should the Consultant fail to correct any such
violation, conduct, or practice to the satisfaction of the County within twentyfour (24)
hours after receiving notice of such violation, conduct, or practice, such suspension to
continue until the violation is cured. The Consultant 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 Consultant 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 immediately 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 nonperformance.
10. NO DISCRIMINATION. The Consultant agrees that there shall be no discrimination as
to race, sex, color, creed or national origin.
11. INDEMNIFICATION. To the maximum extent permitted by Florida law, the
Consultant 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 Consultant or anyone
employed or utilized by the Consultant 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. INSURANCE. The Consultant shall provide insurance as follows:
A. Commercial General Liability: Coverage shall have minimum limits of $500,000
Per Occurrence, Combined Single Limit for Bodily Injury Liability and Property
Damage Liability. This shall include Premises and Operations; Independent
Contractors; Products and Completed Operations and Contractual Liability.
B. Business Auto Liability: Coverage shall have minimum limits of $500,000 Per
Occurrence, Combined Single Limit for Bodily Injury Liability and Property
Damage Liability. This shall include: Owned Vehicles, Hired and NonOwned
Vehicles and Employee NonOwnership.
Page 3 of 11
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C. Workers' Com~ensation: Insurance covering all employees meeting Statutory
Limits in compliance with the applicable state and federal laws.
The coverage must include Employers' Liability with a minimum limit of $500,000
for each accident.
D. Medical Malpractice: $1,000,000 Per Occurrence
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 Contractor during the duration of this Agreement. Renewal
certificates shall be sent to the County ten (10) days prior to any expiration date.
There shall be a thirty (30) day notification to the County in the event of
cancellation or modification of any stipulated insurance coverage.
Contractor shall insure that all subContractors comply with the same insurance
requirements that he is required to meet. The same Contractor shall provide
County with certificates of insurance meeting the required insurance provisions.
13. CONTRACT ADMINISTRATION. This Agreement shall be administered on behalf of
the County by the Human Resources Department.
14. CONFLICT OF INTEREST: Consultant represents that it presently has no interest and
shall acquire no interest, either direct or indirect, which would conflict in any manner
with the performance of services required hereunder. Consultant further represents
that no persons having any such interest shall be employed to perform those services.
15. COMPONENT PARTS OF THIS AGREEMENT. This Agreement consists of the
attached component parts, all of which are as fully a part of the contract as if herein set
out verbatim: ITB 10-5407, Exhibits A and B, insurance certificates, attached hereto and
incorporated by reference.
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
Page 4 of 11
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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 Consultant 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.e. 1324, et seq. and regulations relating thereto, as
either may be amended. Failure by the Consultant to comply with the laws referenced
herein shall constitute a breach of this agreement and the County shall have the
discretion to unilaterally terminate this agreement immediately.
19. OFFER EXTENDED TO OTHER GOVERNMENTAL ENTITIES. Collier County
encourages and agrees to the successful proposer extending the pricing, terms and
conditions of this solicitation or resultant contract to other governmental entities at the
discretion of the successful proposer.
20. AGREEMENT TERMS. If any portion of this Agreement is held to be void, invalid, or
otherwise unenforceable, in whole or in part, the remaining portion of this Agreement
shall remain in effect.
21. ADDITIONAL ITEMS/SERVICES. Additional items and/or services may be added to
this contract upon satisfactory negotiation of price by the Project Manager and Consultant.
22. DISPUTE RESOLUTION. Prior to the initiation of any action or proceeding permitted by this Agreement to
resotve 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 Consultant 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 shalt attempt to
resolve the dispute through Mediation before an agreed-upon Circuit Court Mediator certified by the State
of Florida. The mediation shalt be attended by representatives of Consultant with fult 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.
23. KEY PERSONNEL/PROTECT STAFFING: The Consultant to be utilized for this project
shall be knowledgeable about providing pre-employment physicals and drug testing. The
County reserves the right to perform investigations as may be deemed necessary to ensure
that a competent person(s) will be utilized in the performance of the contract.
Page 5 of 11
IN WITNESS WHEREOF, the Consultant 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 E. B:r~J (,;:lerk of Courts
By: ~O.L.
Dat~I'20~1
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BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
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By: ' '
Fred W. Coyle, Chairman
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Dr. Tulia K. Harris
Consultant
By:
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Second Witness!
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Typed signature and title
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Type/print witness name
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Deputy County Attorney
SCOTT R. TEACH
Print Name
Item# -W
Agenda II\-h..lD
Date l\L..l..LLl
Page 6 of 11
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16E 1
Exhibit A
lO-5407R Employment Physicals and Drug Testing
Scope of Services
Services to be provided include, but are not limited to the following:
1. Brief Description of Contract:
A comprehensive pre-employment physical and drug testing program to benefit Collier County
and reduce liability to the County. This program will ensure the proper placement of employees
based upon physical capabilities related to essential functions of County positions. Also included
will be reassessment of appropriate County employees on a designated basis. This program will
ensure the health of County employees and potential County employees
2. Overview of Contract:
The Consultant shall provide occupational medical services on an "as needed" basis as may be
required by the Collier County Manager's Agency and its participating agencies, located in
Naples, Florida. This program will be available to all Regular, Temporary and Seasonal Employees
of the County Manager's Agency of Collier County and its participating agencies, which currently
include, but are not limited to: County Attorney, Airport Authority, and Pelican Bay Services. The
County has a total of approximately two thousand one hundred (2100) employees.
The location of the facility proposed to provide the occupational medical services will be one of
the factors considered during the evaluation process. The County prefers the medical facility to be
located within ten (10) miles from the Collier County Government Center, 3301 E. Tamiami Trail,
Naples, Florida, with satellite facilities to be provided in areas within Lee or Collier County.
The Consultant must provide all services listed in this Scope of Services. The County does not
guarantee a specific quantity of work.
3. Detailed Scope of Work:
Specific Requirements: The Occupational Medical Services Program will be designed to provide the
medical services listed. Desired hours of operation are from 8:00 a.m. to 5:00 p.m., five (5) days a
week, Monday through Friday, staffed with currently trained and qualified medical personnel. The
County prefers a program that will also provide weekend and extended hours of operation.
Clinical Activities: The following are the activities that shall be required of the Consultant. This list
includes the core function and major emphasis of clinical activities to be performed. Lab results,
medical findings and recommendations are to be reviewed with the examinee.
. Pre-Placement Employment Physical
A basic occupational and medical history is reviewed with an occupational physical exam. (A
Respirator Medical Clearance Evaluation may also be required based on job classification.)
Page 7 of 11
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The medical determination of ability to work is assessed based on the job classification
specifications. A vision exam (near & far acuity, color, depth perception) will be conducted
with this physical at no charge. Ancillary tests to determine medical clearance (i.e., drug
testing, blood alcohol, CBe, lipid panel) are reimbursed per fee schedule.
. Pre-Placement Physical W/CDL Physical
The candidate's medical history is reviewed. (A Respirator Medical Clearance Evaluation may
also be required based on job classification.) The medical examiner, conducts a physical that
evaluates the candidate's medical condition for employment and CDL medical certification.
The physician completes the pre-employment physical form and the Department of
Transportation medical physical form. Laboratory results are reviewed. A vision screen and
urine dipstick is conducted at no additional charge. The DOT card is issued.
. Respirator Medical Clearance Evaluation
A respiratory health questionnaire and medical history is reviewed by a physician, nurse
practitioner or physician's assistant. The physical examination with interpretation of
spirometry and ancillary tests will assess the ability to wear a respirator. A vision exam will
be included at no charge. Spirometry testing is included. Ancillary tests at the published fee
schedule can augment this physical assessment.
. CDL Physical (DOT)
The Department of Transportation Medical Examination Report for commercial driver fitness
determination is conducted in accordance with DOT regulations and requirements. A Medical
Examiners Certificate (DOT Card) will be issued after successful completion of this physicaL
. Fitness for Duty Examination
The Consultant shall perform any fitness for duty examinations requested by the County
Occupational Health Nurse or County Human Resources Department. The fitness for duty
examination content shall be determined by the physician, nurse practitioner or physician's
assistant based on the job classification requirements. A complete medical report shall be
forwarded to the County Occupational Health Nurse within one (1) working day of the
examination.
. Asbestos Medical Examinations and Consultations
The Consultant shall provide medical examinations and consultations following the
requirements of the Asbestos Standard CFR 1926.1101. This examination shall include a
Respirator Medical Clearance Evaluation.
. Laboratory Work
The following tests shall be performed for an all-inclusive fee:
1. Comprehensive Metabolic Panel with Lipids
2. Complete Blood Count (CBC) w /Platelet, Auto Differential
3. Urinalysis Chemistry
. Creatinine
. BUN
. PPD Testing w/Reading
Page 8 of 11
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. Chest x-ray (2-view)
. Chest x-ray (4-view)
. Chest CT w/contrast
. Chest CT without contrast
. Audiometric Screening Test (pure tone air only) with interpretation
. Pulmonary Function Test (with interpretation)
. Drug Screen; HRS 5 or NIDA 5 panel wlMRO
. Blood Alcohol Test
. Hepatitis Panel Test
. Hepatitis A Vaccination Series
. Hepatitis B Vaccination Series
. Hepatitis Titer (if previously immunized)
. HIV 1 & 2 Antibody Test
. Heavy Metals Test
. Pre-exposure Rabies Vaccination Series
. Rabies Titer (if previously immunized)
. Tetanus/diphtheria Vaccination
. EKG
. Cardiac Stress Test (with interpretation)
. Functional Capacity Evaluation
Medical Services Not Listed
Medical services (labs, tests, immunizations, etc) not listed in this document shall be permitted upon
review and authorization by the County Occupational Health Nurse. Pricing for such services shall
not exceed the usual and customary rate as listed by the County's health claim administration
provider for zip code 34112.
Pre-employment Physical Examinations: Pre-employment examinations will usually be scheduled
on short notice. Appointments may be requested for the same day or the following business day.
The medical examination and review of the collected medical and occupational history must be
performed by a licensed physician, nurse practitioner or physician's assistant, preferably experienced
in occupational health. Routine measurements, laboratory specimens and x-rays may be taken by
paramedical personnel.
Written confirmation of the examination results must be provided to the County Occupational Health
Nurse, or designated person, within twenty-four (24) hours. This confirmation must identify any
concerns and/ or accommodation recommendations.
Reports and Records: All medical reports shall be the sole property of Collier County and may not be
used or reproduced in any form without the explicit written permission of the County. The
Consultant shall maintain complete records on each individual examined/ treated. Such records shall
remain confidential in compliance with all HIPPA regulations and will be made available only to the
County's representative and/ or the individual.
Page 9 of 11
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No information, record, report or data derived, compiled, obtained, prepared or developed by the
Consultant from work performed pursuant to the contract may be released, disseminated or disclosed
without written consent of the County.
All medical reports and records shall be formally transferred to the County by the Consultant within
five (5) working days after the receipt of a contract termination notice.
Exhibit B
10-5407R Employment Physicals and Drug Testing
Price Schedule
Item Number Item Description Unit Price
1 Pre-Employment physical $65.00
examinations
2 Alcohol, Blood Test $16.24
3 CDL Physical (DOT) $65.00
4 Pre-Placement Physical $125.00
W /CDL Physical
5 Respirator Medical $75.00
Clearance Evaluation
6 Fit for Duty Examination $65.00
7 Laboratory Work $51.12
8 Creatine $7.70
9 BUN $5.93
10 PPD Testing w /Reading $7.79
11 Chest x-ray (2-view) $33.09
12 Chest x-ray (4-view) $48.03
13 Chest CT w / contrast $325.43
14 Chest CT without contrast $271.51
15 Audiometric Screening Test $33.00
(pure tone air only) with
interpretation
16 Pulmonary Function Test $35.84
(spirometry)
w / interpretation
17 HRS 5 panel w /MRO $20.70
18 NIDA 5 w /MRO $20.70
19 Hepatitis Panel Test $71.62
20 Hepatitis A Vaccination $138.60
Series
21 Hepatitis B Vaccination $76.29
Series
22 Hepatitis Titer $16.12
23 HIV 1 & 2 Antibody Test $20.63
Page 10 of 11
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24
25
Heavy Metals Test
pre-exposure Rabies
vaccination Series
$71.20
$378.36
Page 11 of 11
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THIS CERTIFICATE IS ISSUED AS AMATTER OF INFORMATION ONLY AIIDCONFERS NO RIGHTS UPONTHECERTIFlCATE HOLDER. THIS
CERTFICATE DOES NOT AFFIRIIATlVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES
BELOW. THIS CERTlFICA TI! OF INSURANCI! DOES NOT CONSTIT\JTE A CONTRACT BETWEEN THE ISSUING INSURERIS., AUTHORIZED
IW'RESENTATlVE OR PROOUC ANI) THE CERTIF1CATE HOLDER.
I"ORTANT~ If the cel"tl1lc8te holder is lMI ADDITIONAL INSURI!D, the poUeYlle&J must be endo,.m Ir SUBROGATION IS WAIVeD, SUblect 10
the IerII'lS and eondlllons of the policy, certain policies ""y reqtllre In endorsement A ".menl on Ihls .:ertt1Icate does not confer rights to (he
certtftctte ho*deIln lieu of sue" endoRemetn(s).
PROOl.Ir.:E'R: Phone:~1)1l7g..842eF8)I:(8S8)5;52.1641
CHAPMAN INSURANCE GROUP, LLC
992 TAMlAMI TRAIL UNIT 01
PORT CHARLOTTE F1. 33953
"""""
Brian G. Chapman
19411 979-ll428
bIIan@clgllortda.com
396
""
....
(888)552-1841
-
(AIC.NO,Ul)'
,.....,
.........
Ag6llCyLicJ! Lll56319
"""'"
UlLLENNIUII PHYSICIAN HOLDINGS LLC
MILLENNIUM PHYSIC1AN GROUP, LLC
& MURDOCK FAIILY IIEDlCINE LLC, OR. JULIA HARRIS
19531 COCHRAN BLVD
PORT CHARLOTTE FL 33948
"""""'
INSLRERIl
"""""
INllHt.ERIs) AFFORDING COVERAGE _
Unlvell58l tnsurance Company of North. Amertca
NAlC.
11986
INSI..R::RO'
'N'".'''
-,
COVERAGES
CERTIFICATE NUMBER: 1232
REVISION NUMBER:
nns IS TO CERTIFY THAT THE POLICIES OF INSURANCE LlSlEO Baow HAVE BEEN ISSUED TO THE INSU~eo NAMED ABOVE FOR THE:. POLICY PERIOD
INDICATED. NOTWITHSTANDING AHY REQUIREMeNT, TERM Of! CONomON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHtCH THIS
CERTIFICATE MAY BE ISSUEO OR MA.V PERTAIN, ~~~~SURANCE AFFORDED BV THE~~.?:~;~~_~ OESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
""" TYPE OF "8URANCE """ -- POLICY NUMBiR I,I'OUCY.' ....."".... LOlIT.
A """"" "",uno UFBPDOOOOO1659 -I 09/30/10 09130111 EACH OCCURRENCE . 1,000,000
-00- OAM/rlOE.TORENTBJ
~ ~RCIAlG[;NERAl..l~llTY , . 1.000.000
_ CL.A,IWS-MADE IXloCCUR , MED. EXPl,Nrofona pelton) . 10,000
PERSONAL & NN INJURV . 1,000,000
--
GEN€RAL AGGREGATE . 2,000,000
m~AGG:i~,l~T APn: PER PRODUCTS. COMf'JOP "-GO . 2,000,000
X POLlCY ~;; lac .
"""""""" COMBINED SINGl.E lIMrr -
""""" .
r- (EI BCOdllOl)
f- 1'MYAUTC
BOOlL Y INJURY (P.pllMn) .
I- AllOWIiEOAUTOS BOOL Y INJURY {Pill; It:dd8nO
.
f- SCHEDll.ED AUTOS PROPERTY OJ\MAGE
.
1- HIRED AUTOS {Peroc.cJOent}
NOH.OWNEO ~TOS .
r- .
- ......u .... H~UR EACH OCCURRENCE .
"""" UAO CLAIMS-MADE AGGREGATE .
- OEDUCTIBLE .
RETENTION . .
~ 1~'t.:ii,1 I~
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/1.1('(.. .~~ 0 El. EACH ACCIDENT .
0I'Fl y IiiiIIR8l ElU:l.l.IDED1 ." E.L. OISEASE.EA EMPlOYEE
-.... .
~~~l:RRA.l"lOOS_ E.L. OISE.-.SE.POlICY LMT .
--
DliacRlPl10N OF OPiRATlONI I I.OCATIONI I VEHlCI.ES (Attach ACORD 1ft. AdditIon..~. ichedlM, "Mem .pee. _ ~1rU)
671 GOODLETT!! RD STe 200, NAPLES, F1. 34102
Comer COWIty Boerd of County Commtsslonllf'l!l. IB ltaktd as an Addttlonallnsured on this polley
CERTIFICATE HOLDER
CANCELLATION
Attenllon:
FAX: 1239} 252-6480
SHOULD AHY 0' THE ABOVI!! DI!SCRII!IED POLICIES BI! CANCI!LLED apORE
~e 9P'IAAT1ON DATI! THEREOI", NOnel!! WlU N D!UVERED IN
ACCORDANCI wrrH THE POl.ICY PRDY1StoNS.
AU'THOAilf:C RS'RE9E.Nrll;nl/E:
I 4~r~.~~
Calk Coooty Board 01 County Commissioners
3321 TIIlI1iBIm Trail !!ast
Naples, P'lorld8 34112
raerv .
The ACORD name and logo are registered marks of ACO"D
16 E 1
~ CERTIFICATE OF LIABILITY INSURANCE I DATE(MMlDDfYYYY)
ACORD. 3/15/2011
l /' 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 POLICIES
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 poficy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain ~t~~iCies 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 Renee McLaughlin
NAME:
ALLlANT INSURANCE SERVICES HOUSTON LLC P...:;gN:O, Ex!': 303-824-1403 Tf~,NOI: 303-824-1437
5847 SAN FELIPE, SUITE 2750 E-MAil rmclauQh lin@afliantinsurance.com
HOUSTON, TX 77057 ADDRESS:
PRODUCER
CUSTOMER 10 #:
INSURER S AFFORDING COVERAGE NAIC#
INSURED INSURER A: HOMELAND INSURANCE COMPANY OF NEW YORK 34452
MILLENNIUM PHYSICIAN GROUP, LLC. INSURERS-
8803 TAMIAMI TRAIL E INSURERC,
NAPLES, FL 34113.3347 INSURERD:
INSURERE:
COVERAGES
CERTIFICATE NUMBER:
REVISION
NUMBER:
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 RESPECT TO 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
INSR ADDL SUBR ~~~g~~~Vl ! r~~g6~~Y)
UR TYPE OF INSURANCE INSR WVO POLICY NUMBER LIMITS
GENERAL LIABILITY ! $
EACH OCCURRENCE
COMMERCIAL GENERAL LIABILITY ~~~~~~i~E~~~~~~e~ce\ $
CLAIMS-MADE I I OCCUR MED EXP (Anyone person) $
PERSONAL & ADV iNJURY $
$ ---
GENERAL AGGREGATE
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS/COMPIOP $
AGG
I POLICY I I PROJECT 1 I LaC $
AUTOMOBILE LIABILITY ~~~~~~~~t~INGLE LIMIT $
ANY AUTO ~~~~~; INJURY (Per $
--
ALL OWNED AUTOS ~~~;~iNJURY (Per $
SCHEDULED AUTOS =:c~:~~TY DAMAGE (Per $
HIRED AUTOS $
NON-OWNED AUTOS $
UMBREllA [ OCCUR EACH OCCURRENCE $
L1AB
EXCESSLlAB I CLAIMS-MADE AGGREGATE $
DEDUCTIBLE . $
RETENTION . $
WORKERS COMPENSATION AND I YIN :r~ ST~~_ ~H-
EMPLOYERS' LIABILITY ._~_ OR'(h!MITS _ ER
ANY PROPRIETORfPARTNER/EXECUTIVE [_._~- EL EACH ACCIDENT $
OFFICERJMEM6ER EXCLUDED?
-- - ---_._-_...._~
IMandatorvinNHl E_L_DISEASE- EA $
EMPLOYEE
If yes, describe under ELDISEASE- n -
POLICY LIMIT $
DESCRIPTION OF OPERATIONS below
PER PHYSICIAN $ 250,000
A MEDICAL PROFFESIONAL LIABILITY MPP-3516-11 01/01/11 01/01/12 AGGREGATE $ 750,000
(CLAIMS MADE COVERAGE)
TOTAL POLICY $ 5,000,000
AGGREGATE
DESCRIPTION OF OPERATIONS I lOCATIONS I VEHICLES (Attach ACORD 101, Additional Ramarks Schedule, if mora spaca is raquiredl
The policy(ies) provides coverage for all scheduled medical professionals employed or contracted by the above insured only while they
are working for or on behalf of the insured.
Covered person: HARRIS, JULIA K., M.D., Provider Retroactive Dale: 10/1/2010
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
COLLIER COUNTY BEFORE THE EXPIRATION DATE THEREOF, NOTICE WilL BE
3327 TAMIAMr TRAIL EAST DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
NAPLES, FL 34112
@1988-2009ACORDCORPORATION.Allrightsreserved.
ACORD 25 (2009/09)
The ACORD nam9 and logo are registared marks of ACORD
MEMORANDUM
Date:
March 17,2011
To:
Brenda Reaves, Contract Technician
Purchasing Department
From:
Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re:
Contract Number #10-5488R:
Medical Director for Collier County
Contractor: Dr. Julia K. Harris
Attached is the original contract, referenced above (Item #16E1)
approved by the Board of County Commissioners on October 12, 2010.
The second original document wi]) be held 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
16 E 1
16 E 1
Co~ County
Purchasing Department
3327 Tamiami Trail East
Naples, Florida 34112
Telephone: (239) 252-6020
FAX: (239) 252-6592
Email: BrendaReavesavcollieroov.net
www.collierQov. neUDurchasino
Adminisllalive Seniioes Division
Purchasing
Memorandum
Subject:
Solicitation # 10-5488R "Medical Director for Collier County"
From:
March 8, 2011
Brenda Reave(t-contracUPurChaSing Technician- For Joanne Markiewicz
Date:
To:
Ray Carter, Risk Manager
This Contract was approved by the BCC on October 12, 2010, Agenda Item 16.E.1
The County is in the process of executing this contract with Dr. Julia Harris. The insurance requirements are listed
in Section 12.
Please review the Insurance Certificate(s) for the referenced Contract.
. If the insurance is not in order. please contact the vendorlinsurance 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 questions, please contact me at the above referenced information.
Insurance Approved By:
Risk Management Signature
Date
(Please route to County Attorney via attached Request for Legal Services)
f--'..' 'f
R -, ,- \ \I -
. .~_...J_"
MA~ n S LOil
RISK MANAGEMENT
G/Acquisitions/AgentFormsandLetters/RiskMgmtReviewoflnsurance4/15/201 0/16/09
16 E 1
A G R E E MEN T #10-5488R
Medical Director for Collier County
THIS AGREEMENT, made and entered into on this .'3 day of JJi~ , 201L
by and between Dr. Julia K. Harris, whose address is 8803 Tamiami Trail East,
Naples, Florida 34113, hereinafter called the "Consultant" and Collier County, a political
subdivision of the State of Florida, Collier County, Naples, hereinafter called the "County":
WIT N E SSE T H:
1. COMMENCEMENT. The contract shall be for a one (1) year period, commencing on
execution of this agreement and upon issuance of a purchase order on or after October
1,2010 and terminating on September 30, 2011.
2. STATEMENT OF WORK. The Consultant shall serve as the Medical Director for the
Collier County Occupational Health and Wellness Program in accordance with the
terms and conditions of this Agreement and Exhibit A, attached hereto and
incorporated herein by reference. This Agreement contains the entire understanding
between the parties and any modifications to this Agreement shall be mutually agreed
upon in writing by the Consultant and the County project manager or his designee, in
compliance with the County Purchasing Policy ami Administrative Procedures in effect
at the time such services are authorized.
3. THE CONTRACT SUM. The County shall pay the Consultant for the performance of
this Agreement an estimated maximum annual amount of Twenty Five Thousand
Dollars ($25,000.00) for the performance of this Agreement, based on twelve monthly
payments. Payment will be made upon receipt of a proper invoice and upon approval
by the Project Manager or his designee, and in compliance with Chapter 218, Florida
Statutes, otherwise known as the "Local Government Prompt Payment Act".
4. SALES TAX. Consultant 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 Consultant shall be deemed duly served
if mailed to the Consultant at the following Addres,:
Dr. Julia K. Harris
8803 Tamiami Trail!::'
Naples, Florida 34113
Telephone: 239-732-1050
FAX: 239-430-7821'
Email: driulhar@ao1.com
Page 1 of 8
16 E 1
All Notices from the Consultant to the County shml be deemed duly served if mailed or
faxed to the County to:
Collier County Government Center
Purchasing Department
3327 Tamiami Trail, East
Naples, Florida 34112
Attention: Steve Carnell, PurchasingjGS Director
Telephone: 239-252-8371
Facsimile: 239-252-6584
The Consultant and the County may change the above mailing address at any time
upon giving the other party written notification. All notices under this Agreement must
be in writing.
6. NO PARTNERSHIP. Nothing herein contained shall create or be construed as creating
a partnership between the County and the Consultant or to constitute the Consultant 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 Consultant. Payment
for all such permits issued by the County shall be processed internally by the County.
All nonCounty permits necessary for the prosecution of the Work shall be procured and
paid for by the Consultant. The Consultant shall also be solely responsible for payment
of any and all taxes levied on the Consultant. In addition, the Consultant 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 Consultant agrees to comply with
all laws governing the responsibility of an employer with respect to persons employed
by the Consultant.
8. NO IMPROPER USE. The Consultant 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 Consultant
or if the County or its authorized representative shall deem any conduct on the part of
the Consultant to be objectionable or improper, the County shall have the right to
suspend the contract of the Consultant. Should the Consultant fail to correct any such
violation, conduct, or practice to the satisfaction of the County within twentyfour (24)
hours after receiving notice of such violation, conduct, or practice, such suspension to
continue until the violation is cured. The Consultant further agrees not to commence
operation during the suspension period until the violation has been corrected to the
satisfaction of the County.
Page 2 of 8
16 E 1
9. TERMINATION. Should the Consultant be fonnd to have failed to perform his
services in a manner satisfactory to the County as per this Agreement, the County may
terminate said agreement immediately 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 nonperformance.
10. NO DISCRIMINATION. The Consultant agrees that there shall be no discrimination as
to race, sex, color, creed or national origin.
11. INDEMNIFICATION. To the maximum extent permitted by Florida law, the
Consultant 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 Consultant or anyone
employed or utilized by the Consultant 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. INSURANCE. The Consultant shall provide insurance as follows:
A. Commercial General Liability: Coverage shall have minimum limits of $2,000,000
Per Occurrence, Combined Single Limit for Bodily Injury Liability and Property
Damage Liability. This shall include Premises and Operations; Independent
Consultants; 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 NonOwned
Vehicles and Employee NonOwnership.
C. Workers' Compensation: Insurance covering all employees meeting Statutory
Limits in compliance with the applicable state and federal laws.
The coverage must include Employers' Liability with a minimum limit of $500,000
for each accident.
D. Medical Malpractice: $250,000 each claim.
Page 3 of 8
16 E 1
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 Consultant during the duration of this Agreement. Renewal
certificates shall be sent to the County ten (10) days prior to any expiration date.
There shall be a thirty (30) day notification to the County in the event of
cancellation or modification of any stipulated insurance coverage.
Consultant shall insure that all subConsultants comply with the same insurance
requirements that he is required to meet. The same Consultant shall provide
County with certificates of insurance meeting the required insurance provisions.
The Consultant shall at its own expense, carry and maintain insurance coverage
from responsible companies duly authorized to do business in the State of Florida.
Coverages shall be maintained without interruption from the date of
commencement of the Work until the date of contract termination. Should at any
time the Consultant not maintain the insurance coverage's required herein, the
County may terminate the Agreement.
The amounts and types of insurance coverage shall conform to the mmlmum
requirements with the use of Insurance Services Office (ISO) forms and
endorsements or their equivalents. If Consultant has any self-insured retentions or
deductibles under any of the below listed minimum required coverages,
Consultant must identify on the Certificate of Insurance the nature and amount of
such self-insured retentions or deductibles and provide satisfactory evidence of
financial responsibility for such obligations. All self-insured retentions or
deductibles will be Consultant's sole responsibility.
13. CONTRACT ADMINISTRATION. This Agreement shall be administered on behalf of
the County by the Human Resources Department.
14. CONFLICT OF INTEREST: Consultant represents that it presently has no interest and
shall acquire no interest, either direct or indirect, which would conflict in any manner
with the performance of services required hereunder. Consultant further represents
that no persons having any such interest shall be employed to perform those services.
15. COMPONENT PARTS OF THIS AGREEMENT. This Agreement consists of the
attached component parts, all of which are as fully a part of the contract as if herein set
out verbatim: Exhibit A, insurance certificates, attached hereto and incorporated by
reference.
Page 4 of 8
16E 1
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 Consultant 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.e. 1324, et seq. and regulations relating thereto, as
either may be amended. Failure by the Consultant to comply with the laws referenced
herein shall constitute a breach of this agreement and the County shall have the
discretion to unilaterally terminate this agreement immediately.
19. OFFER EXTENDED TO OTHER GOVERNMENTAL ENTITIES. Collier County
encourages and agrees to the successful proposer extending the pricing, terms and
conditions of this solicitation or resultant contract to other governmental entities at the
discretion of the successful proposer.
20. AGREEMENT TERMS. If any portion of this Agreement is held to be void, invalid, or
otherwise unenforceable, in whole or in part, the remaining portion of this Agreement
shall remain in effect.
21. ADDITIONAL ITEMS/SERVICES. Additional items and/or services may be added to
this contract upon satisfactory negotiation of price by the Project Manager and Consultant.
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 resotve any such disputes
by negotiation. The negotiation shall be attended by representatives of Consultant 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 COlnmencement 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 Consultant with full decision-making
authority and by County's staff person who woutd 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, Fta. Stat.
Page 5 of 8
16 E 1
23. KEY PERSONNEUPROTECT STAFFING: The Consultant to be utilized for this project
shall be knowledgeable about providing pre-employment physicals and drug testing. The
County reserves the right to perform investigations as may be deemed necessary to ensure
that a competent person(s) will be utilized in the performance of the contract.
IN WITNESS WHEREOF, the Consultant 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 E.,Br6f'k! q~rk of Courts
. . .
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
/t ~JL. (","'-Jk
By: (\
Fred W. Coyle, Chairman
By:
JLili2Jd~(f If;" (vi. D.
Typed signature and title
t'Y\ ,,2. A- rJ. R ac\t f-O R.O
Type/print witness name
Item # .llaU
SCOTT R. TEACH
Print Name
Agenda 11\ ~ ...to
Date J.IL..Ll<...!
Date Il-'n--H
Rec'd cr
~/
Page 6 of 8
16 E 1
Exhibit A
10-5488R Medical Director
Scope of Services
1. Overview of Contract:
The Consultant shall provide Medical Director services for the Collier County Occupational
Health and Wellness Programs as may be required by the Collier County Manager's Agency and
its participating agencies, located in Naples, Florida. These programs are be available to all
Regular, Temporary and Seasonal Employees of the County Manager's Agency of Collier County
and its participating agencies, which currently include, but are not limited to: County Attorney,
Airport Authority, and Pelican Bay Services. The County has a total of approximately two
thousand one hundred (2100) employees.
Services to be provided include, but are not limited to the following:
1. Review, recommendations & approval of Standing Medical Orders & Protocols
2. Review and authorization for respirator use based on OSHA medical questionnaire,
PFT results and OSHA Respiratory Standard.
3. Review and evaluate audiometric testing results
4. Authorization for Rx required medical supplies
5. Authorization for Rx required pre-placement medical testing
6. Consultation and recommendations for pre-placement evaluation criteria & findings
7. Consultation for work related injuries & illnesses
8. Fitness for duty evaluations
9. MRO services
Anticipated services for Wellness Program from Medical Director, to include, but not
be limited to:
1. Review & approval of Health Screen Follow-up Intervention Protocol
2. Consultation regarding the Basic Preventative Physical Exam
The Consultant must provide all services listed in this Scope of Services. The County does not
guarantee a specific quantity of work.
Reports and Records: All medical reports shall be the sole property of Collier County and may not be
used or reproduced in any form without the explicit written permission of the County. The
Consultant shall maintain complete records on each individual examined/treated. Such records shall
remain confidential in compliance with all HlPPA regulations and will be made available only to the
County's representative and/or the individuaL
Page 7 of 8
16 E 1
No information, record, report or data derived, compiled, obtained, prepared or developed by the
Consultant from work performed pursuant to the contract may be released, disseminated or disclosed
without written consent of the County.
All medical reports and records shall be formally transferred to the County by the Consultant within
five (5) working days after the receipt of a contract termination notice.
Page 8 of 8
16El
~ CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDIYYYV)
AE~Rif 3/15/2011
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 POLICIES
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(ies) 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(st
PRODUCER CONTACT Renee McLaughlin
NAME
ALLlANT INSURANCE SERVICES HOUSTON LLC P~gN;O.Extl' 303-824-1403 I ~~,N01: 303-824-1437
5847 SAN FELIPE. SUITE 2750 E.MAll rmclauQhlin@alliantinsurance.com
HOUSTON, TX 77057 ADDRESS:
PRODUCER
CUSTOMER 10 II;
INSURER S AFFORDING COVERAGE NAIC#
INSURED INSURER A: HOMELAND INSURANCE COMPANY OF NEW YORK 34452
MILLENNIUM PHYSICIAN GROUP, LLC. INSURERS
8803 TAMIAMI TRAIL E INSURERC'
NAPLES, FL 34113-3347 INSURER 0:
INSURERE:
COVERAGES
CERTIFICATE NUMBER:
REVISION
NUMBER'
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 RESPECT TO 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
INSR ADDl SUBR ;.?lICYEFF POllCYEXP
LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDDIYYYY ~MMIDDIYYYY) LIMITS
GENERAL LIABiliTY $
EACH OCCURRENCE
COMMERCIAL GENERAL LIABILITY ~~~~~~~~~ E~~~;~r?ence) $
CLAIMS-MADE 1 I OCCUR MED EXP (Anyone person) $
PERSONAL & AOV iNJURY $
-- $
GENERAL AGGREGATE
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTSICOMPIOP $
AGG
I POLICY 1 I PROJECT I I LOC $
AUTOMOBILE LIABILITY ~~~~~~~~I~INGLE LIMIT $
ANY AUTO BODILY INJURY (Per $
nerson\
ALL OWNED AUTOS ~~~d~~t;NJURY (Per $
SCHEDULED AUTOS PROPERTY DAMAGE (Per $
accident
HIRED AUTOS $
NON.OWNED AUTOS $
UMBRELLA I OCCUR EACH OCCURRENCE $
L1AB
EXCESSLlAB I CLAIMS"MADE AGGREGATE $
DEDUCTIBLE $ $
RETENTION $ $
WORKERS COMPENSATION AND T ~~STATUsl fc~H.
EMPLOYERS'lIABllITY Y/N X CRY LIMITS ER
iii-"PROPRIETORIPARTN-ERlEXECUTIVE I.~ .-
E L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? --
I --. .
IMandatorvinNHl E.L. DISEASE-EA $
EMPLOYEE
If yes, describe under -...------- - ---- ---- -
E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS below
PER PHYSICIAN $ 250,000
A MEDICAL PROFFESIONAL LIABILITY I MPP-3516-11 01/01/11 01101/12 AGGREGATE $ 750,000
(CLAIMS MADE COVERAGE) I
TOTAL POLICY $ 5,000,000
AGGREGATE
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addillonal R&marks SCklldulll, if mor& spaclI is ,"quir"d)
The policy(ies) provides coverage for all scheduled medical professionals employeel or contracted by the above insured only while they
are working for or on behalf of the insured.
Covered person: HARRIS, JULIA K.. M.D., Provider Retroactive Date: 10/1/2010
CERTIFICATE HOLOER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
COLLIER COUNTY BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
3327 TAM lAM I TRAI LEAST DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
NAPLES, FL 34112
@1988-2009ACORDCORPORATION. All rights reserved.
ACORD 25 (2009109)
The ACORD name and logo are registllred marks of ACORD
16 E 1 I
..............
CC!.-RD' CERTIFICATE OF LIABILITY INSURANCE I ..'" ~
031081201'
THIl. CATE U ;rSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO UPONTHECI!R11ACATE HOLDER.--rRTS
CERTIFICATe DOES AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE! CO\lERAOl! AFFORIlEO BY THE POLICIES
BELOW. THIS C1!R1l CAll; OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BElWEEN THE I88UING INSUIleft(S), AUTHORIZeD
R1!PRESENTATIve OF PRODUCER, AND THE CERTIFICATE! HOLDeR.
lMPOft'rAt4T; If lb. G.rtIf .... _or Is .. ADDlnONAL INSURID, ... poIlcy~"' ...... be oAdO,"". II 8U1lA0GA11ON IS WAIVeD, oubjool ..
0.. termI ...s wntItfQns of the policy. certain poJk:_ may '*WIre an endoJl.tmenl A. .tat.runt on th18 cdftcate ciON not oonfw rtg... to 1M
certllceteftOldtrln I.. of ""hon_~
""""""" ...... (0<"0'"1"'" Fox (tlD8)....7<l41 I""""" Brian G.. Chopman
CHAPMAN INSURANCE GROUP, LLC .""'" t:i:...
992 TAMlAIIIl TRAIL UNI 'lll~' .=. lid.. (841) .78-8426 18118) 1182-764'._
<<-MAIL brl....lgIIotlda.com
POIlT CHAIU.OTTE FL 3 63 ......... .
PROOOC<!Il 396
.. n
- . #QeRqt IJc:lJ; L.05M19 tNIIURER(SI ~POROING COVERAOII _. NIdO .
"""'- lH6lJA"RA . UnlverwallmlW'1lnce Cornpa~ of North AmeriG8 '19116
Mlu..ENNIUM PHYSICIA HOLDINGS LLC INllURMI ~ Progreulve c..ualty fRlurance
MILLENNIUM PHY81CIA GROUP, LLC
& MURDOCK FAlMLV II DIOINE LLC, OR. JULIA HARRIS ,.......... ; Mount Vernon In.urlne. 28&12
19531 COCHRAN BLVD ...,
PORT CHAIU.OTTE FL 3948 INIUla!RI ~
~f;
COVl!RAGES CERTIFICATE NUMBER: 1255 REVISION NUMB!!R:
THIS", 'u""RTIFY ~'.:!JiI'. PO':ICl6lO_0FINSURANCEY81ED lIE SEENIS8UEO TO THe INSURED NAMl!D ABOVE FOR THE POUCY PERIOD
INDICATED. NOTWITHsTANDING ANY REQUIREMENT, TERM OR CONOITlOH Of ANY CONTRACT OR OTltER DOCUMENT WITH RESPEcr TO WHICH THIS
CE~~FlCATE MAY 8E-~m OR MAY PERTAIN. THE INSUAANCE AFFORDED BY T~ POLICIES DEsCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS.
.. ,~,.o' ,.ee",
~ ~ I: I~ POLIO't HUMBER -.", I'OUCV "'" LlMITO
-..
A GlINIlJUL lJilM..ITY UFBPOBOOOOI659 09130110 09130/11 EACH OCCURRENCE . 1,000,000
........"'........ -
=p COM\lERClAI. GENE llAlllLllY . 1,000,000
Ct.AlM""""'" I~ OCC'" - 10,000
MBl.. EXP (/Vr,fCN pMClll) .
j ~&ArNINJURY . -- 1,000,000
~.~RAlAOORE6An= ~ 2,000,000
GEH't I\OOftEGATE UMIT n:PER; ~.OON"""AGG . .. 2,000.000
II xlP01.ICYII~. lOC .
. cO~lNE6 SINGlE UMIT
"""""'"'-' IWIOUTY 0444529.1 11/20/10 11120111 I 1,000,000
- (EaacrldeAil)
- "" AUTO --
EtOD/I.Y INARY lPeI peqon) .
X N..LOWNeDAUT08 BODllY 1NARV' (Per GddtnI)
.
SCHEDUt.EllIWTOS PROPERTY DAW.GE .- .
X HIREOAUTOS (PeraccictlWlll .
X HOtrf.OWNEDAlITOS ---. .
- .
- . X -1 ~u; "- 6,000.000
C "-"-' UAa XL2110SIJA. 12/14110 12114111 EACH OCCURRENCE .
- u._ .
B<<II UAa CtAIol......,. """"""'TE
..-.
- OEDUCnBL! -. . -.-
RETENI1QN . . .-
J~~lION I I 01H .
I~-~ TIN .. -
:r-~- - ~T 1::1 E.L EACHACClO9IT I
N" - .
iMandllolyrn.... E..L.. DISfNlE-EA EMPlO'rH I.
w""'_____ E.L. DlBEASE-POUCY Uyrr
_.!'Il~0I1ClP!JtA1'IOf'IS~.. -.. S -
.-- .. ...-- . ..-.
DEBCRlPnONOF OPERATJDNa LOCATIOHlI IVI!IlICU!I5(M.ch ACDRD101, Addltlonal ~.lctItdul..lfmo~ .paae'... ~ulAldI
8803 T.-tIaml TraY East. ~apl.a, FL :1<1113
Collier County _ of C ounty commlulonere ~ 18 listed.. 8n Additional Insured on thl. peliey.
HOLDER CANCeLI.A .......
Colli.. County Boai'd I County Cornml...lonars SHQULD AlIV OF TME ABove DESCRIBeD POUCI&$ _ CANCfit.1.a) BefORE
THE ElCPIRAllOH DATE TtteIWlF, NOTICE WIlL Be DlUV2lI!D IN
3327 Tlmlaml Trell Eo I ACCORD.u.tct! WITH THe POLICY PROVISIONS.
Naples, FL 34112
....
I,lJnfI'.IRlZaJ ~ATlW
AUanUOII: Fax: 9-2/;2_ ~Mi1t;~~
"~URU .. , The ACORD name and 101lO are regralared m:'J.'"'.:I-'~Ro . NI "'II'" __T.