CONTRACT FOR THE PURCHASE AND INSTALLATION OF WATER FLUORIDATION EQUIPMENTDocuSign Envelope ID: 1CBOBB08-6DFE-472A-8730-5C01E87FC4AC
CFDA No. 91758
CSFA No. 64.001
STATE OF FLORIDA
DEPARTMENT OF HEALTH
STANDARD CONTRACT
❑ Client ® Non -Client
0 Multi -County
THIS CONTRACT is entered into between the State of Florida, Department of Health, hereinafter referred to as the "Department,"
and City of Clearwater hereinafter referred to as "Provider," and jointly referred to as the "parties."
THE PARTIES AGREE:
I. PROVIDER AGREES:
A. To provide services in accordance with the terms specified in Attachment I.
B. To the Following Governing Law
1. State of Florida Law: This contract is executed and entered into in the state of Florida, and will be construed, performed, and
enforced in all respects in accordance with the laws, rules, and regulations of the state of Florida. Each party will perform its
obligations in accordance with the terms and conditions of this contract.
2. Federal Law
a. If this contract contains federal funds, Provider must comply with the provisions of 2 C.F.R. part 200, appendix II, and other
applicable regulations as specified in Attachment I.
b. If this contract includes federal funds that will be used for construction or repairs, Provider must comply with the provisions
of the Copeland "Anti -Kickback" Act (18 U.S.C. section 874), as supplemented by Department of Labor regulations (29
C.F.R. part 3, "Contractors and Subcontractors on Public Building or Public Work Financed in Whole or in Part by Loans or
Grants from the United States"). The act prohibits providers from inducing, by any means, any person employed in the
construction, completion, or repair of public work, to give up any part of the compensation to which he or she is otherwise
entitled. All suspected violations must be reported to the Department.
c. If this contract includes federal funds that will be used for the performance of experimental, developmental, or research work,
Provider must comply with 37 C.F.R., part 401, "Rights to Inventions Made by Nonprofit Organizations and Small Business
Firms under Governmental Grants, Contracts, and Cooperative Agreements."
d. If this contract contains federal funds and is over $100,000, Provider must comply with all applicable standards, orders, or
regulations of the Clean Air Act, as amended (42 U.S.C. chapter 85) and the Clean Water Act, as amended (33 U.S.C.
chapter 26), Executive Order 11738, and Environmental Protection Agency regulations codified in Title 40 of the Code of
Federal Regulations. Provider must report any violations of the above to the Department.
e. If this contract contains federal funding in excess of $100,000, Provider must, prior to contract execution, complete the
Certification Regarding Lobbying form, Attachment III . If a Disclosure of Lobbying Activities form, Standard Form LLL,
is required, it may be obtained from the Contract Manager. All disclosure forms as required by the Certification Regarding
Lobbying form must be completed and returned to the Contract Manager.
f. Employment of unauthorized aliens is a violation of the Immigration and Naturalization Act, 8 U.S.C. section 1324a, and
such violation will be cause for unilateral cancellation of this contract by the Department. Provider must use the U.S.
Department of Homeland Security's E -Verify system, https://e-verifv.uscis.gov/emp, to verify the employment eligibility of
all new employees hired during the contract term by Provider. Provider must also include a requirement in subcontracts that
the subcontractor must use the E -Verify system to verify the employment eligibility of all new employees performing work
or providing services under this contract who are hired by the subcontractor during the contract term. Providers meeting the
terms and conditions of the E -Verify System are deemed to be in compliance with this provision.
g. Provider must comply with President's Executive Order 11246, Equal Employment Opportunity (30 Fed. Reg. 12935), as
amended by President's Executive Order 11375, (32 Fed. Reg. 14303), and as supplemented by regulations at 41 C.F.R.
chapter 60.
h. Provider must comply with the Pro -Children Act of 1994, 20 U.S.C. sections 6081-6084, which requires that smoking not be
permitted in any portion of any indoor facility used for the provision of federally funded services including health, day care,
early childhood development, education or library services on a routine or regular basis, to children up to age 18. Provider's
failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to $1,000 for
each violation and the imposition of an administrative compliance order on the responsible entity. Provider must include a
similar provision in any subcontracts it enters under this contract.
i. Health Insurance Portability and Accountability Act of 1996 (HIPAA): When applicable, Provider must comply with Federal
Privacy and Security Regulations developed by the U.S. Department of Health and Human Services as specified in 45 C.F.R.
parts 160 and 164 promulgated pursuant to HIPAA, Pub. L. No. 104-191, and the Health Information Technology for
Economic and Clinical Health Act, Title XIII of Division A, Title IV of Division B, Pub. L. No 111-5, collectively referred to
as "HIPAA."
j. Provider is required to submit a W-9 to the Department of Financial Services (DFS) electronically prior to doing business
with the state of Florida via the Vendor Website at https://flvendor.myfloridacfo.com. Any subsequent changes to Provider's
Form Revised 11/16
1
Contract # COHS2
DocuSign Envelope ID: 1CBOBB08-6DFE-472A-8730-5C01E87FC4AC
W-9 must be made on this website; however, if Provider needs to change its Federal Employer Identification Number
(FEID), it must contact the DFS Vendor Ombudsman Section at (850) 413-5519.
k. If Provider is determined to be a subrecipient of federal funds, Provider will comply with the requirements of the American
Recovery and Reinvestment Act and the Federal Funding Accountability and Transparency Act, by obtaining a DUNS (Data
Universal Numbering System) number and registering with the federal Central Contractor Registry (CCR). No payments
will be issued until Provider has submitted a valid DUNS number and evidence of registration (i.e., a printed copy of the
completed CCR registration) in CCR to the Contract Manager. To obtain registration and instructions, visit
http://fedgov.dnb.com/webform and www.ccr.gov.
C. Audits, Records (including electronic storage media), and Records Retention
1. To establish and maintain books, records, and documents in accordance with generally accepted accounting procedures and
practices, which sufficiently and properly reflect all revenues and expenditures of funds provided by the Department under this
contract.
2. To retain all client records, financial records, supporting documents, statistical records, and any other documents pertinent to this
contract for a period of six years after termination of the contract, or if an audit has been initiated and audit findings have not been
resolved at the end of six years, the records must be retained until resolution of the audit findings or any litigation which may be
based on the terms of this contract.
3. Upon completion or termination of this contract and at the request of the Department, Provider will, at its expense, cooperate with
the Department in the duplication and transfer of any said records or documents during the required retention period as specified
in Section I, paragraph C.2., above.
4. Persons duly authorized by the Department and federal auditors, pursuant to 2 C.F.R. section 200.336, will have full access to and
the right to examine any of Provider's records and documents related to this contract, regardless of the form in which kept, at all
reasonable times for as long as records are retained.
5. To ensure these audit and record keeping requirements are included in all subcontracts and assignments.
6. If Provider is a recipient or subrecipient as specified in Attachment II , Provider will perform the required financial and
compliance audits in accordance with the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for
Federal Awards, 2 C.F.R. part 200, subpart F and section 215.97, Florida Statutes, as applicable and conform to the following
requirements:
a. Documentation. To maintain separate accounting of revenues and expenditures of funds under this contract and each Catalog
of State Financial Assistance (CSFA) or Catalog of Federal Domestic Assistance (CFDA) number identified on the attached
Exhibit 1, in accordance with generally accepted accounting practices and procedures. Expenditures which support
Provider's activities not solely authorized under this contract must be allocated in accordance with applicable laws, rules, and
regulations and the allocation methodology must be documented and supported by competent evidence.
b. Provider must maintain sufficient documentation of all expenditures incurred (e.g., invoices, canceled checks, payroll detail,
bank statements, etc.) under this contract which evidences that expenditures are:
1) Allowable under the contract and applicable laws, rules, and regulations;
2) Reasonable; and
3) Necessary in order for Provider to fulfill its obligations under this contract.
All documentation required by this section is subject to review by the Department and the state of Florida Chief Financial
Officer. Provider must timely comply with any requests for documentation.
c. Annual Financial Report. Within 45 days from the end of each contract year, but no later than submission of the final invoice
for that year, submit to the Department an annual financial report stating, by line item, all expenditures made as a direct result
of services provided through this contract. Each report must include a statement signed by an individual with legal authority
to bind Provider, certifying that these expenditures are true, accurate, and directly related to this contract.
d. To ensure that funding received under this contract in excess of expenditures is remitted to the Department within 45 days of
the end of each contract year and the contract end date.
7. Public Records: Keep and maintain public records, as defined by Chapter 119, Florida Statutes that are required by the
Department to perform the services required by the contract. Upon request from the Department's custodian of public records,
provide the Department with a copy of the requested public records or allow the records to be inspected or copied within a
reasonable time at a cost that does not exceed that provided in Chapter 119, Florida Statutes, or as otherwise provided by law.
Ensure that public records that are exempt or that are confidential and exempt from public record disclosure are not disclosed,
except as authorized by law for the duration of the contract term and following completion of the contract if Provider does not
transfer the public records to the Department. Upon completion of the contract, transfer to the Department at no cost, all public
records in possession of Provider or keep and maintain public records required by the Department to perform the contract
services. If Provider transfers all public records to the Department upon completion of the contract, Provider will destroy any
duplicate public records that are exempt or confidential and exempt. If Provider keeps and maintains public records upon
completion of the contract, Provider will meet all applicable requirements for retaining public records. All records stored
electronically must be provided to the Department, upon request of the Department's custodian of public records, in a format that
is compatible with the information technology systems of the Department. The Department may unilaterally terminate this
contract if Provider refuses to allow access to all public records made or maintained by Provider in conjunction with this
contract, unless the records are exempt from section 24(a) of Art. I of the State Constitution and section 119.07(1), Florida
Statutes. 2
Form Revised 11/16
Contract # COHS2
DocuSign Envelope ID: 1CBOBB08-6DFE-472A-8730-5C01E87FC4AC
If the Provider has questions regarding the application of Chapter 119,
Florida Statutes, to the Provider's duty to provide public records relating
to this contract, contact the custodian of public records at (850)245-4005,
PublicRecordsReuuestAflhealth.gov or 4052 Bald Cypress Way, Bin A02,
Tallahassee, FL 32399.
8. Cooperation with Inspectors General: To the extent applicable, Provider acknowledges and understands it has a duty to and will
cooperate with the inspector general in any investigation, audit, inspection, review, or hearing pursuant to section 20.055(5),
Florida Statutes.
D. Monitoring by the Department: To permit persons duly authorized by the Department to inspect any records, papers, documents,
facilities, goods, and services of Provider, which are relevant to this contract, and interview any clients or employees of Provider to
assure the Department of satisfactory performance of the terms and conditions of this contract. Following the Department's monitoring,
at its sole and exclusive direction, the Department may provide Provider with a written report or take other actions including the
assessment of financial consequences pursuant to section 287.058(1)(h), Florida Statutes, and termination of this contract for cause.
E. Indemnification
1. Provider is liable for and will indemnify, defend, and hold harmless the Department and all of its officers, agents, and employees
from all claims, suits, judgments, or damages, consequential or otherwise and including attorneys' fees and costs, arising out of
any act, actions, neglect, or omissions by Provider, its agents, or employees during the performance or operation of this contract
or any subsequent modifications thereof, whether direct or indirect, and whether to any person or tangible or intangible property.
2. Provider's inability to evaluate liability or its evaluation of no liability will not excuse Provider's duty to defend and indemnify the
Department within seven days after certified mail or courier delivery notice from the Department. Only adjudication or judgment
after highest appeal is exhausted specifically finding Provider not liable will excuse performance of this provision. Provider will
pay all costs and fees related to this obligation and its enforcement by the Department. The Department's failure to notify
Provider of a claim will not release Provider of the above duty to defend. NOTE: This section, I.E, Indemnification, is not
applicable to contracts executed between state agencies or subdivisions, as defined in section 768.28, Florida Statutes.
F. Insurance: To provide adequate liability insurance coverage on a comprehensive basis and to hold such liability insurance at all times
during the existence of this contract and any renewal(s) and extension(s) of it. Upon execution of this contract, unless it is a state agency
or subdivision as defined in section 768.28, Florida Statutes, Provider accepts full responsibility for identifying and determining the
type(s) and extent of liability insurance necessary to provide reasonable financial protections for Provider and the clients to be served
under this contract. The limits of coverage under each policy maintained by Provider do not limit Provider's liability and obligations
under this contract. Upon the execution of this contract, Provider must furnish the Department written verification supporting both the
determination and existence of such insurance coverage. Such coverage may be provided by a self-insurance program established and
operating under the laws of the state of Florida. The Department reserves the right to require additional insurance as specified in
Attachment I.
G. Safeguarding Information: Not to use or disclose any information conceming a recipient of services under this contract for any
purpose not in conformity with state and federal law except upon written consent of the recipient, or the responsible parent or guardian
when authorized by law.
H. Assignments and Subcontracts
1. To neither assign the responsibility of this contract to another party nor subcontract for any of the work contemplated under this
contract without prior written approval of the Department, which will not be unreasonably withheld. Any sub -license,
assignment, or transfer otherwise occurring will be null and void. In the event the use of subcontracts is allowed, Provider will
remain responsible for all work performed and all expenses incurred in connection with the contract. In addition, this contract will bind
the successors, assigns, and legal representatives of Provider and of any legal entity that succeeds to the obligations of the Department.
2. Provider will be responsible for all work performed and all expenses incurred for this contract. If the Department permits
Provider to subcontract all or part of the work contemplated under this contract, including entering into subcontracts with vendors
for services or commodities, the Department will not be liable to the subcontractor for any expenses or liabilities incurred under
the subcontract and Provider will be solely liable to the subcontractor for all expenses and liabilities incurred under the
subcontract. If the Department permits Provider to subcontract, such permission will be indicated in Attachment I.
3. The Department will at all times be entitled to assign or transfer, in whole or part, its rights, duties, or obligations under this contract to
another governmental agency in the state of Florida, upon prior written notice to Provider.
4. Unless otherwise stated in the contract between Provider and subcontractor, payments made by Provider to the subcontractor must be
within seven working days after receipt of full or partial payments from the Department in accordance with section 287.0585, Florida
Statutes. Failure to pay within seven working days will result in a penalty charged against Provider to be paid by Provider to the
subcontractor in the amount of one-half of one percent of the amount due per day from the expiration of the period allowed herein for
payment. The penalty will be in addition to actual payments owed and will not exceed 15 percent of the outstanding balance due.
I. Return of Funds: Return to the Department any overpayments due to unearned funds or funds disallowed and any interest attributable
to such funds pursuant to the terms of this contract that were paid to Provider by the Department. In the event that Provider or its
Form Revised 11/16
3
Contract # CO11S2
DocuSign Envelope ID: 1CBOBB08-6DFE-472A-8730-5C01E87FC4AC
independent auditor discovers that overpayment has been made, Provider will repay the overpayment within 40 calendar days without
prior notification from the Department. In the event that the Department first discovers an overpayment has been made, the Department
will notify Provider in writing of such a finding. Should repayment not be made in the time specified by the Department, Provider will
pay interest of one percent per month compounded on the outstanding balance after 40 calendar days after the date of notification or
discovery.
J. Transportation Disadvantaged: If clients are to be transported under this contract, Provider must comply with the provisions of
Chapter 427, Florida Statutes, and Florida Administrative Code Chapter 41-2. Provider must submit the reports required pursuant to the
Department's Internal Operating Procedure (IOP) 56-58-15, Transportation Disadvantaged Procedure.
K. Purchasing
1. Prison Rehabilitative Industries and Diversified Enterprises, Inc. (PRIDE): It is expressly understood and agreed that any articles
which are the subject of, or required to carry out, this contract shall be purchased from the corporation identified under
Chapter 946, Florida Statutes, in the same manner and under the same procedures set forth in section 946.515(2) and (4),
Florida Statutes; and for purposes of this contract the person, firm, or other business entity carrying out the provisions of this
contract (Provider) shall be deemed to be substituted for this agency (the Department) insofar as dealings with such
corporation are concerned This clause is not applicable to subcontractors unless otherwise required by law. An abbreviated list of
products and services available from PRIDE may be obtained by contacting PRIDE at 1-800-643-8459.
2. Procurement of Materials with Recycled Content: Any products or materials which are the subject of, or are required to carry out this
contract will be procured in accordance with the provisions of sections 287.045 and 403.7065, Florida Statutes.
3. MyFloridaMarketPlace Vendor Registialion: Each vendor doing business with the state of Florida for the sale of commodities or
contractual services as defined in section 287.012, Florida Statutes, must register in the MyFloridaMarketPlace system, unless
exempted under Florida Administrative Code Rule 60A-1.030(3).
4. MyFloridaMarketPlace Transaction Fee:
a. The state of Florida, through the Department of Management Services, has instituted MyFloridaMarketPlace, a statewide
procurement system. Pursuant to section 287.057(22), Florida Statutes, all payments will be assessed a Transaction Fee of one
percent, which Provider will pay to the State.
b. For payments within the State accounting system (FLAIR or its successor), the Transaction Fee will, when possible, be
automatically deducted from payments to the vendor. If automatic deduction is not possible, Provider will pay the Transaction Fee
pursuant to Florida Administrative Code Rule 60A-1.031(2). By submission of these reports and corresponding payments, vendor
certifies their correctness. All such reports and payments will be subject to audit by the State or its designee.
c. Vendor will receive a credit for any Transaction Fee paid by Vendor for the purchase of any item, if such item is returned to
Vendor through no fault, act, or omission of Vendor. Notwithstanding the foregoing, a Transaction Fee is non-refundable when an
item is rejected or returned, or declined, due to the vendor's failure to perform or comply with specifications or requirements of
this contract. Failure to comply with these requirements will constitute grounds for declaring the vendor in default and recovering
reprocurement costs from the vendor in addition to all outstanding fees. Providers delinquent in paying transaction fees may be
excluded from conducting future business with the State.
L. Civil Rights Requirements: Civil Rights Certification: Provider must comply with applicable provisions of the Department's
publication titled, "Methods of Administration, Equal Opportunity in Service Delivery."
M. Independent Capacity of the Provider
1. Provider is an independent contractor and is solely liable for the performance of all tasks and deliverables contemplated by this
contract.
2. Except where Provider is a state agency, Provider, its officers, agents, employees, subcontractors, or assignees, in performance of
this contract, will act in the capacity of an independent contractor and not as an officer, employee, or agent of the state of Florida.
Provider will not represent to others that it has the authority to bind the Department unless specifically authorized to do so.
3. Except where Provider is a state agency, Provider, its officers, agents, employees, subcontractors, or assignees are not entitled to state
retirement or state leave benefits, or to any other compensation of state employment as a result of performing the duties and obligations
of this contract.
4. Provider agrees to take such actions as may be necessary to ensure that each subcontractor of Provider understand they are
independent contractor and will not be considered or permitted to be an agent, servant, joint venturer, or partner of the state of
Florida.
5. Unless justified by Provider and agreed to by the Department in Attachment 1, the Department will not furnish services of support
(e.g., office space, office supplies, telephone service, secretarial, or clerical support) to Provider, or its subcontractor or assignee.
6. All deductions for social security, withholding taxes, income taxes, contributions to unemployment compensation funds, and all
necessary insurance for Provider, Provider's officers, employees, agents, subcontractors, or assignees will be the responsibility of
Provider.
N. Sponsorship: As required by section 286.25, Florida Statutes, if Provider is a non-governmental organization which sponsors a
program financed wholly or in part by state funds, including any funds obtained through this contract, it will, in publicizing, advertising,
or describing the sponsorship of the program, state: "Sponsored by (Provider's name) and the State of Florida, Department of Health."
If the sponsorship reference is in written material, the words "State of Florida, Department of Health" will appear in at least the same
size letters or type as Provider's name.
Form Revised 11/16
4
Contract # COHS2
DocuSign Envelope ID: 1CBOBB08-6DFE-472A-8730-5C01E87FC4AC
O. Final Invoice: To submit the final invoice for payment to the Department no more than 45 days after the contract ends or is
terminated. If Provider fails to do so, all right to payment is forfeited and the Department will not honor any requests submitted after the
aforesaid time period. Any payment due under the terms of this contract may be withheld until all deliverables and any necessary
adjustments have been approved by the Department.
P. Use of Funds for Lobbying Prohibited: Comply with the provisions of sections 11.062 and 216.347, Florida Statutes, which prohibit the
expenditure of contract funds for the purpose of lobbying the Legislature, judicial branch, or a state agency.
Q. Public Entity Crime and Discriminatory Vendor
1. Pursuant to section 287.133, Florida Statutes, the following restrictions are placed on the ability of persons convicted of public entity
crimes to transact business with the Department: When a person or affiliate has been placed on the convicted vendor list following a
conviction for a public entity crime, he or she may not submit a bid on a contract to provide any goods or services to a public entity,
may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not
submit bids on leases of real property to a public entity, may not be awarded or perform work as a contractor, supplier,
subcontractor, or consultant under a contract with any public entity, and may not transact business with any public entity in excess
of the threshold amount provided in section 287.017, Florida Statutes, for CATEGORY TWO for a period of 36 months from the
date of being placed on the convicted vendor list.
2. Pursuant to section 287.134, Florida Statutes, the following restrictions are placed on the ability of persons convicted of
discrimination to transact business with the Department: When a person or affiliate has been placed on the discriminatory vendor
list following a conviction for discrimination, he or she may not submit a bid on a contract to provide any goods or services to a
public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public
work, may not submit bids on leases of real property to a public entity, may not be awarded or perform work as a contractor,
supplier, subcontractor, or consultant under a contract with any public entity, and may not transact business with any public entity in
excess of the threshold amount provided in section 287.017, Florida Statutes, for CATEGORY TWO for a period of 36 months
from the date of being placed on the discriminatory vendor list.
R. Patents, Copyrights, and Royalties
1. Any inventions or discoveries developed in the course of or as a result of services performed under this contract which are
patentable pursuant to 35 U.S.C. section 101, are the sole property of the state of Florida. Provider must inform the Department of
any inventions or discoveries developed in connection with this contract, and will be referred to the Department of State for a
determination on whether patent protection will be sought for the invention or discovery. The state of Florida will be the sole owner
of all patents resulting from any invention or discovery made in connection with this contract.
2. Provider must notify the Department of State of any books, manuals, films, or other copyrightable works developed in connection
with this contract. Any and all copyrights accruing under or in connection with the performance under this contract are the sole
property of the state of Florida.
3. Provider, without exception, will indemnify and save harmless the state of Florida and its employees from Liability of any nature or
kind, including cost and expenses for or on account of any copyrighted, patented, or unpatented invention, process, or article
manufactured by Provider. Provider has no liability when such claim is solely and exclusively due to the Department of State's
alteration of the article. The state of Florida will provide prompt written notification of claim of copyright or patent infringement.
Further, if such claim is made or is pending, Provider may, at its option and expense, procure for the Department of State, the right
to continue use of, replace, or modify the article to render it non -infringing. If Provider uses any design, device, or materials
covered by letters, patent, or copyright, it is mutually agreed and understood without exception that the bid prices will include all
royalties or cost arising from the use of such design, device, or materials in any way involved in the work.
S. Construction or Renovation of Facilities Using State Funds: Any state funds provided for the purchase of or improvements to real
property are contingent upon Provider granting to the state a security interest in the property at least to the amount of the state funds
provided for at least five years from the date of purchase or the completion of the improvements or as further required by law. As a
condition of a receipt of state funding for this purpose, Provider agrees that, if it disposes of the property before the state's interest is
vacated, Provider will refund the proportionate share of the state's initial investment, as adjusted by depreciation or appreciation.
T. Electronic Fund Transfer: Provider agrees to enroll in Electronic Fund Transfer (EFT) provided by DFS. Questions should be
directed to DFS's EFT Section at (850) 410-9466. The previous sentence is for notice purposes only. Copies of the authorization form
and sample bank letter are available from DFS.
U. Information Security: Maintain confidentiality of all data, files, and records including client records related to the services provided
pursuant to this contract and will comply with state and federal laws, including, but not limited to, sections 381.004, 384.29, 392.65, and
456.057, Florida Statutes.
V. Venue: Venue for any legal actions arising from this contract will be in Leon County, Florida, unless the contract is entered into on by
one of the Department's county health department, in which case, venue for any legal actions will be the pertinent county.
II. METHOD OF PAYMENT
A. Contract Amount: The Department agrees to pay Provider for completion of the deliverables as specified in Attachment I, in an
amount not to exceed $155,000.00 , subject to the availability of funds. The state of Florida's performance and obligation to pay under
this contract is contingent upon an annual appropriation by the Legislature. The costs of services paid under any other contract or from
any other source are not eligible for reimbursement under this contract.
Form Revised 11/16
5
Contract # COHS2
DocuSign Envelope ID: 1 CBOBB08-6DFE-472A-8730-5C01 E87FC4AC
B. Contract Payment:
1. Provider must submit bills for fees or other compensation for services or expenses in sufficient detail for a proper pre -audit and
post -audit thereof.
2. Where reimbursement of travel expenses are allowable as specified in Attachment I, bills for any travel expenses must be submitted in
accordance with section 112.061, Florida Statutes. The Department may, if specified in Attachment I, establish rates lower than the
maximum provided in section 112.061, Florida Statutes.
3. Pursuant to section 215.422, Florida Statutes, the Department has five working days to inspect and approve goods and services, unless
this contract specifies otherwise. With the exception of payments to health care providers for hospital, medical, or other health care
services, if payment is not available within 40 days, measured from the latter of the date the
invoice is received or the goods or services are received, inspected and approved, a separate interest penalty set by the State of Florida's
Chief Financial Officer pursuant to section 55.03, Florida Statutes, will be due and payable in addition to the invoice amount. To obtain
the applicable interest rate, contact the Department's fiscal office or contract administrator. Payments to health care providers for
hospitals, medical, or other health care services, will be made not more than 35 days from the date eligibility for payment is determined,
at the daily interest rate of 0.03333 percent. Invoices returned to Provider due to preparation errors will result in a payment delay.
Interest penalties less than one dollar will not be enforced unless Provider requests payment. Invoice payment requirements do not start
until a properly completed invoice is provided to the Department.
C. Vendor Ombudsman: A Vendor Ombudsman has been established within DFS whose duties include acting as an advocate for
providers who may be experiencing problems in obtaining timely payment from a state agency. The Vendor Ombudsman may be
contacted at (850) 413-5516 or by calling the DFS Consumer Hotline at 1-(800)-342-2762.
Ill. PROVIDER CONTRACT TERM
A. Effective and Ending Dates: This contract will begin on 2/15/2018 or on the date on which the contract has been signed by both
parties, whichever is later. It will end on 6/30/2019 .
B. Termination
1. Termination at Will: This contract may be terminated by either party upon no less than 30 calendar days' written notice to the other
party, without cause, unless a lesser time is mutually agreed upon in writing by both parties. The notice must be delivered by certified
mail, return receipt requested, or in person with proof of delivery.
2. Termination Because of Lack of Funds: In the event funds to finance this contract become unavailable, the Department may terminate
the contract upon no less than 24 hours' written notice to Provider. The notice must be delivered by certified mail, return receipt
requested, or in person with proof of delivery. The Department will be the final authority as to the availability and adequacy of funds.
3. Termination for Breach: This contract may be terminated for non-performance upon no less than 24 hours' written notice to Provider. If
applicable, the Department will employ the default provisions in Florida Administrative Code Rule 60A-1.006(3). Waiver of breach of
any provisions of this contract will not be deemed to be a waiver of any other breach and will not be construed to be a modification of
the terms of this contract. The provisions herein do not limit the Department's right to remedies at law or in equity.
4. In the event this contract is terminated, Provider will be compensated for any deliverables completed prior to the Department's
notification to Provider of contract termination.
C. Renegotiation or Modification: Modifications of provisions of this contract will only be valid when they have been reduced to writing
and duly signed by both parties. The rate of payment and dollar amount may be adjusted retroactively to reflect price level increases and
changes in the rate of payment when these have been established through the appropriations process and subsequently identified in the
Department's operating budget.
D. Contract Representatives Contact Information:
1. The name, mailing address, and telephone number of Provider's 3. The name, address, and telephone number of the
official payee to whom the payment will be made is: Department's Contract Manager is:
City of Clearwater
PO Box 4748
Clearwater, FL 33758-4748
727-562-4744
2. The name of the contact person and street address where Provider's
financial and administrative records are maintained is:
Rosemarie Call
112 S. Osceola Avenue
Clearwater, FL 33756
727-562-4093
Form Revised 11/16
6
Sean Isaac
4052 Bald Cypress Way Bin # A-14
Tallahassee, FL 32399
850-558-9660
4. The name, address, and telephone number of Provider's
representative responsible for administration of the program
under this contract is:
Jeremy Brown
100 S. Myrtle Avenue
Clearwater, FL 33756
727-562-4815
Contract # COHS2
DocuSign Envelope ID: 1CBOBB08-6DFE-472A-8730-5C01E87FC4AC
5. Provide written notice to the other party of any changes in the above contract representative's contact information. Any such changes will
not require a formal amendment to this contract.
E. All Terms and Conditions Included: This contract and its attachments and exhibits as referenced, I, II, III, IV, V, VI contain all the
terms and conditions agreed upon by the parties. There are no provisions, terms, conditions, or obligations other than those contained
herein, and this contract will supersede all previous communications, representations, or agreements, either verbal or written between the
parties. If any term or provision of this contract is found to be illegal or unenforceable, the remainder of the contract will remain in full
force and effect and such term or provision will be stricken.
I have read the above contract and understand each section and paragraph.
IN WITNESS THEREOF, the parties hereto have caused this 24 page contract to be executed by their undersigned, duly authorized,
officials.
PROVIDER: CITY OF CLEARWAT
it<IR
SIGNATURE: W
PRINT/TYPE NAME: WILLIAM B. HORNE 11
TITLE: CIT}; MANAGER
DATE:
STATE AGENCY 29 -DIGIT FLAIR CODE:
FEID# (OR SSN): 596000289
PROVIDER FISCAL YEAR ENDING DATE: 09/30
pproved as to form:
Paul Richard Hull
Assistant City Attorney
STATE OF FLORIDA, DEPARTMENT OF HEALTH
SIGNATURE:
PRINT/TYPE NAME: SHANNON HUGHES
TITLE: DIRECTOR, DIVISION OF COMMUNITY HEALTH
PROMOTION
DATE:
BY SIGNING THIS CONTRACT, THE ABOVE ATTESTS
THERE IS EVIDENCE IN THE CONTRACT FILE
DEMONSTRATING THIS CONTRACT WAS REVIEWED
BY THE DEPARTMENT'S OFFICE OF
THE GENERAL COUNSEL.
Attest:
Rosemarie Call
City Clerk
Form Revised 11/16
7
Contract # COHS2
DocuSign Envelope ID: 1 Cl30BB08-6DFE-472A-8730-5C01 E87FC4AC
DocuSign Envelope ll):1CB0B808-6DFE-472A-8730-5C01E87FC4AG
5. Provide written notice to the other party of any changes in the above contract representative's contact information. Any such changes will
not require a formal anicridinent to this contract.
E. All Terms and Conditions Included:This contract and its attachments and exhibits as referenced AIl�III INI V.VI contain all the
terns and conditions agreed upon by the parties. There are no provisions,terms,conditions,or obligations other than those contained
herein,and this contract will supersede a[.I previous communications,representations,or agreements,either verbal or written between the
hall
parties. If any terns or provision of this contract is found to be illegal or unenforceable,the rernainder of the contractwi remain n
force and effect and such term or provision will be stricken.
I have read the above contract and understand each section and paragraph.
IN WITNrss TIIERF.OF,the parties hereto have caused this -24 page contract to be executed by their undersigned,duly authorized,
officials.
nVV A PTNIENT OF HEALTH
PROVIDER: CITN'0FCLEARNVAT STATE DocuSigne4 by:S
SIGNATU S6* VU
S1qNAT[JRF- -- 4�
Pgl,N,I,//Ti Yjr,i.,N ANNIE,: W-LIA"ANI R.HORNE I PRINT/T', sFscaiaUyssiacAES
TITLE' DIRECTOR,DIVISION OFCOMMUNITY11EAL'I'll
TI nx: CITY NIANACER PROMOTION
DATO/7/2018
DATE: -3 j
Z='A BY SIGNING THIS CONTRACT,THE ABOVE ATTESTS
S,rATF A(;Escy 29-DIGIT FLAIR CODE:__ THERE IS EVIDENCE IN THE CONTRACT FILE
DEMONSTRATING J'HIS CONTRACT WAS REVIEWED
FEID#(OR SSN): 596000299BY THE DEPARF
TMENT'S OFFICE O
PROVIDER FISCAL YEAR ENDING IDATF*� 09/30 THE GENERAL COUNSEL.
p Apr o �Pd�as �to f 0 r W.
Paul Richard Hull
Assistant City Attorney
VIA
yW
NJ
Attest:
ro -14
Rosemarie Call
City Clerk80SW10
7
Forin Revised 11F 16 Contract 4('01 IS2
DocuSign Envelope ID: 1CBOBB08-6DFE-472A-8730-5C01E87FC4AC
ATTACHMENT I
A. Services to be Provided
1. General Description
City of Clearwater
a. General Statement: This contract is for the purchase and installation of water
fluoridation equipment for the provision of increasing access to fluoridated water in
Clearwater, Florida.
b. Authority: Section 381.0052, Florida Statutes.
2. Definition of Term:
a. Cost Estimate: A plan, which lists the estimated invoice price of the equipment or item
that will be purchased. The cost estimate must include the quantity of items that will be
purchased, the name of the item, the type, and size of the item, the manufacturer, and
model number along with the total item price.
b. Project Close Out Report: A report stating that all applicable administrative actions and
required work of the contract have been completed.
c. Quarter: A three-month period of the contract, coinciding with the state's fiscal
year. The quarters are July through September (first quarter), October through
December (second quarter, January through March (third quarter), and April through
June (fourth quarter).
B. Manner of Service Provision
1. Scope of Work: Provider will purchase and install water fluoridation equipment to assist in the
provision of increasing access to fluoridated water and maintaining optimal fluoride
concentration at a consistent level within Clearwater, Florida.
a. Tasks: Provider will perform the following tasks:
1) Complete and submit the cost estimate to the Contract Manager
immediately upon contract execution. Update the cost estimate as
necessary throughout the contract term and submit it to the Contract
Manager within 5 business days of any updates.
2) Purchase and install water fluoridation equipment by June 30, 2019. All
purchases must be in accordance with the approved Cost Estimate. Take
photos of each item purchased and maintain them throughout the
contract term. All purchases and installations must be in accordance with
Rule 62-555.325, Florida Administrative Code.
3) Prepare a Quarterly Progress Report, including documentation clearly
showing the progress, delays, purchases, unit costs, total costs of the
goods or services, number of items purchased, date of delivery or
installation, manufacturer, retailer, serial number and submit it to the
Contract Manager with the quarterly invoice.
8 Contract #COHS2
DocuSign Envelope ID: 1 CBOBB08-6DFE-472A-8730-5001 E87FC4AC
City of Clearwater
4) Complete the Clearwater Fluoridation Project and prepare a Project Close
Out Report. Submit the report to the Contract Manager within 30 days of
project completion but no later than June 30, 2019. The report will
include at a minimum equipment photos, itemized list of equipment
purchased, and the location of the installed water fluoridation system.
The Project Closeout Report will include a list of all equipment costing
$5,000 or more with the following information for each item: description of
item, manufacturer, serial number, quantity purchased, condition of each,
location (the water plant's physical address), purchase cost, date
received.
b. Deliverables: Provider must complete or submit the following deliverables in the time
and manner specified:
1) Purchase and installation of water fluoridation equipment as specified in Tasks
B.1.a.1) through B.1.a.4).
c. Performance Measures: The Deliverables must be met at this minimum level of
performance:
1) Deliverable B.1.b.1):
a) The cost estimate must be completed and submitted as specified.
b) Equipment must be purchased and installed as specified.
c) Quarterly Progress Reports must be submitted as specified.
d) Project Closeout Report must be submitted as specified.
2. Financial Consequences: Failure to complete or submit a deliverable in the time and manner
specified will result in a reduction in payment for that deliverable as follows:
a. Deliverable B.1.b.1):
1) Failure to complete and submit the cost estimate as specified will result in a one
percent reduction in the payment amount.
2) Failure to purchase and install the equipment as specified will result in a twenty
percent reduction in the invoice amount. An additional reduction of one percent
will result in the invoice amount for every five days thereafter the equipment is
not installed.
3) Failure to submit the Quarterly Progress Reports as specified will result in a
reduction of five percent in the invoice amount. An additional reduction of one
percent will result in the invoice amount for every five days thereafter the report is
not submitted.
4) Failure to submit the Project Closeout Report as specified will result in a
reduction of five percent in the invoice amount. An additional reduction of one
percent will result in the invoice amount for every five days thereafter the report is
not submitted.
9 Contract #COHS2
DocuSign Envelope ID: 1CBOBB08-6DFE-472A-8730-5C01E87FC4AC
City of Clearwater
3. Service Location and Equipment:
a. Service Location: The water fluoridation system will be used in Clearwater, Florida and
is located at 1657 Palmetto Street, Clearwater, FL 33755 and 21133 US Hwy 19 N,
Clearwater, FL 33765.
b. Equipment: Provider will be responsible for maintaining all equipment purchased under
this contract.
C. Method of Payment
1. Payment: This is a cost reimbursement contract. The Department will reimburse Provider upon
completion of the deliverable specified in Section B.1.b. and in accordance with the terms and
conditions of the contract a total dollar amount not to exceed $155,000.00, subject to the
availability of funds. Provider may seek reimbursement up to $150,000.00 for the first year of
the contract, ending June 30, 2018, and up to $5,000.00 for the second year of the contract,
ending June 30, 2019.
2. Unit of Service: A unit of service will consist of the completion of the deliverable as specified in
Section B.1.b.
3. Invoice Requirements: Payment must be requested through submission of a properly
completed invoice to the Contract Manager within 30 days from the end of each quarter.
Deliverable must be completed as specified in Section B.1.b. prior to any payments being made.
All appropriate supporting documentation must be included for the invoice to be reviewed and
assessed for payment.
4. Supporting Documentation:
a. Budget: Attach a copy of the Department approved cost estimate and budget justification
for the initial contract year upon contract execution. Each subsequent contract year, the
budget must be submitted to the Contract Manager for approval by August 1. Any
revisions to an approved cost estimate or budget justification must be submitted to the
Contract Manager for review and approval prior to implementation.
b. Expenses: Receipts are required for all expenses incurred for which reimbursement is
sought.
c. Cost Reimbursement Documentation Requirements: Paid invoices or receipts must
support payments made to subcontractors. Receipts and proper documentation are
required for all expenses incurred for which reimbursement is sought.
D. Special Provisions
1. Contract Renewal: This contract may be renewed on a yearly basis for no more than three
years beyond the initial contract or for the term of the original contract, whichever is longer, and
under the same terms and conditions as the original contract. Renewals must be in writing,
made by mutual agreement, and will be contingent upon satisfactory fiscal and programmatic
performance evaluations as determined by the department, and will be subject to the availability
of funds.
10 Contract #COHS2
DocuSign Envelope ID: 1CBOBB08-6DFE-472A-8730-5C01E87FC4AC
City of Clearwater
2. Non -Expendable Property Clause: Non -expendable property is defined as tangible personal
property of a non -consumable nature that has an acquisition cost of $1000 or more per unit and
an expected useful life of at least one year, and hardback -bound books, which are not circulated
to students or the general public, with the value or cost of $250 or more. Hardback books with a
value or cost of $250 or more should be classified as OCO (Other Capital Outlay) expenditures.
All such property purchased under this contract must be listed on the property records of
Provider. Said listing must include a description of the property, model number, manufacturer's
serial number, funding source, information needed to calculate the federal or state share, date
of acquisition, unit cost, property inventory number, and information on the location, use and
condition, transfer, replacement or disposition of the property.
All such property purchased under this contract must be inventoried annually and an inventory
report must be submitted to the Department along with the final expenditure report. A report of
non -expendable property must be submitted to the Department along with the expenditure
report for the period in which it was purchased. Unless otherwise determined by the
Department, title (ownership) to all non -expendable property acquired with funds from the
contract will be vested in the Department upon completion or termination of the contract. At no
time will Provider dispose of non -expendable property purchased under this contract except with
the permission of the Department in accordance with their instructions.
3. Use: Equipment purchased under this contract must be used for the services indicated in this
contract throughout the useful life of the water fluoridation system. The water fluoridation
system must not be sold without the Department's prior written approval. This provision
remains effective after the end date of the contract.
END OF TEXT
11 Contract #COHS2
DocuSign Envelope ID: 1CBOBB08-6DFE-472A-8730-5C01E87FC4AC
City of Clearwater
ATTACHMENT II
FINANCIAL AND COMPLIANCE ATTACHMENT
The administration of resources awarded by the Department of Health to Provider may be federal or state financial
assistance as defined by 2 C.F.R. § 200.40 and/or section 215.97, Florida Statutes, and subject to audits and/or
monitoring by the Department of Health, as described in this section. For this contract, the Department of Health has
determined the following relationship exist:
1. Vendor. Funds used for goods and services for the Department of Health's own use and creates a
procurement relationship with Provider which is not subject to compliance requirements of the FederalState
program as a result of the contract.
2. X RecipientlSubrecipient of state financial assistance. Funds may be expended only for allowable
costs resulting from obligations incurred during the specified contract period. In addition, any balance of
unobligated funds which has been advanced or paid must be refunded to the state agency. As well as funds paid
in excess of the amount to which the recipient/subrecipient is entitled under the terms and conditions of the
contract must be refunded to the state agency.
3. X Recipient/Subrecipient of federal financial assistance. Funds paid in excess of the amount to which
the recipient/subrecipient is entitled under the terms and conditions of the contract must be refunded to the state
agency. In addition, the recipient/subrecipient may not earn or keep any profit resulting from Federal financial
assistance, unless explicitly authorized by the terms and conditions of the Federal award.
MONITORING
In addition to reviews of audits conducted in accordance with 2 C.F.R. Part 200, subpart F (formerly OMB A-133) and
section 215.97, Florida Statutes, monitoring procedures may include, but not be limited to, on-site visits by
Department of Health staff, limited scope audits, and/or other procedures. By entering into this contract, Provider
agrees to comply and cooperate with any monitoring procedures/processes deemed appropriate by the Department
of Health. In the event the Department of Health determines that a limited scope audit of Provider is appropriate,
Provider agrees to comply with any additional instructions provided by the Department of Health to Provider
regarding such audit. Provider further agrees to comply and cooperate with any inspections, reviews, investigations,
or audits deemed necessary by the Chief Financial Officer (CFO) or Auditor General.
AUDITS
PART l: FEDERALLY FUNDED
This part is applicable if Provider is a State or local government or a non-profit organization as defined in 2 C.F.R.
Part 200, subpart F.
1. In the event that Provider expends $750,000 or more in Federal awards during its fiscal year, Provider must
have a single or program -specific audit conducted in accordance with the provisions of 2 C.F.R. § 200.501.
EXHIBIT 1 to this contract indicates Federal resources awarded through the Department of Health by this
contract. In determining the Federal awards expended in its fiscal year, Provider shall consider all sources of
Federal awards, including Federal resources received from the Department of Health. The determination of
amounts of Federal awards expended should be in accordance with the guidelines established by 2 C.F.R.
§§ 200.502-.503. An audit of Provider conducted by the Auditor General in accordance with the provisions of
2 C.F.R., subpart F will meet the requirements of this part.
2. In connection with the audit requirements addressed in Part I, paragraph 1, Provider shall fulfill the
requirements relative to auditee responsibilities as provided in 2 C.F.R. §§ 200.508-.512.
3. If Provider expends less than $750,000 in Federal awards in its fiscal year, an audit conducted in
accordance with the provisions of 2 C.F.R. § 200.501(d) is not required. In the event that Provider expends
less than $750,000 in Federal awards in its fiscal year and elects to have an audit conducted in accordance
12
Revised -01-26-2017 Contract #:COHS2
DocuSign Envelope ID: 1CBOBB08-6DFE-472A-8730-5C01E87FC4AC
City of Clearwater
with the provisions of 2 C.F.R. § 200.506, the cost of the audit must be paid from non -Federal resources (i.e.,
the cost of such audit must be paid from Provider resources obtained from other than Federal entities.)
4. An audit conducted in accordance with this part shall cover the entire organization for the organization's
fiscal year. Compliance findings related to contracts with the Department of Health shall be based on the
contract's requirements, including any rules, regulations, or statutes referenced in the contract. The financial
statements shall disclose whether or not the matching requirement was met for each applicable contract. All
questioned costs and liabilities due to the Department of Health shall be fully disclosed in the audit report
with reference to the Department of Health contract involved. If not otherwise disclosed as required by 2
C.F.R. § 200.510, the schedule of expenditures of Federal awards shall identify expenditures by funding
source and contract number for each contract with the Department of Health in effect during the audit period.
Financial reporting packages required under this part must be submitted within the earlier of 30 days after
receipt of the audit report or 9 months after the end of Provider's fiscal year end.
PART 11: STATE FUNDED
This part is applicable if Provider is a nonstate entity as defined by section 215.97(1)(n), Florida Statutes.
1. In the event that Provider expends a total amount of state financial assistance equal to or in excess of
$750,000 in any fiscal year of such Provider (for fiscal years ending June 30, 2017 or thereafter), Provider
must have a State single or project -specific audit for such fiscal year in accordance with section 215.97,
Florida Statutes; applicable rules of the Department of Financial Services; Chapter 10.550 (local
governmental entities) or Chapter 10.650 (nonprofit and for-profit organizations), Rules of the Auditor
General. EXHIBIT I to this contract indicates state financial assistance awarded through the Department of
Health by this contract. In determining the state financial assistance expended in its fiscal year, Provider
shall consider all sources of state financial assistance, including state financial assistance received from the
Department of Health, other state agencies, and other nonstate entities. State financial assistance does not
include Federal direct or pass-through awards and resources received by a nonstate entity for Federal
program matching requirements.
2. In connection with the audit requirements addressed in Part 11, paragraph 1, Provider shall ensure that the
audit complies with the requirements of section 215.97(8), Florida Statutes. This includes submission of a
financial reporting package as defined by section 215.97(2), Florida Statutes, and Chapter 10.550 (local
governmental entities) or Chapter 10.650 (nonprofit and for-profit organizations), Rules of the Auditor
General.
3. If Provider expends less than $750,000 in state financial assistance in its fiscal year (for fiscal years ending
June 30, 2017 or thereafter), an audit conducted in accordance with the provisions of section 215.97, Florida
Statutes, is not required. In the event that Provider expends less than $750,000 in state financial assistance
in its fiscal year and elects to have an audit conducted in accordance with the provisions of section 215.97,
Florida Statutes, the cost of the audit must be paid from the nonstate entity's resources (i.e., the cost of such
an audit must be paid from Provider resources obtained from other than State entities).
4. An audit conducted in accordance with this part shall cover the entire organization for the organization's
fiscal year. Compliance findings related to contracts with the Department of Health shall be based on the
contract's requirements, including any applicable rules, regulations, or statutes. The financial statements
shall disclose whether or not the matching requirement was met for each applicable contract. All questioned
costs and liabilities due to the Department of Health shall be fully disclosed in the audit report with reference
to the Department of Health contract involved. If not otherwise disclosed as required by Florida
Administrative Code Rule 691-5.003, the schedule of expenditures of state financial assistance shall identify
expenditures by contract number for each contract with the Department of Health in effect during the audit
period. Financial reporting packages required under this part must be submitted within 45 days after delivery
of the audit report, but no later than 9 months after Provider's fiscal year end for local governmental entities.
Non-profit or for-profit organizations are required to be submitted within 45 days after delivery of the audit
report, but no later than 9 months after Provider's fiscal year end. Notwithstanding the applicability of this
portion, the Department of Health retains all right and obligation to monitor and oversee the performance of
this contract as outlined throughout this document and pursuant to law.
13
Revised -01-26-2017 Contract #:COHS2
DocuSign Envelope ID: 1CBOBB08-6DFE-472A-8730-5C01E87FC4AC
City of Clearwater
PART III: REPORT SUBMISSION
1. Copies of reporting packages for audits conducted in accordance with 2 C.F.R. § 200.512 and section
215.97(2), Florida Statutes, will be submitted by or on behalf of Provider directly to each of the following:
A. The Department of Health as follows:
SingleAuditsna.fihealth.gov
Pursuant to 2 C.F.R. § 200.521, and section 215.97(2), Florida Statutes, Provider shall submit an
electronic copy of the reporting package and any management letter issued by the auditor to the
Department of Health.
Audits must be submitted in accordance with the instructions set forth in Exhibit 3 hereto, and
accompanied by the Single Audit Data Collection Form, Exhibit 4. Files which exceed electronic
email capacity may be submitted on a CD or other electronic storage medium and mailed to:
Florida Department of Health
Bureau of Finance & Accounting
Attention: Single Audit Review
4052 Bald Cypress Way, Bin B01
Tallahassee, FL 32399-1729.
B. The Federal Audit Clearinghouse (FAC), the Internet Data Entry System (IDES) is the place to submit
the Federal single audit reporting package, including form SF -SAC, for Federal programs. Single audit
submission is required under the Single Audit Act of 1984 (amended in 1996) and 2 C.F.R. § 200.36 and
§ 200.512. The Federal Audit Clearinghouse requires electronic submissions as the only accepted
method for report compliances. FAC's website address is: https://harvester.census.qov/sac/
C. Other Federal agencies and pass-through entities in accordance with 2 C.F.R. §200.331 and § 200.517.
D. Additionally, copies of state financial assistance (CSFA) reporting packages required by Part II of this
contract shall be submitted to the Auditor General's Office (one electronic and one paper copy of the
financial reporting package).
• The electronic copy should be emailed by or on behalf of Provider directly to the Auditor
General's Office at: flaudgen localgovta(�aud.state.fl.us.
• Paper copies mail to:
Auditor General's Office
Claude Pepper Building, Room 401
111 West Madison Street
Tallahassee, Florida 32399-1450
2. Any reports, management letter, or other information required to be submitted to the Department of Health
pursuant to this contract shall be submitted timely in accordance with 2 C.F.R. § 200.512, Florida Statutes,
and Chapter 10.550 (local governmental entities) or Chapter 10.650 (nonprofit and for-profit organizations),
Rules of the Auditor General, as applicable.
3. Providers, when submitting financial reporting packages to the Department of Health for audits done in
accordance with 2 C.F.R. § 500.512 or Chapter 10.550 (local governmental entities) or Chapter 10.650
(nonprofit and for-profit organizations), Rules of the Auditor General, should indicate the date that the
reporting package was delivered to Provider in correspondence accompanying the reporting package.
14
Revised -01-26-2017 Contract #:COHS2
DocuSign Envelope ID: 1CBOBB08-6DFE-472A-8730-5C01E87FC4AC
City of Clearwater
PART IV: RECORD RETENTION
Provider shall retain sufficient records demonstrating its compliance with the terms of this contract for a period of six
years from the date the audit report is issued, and shall allow the Department of Health or its designee, the CFO, or
the Auditor General access to such records upon request. Provider shall ensure that audit working papers are made
available to the Department of Health, or its designee, CFO, or Auditor General upon request for a period of six years
from the date the audit report is issued, unless extended in writing by the Department of Health.
End of Text
15
Revised -01-26-2017
Contract #:COHS2
DocuSign Envelope ID: 1CBOBB08-6DFE-472A-8730-5C01E87FC4AC
EXHIBIT 1
Federal Award Identification #: N/A
City of Clearwater
Department's Federal Award Date: N/A Department's Federal Award Indirect Rate: N/A
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS AGREEMENT CONSIST OF
THE FOLLOWING:
Federal Agency 1 Centers for Disease Control and Prevention CFDA# 93.758 Title Fluoridation Proiect $ 150,000.00
TOTAL FEDERAL AWARDS $ 150.000.00
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT TO THIS
AGREEMENT ARE AS FOLLOWS:
N/A
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS AGREEMENT CONSIST OF THE
FOLLOWING:
State financial assistance subject to section 215.97, Florida Statutes: CSFA# 64.001 Title Fluoridation Project $ 5.000.00
TOTAL STATE FINANCIAL ASSISTANCE AWARDED PURSUANT TO SECTION 215.97, FLORIDA STATUTES
$ 5.000.00
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS AGREEMENT
ARE AS FOLLOWS:
Rule 62-555.325, Florida Administrative Code
Financial assistance not subject to section 215.97, Florida Statutes or 2 C.F.R. § 200.40: $ N/A
Matching and Maintenance of Effort *
Matching resources for federal Agency(s):
Agency: N/A CFDA# N/A Title N/A $ N/A
Maintenance of Effort (MOE):
*Matching Resources, MOE, and Financial Assistance not subject to section 215.97, Florida Statutes or 2 C.F.R. § 200.306
amounts should not be included by Provider when computing the threshold for single audit requirements totals. However, these
amounts could be included under notes in the financial audit or footnoted in the Schedule of Expenditures of Federal Awards and
State Financial Assistance (SEFA). Matching, MOE, and Financial Assistance not subject to section. 215.97, Florida Statutes or 2
C.F.R. § 200.306 is not considered State or Federal Assistance.
16
Revised -01-26-2017 Contract #:COHS2
DocuSign Envelope ID: 1CBOBB08-6DFE-472A-8730-5C01E87FC4AC
EXHIBIT 2
City of Clearwater
PART I: AUDIT RELATIONSHIP DETERMINATION
Providers who receive state or federal resources may or may not be subject to the audit requirements of 2 C.F.R. § 200.500,
and/or section 215.97, Florida Statutes, Providers who are determined to be recipients or subrecipients of federal awards and/or
state financial assistance may be subject to the audit requirements if the audit threshold requirements set forth in Part 1 and/or
Part II of Exhibit 1 is met. Providers who have been determined to be vendors are not subject to the audit requirements of 2
C.F.R. § 200.501, and/or section 215.97, Florida Statutes. Providers who are "higher education entities" as defined in Section
215.97(2)(h), Florida Statutes, and are recipients or subrecipients of state financial assistance, are also exempt from the audit
requirements of Section 215.97(2)(a), Florida Statutes. Regardless of whether the audit requirements are met, providers who have
been determined to be recipients or subrecipients of Federal awards and/or state financial assistance must comply with applicable
programmatic and fiscal compliance requirements.
For the purpose of an audit, the Provider has been determined to be:
Vendor not subject to 2 C.F.R. § 200.501 and/or section 215.97, Florida Statutes
X Recipient/subrecipient subject to 2 C.F.R. § 200.501and/or section 215.97, Florida Statutes
Exempt organization not subject to 2 C.F.R. § 200.501; For Federal awards for-profit subrecipient organizations are
exempt as specified in 2 C.F.R. § 200.501(h).
Exempt organization not subject to section 215.97, Florida Statutes, for state financial assistance projects, public
universities and community colleges. Exempt organizations must comply with all compliance requirements set forth
within the contract.
NOTE: If Provider is determined to be a recipient/subrecipient of federal and or state financial assistance and has been approved
by the department to subcontract, it must comply with section 215.97(7), Florida Statutes, and Florida Administrative Code Rule
691-.5006, [state financial assistance] and 2 C.F.R. § 200.330 [federal awards].
PART II: FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Providers who receive Federal awards, state
maintenance of effort funds, or state matching funds on Federal awards and who are determined to be a subrecipient must comply
with the following fiscal laws, rules and regulations:
1. 2 C.F.R. Part 200- Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards
2. Reference Guide for State Expenditures
3. Other fiscal requirements set forth in program laws, rules, and regulations
*Some Federal programs may be exempted from compliance with the Cost Principles Circulars as noted in the 2 C.F.R. §
200.401(5) (c).
**For funding passed through U.S. Health and Human Services, 45 C.F.R. Part 92; for funding passed through U.S.
Department of Education, 34 C.F.R. Part 80.
STATE FINANCIAL ASSISTANCE. Providers who receive state financial assistance and who are determined to be a
recipient/subrecipient must comply with the following fiscal laws, rules and regulations:
1. Section 215.97, Florida Statutes
2. Florida Administrative Code Chapter 691-5,
3. State Projects Compliance Supplement
4. Reference Guide for State Expenditures
5. Other fiscal requirements set forth in program laws, rules and regulations
Additional guidance may be obtained at Audit Guidance. *Enumeration of laws, rules and regulations herein is not exhaustive or
exclusive. Fund recipients will be held to applicable legal requirements whether or not outlined herein.
End of Text
17
Revised -01-26-2017 Contract #:COHS2
DocuSign Envelope ID: 1 CBOBB08-6DFE-472A-8730-5C01 E87FC4AC
EXHIBIT 3
City of Clearwater
INSTRUCTIONS FOR ELECTRONIC SUBMISSION
OF SINGLE AUDIT REPORTS
Single Audit reporting packages ("SARP") must be submitted to the Department in an electronic format. This change will eliminate
the need to submit multiple copies of the reporting package to the Contract Managers and various sections within the Department
and will result in efficiencies and cost savings to Provider and the Department. Upon receipt, the SARP's will be posted to a
secure server and accessible to Department staff.
The electronic copy of the SARP should:
> Be in a Portable Document Format (PDF).
➢ Include the appropriate letterhead and signatures in the reports and management letters.
Be a single document. However, if the financial audit is issued separately from the Single Audit
reports, the financial audit reporting package may be submitted as a single document and the Single
Audit reports may be submitted as a single document. Documents which exceed 8 megabytes (MB)
may be stored on a CD and mailed to: Bureau of Finance & Accounting, Attention: Single Audit
Review, 4052 Bald Cypress Way, Bin B01 (HAFA), Tallahassee, FL 32399-1729.
➢ Be an exact copy of the final, signed SARP provided by the Independent Audit firm.
> Not have security settings applied to the electronic file.
➢ Be named using the following convention: [fiscal year] [name of the audited entity exactly as stated within the audit
report].pdf. For example, if the SARP is for the 2015-2016 fiscal year for the City of Gainesville, the document should be
entitled 2010 City of Gainesville.pdf.
> Be accompanied by the attached "Single Audit Data Collection Form." This document is necessary to ensure that
communications related to SARP issues are directed to the appropriate individual(s) and that compliance with Single
Audit requirements is properly captured.
Questions regarding electronic submissions may be submitted via e-mail to SingleAudits( flhealth.gov or by telephone to
the Single Audit Review Section at (850) 245-4185.
18
Revised -01-26-2017 Contract #:COHS2
DocuSign Envelope ID: 1CBOBB08-6DFE-472A-8730-5C01E87FC4AC
Single Audit Data Collection Form
GENERAL INFORMATION
1. Fiscal period ending date for the Single Audit.
2. Auditee Identification Number
a. Primary Employer Identification Number (EIN)
Month Day Year
/ /
b. Are multiple EINS covered in this report fYes No
c. If "yes", complete No. 3.
3. ADDITIONAL ENTITIES COVERED IN THIS REPORT
Employer Identification # Name of Entity
4 AUDITEE INFORMATON
5. PRIMARY AUDITOR INFORMATION
a. Primary auditor name:
a. Auditee name:
b. Primary auditor address (number and street)
b. Auditee address (number and street)
City
City
State Zip Code
State Zip Code
c. Auditee contact
Name:
c. Primary auditor contact
Name:
Title:
Title:
d. Auditee contact telephone
( ) -
d. Primary auditor contact telephone
( ) -
e. Auditee contact FAX
( ) -
e. Primary auditor E-mail
( ) -
f. Auditee contact E-mail
f. Audit Firm License Number
6. AUDITEE CERTIFICATION STATEMENT—This is to certify that, to the best of
my knowledge and belief, the auditee has: (1) engaged an auditor to perform
an audit in accordance with the provisions of 2 C.F.R. § 200.512 and/or section
215.97, Florida Statutes, for the period described in Item 1; (2) the auditor has
completed such audit and presented a signed audit report which states that the
audit was conducted in accordance with the aforementioned Circular and/or
Statute; (3) the attached audit is a true and accurate copy of the final audit
report issued by the auditor for the period described in Item 1; and (4) the
information included in this data collection form is accurate and complete. I
declare the foregoing is true and correct.
AUDITEE CERTIFICATION Date /____/
Date Audit Received From Auditor: / /
Name of Certifying Official:
(Please print clearly)
Title of Certifying Official:
(Please print clearly)
Signature of Certifying Official:
EXHIBIT 4
19
Revised -01-26-2017
Contract #:COHS2
CERTIFICATION REGARDING LOBBYING Attachment III
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND COOPERATIVE AGREEMENTS
Contract # COHS2
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or an
employee of any agency, a member of Congress, an officer or employee of Congress, or
an employee of a member of Congress in the connection with the awarding of any federal
contract, the making of any federal grant, the making of any federal loan, the entering into
of any cooperative agreement, and the extension, continuation, renewal, amendment or
modification of any federal contract, grant, loan or cooperative agreement.
(2) If any funds other than federal appropriated funds have been paid or will be paid, to any
person for influencing or attempting to influence an officer or an employee of any agency, a
member of Congress, an officer or employee of Congress, or an employee of a member of
Congress in the connection with this federal contract, grant, loan or cooperative agreement,
the undersigned shall complete and submit Standard Form -LLL, "Disclosure of Lobbying
Activities'; in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the
award documents for all sub -awards at all tiers (including subcontracts, sub -grants and
contracts under grants, loans and cooperative agreements) and that all sub -recipients shall
certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for
making or entering into this transaction imposed by 31 U.S.C. §1352 (1996). Any person who
fails to file the required certification shall be subject to a civil penalty of not Tess than $10,000
and not more than $100,000 for each such failure.
LI) ALA, 1404,1,(1_)ar
S-- b -- zo 18
Signature Date
William B. Horne II COHS2
Name of Authorized Individual Application or Contract Number
City of Clearwater
Name of Organization
1650 N. Arcturas Ave, Clearwater, FL 33765
Address of Organization
20
DocuSign Envelope ID: 1CBOBB08-6DFE-472A-8730-5C01E87FC4AC
City of Clearwater
Attachment IV
Data Security and Confidentiality
1. Data Security and Confidentiality:
a. Provider, its employees, subcontractors, and agents will comply with all security
procedures of the Department in performance of this contract. Provider will provide
immediate notice to the Department's Information Security Manager (ISM), or their
designee, in the event it becomes aware of any security breach and any
unauthorized transmission of State Data as described below or of any allegation
or suspected violation of security procedures of the Department. Except as
required by law or legal process and after notice to the Department, Provider will
not divulge to third parties any confidential information obtained by Provider or its
agents, distributors, resellers, subcontractors, officers or employees in the course
of performing contract work, including, but not limited to, Florida Administrative
Code Chapter 74-2, security procedures, business operations information, or
commercial proprietary information in the possession of the state or the
Department. At the request of the Department the Provider will obtain a current
American Institute of Certified Public Accountants (AICPA) "Standards for
Attestation Engagements no. 16" (SSAE 16). The Department may review the
Provider's SSAE 16 in lieu of the Department conducting a test.
b. Loss of Data: In the event of loss of any State Data or record(s) where such loss
is due to the negligence of Provider or any of its subcontractors or agents, Provider
will be responsible for recreating such lost data in the manner and on the schedule
set by the Department at Provider's sole expense, in addition to any other
damages the Department may be entitled to by law or the Contract. Failure to
maintain security that results in certain data release will subject Provider to
administrative sanctions for failure to comply with section 501.171, Florida
Statutes, together with any costs to the Department of such breach of security
caused by Provider. If State Data will reside in Provider's system, the Department
may conduct, or request Provider conduct at Provider's expense, annual network
penetration test, or security audit of Provider systems on which State Data resides.
Provider will:
1) Copies: At contract termination or expiration --submit copies of all finished
or unfinished documents, data, studies, correspondence, reports and other
products prepared by or for the Contractor under the Contract; submit
copies of all State Data to the Department in a format to be designated by
the Department in accordance with section 119.0701, Florida Statutes,;
shred or erase parts of any retained duplicates containing personal
information of all copies to make any personal information unreadable.
2) Originals: At contract termination or expiration --retain its original records,
and maintain, in confidence to the extent required by law, Provider's
original records in unredacted form, until the records retention schedule
expires and to reasonably protect such documents and data during any
pending investigation or audit;
CONTRACT #: COHS2
21
DocuSign Envelope ID: 1CBOBB08-6DFE-472A-8730-5C01E87FC4AC
City of Clearwater
3) Both Copies and Originals: Upon expiration of all retention schedules and
audits or investigations and upon notice to the Department, destroy all
State Data from Provider's systems including, but not limited to, electronic
data and documents containing personal information or other data that is
confidential and exempt under Florida public records law.
c. Data Protection: No State Data or information will be stored in, processed in, or
shipped to offshore locations or outside of the United States of America, regardless
of method, except as required by law. Access to State Data will only be available
to approved and authorized staff, including offshore Provider personnel, that have
a legitimate business need. Requests for offshore access will be submitted in
accordance with the Department established processes and will only be allowed
with express written approval from the Deputy Secretary of Administration. Third
parties may be granted time-limited terminal service access to IT resources as
necessary for fulfillment of related responsibilities with prior written approval by the
ISM. Third parties will not be granted remote access via VPN, private line, or
firewall holes, without an approved exemption. Requests for exceptions to this
provision must be submitted to the ISM for approval. When remote access needs
to be changed, the ISM will be promptly notified. Provider will abide by all
Department and State data encryption standards regarding the transmission of
confidential or confidential and exempt information. Offshore data access must be
provided via a trusted method such as SSL, TLS, SSH, VPN, lPSec or a
comparable protocol approved by the ISM. Confidential information must be
encrypted using an approved encryption technology when transmitted outside of
the network or over a medium not entirely owned or managed by the Department.
Provider agrees to protect, indemnify, defend, and hold harmless the Department
and State from and against any and all costs, claims, demands, damages, losses
and liabilities arising from or in any way related to Provider's breach of data security
or the negligent acts or omissions of Provider related to this subsection.
d. All employees, subcontractors, or agents performing work under the contract must
comply with all security and administrative requirements of the Department.
Provider will not divulge to third parties any confidential information obtained by
Provider or its agents, distributors, resellers, subcontractors, officers or employees
in the course of performing Contract work, including, but not limited to, security
procedures, business operations information, or commercial proprietary
information in the possession of the state or the Department.
2. Notice Requirement: Provider will notify the Department upon detection of anomalous or
malicious traffic within the scope of contracted services. To the extent applicable, failure
to notify the Department of events or incidents that result in breach will subject Provider
to administrative sanctions, together with any costs to the Department of such breach of
security.
CONTRACT #: COHS2
22
DocuSign Envelope ID: 1CBOBB08-6DFE-472A-8730-5C01E87FC4AC
Attachment V - INVOICE
City of Clearwater CONTRACT #: COHS2
CONTRACT TITLE:.
CITY OF CLEARWATER FLUORIDATION UPGRADE
PERIOD COVERED BY THIS INVOICE:
FROM:
TO:
INVOICE NUMSt_
COHS2-Q
FEID
596000289
QUANTITY
2
COST ESTIMATE
PAID AMOUNT
YEAR TO DATE
BALANCE
INVOICE #
INVOICE
DATE
PAYMENT
DATE
43,000.00
$ 43,000.00
2
2
2
2
2
5,000.00
$ 5,000.00
25,000.00
$ 25,000.00
1,200.00
$ 1,200.00
16,000.00
$ 16,000.00
4,000.00
$ 4,000.00
otal
94,200.00
$ 94,200.00
4,000.00
'111111E1111111Allik!'
$ 4,000.00
4,000.00
$ 4,000.00
48,000.00
$ 48,000.00
4,800.00
$ 4,800.00
otal
gankffikikkkkdin
otal
$ 60,800.00
$ 60,800.00
EMINter
155,000.00
$ 155,000.00
TOTAL PRICE
AMOUNT
CHARGED TO
CONTRACT
DocuSign Envelope ID: 1CBOBB08-6DFE-472A-8730-5C01E87FC4AC
BUDGET NARRATIVE
Attachment VI
Provider Name:
City of Clearwater
CONTRACT
AMOUNT:
$155,000.00
Start Date:
2/15/2018
END Date:
6/30/2019
This contract is limited to direct expenses. These costs are limited to equipment and installation costs for a
fluoridation s stem.
ITEMIZED DIRECT EXPENSES
EQUIPMENT
Fluoridation E • ui • ment
Meterin• Pum./Skid
Transfer Pump
Fluoride Bulk Tank
Da Tank
Air Scrubber
Ma. netic Level Indicators
Pi•in•
Fittin • s
Sub -Total
Material
Electrical Costs
Containment Coating
Sub -Total
Grand Total
QUANTITY
2
2
2
2
2
2
2
2
MANUFACTURER
ITEM PRICE
$ 43,000.00
$ 5,000.00
$ 25,000.00
$ 1,200.00
$ 16,000.00
$ 4,000.00
$ 4,000.00
$ 4,000.00
$ 102,200.00
$ 48,000.00
$ 4,800.00
$ 52,800.00
$ 155,000.00
CONTRACT #:COH52 24
Ce €ic
Envelope Id: 1 CB0BB086DFE472A87305C01 E87FC4AC
Subject: Contract COHS2: Please DocuSign this contract from the Florida Department of Health
Source Envelope:
Document Pages: 25
Certificate Pages: 5
AutoNav: Enabled
Envelopeld Stamping: Enabled
Time Zone: (UTC -08:00) Pacific Time (US & Canada)
Signatures: 0
Initials: 0
Status: Original
2/19/2018 10:28:35 AM
Bill Home
William.Home@MyClearwater.com
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 2/19/2018 12:15:16 PM
ID:c3087818-fe28-Odea-84ac-1e4a6a2133aa
Cindy Dick
Cindy.Dick@fihealth.gov
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Holder: Deborah Brown
DeborahoBrown3@fihealth.gov
Status: Sent
Envelope Originator:
Deborah Brown
Deborah.Brown3@fihealth.gov
IP Address: 167.78.4.20
Location: DocuSign
Sent: 2/19/2018 10:37:29 AM
Viewed: 2/19/2018 12:15:16 PM
a
Sean Isaac
Sean.lsaac@flhealth.gov
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Michele Franklin
Michele.Franklin@fihealth.gov
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
COPIED
COPIED
Timesi
Sent: 2/19/2018 10:37:28 AM
Viewed: 2/19/2018 11:02:55 AM
Sent: 2/19/2018 10:37:28 AM
Viewed: 2/19/2018 11:27:41 AM
Cae on .Copy .Events
Abigail Holicky
Abigail.Holicky@flhealth.gov
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Itu
COPIED
Timestamp
Sent: 2/19/2018 10:37:29 AM
Viewed: 2/19/2018 1:23:16 PM
Envelope Sent
Hashed/Encrypted
2/19/2018 10:37:29 AM
Electronic Record and Signature Disclosure created on: 3/24/2017 10:05:43 AM
Parties agreed to: Bill Horne
ELECTRONIC RECORD AND SIGNATURE DISCLOSURE
From time to time, Carahsoft OBO Florida Department of Health (we, us or Company) may be
required by law to provide to you certain written notices or disclosures. Described below are the
terms and conditions for providing to you such notices and disclosures electronically through
your DocuSign, Inc. (DocuSign) Express user account. Please read the information below
carefully and thoroughly, and if you can access this information electronically to your
satisfaction and agree to these terms and conditions, please confirm your agreement by clicking
the 'I agree' button at the bottom of this document.
Getting paper copies
At any time, you may request from us a paper copy of any record provided or made available
electronically to you by us. For such copies, as long as you are an authorized user of the
DocuSign system you will have the ability to download and print any documents we send to you
through your DocuSign user account for a limited period of time (usually 30 days) after such
documents are first sent to you. After such time, if you wish for us to send you paper copies of
any such documents from our office to you, you will be charged a $0.00 per -page fee. You may
request delivery of such paper copies from us by following the procedure described below.
Withdrawing your consent
If you decide to receive notices and disclosures from us electronically, you may at any time
change your mind and tell us that thereafter you want to receive required notices and disclosures
only in paper format. How you must inform us of your decision to receive future notices and
disclosure in paper format and withdraw your consent to receive notices and disclosures
electronically is described below.
Consequences of changing your mind
If you elect to receive required notices and disclosures only in paper format, it will slow the
speed at which we can complete certain steps in transactions with you and delivering services to
you because we will need first to send the required notices or disclosures to you in paper format,
and then wait until we receive back from you your acknowledgment of your receipt of such
paper notices or disclosures. To indicate to us that you are changing your mind, you must
withdraw your consent using the DocuSign 'Withdraw Consent' form on the signing page of your
DocuSign account. This will indicate to us that you have withdrawn your consent to receive
required notices and disclosures electronically from us and you will no longer be able to use your
DocuSign Express user account to receive required notices and consents electronically from us
or to sign electronically documents from us.
All notices and disclosures will be sent to you electronically
Unless you tell us otherwise in accordance with the procedures described herein, we will provide
electronically to you through your DocuSign user account all required notices, disclosures,
authorizations, acknowledgements, and other documents that are required to be provided or
made available to you during the course of our relationship with you. To reduce the chance of
you inadvertently not receiving any notice or disclosure, we prefer to provide all of the required
notices and disclosures to you by the same method and to the same address that you have given
us. Thus, you can receive all the disclosures and notices electronically or in paper format through
the paper mail delivery system. If you do not agree with this process, please let us know as
described below. Please also see the paragraph immediately above that describes the
consequences of your electing not to receive delivery of the notices and disclosures
electronically from us.
How to contact Carahsoft OBO Florida Department of Health:
You may contact us to let us know of your changes as to how we may contact you electronically,
to request paper copies of certain information from us, and to withdraw your prior consent to
receive notices and disclosures electronically as follows:
To contact us by email send messages to: antonio.dawkins@flhealth.gov
To advise Carahsoft OBO Florida Department of Health of your new e-mail address
To let us know of a change in your e-mail address where we should send notices and disclosures
electronically to you, you must send an email message to us at antonio.dawkins@flhealth.gov
and in the body of such request you must state: your previous e-mail address, your new e-mail
address. We do not require any other information from you to change your email address..
In addition, you must notify DocuSign, Inc to arrange for your new email address to be reflected
in your DocuSign account by following the process for changing e-mail in DocuSign.
To request paper copies from Carahsoft OBO Florida Department of Health
To request delivery from us of paper copies of the notices and disclosures previously provided
by us to you electronically, you must send us an e-mail to antonio.dawkins@flhealth.gov and in
the body of such request you must state your e-mail address, full name, US Postal address, and
telephone number. We will bill you for any fees at that time, if any.
To withdraw your consent with Carahsoft OBO Florida Department of Health
To inform us that you no longer want to receive future notices and disclosures in electronic
format you may:
i. decline to sign a document from within your DocuSign account, and on the subsequent
page, select the check -box indicating you wish to withdraw your consent, or you may;
ii. send us an e-mail to antonio.dawkins@flhealth.gov and in the body of such request you
must state your e-mail, full name, IS Postal Address, telephone number, and account
number. We do not need any other information from you to withdraw consent.. The
consequences of your withdrawing consent for online documents will be that transactions
may take a longer time to process..
Required hardware and software
Operating Systems:
Windows2000? or WindowsXP?
Browsers (for SENDERS):
Internet Explorer 6.0? or above
Browsers (for SIGNERS):
Internet Explorer 6.0?, Mozilla FireFox 1.0,
NetScape 7.2 (or above)
Email:
Access to a valid email account
Screen Resolution:
800 x 600 minimum
Enabled Security Settings:
•Allow per session cookies
•Users accessing the internet behind a Proxy
Server must enable HTTP 1.1 settings via
proxy connection
** These minimum requirements are subject to change. If these requirements change, we will
provide you with an email message at the email address we have on file for you at that time
providing you with the revised hardware and software requirements, at which time you will
have the right to withdraw your consent.
Acknowledging your access and consent to receive materials electronically
To confirm to us that you can access this information electronically, which will be similar to
other electronic notices and disclosures that we will provide to you, please verify that you
were able to read this electronic disclosure and that you also were able to print on paper or
electronically save this page for your future reference and access or that you were able to
e-mail this disclosure and consent to an address where you will be able to print on paper or
save it for your future reference and access. Further, if you consent to receiving notices and
disclosures exclusively in electronic format on the terms and conditions described above,
please let us know by clicking the 'I agree' button below.
By checking the 'I Agree' box, I confirm that:
• I can access and read this Electronic CONSENT TO ELECTRONIC RECEIPT OF
ELECTRONIC RECORD AND SIGNATURE DISCLOSURES document; and
• I can print on paper the disclosure or save or send the disclosure to a place where I can
print it, for future reference and access; and
• Until or unless I notify Carahsoft OBO Florida Department of Health as described
above, I consent to receive from exclusively through electronic means all notices,
disclosures, authorizations, acknowledgements, and other documents that are required
to be provided or made available to me by Carahsoft OBO Florida Department of
Health during the course of my relationship with you.
DocuSign Envelope ID: 1CBOBB08-6DFE-472A-8730-5C01E87FC4AC
CONTRACT SUMMARY
This contract action has completed the Department's routing process and has
received the required approvals for execution.
Division/CHD/Office: Community Health Promotion
Provider Name: City of Clearwater
Contract Number: COHS2
Original Contract Amount: $155,000.00
Total Contract Amount (sum of executed actions): $0.00
Original Contract Start Date: 2/15/2018
Contract End Date (include executed actions): 6/30/2019
Procurement Award Date:
Contract Negotiations Completion Date: 2/1/2018
DESCRIPTION OF CONTRACTUAL SERVICES:
This contract is for the purchase and installation of water fluoridation equipment for the provision of
initiating access to fluoridated water.
CONTRACT ACTION:
AMENDMENT(Y/N): AMENDMENT AMOUNT:
CHANGE TO TERM(Y/N):
START DATE: END DATE:
RENEWAL: RENEWAL AMOUNT:
START DATE: END DATE:
DESCRIPTION OF CONTRACT AMENDMENT ACTION:
This contract complies with all of the following requirements:
• A statement of work
• Quantifiable and measurable deliverables
• Performance measures
• Financial consequences for non-performance
• Terms and conditions which protect the interest of the state
• All requirements of law have been met regarding the contract
• Documentation in the contract file is sufficient to support the contract and the attestation (examples:
business case; directive to establish contract; subject research and analysis, etc.)
• if the contract is established by way of a competitive solicitation as identified in section 287.057(1), Florida
Statutes, the costs of the contract are the most advantageous to the state or offer the best value