Loading...
Backup Documents 10/08/2019 Item #16E 3 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO !6 E 3 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 N/A- 2. County Attorney Office County Attorney Office /e)41/- �1/- Ii , 4. BCC Office Board of County Commissioners \f't /s/ \cc 4. Minutes and Records Clerk of Court's Office i s* toI tt 4 5. Procurement Services Procurement Services _t 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 Ana Reynoso/PURCHASING Contact Information 239-252-8950 Contact/ Department Agenda Date Item was OCTOBER 8, 2019 Agenda Item Number 46+731, L+= - — Approved by the BCC Type of Document AMENDMENT ✓ Number of Original 2 Attached Documents Attached PO number or account N/A 14-6293 MILLENIU number if document is MILLENIUM PHYSICI S to be recorded PHYSICIANS GROUP, LLC GROUP, LLC 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 N/A 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 AR 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 AR 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 AR 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 10/08/2019 and all changes made during 1/A is not the meeting have been incorporated in the attached document. The County ;► option for Attorney's Office has reviewed the changes,if applicable. � {l ®is line. 9. Initials of attorney verifying that the attached document is the version o -°-- °/A is not BCC,all changes directed by the BCC have been made,and the document is ready for the u o etion for Chairman's signature. OCT 0 8 201, Risk Management 16E3 MEMORANDUM Date: October 14, 2019 To: Ana Reynoso, Purchasing Tech Procurement Services From: Ann Jennejohn, Deputy Clerk Minutes & Records Department Re: Agreement #14-6293, Amendment No. 2 "Collier County Onsite Medical Clinic" Contractor: Millennium Physician Group, LLC Attached, is an original copy of the contract referenced above, (Item #16E3) approved by the Board of County Commissioners on Tuesday, October 8, 2019. The second original contract has been 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 2019 FLORIDA LIMITED LIABILITY COMPANY ANNUAL REPORT FILED 16 E 3 DOCUMENT#L08000011177 Apr 15, 2019 Entity Name: MILLENNIUM PHYSICIAN GROUP, LLC Secretary of State 5376010451 CC Current Principal Place of Business: 6321 DANIELS PARKWAY SUITE 201 FORT MYERS, FL 33912 Current Mailing Address: 6321 DANIELS PARKWAY SUITE 201 FORT MYERS, FL 33912 US FEI Number: 26-2909414 Certificate of Status Desired: No Name and Address of Current Registered Agent: HOLMES,DAVID A. FARR LAW FIRM 99 NESBIT STREET PUNTA GORDA,FL 33950 US The above named entity submits this statement for the purpose of changing its registered office or registered agent,or both,in the State of Florida. SIGNATURE: DAVID A. HOLMES 04/15/2019 Electronic Signature of Registered Agent Date Authorized Person(s) Detail : Title MGR Title CEO Name FOX,BRIAN Name KEARNS,KEVIN Address 6321 DANIELS PARKWAY SUITE 201 Address 6321 DANIELS PARKWAY SUITE 201 City-State-Zip: FORT MYERS FL 33912 City-State-Zip: FORT MYERS FL 33912 Title COO Title TREASURER Name MCKINLEY, ROY Name DELANOIS,GARY Address 6321 DANIELS PARKWAY SUITE 201 Address 6321 DANIELS PARKWAY SUITE 201 City-State-Zip: FORT MYERS FL 33912 City-State-Zip: FORT MYERS FL 33912 Title CAO Name BRAY,ROBERT Address 6321 DANIELS PARKWAY SUITE 201 City-State-Zip: FORT MYERS FL 33912 I hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under oath;that I am a managing member or manager of the limited liability company or the receiver or trustee empowered to execute this report as required by Chapter 605,Florida Statutes;and that my name appears above,or on an attachment with all other like empowered. SIGNATURE:BRIAN FOX MANAGER 04/15/2019 Electronic Signature of Signing Authorized Person(s)Detail Date 16E3 SECOND AMENDMENT TO AGREEMENT#14-6293 FOR "COLLIER COUNTY ON-SITE MEDICAL CLINIC" THIS AMENDMENT, made and entered into on this ?6\ day ofbelixy-' 2019, by and between Millennium Physician Group, LLC (the "Provider" or "Millennium") and Collier County,a political subdivision of the State of Florida, (the "County" or"Owner"): WHEREAS, on September 9, 2014 (Agenda Item 16.E.7), the County entered into an Agreement with Provider,with a commencement date of November 14,2014,to provide on-site primary care health services with an initial five-year term with five (5) additional one (1) year renewal terms; and WHEREAS, on October 10, 2017 (Agenda Item 16.E.2), the County approved the First Amendment to the Agreement expanding all four clinic models to include limited pharmacy services with reimbursement from the County for the actual cost paid by Provider with no additional markup to the County; and WHEREAS,the parties desire to further amend the Agreement to: (i)replace Exhibit A Scope of Services in its entirety by deleting the expanded language for options 2, 3, and 4, (ii) incorporate the Exhibit B-1 Fee Schedule to include pricing for the next five year period (years 6, 7, 8, 9 and 10), and (iii)renew the agreement for an additional five (5) year term. NOW, THEREFORE, in consideration of the mutual promises and covenants herein contained, it is agreed by the parties as follows: 1. The Exhibit A- Scope of Services is hereby replaced in its entirety with the attached. 2. The attached Exhibit B-1 Fee Schedule is hereby incorporated into the Agreement. 3. To renew the Agreement for an additional five (5) year period to begin on November 14, 2019 and ending on November 13, 2024. SIGNATURE PAGE TO FOLLOW EXHIBIT A& EXHIBIT B-1 to follow Signature page **Remainder of this page left blank intentionally** Page 1 of 8 Second Amendment to Agreement N 14-6293 �� Ctk 16E3 IN WITNESS WHEREOF,the Parties have executed this Amendment on the date and year first written above by an authorized person or agent. ATTEST: Crystal K.1Sitiki,CIO*of Courts& BOARD OF COUNTY COMMISSIONERS Comptrott "',•.� OG COLLIER CO . Y FLORIDA i Ift , N µr '4- # 1 , ' -<1.A ? .40 i B}� ,41 `iii.1 •.C., By: -_. 1 —.�. 't , W/iam L. McDaniel Jr.,Chairm.n Dated: atr 'r (SEAL) 'A asst as to Chairman's ignature only. Provid• '• itnesses: PROVIDER: 1' ille :ium Physician roup,LLC first Witness BIP(,),_ .. ure f -_-.;•//QA', TTy e/print witness nameT r-. ' V-. 11C04-0 /4'7 TType/print signature and titl T Second Witn c (( ct S-1-1+cci `479c.t.) C Date TType/print fitness nameT Ap roved .s to o • ' -gality: WR jar '. 'each,Deputy County Attorney Item# 4E3 Agendl Cate .0.._�l, Date 10 R Recd ____-� � i Deputy Clerk Agreement#14-6293 Collier County On Site Medical Clinic , Page 2 of 8 L Second Amendment to Agreement#14-6293 [1 16E3 Agreement#14-6293 Collier County On Site Medical Clinic Exhibit A Scope of Services This Agreement is for On-Site Primary Care Health Services, utilizing an integral approach to promote a healthy and productive workforce through the provision of cost-effective onsite primary healthcare services to employees enrolled under the Collier County Group Insurance Plan,along with the provision of on-site limited pharmacy services 1. REQUIRED SERVICES-Current and General Services The Provider shall provide on-going support to onsite professional staff serving CCG through its corporate infrastructure and management resources,to include the following: 1. Provision of primary care services to employees,eligible spouses and covered dependents age fifteen(15) or older who choose to use the clinic for that purpose. 2. Occupational Injuries/illnesses treatment following a referral by the County's Occupational Health Nurse or Risk Analyst. 3. Treatment of non-occupational injuries/illnesses. 4. Treatment of episodic health conditions. 5. Phlebotomy Services. 6. Follow up blood chemistry screening and measurement. 7. Counseling on health related issues. 8. Maintain patient health records consistent with all applicable State and Federal laws, to include relevant privacy regulations and HIPAA guidelines. 9. The clinic will be expected to export lab and measurement results to CHP in a CVA or Excel format with the person's name and ID number they have been assigned by the medical plan administrator Allegiance Benefit Plan Administrations. Transfers are to occur on a weekly basis. The clinic will also be expected to retain this data in its own EMR. 10. Provide an electronic medical records system to house all screening data as well as the data that might be collected in the course of providing primary care and other services. Such medical record system will be required to interface with the HIE (Health Information Exchange) that may be established in Collier County. 11. The MedCenter will initiate and then transfer of medical records to the employee/spouse's primary care physician after seeking the appropriate releases from the patient. 12. Maintain open and frequent communication with CCG's Risk Management representatives regarding observable trends in workplace injuries and illnesses as indicated by patient utilization of onsite health care services. 13. Administer the Commit to Quit-Nicotine Cessation program, Take Charge Diabetes program and the New You Medically Managed Weight Loss program. Page 3 of 8 Second Amendment to Agreement#14-629316 CAO 16E3 14. Limited Occupational Health and Worker's Comp treatment following a referral by the County's Occupational Health Nurse or Risk Analyst. 15. Claims for medical services are filed with current TPA for record keeping and payment purposes, as needed. Claim data must be submitted within thirty (30) days of the date incurred. 16. Foster efficient patient care by coordinating efforts with CHP Health Advocates and the CCG Wellness Program staff. 17. Clinical oversight and support of onsite professional staff; 18. Regular onsite visitation by the Manager of Client Operations, the Senior Director of Operations and other vendor senior management at appropriate intervals to ensure program success and client satisfaction; 19. Regular meetings with CCG's Risk Management and Wellness staff. The focus of these meetings is to: a. Address emerging issues regarding operations; b. Foster efficient operations and provide a platform to address questions and promptly address service concerns; c. Promote two-way communications to ensure that the clinic is fulfilling the needs of CCG and its employees; d. Assist the Provider in understanding the business practices and culture of the CCG; and e. Discuss the results of customer satisfaction surveys and other data and, where appropriate,formulate strategies and processes to address concerns 20.Training and oversight of onsite professionals; 21. Reporting of onsite health care facility and program activity consistent with CCG's requirements; 22. Training of the onsite staff in the use of information systems and ongoing support of the information systems used by the onsite staff in operating the program; 23. Nursing practice standards and protocols to be used by onsite professional staff; 24. Quality assurance programs to ensure compliance with practice standards by onsite professional staff; 25. Maintenance and replacement of medical equipment located in the onsite medical facility; 26. Maintenance of medical and medication supply inventory consistent with program needs; 27. Maintenance and replacement of information technology workstations,to include printers, copiers and fax machines; and 28. Maintenance of information systems applications operating on the medical facility workstations hosted by the selected vendor or its information technology partners. The onsite clinic currently has operating hours of 8:00 AM until 5:00 PM Monday through Friday and it is closed on County recognized holidays.The County reserves the right to modify Page 4 of 8 Second Amendment to Agreement#14-6293 CA 16E3 the schedule to allow for evening and/or Saturday hours at no additional cost to the County provided the total hours per week do not exceed the current total operating hours. Quality Improvement and Grievance Procedures The Provider is an independent contractor and shall follow the practices and standards applicable to all similarly situated medical professionals.The Provider shall make every effort to accommodate the medical needs of patients according to these standards.The Provider shall establish a formal grievance process to address questions or complaints,if any, that may arise and shall maintain a continuous quality improvement process to address opportunities to improve medical services. The Provider shall address patient complaints and concerns in accordance with the grievance procedure required herein,and in accordance with the dismissal procedures under Exhibit C Provider Patient Dismissal Policy and Procedure,attached herein and incorporated by reference. Staffing for Current Clinic Model Staffing shall be based on the following staff: • Receptionist Staff-forty (40) hours per week • Medical Technician-forty(40) hours per week • PA-C-forty (40)hours per week • Physician Medical Director who is responsible for the general oversight of the clinic - two (2)hours per week • Administrative Services-two (2)hours per week CCG wants to continue to receive these services, however; the services under this Agreement are expanded and clarified to include three (3) additional potential options, as identified in Section 2 below. The Invest in Your Health Program The onsite clinic currently has operating hours of 7:30 AM until 5:00 PM,and is an integral part of the County's Health plan which includes an innovative wellness program referred to as f Invest in Your Health Program.Under the program,covered employees and spouses do not have a choice of health plans in the traditional sense where an employee can buy better coverage. Under the plan that was implemented in 2009,employees earn their way to better coverage by completing a variety of"qualifiers" that are intended to help members become aware of their health status and act on that knowledge. These activities can be summarized as follows: • Have blood drawn and specific tests performed including Hemoglobin A1C, Fasting Glucose, Lipid Panel, Kidney Function (BUN, eGFR, Creatine, and Serum Cotinine. In addition to blood chemistry, the individual's weight, height, waist circumference, blood pressure and BMI are taken. Once the labs are processed,this information is relayed to the Health Advocates to follow-up with the member. This service is currently provided by Quest Diagnostics. Page 5 of 8 Second Amendment to Agreement#14-6293 16E3 • The member meets with a Health Advocate to discuss the results of the tests,measurements and reports. This service is provided locally in person by Community Health Partners (CHP) to those employees categorized with multiple health risks. The participants identified at high risk or with Diabetes also meet with the Wellness Educators. CHP and the Wellness Team will continue to provide this service and will coordinate efforts with the clinics. • Participate in programs that are provided by CHP and CCG's Wellness Manager which includes: o Programs include disease management programs offered by CHP for Gastric Bypass Nutrition Program. o Case management services for patients who have acute health episodes that result in significant expenses o Structured programs developed and coordinated by the CCG's Wellness Programs Manager. 2. CLINIC OPTIONS-BRIEF DESCRIPTIONS Additional clinic options may be considered, in addition to the Current Clinic (Option 1) for implementation in the future.These options are: Option 1: Current Clinic (Current and General Services), along with the provision of on-site limited pharmacy services as further set forth in Section 3, Clinic Options-Detailed Descriptions Option 2: Expanded Model Option 3: Medical Home Model Option 4: Primary Care Model The County reserves the right to phase the implementation of Options 2,3, and 4,beyond Option 1 over a period of time provided,in the County's sole opinion,that Millennium has the capability to deliver each of the options requested. It is understood that should the County wish to expand services in subsequent years and should a new location be required, Millennium shall assist the County in the required analysis and possess the required expertise to implement this expansion. 2.1. LABORATORY AND BIOMETRIC SCREENING SERVICES Under the Expanded,Medical Home,and Primary Care models,the CCG wishes for the Clinic to become the focal point for the Laboratory and Biometric Screening portion of the Invest in Your Health Program. The Provider shall be responsible for coordinating the annual Lab Draw and Biometric Screening program to assist members in meeting program qualifiers. The following laboratory panel will be measured as part of the program. The current laboratory panel shall consist of the following tests: Page 6 of 8 Second Amendment to Agreement#14-6293 41) 16E 3 • Hemoglobin A1C • Fasting Glucose • Lipid Panel • Kidney Function(BUN,eGFR,Creatine) • Serum Cotinine Any additional tests may be added to this list at the discretion of the County,and pricing for those tests shall be quoted in writing to the County and added to the existing price list. The cost to perform the draw shall be included in the clinic proposal price,however,the cost of the testing shall be billed separately to the County's third party administrator for payment. The CCG is interested in a simplified personal wellness report which communicates lab values, normative values and past values for comparison. The Provider shall also integrate lab values into a personal wellness profile report to be utilized by health coaches,clinic staff and wellness staff for health counseling purposes. The County reserves the right not to include the Laboratory and Biometric screening portion as part of the Provider's services,and to select a firm of its choosing. The County also reserves the right to implement the Laboratory and Biometric Screening Services portion of this Agreement in year two(2) or subsequent years of the Agreement. 4. CLINIC OPTIONS -BRIEF DESCRIPTIONS-DETAILED DESCRIPTIONS Option 1-Current Clinic Model-Duplicate the current clinic model,including the provision of on-site pharmacy services to be provided under all clinic models options, should they be implemented,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. Medications will be purchased directly from Provider 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. tf Page 7 of 8 C,A Second Amendment to Agreement#14-6293 16E3 Exhibit B-1 FEE SCHEDULE Pricing-Years 6-10 1+..egad 1T+a6e n..aar n.n to,. Hemet( lnrela 223 Spouse 101 Oepandoou over ago 15 107. Men Sir Opo,M;art.n Collar County C.n.pa.Goias& Ter 6 Pow 7 Yew 3 Yew 9 Ter 10 Cit Cost Opti GI.Cast00 I gat Cal O►l Ist.ten OP 1 1st Coe.091 Option l Rau .3) Options Rao lartrtal Option l Port ,, ' Open 1 Rate ,- Option l Rata euual CurM. e.C ,t lens., CVr.SCIaK Unite: Cvie,t Cie c:ever: C:.-erl Ci,,C:tr.tcti C✓rtM Cine HMta awt,y kaKr.6Coat(state as KIM) 1173 316 166112 S 1115 t 52661550 S 1274 5 33/96601 $ 1528 5 555.6(764 5 1392 , 57742691 Otte Meeeet Sepphes aro:^aara.ot(State n KOMI 6 503 , 115 0 S 317 2 4507762 S 330 , 08300.72 343 92.01995 . 360 . 9662095 M1b-agerte^1 tee(ream ataKpMl 222 2 5969565 5 231 5 6204567 5 261 2 63 567 01 S 250 2 67.11969 . 261 , 70.5074/ ilrpe+errata,tee(L,..p tart peal at i'xepter) $ S $ • $ - $ • S 5 1 ; ►MMM/[strutted Parte' $ 17.06 5 4$7,614.66 5 12.74 5 675376.711 5 ISS S 493pts.77 $ 19.19 $ 514,01632 $ 2015 5 360,555.06 . ..r 51107 O..se•9.3.1 C.er. Curre.Option I Current Option 1 Coma Option 1 Currier Option I Current Option 1 Option l hate Vaal Cost 091 Option t Rea 17064(.1 0p 1 Option 1 Rove I Total Cost 0p 1 Option 1 hate 17«M Cost OP I Option 1 Rau I Tota Cost 091 camel Cant It's..: C1r5N Cnrt:rite, Cvrrt C.ric levet, CGrert/la sonic: Cvrtrt C.ic arrant ...rap_.1 M.naee.'....t Mentay St a ens Can Ileo as PIKJI 607 5 /6262591 5 651 5 169 331 95 S 696 $ 176.112 51 $ 635 S 165.15701 $ 717 , 192.51466 O ..Mad ea,Supp,or awe-: -to Orate sr PEP.' 1 37 . 32 129 75 S 165 5 351111.97 S 1 Ort70 5 45 547 57 S 1 77 $ 17.190 27 S 1 45 a 49.759 79 htarsgn.m eice!13.3e a 96p51! 115 a 3072335 2 119 2 31 973 09 r 124 5 31 252 01 S 129 5 3355209 S 115 36 311 20 ira'evtrtotr hef',uvpart pad atir.apt o-. ; • ; - $ • r+ $ $ • • • $ , /6tw..tel Animal 5 673 S 233,69905 S 9.14 $ 245,127.01 S 9.50 S 234,132.09 $ 9.14 $ 265.12!36 $ 1036 $ 376.36)01 1 rririkNM 1 s 2s 61.I I s 26.33 I I s 27.95 I I s 29.07 I I s 30.921 I lweeeee Pe Dose /ream,(Meamor:a lett ne) $ 21000 Shirgna I1O.'es Vaccine.Soma of2) $ 313.03 I I ,,,tom bairtion burrow/Cou-t Rate Shine 6►nounwa. 500 5 2002 . 10012 50 Alert $ 10,012 SO (.1.°1---- Page 8 of 8 Second Amendment to Agreement#14-6293 CJ 16E3 ACRD® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 05/21/2019 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Ashlee Hill NAME: Iron Ridge Insurance PHONE (800)775-8526 FAX (239)288-7544 (A/C,No,Ext): (A/C,No): 4971 Royal Gulf Circle E-MAIL ahill@ironridgeinsurance.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Fort Myers FL 33966 INSURER A: National Fire&Marine Insurance Company 20079 INSURED INSURER B: Technology Insurance Company 42376 Millennium Healthcare,LLC INSURER C: 6321 Daniels Parkway INSURER D: Suite 200 INSURER E: Fort Myers FL 33912 INSURER F: COVERAGES CERTIFICATE NUMBER: CL1952104612 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 POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE $ 1,000,000 REN)ED CLAIMS-MADE X OCCUR PREMISES O(Ea occurrence) $ 300,000 MED EXP(Any one person) $ 5,000 A Y HN010657 05/28/2019 05/28/2020PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY JECT PRO- X LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ X UMBRELLA LIABOCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE Y EN010657 05/28/2019 05/28/2020 AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE EORH AND EMPLOYERS'LIABILITY Y/N 1,000,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE NIA TWC3767481 01/01/2019 01/01/2020 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1000000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , , DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Contract#11-573-NS Auto Coverage as follows: Policy#BAS-19-58360034;Ohio Casualty Insurance Company,$1,000,000 CSL,effective 11/20/18-11/20/19 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Collier County Board of County Commission ACCORDANCE WITH THE POLICY PROVISIONS. 3299 Tamiami Trail East AUTHORIZED REPRESENTATIVE Suite 303 Naples FL 34112-5746 ►J..,,,.,,,� z- 1. ---f', °GtJ 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 16E3 Additional Named Insureds Other Named Insureds Millennium IPA, LLC (462881666) Limited Liability Company, Additional Named Insured Millennium Physician Group, LLC (262909414) Limited Liability Company, Additional Named Insured ProCare Med, LLC d/b/a Millennium Accountable Care Limited Liability Company, Additional Named Insured OFAPPINF(02/2007) COPYRIGHT 2007,AMS SERVICES INC