HomeMy WebLinkAboutDocumentation_Regular_Tab 06_10/12/2017 • � • •
emo
To: Michael Couzzo, Village Manager
From: Joel Medina, Fire Chief �
cc: Village Council
oate: August 22, 2017
Re: Availity Advanced Clearinghouse Direct Agreement
The Village of Tequesta Fire-Rescue bills for EMS transportation to local hospitals.
Availity Advanced Clearinghouse acts as an electronic healthcare gateway befinreen
payers, hospitals, providers, and their agents and operates an electronic system to
facilitate transactions. The current clearinghouse we use, Health—E-Web was bought
out by Availity effective 9/1/2017 and they are requiring we execute the attached
Agreement if we wish to continue our relationship with them. The monthly fee is
comparable to what we have historically paid in the past and the funds have been
budgeted ftom Acct. No. 001-192-546-320.
It is respectfully requested this Agreement be executed in order facilitate a seamless
transition with this new clearinghouse.
AVAILITY ADVANCED CLEARINGHOUSE DIRECT AGREEMENT
This Advanced Clearinghouse Agreement(together with any and all schedules,exhibits and amendments
thereto, the ` reement") is entered into as of Auaust 21. 2017 (the "Effective Date") by and between
Availity, L.L.C., a Delaware limited liability company, with its principal place of business at 10752
Deerwood Park Blvd South, Suite 110, Jacksonville, FL 32256(together with its wholly-owned subsidiary,
RealMed Corporation, a Delaware Corporadon ("RealMed"), hereinafter collectively referred to as
"Availit "), and Tequesta Fire Rescue, with its principal place of business at 357 Tequesta Drive,Jupiter,
FL 33469("Submit er").
WHEREAS, Availity acts as an electronic healthcare gateway with respect to real-time web and other
electronic health care transactions("Transactions")between and among payers, hospitals, providers and
their agents and operates an electronic system to facilitate such transactions (together with RealMed
Corporation's Revenue Cycle Management and related systerns,the"Availitv Svstem°);and
WHEREAS, Availity has relationships with health plans to assist such health plar�s with exchanging
administrative and value added transactions, pursuant to which Availity has established connectivity to
such health plans for the transmission of electronic administrative and clinical transactions directed to or
originating from the payer("Availitv Services');and
WHEREAS, Availity offers, among other ServiCes, an "All Payer" solution ("Availit� Advanced
Clearinahouse") to providers to exchange electronic administrative transactfons to commercial health
plans and govemment payers;and
NOW, THEREFORE, in cansideration of the foregoing premises and mutual promises and covenants
corrtained herein,the parties hereto agree as follows:
1. Use and Access to Availltv Svstem and Avaflitv Services.
Availity hereby grants Submitter a personal, revocable, limited, non-exclusive, non-transferable,
non-assignable license to access and use the Availity System for the Availity Services,
conditioned upon Submitter's continued acceptance of, and compliance with, the terms of this
Agreement. Availity reserves the right to bar, restrict or suspend Submitter's access to the
Availity System and the Availity Services at any time for any reason. The Availity Services that
will be included in this Agreement are identified in Exhibit A.
2. Provider and Availitt►Responsibilities.
(a) Availitv Orcaanizational Access Apreement. Submitter understands and agrees that
Submitter's ac�ess to the Availity System and Availity Services is conditioned upon
Submitter's acceptance and compliance with the terms and conditions of the Availity
Organizational Access Agreement ("Availitv OAA"), with such Availity OAA to be
electronically signed during the Availity System product registration process.
(b) Pricing. Terms and Discounts. Prices,discounts and other terrns for the Availity Services
are set forth In Exhlblt A and are subJect to change at any tlme, to teke effect no sooner
than the end of the Initial Term of this Agreement and with at least thirty(30)days written
notice by Availity to Submitter. Notwithstanding the above, Availity reserves the right to
adjust pricing at any time as new functionality is introduced and offered to Submitter.
(c) Calculatinq the Availitv Advanced Clearinahouse Monthlv Service Fee. As of the last day
of each month, Availity shall calculate the monthly fee ("Monthlv Fee") based on the
method described in Exhibit A.
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Submitter agrees to provide Availity with credit card or ACH billing information at the time
of registration. Availity shall charge Submitter's credit card in accordance with Exhibit A
on a monthly basis, beginning the month following the Active Date of the Agreement.
The "Active Date" is the date on which the Submitter executes the Availity OAA.
Submitter shall have the right to confirm the number of EDI and Real Time
claimlencounter transactions charged to the Submitter's credit card each month. In the
event Submitter disputes any amount charged by Availity, Submitter shall timely send a
wntten nobce detailing any disputed amounts.
(d) Provision of Availitv Services. Availity agrees to provide the Availity Services in a
professional and competent manner in accordance with accepted industry practices and
the terms of this Agreement. Availity Services will be provided in accordance with all
applicable laws and regulations and will at all times while this Agreement is in effect meet
all applicable HIPAA and HITECH requirements(as they may evolve from time to time.)
3. WaRanties and Covenants.
(a) Each party hereto represents and warrants to the other party that this Agreement is a
legal, valid and binding obligation, enforceable against such party in accordance with its
terms except that such enforcement may be subject to bankruptcy, insolvency,
reorganization, moratorium or similar laws now or hereafter in effect relating to creditors'
rights.
(b) Availity and Submitter agree to fully comply with all applicable laws, rules and
regulations, including the Heafth Insurance Portabdity and Accountability Act and its related
regulations("HIPAA")and HITECH Act under the ARRA.
(c) Submitter represents and warrants to Availity that neither it nor any individual with a direct
or indirect ownership interest of�ve percent (5°�) or more in such party, nor any of its
officers,directors,employees or agents who will be providing services hereunder,nor any
of their immediate family: (i) is now or ever has been debarred, excluded or suspended
from any federal and/or state health care program; or (ii) is now the subject of any
investigation or proceeding that may result in such penalties. Submitter acknowledges
that if Submitter receives any notice from any governmental or regulatory agency
containing a notice of a violation of any applicable law, rule or regulation, or imposing or
threatening to impose any fine, penalty or sanction of any kind, including, but not limited
to, exclusion, suspension or debarment from any federal and/or state health care
program, which in Availity's sole discretion impairs Availity's operations or Submitter's
ability to pertoRn under this Agreement, Availiry shall have the right to terminate this
Agreemerrt immediately,without penalty.
(d) Neither Submitter nor Availity shall distribute, publish or othervvise use any logos or
trademaiics, (collectively the "Ma�ks") of the other party without first obtaining written
appraval to use such material. Submitter shall not send any correspondence or other
materials that would appear to be joindy issued by Availity and/or its affiliates, and
Submitter without Availity's and/or its affiliates' written approval. In the event that either
party leams of any fraudulent or abusive use of the other party's Marlcs, it shall immediately
notify the other party.
(e) Practice Manaaement Vendors. Submitter represents and warrants that, as of the
Effective Date of this Agreement, Submitter is not contracted with any practice
management vendor who is, as af the Effective Date of this Agreement, an Availity
Advanced Clearinghouse reseller. If Submitter contracts with any practice management
vendor other than as listed bebw at any time after the Effective Date of this Agreement,
Submitter agrees to immediatety notify Availity in writing. In the event Submitter conhacts
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with any practice management vendor who is an Availity Advanced Clearinghouse
reseiler,Availity reserves the right to terminate this Agreement immediately.
Submitter represents and warrants that, as of the Effective Date of this Agreement,
Submitter uses the following practice management vendor and software: '
Vendor Name: � S
Software Name:
(f) Press Releases. Neither party shall issue any press release, make any public statement,
or othervvise make public this Agreement or the parties' relationship without the other
party's advance written consent and advance written approval of the content of any such
release, statement, or any other material.
(g) THE PROVISIONS OF THIS SECTION 3 ARE SUBMITTER'S AND AVAILITY'S ONLY
WARRANTIES CONCERNING THE AVAILITY SERVICES AND THIS AGREEMENT,
AND ARE MADE EXPRESSLY IN LIEU OF ALL OTHER WARRANTIES AND
REPRESENTATIONS, EXPRESS OR IMPLIED, INCLUDING ANY IMPLIED
WARRANTIES OF MERCHANTABILITY, NON-INFRINGEMENT, FITNESS FOR A
PARTICULAR PURPOSE OR OTHERWISE.
4. Indemn' .
(a) Submitter shall defend, indemnify and hold harmless Availity fram and against any and all
losses, liabilities, judgments, awards and costs (including reasonable legal fees and
expenses)arising out of or related to: (i)the negligence of Submitter; (ii)any breach by
Submitter of any warranty, covenant or other obliga6on or the inaccuracy of any
representation of Submitter in this Agreement; (iii)the violation by Submitter of any local,
state or federal law,rule or regulation;or(iv)any act,failure to ad,omission,representation
or misrepresentation by Submitter or the employees, officer or agents of Submitter.
Notwithstanding anything contained in this Agreement to the contrary, Submitter's liability
to Availity is limited to the amounts provided in Sec. 768.28, Florida Statutes, for any
single claim or judgment ($200,000.00) and for any total occurrence ($300,000.00). In
addition, any award of altorney's fees against Submitter shall not exceed the amounts
provided in Sec. 768.28, Fbrida Statutes (25°k of any settlement or judgment). Nothing
contained in this Agreement shall be construed as a waiver of Submitter's sovereign
immunity or its consent to be sued.
(b) Availity shall defend, indernnify, and hold hartnless Submitter from and against any and
all losses, liabilities, judgments, awards and costs (including reasonable legal fees and
expenses) arising out of or related to: (i) the negligence of Availity; (ii) any breach by
Availity of any wairanty, covenant or other obligation or the inaccuracy of any
representation af Availity in this Agreement; (iH)the violation by Availity of any local, state
or federal law, rule or regulation; or(iv)any act, failure to act, omission, representation or
misrepresentation by Availity or the employees,afficer or agents of Availity.
5. Limitation of Liabilitv.
(a) NEITHER SUBMITTER NOR AVAILITY SHALL BE LIABLE TO THE OTHER PARTY
FOR LOST PROFITS OR FOR ANY INDIRECT, SPECIAL, INCIDENTAL OR
CONSEQUENTIAL DAMAGES WHATSOEVER.
(b) EXCEPT FOR SUBMITTER'S AND AVAILITY'S OBLIGATIONS IN SECTION 4(a) AND
4(b), RESPECTIVELY, BOTH PARTIES LIABILITY TO THE OTHER HEREUNDER FOR
DAMAGES REGARDLESS OF THE LEGAL THEORY OF THE CLAIM SHALL NOT
EXC�ED$10,000.
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6. Confidential Infortnation and Access to Information.
(a) Availity and Submitter adcnowledge that this Agreement and the transacaons contemplated
hereunder invdve certain business infomiation which the parties consider c�nfidential and
proprietary to them and, as a resuR,the pardes shall treat such documents and infortnation
as stridly confidential. Nolwithstanding the foregang, each party's obligation(as a recipient
of co�'idential information hereunder) to maintain the other part�s information oonfidential
shall not apply to any portion of such i►�foRnation which:
(i) is or becomes public knowledge through no wrongful act of the recipient;
(ii) is lawfully obtained by the recipient from a third party;
(iii) is developed by the recipient independently of the disclosing party or such
disclosing party's infortnation;
(iv) is approved for release by the written authorization of the�sclosing party;or
(v) is legally compelled to be disdosed pursuant to any applicable law, regulation or
order af a court of competent jurisdiction.
(b) In the event that any patient informadon that is conside�ed"protected health information"as
defined under HIPAA or any other similar state law comes within Availity's or Submitter's
custody, possession or knowledge or is devebped, compiled, prepared or used by Availity
or Submitter in the course of or in connection with this Ac,�eement, Availity and Submitter
agree to, and agree t�make their personnel agree to,the same restrictions and conditions
that apply to Availity or Submitter, as applicat�e. Submitter and Availity agree to abide by
the terms and conditions of any applicable business associate agreement between
Submitter and Availity, which business associate agreement shall be agreed to during the
Availity System portal registration process.
(c) Audlt Riphts. During the Term and continuing for one (1) year following the end of the
Term but no more than once in a 12-month period, Availity (including through its third
party auditors)will have the right at iis expense, on thirty(30) calendar days prior written
notice to conduct an audit of Submitter, its records and operations that are direcUy related
to this Agreement for the purpose of determining compliance with this Agreement with
respect to those categories of compliance set forth in this Agreement. Subject to the
confidentiality obligations herein, to facilitate audits, Submitter will permit the Availity
auditors (including its third party auditors who have agreed to the confidentiality
obligations} to examine, and/or copy, as reasonably required, its books and records,
computer operations and data, in connection with matters or purposes related to the
performance of this Agreement. Additional audit requirements include the following: (1)
the audiUexamination must be perfortned in accordance with Submitter's reasonable
security and privacy policies/procedures, copies of which will be furnished prior to the
audiUexamination, (2) the auditor must execute a nondisclosure agreement prior to the
audit, or alternatively agree to indemnify and defend the Submitter against loss or
damage occurring as a result of any use of information by such auditor, to the extent that
Availity would be liable had it made such use of Submitter's information, in a form and
substance reasonably acceptable to counsel of Submitter, and (3) the audit can only be
perfoRned during normal business hours (9:00 a.m. to 5:00 p.m. — Monday through
Friday)on a date requested in writing by Availity and reasonably acceptable to Submitter.
The results of all audits will be Confidenaal Information.
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7. Term and TerminaGon.
(a) Term. This Agreement shall commence on the Effective Date and continue for a term of
one (1) year from the Effective Date (the "IniUal Term"). This Agreement shall be
automatically renewed for additional one (1) year terms (each, a "Renewal Term" and
collectively with the Initial Term,the"Term")unless terminated as set forth below.
(b) Termination. This Agreement may be tertninated as follows:
(i) At any time by either party upon a thirty(30)days advance written notice;or
(ii) At the election of either party, by written notice to the other party if: (A)either party
c�mmences a voluntary case or other proc�edi�g seeking rehabilitadon,liquida6on,
reorganization or other relief with respect to itself�r its debts under any insolvency,
bankruptcy or simifar law or statute, or makes an assignment of its property or any
substantial portion thereof for the benefit of creditors and such proceeding or
assignment is continuing or in effed at the time of such notioe; or (B) there is
commenced against effher party an involuntary proceeding seeking to have either
pany declared insolvent,impaired,bankrupt or seeking to have a receiver appointed
with respect to a substaMial portion of its property or there is entered an order
declaring either perty insolvent, impaired, bankrupt or appointing a receiver with
respect to a substantial portion of its property and such proc�eding or order is not
dismissed within sixty(60)days after its filing;or
(iii) If either party materially breaches any representation, warranty or covenant
contained in this Agreement and such breach oontinues for thirty(30)days after the
breaching party is notified of such breach by the non-breaching party,then the non-
breaching party may teRninate this Agreement immediately by giving notice to the
breaching party. Examples of material breaches include, but are not limited to: (1)
failure to provide adequate or appropriate training or fading to attend Availity training
sessions, (2) misrepresenting eny of the Availity Services, and/or (3) failure to
respond to Availiry or User inqulries within a reasonable period of time;or
(iv) In accordance with Section 3(e).
(c) Effect of Termination. In the event that this Agreement is terminated for any reason, all
Availity Services will be terminated. In addition, Sections 3 through 13 indusive and
Section 15 shall survive the termination of this Agreement pursuant to this Section 7.
The exercise of either party of any right of termination shall not constitute a waiver of any
other rights or remedies available to such party for violation of the tertns of this
Agreement or under applicable law.
(d) Payment Default. If Submitter fails to make any past due undisputed payment within ten
(10) business days after receiving a written demand for such delinquent payment (a
"Payment Uefaull°), then to the extent permitted by applicable law,Availity shall have the
right to exercise any one o�more of the following remedies: (A)assess Submitter a late
charge of 1.5% of such late payment (or such lesser rate as is the maximum rate
allowable under applicable law), (B)terminate this Agreement and exercise the additional
remedles set forth In Section 7(c) above; (C) deny Submitter access to the Availlty
Services; (D) proceed by court action to recover damages and expenses incurred by
Availity by reason of such Payment Default;and/or(E)exercise any othe�right or remedy
available at law or in equity.
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8. Nature of Relationshi�Between Parties. Nothing herein shall be construed to place the parties
in a relationship of partners or jant venturers and this Agreement does not make either party the
agent or legal representative of the other for any purpose wtratsoever. The parties further agree
that no representation shall be made by eithe� party that would create an apparent agency,
employment, partnership or joint venture. Neither party shall have the power, expressed or
implied, to obligate or bind the other in any manner whatsoever. Neither party shall be
responsible for any act or omission of the other or any employee of the other.
9. Assianment of AoreemeM and Bindina Effect. Neither party shall assign this Agreement or
any of its obligations under this Agreement without the prior written consent of the other party,
except to an entity that succeeds to all of its business or assets to which this Agreement relates.
Notwithstanding the foregoing, Availity may, upon written notice to the other party, assign this
Agreement to one or more of its a�liates or subsidiaries or to any party acquiring substantially all
of its assets; a�ovided, however, such assignment shall not relieve the assignee of any
obligations or liabilities created under or related to this Agreemenl. The rights and obligations of
this Agreement shall inure to the benefit of and be binding upon the legal representative,
successors and assigns of both parties.
10. Severabilitv. The provisions of this Agreement shall be severable and, if any provision of this
Agreement shall be held or declared to be illegal, invalid or unenforceable, such illegality,
invalidity or unenforceability shall not affect any other provision hereof, and the remainder of this
Agreement, disregarding such invalid portion, shall contfnue in full force and effect as though
such void provision had not been oontained herein.
11. Notfce. Unless expressly provided herein, all notices, claims, certificates, requests, demands
and other communications hereunder shall be in writing and shall be deemed to be duly given: (a)
when personally delivered, or (b) if mailed, registered or certified mail, postage prepaid, retum
receipt requested, on the date the return receipt is executed or the letter refused by the
addressee or its agent, or (c} sent by electronic mail, or (d) if sent by ovemight courier which
delivers only upon the signed receipt of the addressee, on the date the receipt acknowtedgment
is executed or refused by the addressee or its agent:
(i) if to Availity:
Availity, L.L.C.
10752 Deerwood Park Blvd. South
Suite 110
Jacksonville, Florida 32256
Attn.: Legal Department
(ii) if to Submitter:
Tequesta Fire Rescue
357 Tequesta Drive
Jupiter, FL 33469
Attn: Legal Depa�tment
12. Govemina Law 8 Venue. This Agreement will be govemed by the laws of the State of Florida.
In addition, the parties agree that if or when Uniform Computer Information Transactions Act
("UCITA") is enacted in this governing state, the provisions of UCITA will not apply to this
Agreement. If any provision of this Agreement or the application of any such p�ovision shall be
held by a tribunal of competent jurisdiction ta be contrary to law, the remaining provisions of this
Agreement shall continue in full force and effed to the maximum extent possible. Jurisdietion and
venue for all disputes relating to this Agreement shall lie with the state and federal courts located
in Duval County,Florida.
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13. Costs.Attornevs'Fees.and Exnerts'Fees. In the event any obligation of this Agreement must
be enforced, through litigation, arbitration or otherwise, the prevailing Party will be entiUed to
recover reasonable costs and expenses incurred in enforcing the obligation, including costs,
reasonable attomeys'fees and experts'fees.
14. Force Maieure. No failure, delay or default in performance of any obligation under this
Agreement will constitute an event of default or a breach of representation or warranry under this
Agreement to the extent it is caused by a strike;fire; shortage of materiais; unavoidable casualty;
civil disorder; riot; insurrection; vandalism; war; inclement weather; failure of the internet; failure
or error of any intemet access provider; failure or impairment of any lines of transmission
belonging to any third party; failure or impairment of any thlrci party server, router, other
equipment or software through which transmissions occur; or, other extraordinary cause if such
cause or condition is beyond the reasonable control and without the negligence of the Party
othervvise chargeable, for so long as such cause or condition continues and for a reasonable
pe�iod of time thereafter. Notwithstanding the foregoing, such cause or conditio� will not include
a Partys lack of funds, lack of credit, or other financlal inability to perform. If a Party intends to
rely on the foregoing fo�ce majeure protection, it will timely notify the other in order to permit the
other in its sole discreli�n to suspend or curtail its own performance under this Agreement for
such time as the failure, delay or default continues. Should either party be delayed in the
perfortnance of any material obligation hereunder for a period of more than ninety(90)days as a
result of an event of force majeure,the other party may elect to terminate this Agreement,
15. Palm Beach Counri Office of Inscector General. Pursuant to Article XII of the Palm Beach
County Charter, the Office of the Inspector General has jurisdiction to investigate municipal
matters, review and audit municipal contracts and other transactions, and make reports and
recommendations to municipal goveming bodies based on such audits, reviews,or investigations.
All parties doing business with the �Ilage shall fully cooperate with the inspector general in the
exercise of the inspector general's functions, authority, and power.The inspector general has the
power to take swom statements, require the production of records, and to audit, monitor,
invesGgate and inspect the activities of the Village, as well as contractors and lobbyists of the
Vllage in order to detect, deter, prevent, and eradicate fraud, waste, mismanagement,
misconduct, and abuses.
16. Pubflc Records. In accordance with Sec. 119.0701, F/orida Statutes, Availity must keep and
maintain this Agreement and any other records associated therewith and that are associated with
the pertormance of the work described therein. Upon request from the Submitter's custodian of
public records, Availity must provide the Submitter with copies of requested records, or allow
such records to be inspected or copied, within a reasonable time in accordance with access and
cost requirements of Chapter 119, Florida Statutes. A vendor (including Availity) who fails to
provide the public records to the Submitter, or fails to make them available for inspection or
copying, within a reasonable time may be subject to attomey's fees and costs pursuant to Sec.
119.0701, Florida Statutes, and other penalties under Sec. 119.10, Florida Statutes. Further,
Availlty shall ensure that any exempt or confldential records assoclated with thls Agreement or
assodated wlth the pertormance of the work described therein are not dlsdosed except as
authorized by law for the duration of the Agreement term, and following completion of the
Agreement if Availity dces not transfer the records to the Submitter. Finally, upon completion of
the Agreement,Availity shall transfer,at no cost to the Submitter,all public records in possession
of Availity,or keep and maintain public records required by the Submitter. If Availity transfers all
public reCords to the Submitter upon Completion of the Agreement, Availity shall destroy any
duplicate public records that are exempt or oonf'�denbal and exempt from public records
disclosure requirements. If Availity keeps and maintains public reCords upon completion of the
Agreement, Availiry shall meet all applicable requirernents for retaining public records. Records
that are stored electronically must be provided to the Submitter, upon request from the
Submitter's custodian of public records, in a foRnat that is compatible with the Submitter's
infamation technology systems.
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17. Miacellaneous. No provision of this Agreement shall be deemed waived unless such waiver
shall be in writing and signed by the party against which the waiver is sought to be enforced. The
waiver by either of the parties hereto of any breach of any provision hereof by the other party
shall not be construed to be either a waiver of any succeeding breach of any such provision or a
waiver of the provision itself. The headings of the several sections are inserted for convenience
of reference only and are not intended to be a part of or to affect the meaning or interpretation of
this Agreement. This Agreement contains the entire agreement between the parties with respect
to the subject matter hereof and supersedes all previous written or oral understandings,
agreements, negotiations, commitments, or any other writings or communications with respect to
such subject matter. This Agreement may not be changed or modified in any manner except by
an instrument in writing signed by each of the parties. This Agreement may be executed in
counterparts, and facsimile transmission of a signed copy of this Agreement shall constitute
effective execution and delivery of this Agreement. If any provisions of this Agreement are found
to be un-enforceable,the remainder of this Agreement shall remain in force.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement by their duly authorized
officers as of the date first above written.
AVAILITY, L.L.C. SUBMITTER
By: By:
Name: Name: M IC,hq,�2 CO UZZO
Title: Title: V��lQqe N�n�'�r
U
Date: Date: �-a�"/7
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EXHIBIT A
TransacUon Descriotions and Pricina
A. TRANSACTIONS:
Availity Advanced Clearinghouse supports the following transactions (5010 ANSI x12 verslon
only)access to all payer functionaNty(check a!!that app/y):
EDI Transactions: Listed below are the batch EDI transactions that are available through Availity
Advanced Clearinghouse.
� Eligtbllity & Benefits Irn�uiry Request and Response (270 S 271): The Eligibility & Benefits
allows a Provider to submit an electronic request for verification of a patienYs eligibility and
selected benefit information. The Eligibility 8� Benefits response from the Sponsoring Health Plan
Processing System verifies eligibility. This response also allows for benefit details if available in
the Sponsoring Health Plan processing system.
� Referral and Authorizadon Request and Response (278 &2T8): Refenals and Authorizations
are requests from Providers for procedurat inpatient, or specialist visit authorization as required
under certain managed care products. This Transaction allows a Provider to submit Referral and
Authorization requests electronically through the Availity System for transmission to the
Sponsoring Health Plan processing system. The Referral and Authorization response from the
Sponsoring Health Plan processing system indicates the parameters of the authorization and
gives the Provider a referral/authorization number if the authorization can be pr�essed
automatically.
� Claim Submission Request and Electronic Remlttance Advice �ERA) (837 8 835): Claim
Transactions are requests for payment for, or submission of irifamation relating to, services
rendered by Providers. For purposes of this Agreement, this definition shall include professional
(837P),facility(837F),encounters(837E}, and claims resulting from worker's compensation. The
ERA is used for submitting a payment of claims or Uansfer of remittance information from the
Sponsoring Health Plan processing system to Provider through a depository financial institution.
An ERA may contain one or more dairns.
� Claim Status Inquiry Request and Response (276 8 277): This transaction allows a Provider
to submit an electronic request for information regarding the status of a claim. The claim status
inquiry response may contain information on multiple claims, all of which meet the request
criteria.While there is information about multiple claims,this is dassified as a single response.
Real-Time Transactions: Listed below are the Real-Time Transaction descriptions available through
Availlty Advanced Clearinghouse.
� Eligibility & Beneflts tnquiry Request and Response (270 8 271): This transaction allows a
Provider to 5ubmit an electronic request for verification of a patient's eligibility and selected
benefit infortnation. The Eligibility& Benefits response from the Health Plan Processing System
verifies eligibility. This response also allows for benefit details if available in the Health Plan
Processing System.
� Referral and Authorization Request and Response (278 &278): Referrals and Authorizations
are requests from Providers for procedural inpatient, or specialist visit authorization as required
under certain managed care products. This Transaction allows a Provider to submit Referral and
Authorization requests electronically through the Availity Processing System for transmission to
the Health Plan Processing System. The Referral and Authorization response from the Health
Plan Processing System indicates the parameters of the authorization and gives the Provider a
referral/authorization number if the authorization can be processed automatically.
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� Claim Submission Request and Electronic Remittance Advice-ERA (837 8 835�: Claim
Transactions are requests for payment for, or submission of ir�foRnation relating to, services
rendered by Providers. Providers submit Claim Transactions through the Availity Processing
System for transmission to the Health Plan Processing System. For purposes of this Agreement,
this definition shall include professional (837P), facility (837F), encounters (837E), and claims
resulting firom worker's compensation. The ERA is used for submitting a payment of claims or
transfer of remittance information from the Health Plan Processing System to Provider through a
depository financial institution.An ERA may contain one or more claims.
� Claim Status Inquiry Request and Response (276 8 277): This transaction allows a Provider
to submit an electronic request for information regarding the status of a claim. The claim status
inquiry response may contain infonnation on multiple claims, all of which meet the request
criteria.While there is information about multiple claims, this is classified as a single response.
B. PRICING:
1. User Monthlv Fee: Submitter shall pay Availity a minimum of $55.00 per equivalent
provider per month("PPPM")based on the Transactions selected in Section A.
For the avoidance of doubt, the following formula and sample calculations are provided
for clarity. The PPPM charge shall be calculated using the following formula:
Submitter monthly claim volume/200 = Equivalent P�ovider Count, thert Equivalent
Provider Count(rounded up)x PPPM=Monthly Fee
Sample Calculatbns
I im I im Eauivalent MoMhlv Fee
2�Q Provider Count
R un
0 N/A 1 $55.00
150 0.75 1 1 x$55.00=$55.00
300 1.5 2 2 x$55.00=$110.00
580 2.9 3 3 x$55.00=$165.00
630 3.15 4 4 x$55.00=$220.00
1,000 5 5 5 x$55.00=$275.00
5,000 25 25 25 x$55.00=$1,375.00
Notes:
1) The monthly claim volume is based upon all claim Transactions submitted within a
month,as defined in this Exhibit A, including any duplicate submissions.
2) Availity will monitor Transaction volumes on a monthly basis to ensure there is a 1:1
ratio of Eligibility & Benefrt Request Inquiries (270) to Claim Submissio� Requests
(837). Vendor adcnowledges and agrees (a) in the event Availity, in its sole
discretion, determines that there is a high ratio of Eligibility 8 Benefd Request
Inquiries to Claim Submission Requests, Availity reserves the right to add additional
claims to the Orgenization Mailbox monthly claim volume in order to restore the 1:1
ratio of Eligibility 8� Benefit Request Inquirles to Claim Submission Requests and (b)
Availity may, in its sole discretion, elect to terminate this Agreement in the event
Vendor fails to pay Availiry the additfonal fees associated with the restoratlon of the
1:1 ratio of Eligibility 8 Benefit Request Inquiries to Claim Submission Requests.
3) The Parties agree that Availity reserves the right to pass through any third party fees
associated with any Transaction. Such pass through fees shall be billed to Submitter
Page 10 of 11 v2017.05.05
each month;orovided, however,that Availity agrees to provide Submitter with at least
a thirty(30)days written notice prior to billing Submitter for any third party fees.
2. Connectivitv Fee: Should Submitter request access to any health plan for which
connectivity is not available, Availity reserves the right to charge Submitter$175.00 per
hour for Availity's connectivity services.
Page 11 of 11 v2017.05.05
ADDENDUM
Public Records: In accordance with Sec. 119.0701, Florida Statutes, the Contractor
must keep and maintain this Agreement and any other records associated therewith and that aze
associated with the performance of the work described in the Scope of Services. Upon request,
the Contractor must provide the public with access to such records in accordance with access and
cost requirements of Chapter 119,Florida Statutes. Further,the Contractor shall ensure that any
exempt or confidential records associated with this Agreement or associated with the
performance of the work described in the Scope of Services are not disclosed except as
authorized by law. Finally, the Contractor shall retain the records described in this paragraph
throughout the performance of the work described in the Scope of Services,and at the conclusion
of said work, transfer to the Village, at no cost to the Village, all such records in the possession
of the Contractor and destroy any duplicates thereof. Records that are stored electronically must
be transferred to the Village in a format that is compatible with the Village's information
technology systems.
Village of T'equesta
345 Tequesta Drive 561-768-0700
Tequesta,FL 33469 www.tequesta.org
TEQUESTA PUBLIC WORKS DEPARTMENT MEMOR.ANDUM
To: Michael R. Couzzo,Village Manager
From: Douglas M. Chambers, Deputy Director Public Works
Subject: Vendor Credit Application: Costa Farms
Date:July 10, 2017, 2017
The attached agenda item is a Vendor required credit application from Costa Farms.
We will utilize Costa Farms for the purchase of their line of drought tolerant plants.
Examples:
Sedum: Evolvulus:
'b••� �/
i
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4
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. •\ lY.
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Costa Farms is located at 21800 SW 182"d St Miami Fla.
Douglas M. Chambers
Deputy Public Works Director
dchambers@tequesta.or�
561-768-0483
Vice-Mayor Vince Arena :vlayor Abby Brennan Council Member Tom Patemo
Council Member Steve Okun Council Member Frank D'Ambra
Village Managei Michael Couzzo
��'' � BERNECKERS
���
,�
Fa rms
�a����
Costa Farms, LLC
NEW ACCOUNT
CREOIT APPLICATION _ TERMS: NE7 30 DAYS
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(AItEA ODEf FAX NO. E ADDFtE38
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PLEASE ATTACH FlNM�iCCIAL IWO OPERTING 6TATHYENTS TO 7HI8 APPUCA'IYON
TRME REF�CES ` --- (AREA COOE)TELEPF�ONE N0. (AF'tEA COOE]FAX N�.
t. ._ . e�-a8 -3��
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4. ' eri�o� qla-3�-785� _
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BANK REfERENCES N CONTAGT W1ME
'. (�nk o� �r�rrecica- 5�t-�l3�- _ _ Do�}7�oy��
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111PE Of BUSINESS: W�iOI.ESAI.E' BROICER: RETAIL: �R.
COMPANY STRIJCTURE: CORPORI17fON: P ERSHN'; SOLEPRO�E7ROBWP:
COIAPANY OFFICEftB ADORESS (AREI►GGOE1 TELEPHONE NO.
1 OR OMIMER'
� �c,S(,P�,c..�p5`�a �f, -�lo •O�lo�
BUY R CO ACT PERSON: �
ACCOUNTS PAYA9LE T RSON: �
IWOUFIT OF CREDIT REQIJESTEO: �����T�
NO.YEARS W BU31NE3� FLORIOA SALES T1U(NO. --- It�ORT PERMIT NO.(CANADMNS ONLY)
loo t's . 85-f�or5'833o�qC.-`1
COMPANY FEOERAl.I.D.1�
59-coo�t�yoe 1 _ . .
SK3NATURE: /' � ��: ' � a�Q� �
PR EMf( ) OMVNER
TO TH�f!E$T QF YPUR KNONN.EOCiE: TIiC FOR[OOINd 15 CORRECT
Gosta Fenns,Ll.G,21e00 8W 16Yi°Avenu�,Goulda,Fl.3�1T0,Toll Frse No. (60��E27-7074'GedM Dapt.F�x No.(7�6)2T2�d1�7
�� BERNECKERS
_'� �rw
Farms
c.�a»..��,...��...�..�,.
� Costa Farms, LLC
NEW ACCOUNT
CREDIT Af'PUCA'fION TERA13: N�T 30 DAYS
PURCHASE AGREEMENY
As a valued credit customer I understand and aqree to the fdlowing terma:
1. All prices are F.O.B.GoWcls, Florlda. Prioes are subJect to change without notice.
Z. All claims muat be reported within(24)hours of receipt vF produck
Clai�ns relatad to au�litrr control iss�ea� must be acoompanied with pictunes and an
authorizatlon number(RGA!�must be ol�ained trom Costa Nursery Famns.
P�ea�e contact you►CNF Sales RepresentetMe and mail yo�pidures with a note to: 22290
SW 162n°Avenue,Coul�, Fl•33170.AtEn: Acoamts Rece(vablel Credit Dep�
�laims related to shorta�es odand dam�aes on frei�ht "collect" shrom�nl� must be filed
with lhe Canier. Cosis Nur�ery Farms not being the consignee cannot f�e any daim for
shortages or loss of product.
Cla(ms related vour reoeivina oersonnel must nc�te to shorta�es cr/and damaqes on he�ht
'g@�ajd`shitxnents on the bill o#ladin�_An authorization number(RGA� musl be obtalned
irom Coata Nuraery Fanns within twenty-four(24)hou�s.
3. Coste Nursery Farms, Inc. invokes are dated and proceased the day of shipment. Discour�t,
if applicable.is allowed oNy withtn epec�fled terms.
4. Invoices no� paid within 30 days are subject to 1.v% interest charge per montt�. which Ihwe
agree to pey.
5. Retumed chedcs wiq be subJect to a thN1y-five doNare(�35.00)servioe fee.
6. Should the acc�uM beco�delMquent to the po�t that kgal adion is neoessary I I we agree
to pay attomey feee end couA costs.
7. If �nylime there shoaid be e change In the compar�y'a loca6on, phone number or
adminlstrative swcturo, l J We will inform Ccsta Nursery Farms, lnc. Credlt DeparbneM of
the c�ange.
Acknowledged by:
(s�ynawre R�ulrad)
P�,���: M<<na�c. �e• cou zza
Compeny Name: ��1 I��G re e-�' T,����,�s
Tit�e: v t �� A�P a a0 r
Cosh iarme.LLC,21l00 SW id2"'Av�rw..Goulds.Fl.3:1170,Tell Frw Mo. (���•701�•Crodlt Opt F�c Na�T2�133
" BERNECKERS
�� ��iw
Fa rms
�.u�.a w�..��w.n�..
Costa Farms, LLC
NEW ACCOUNT
CREDIT APPLICATION TERMS: NE'7 30 OAY3
GUARANTEE
The undersign (jointty end severally)in consideretion of your extendi credit to the
abov�e eppl'�cant, hereby unoonditionally guarantee paymerrt of ndebtedness,
�abilities, or obligati ,said applicant shall at any dme owe C Nurse�y Farms, Inc. or
ar�r of its subsidiaries afflliated companies.We authoriz ou to obtain our cansumer
credic raport�om any or -natbnal credit bureaus.
This guarantee shall be a ing, absolute a conditional guarantee and shall remain
in full foroe and effed uMil exp ly revok� a writfen notice from the undersigt�ed
sent certified mail, rebum receipt r ted aiso,until all said indebtedness•,IiabNfies, •
and obligatiorts created before receivi ch notice shall be fulfy pa1d. • �
1'his guarantpe exbends to and indu s a and all interest due o�to become due
together with any ar�d aN costs expenses, ncluding but not I'anked to coUedlon agency
t�,atbomey fees and caurt incu�red by a Nu�sery Farms, I�c. or i�affiCates,in
connection with any matte� reci by ihis guaran e.
�CUTED this day of �20
Hmro Addrsic:
GuatuMo�'t 9
Slwat!CRy/Sla�s Guarontor's ( PriM?
5oclal S�asiy I�mba� •--.._.�._,_
Co�fa Feens.U.C,11�00 SW 1i�'�Maau�,Ooldds�R17S170�TaU Fne No. (�06?u7-7�T4•C�It DeP�Rsx Na�7M)272-E1�i
� �'� BERNECKERS
� �'G�i
�` �
Fa rms
a�,.�nka»+�,.w*.�..,.wr�..
Costa Farrns, LLC
NEW ACCOUNT
CREDIT APPUCATION TERRAS: NET 30 DAYS
AUTHORI7_A'fION TO RELEASE IAIFORMATION
I hereby authorize our refierenoes and bank to r+�fease any infotmation r�ecessary to assist in
establishing a line of Cred�.
oa�: ---��-7��7 -
TT
Customer(S) Cornpany's
n,�a: 1;ll��..�. o��� u�.s�-�c. ___..._
Address: _ c3�� _�_'7„"t�''�T� �r'�
c�ty�scat�ziP .._ a � �L 3 3.�5� .
Autho�ized by: �at�.w�» �
�dD , ._._...�.....�
.
Print Name: �l �(�l!L �G[ ZZ.O
Title of Signer: !,l!4 G �Q�Q
�o�ies of said document can be used ai anvtene to recover ir�fom�atfon as la� as the comaenY
contlnues busineae relatlonehb with ihe ebove-mertuoned CREDITOR.
cosra Fanns,uc.2�aoo aw��z�"ar.aua.c�oua�,�ss��o,roa Rns No. leao)ui•ror4•c�aac aa�F+uc No.i»81r�2-s�aa
PUBLIC RECORDS. In accordanoe with Sec. 119.0701, Florida
Statutes. CONTRACTOR rrxist laeep and maintain this AgrBement
and any other recads associabed thenewith and that are assoaa�ed
with the pe�fom�anoe of tl�e work desc�lbed in the Proposal or
Bid. Upon request from the ViNage's custodian of pub�ic recoNs�
CONTRACTOR must provide the Yllage with copies of requesbed
records, or allow such records to be ir�ec�ed or c�pied, within a
�easonabie time in acoordanoe with access and oost requiremeMs af
Chapter 119, Flor�da Statutes. A CONTRACTOR who faNs to
provide the pubic rec�rds to the V'illage, or fa�s to make them
avaaable ior inspection or oopying,within a reaso�ble 6me may be
subjec� to attomey's fees and costs pursuant to Sec. 119.0701,
Fb�de Shetutes, and other penalties under Sec. 119.10, FJbrida
Statutes. Fu�ther, CONTRACTOR shall ensure that any exempt or
confidential reco�ds assoc�abecl with this Agreement or assodated
w�h the perfonnance of the w�ork desc�ibed in the Proposal or Bid
are not disdo�ed except as autl�orized by law for the dur�ion of the
Apneement term, and following oanpletion of the A�eemeM if the
CONTRACTOR does not trar�er the reconls to tl�e ViNage. FinaNy,
upon co�letion of the AAreement.CONTRACTOR shalt trans��at
no c�st to the V�lage, all p�lic records in possession of the
CONTRACTOR,or keep ar�cl maintain publ"ic records nequited by the
Vilage. If the CONTRACTOR transfe�s all public records bo the
V�age upon oompletion of the Agreement,the CONTRACTOR shaN
destroy any duplicale pubC�c reoor+ds tl�are exempt or oor�fidentiaal
and e�oempt f�m pubNc reconds disdesure requirements. If ft�
CONTRACTOR ke�s and maintains pub�c reaords upon
�ompleBon of the A�r+eemeM, the CONTRACfiOR shaN meet all
appticable requ�+err�eMs for r�eteining public reconds. Reconds that
are stior�ed elec.�+onicaUy must be provided to the VILLAGE, upo� �
r�equest from the ViMage's custiodian of public reoords,in a format that
is c�mp�ble with the Viilage's informa�on technology sys�ems. .
IF CONTRACTOR HAS QUESTIONS REGAR�NG THE
APPLICATtON OF CHAPTER 119� FLORIDA
STATUTES, TO CONTRACTOR'S DUTY TO PROVIDE
PUBI.IC RECORD8 RELATING TO THIS AGREEMENT,
PLEASE CONTACT THE VILLAGE CLERK, RECORDS
CU8TODIAN FOR THE VILLAQ�E, AT (S61) 768-0685,
OR AT bncwilliams�sauesta.ora. OR AT 345
TEQUESTA DRIVE, TEQUESTA, FLORIDA 33r169.
Village of Tequesta
345 Tequesta Drive 561-768-0700
Tequesta,FL 33469 www.tequesta.org
TEQUESTA PUBLIC WORKS DEPARTMENT MEMORANDUM
To: Michael R. Couzzo,Village Manager
From: Douglas M. Chambers,Public Works Superintendent
Subject: Village Hall Baseboatd Molding Replacement
Date:August 10,2017
The attached Agenda item addresses the need to replace 117' (Feet) of 8" custom baseboard
molding in Village Hall.The existing baseboard is warped due to water damage.The drinking
water fountain-condensing cooler failed causing a water leak on the Administration side of
Village Hall.The baseboard absorbed the water on the floor causing the wood to warp.
We received 2 quotes to purchase, install and stain new custom baseboard molding to match the
existing baseboard.
DG Carpentry was selected to complete the work. This Contractor was 1 of 3 recommended local
contractors by Home Depot for carpentry and molding work.
Total Amount of Proposal $2,961.78
Douglas M.Chambers
Deputy Director Public Works
Village of Tequesta
Vice-Mayor Vince rlrena Mayor Abby Bcennan Council Member Tom Paterno
Council Member Steve Okun Council Member Frank D'�lmbra
Village Manager Michael Couzzo
Proposal
From: DG CARPENTRY LLC 7uly 22, 2017
4114 Waverly Dr.
West Palm Beach, F133407
561-670-5870
Submitted to: Janet McCorkle
Village of Tequesta
345 Tequesta Dr
Tequesta Fl
561-2142199
I hereby propose to furnish all the labor and materials necessary for ihe completion of the
following: InstaU 117 feet of new base in water damaged area of building hallway and
surrounding rooms that were effected.New base boards to match existing as close as
possible.Base boards are 8 inches in height and cherry stained. Installation will take
place approximately 45 weeks&om time of material ordering. A deposit is required for
ordering materials.
All labor is guaranteed to be as specified,and the above work to be performed in
accordance with specifications as discussed above. Woric will be completed in a
substantial workmanlike manner for the sum of: Two thousand nine hundred sixty-one
and 78/100 Dollars(�2,961.78)
Payments to be made as follows:
Deposit$1,936.78(Custom base material)
Balance upon completion of the job. �1,025.00 Net 30 days
Any aCteration or�eiriativn from a6o�ue specifuations i�nfving e.�tra cost, unlT 6e eXecuted only upon
w►itten orcfer.� arafwiQ�6econu an r,Xtra charge ov�esandadoUe the estimate.Allagreements
contingent upon stri�s, aai�ents or�eCays 6ryoraf our controL
Respectfiilly Submitted
Derrell Gibson
Tlvs proposal may be withdrawn by me if not accepted withia 30 days.
�.�u■aa�
The above prices,specifications and conditions aze satisfactory and are hereby accepted.
You are authorized to do the work as specified.Payment will be made as outlined above.
Signature: �- �
Date: Y 1
PUBLIC RECORDS. In accordance with Sec. 119.0701, Florida Srarutes,
CONTRACTOR must keep and maintain this Agreement and any other
records associated therewith and that are associated with the
performance of the work described in the Proposal or Bid. Upon request
from the Village's custodian of public records, CONTRACTOR must provide
the Village with copies of requested reco�ds, or allow such records to be
inspected or copied, within a reasonable time in accordance with access
and cost requirements of Chapter 119, F/orida Statutes. A CONTRACTOR
who falls to provide the pu blic records to the Vi Ilage,or fails to make them
available for inspection or copying, within a reasonable time may be
subject to attorney's fees and costs pursuant to Sec. 119.0701, Florida
Statutes,and other penalties under Sec. 119.10,Florida Sratures. Further,
CONTRACTOR shall ensure that any exempt or confidential reco�ds
associated with this Agreement or associated with the performance of the
work described in the Proposal or Bid are not disclosed except as
authorized by law for the duration of the Agreement term, and following
completion of the Agreement if the CONTRACTOR dces not transfer the
records to the Village. Finally, upon completion of the Agreement,
CONTRACTOR shall transfer, at no cost to the�Ilage, all public�ecords in
possession of the CONTRACTOR, or keep and maintain public records
required by the Vitlage. If the CONTRACTOR transfers all public records to
the Village upon completion of the Agreement, the CONTRACTOR shall
destray any duplicate public records that are exempt or confidential and
exempt from public records disclosure requirements. tf the CONTRACTOR
keeps and maintains public records upon completion of the Agreement,
the CONTRACTOR shall meet all applicable requirements for retaining
public records. Reco�ds that are stored electronically must be provided to
the VILLAGE, upon request from the �Ilage's custodian of public�ecords,
in a format that is compatible with the �Ilage's information technology
systems.
IF CONTRACTOR HAS QUESTIONS REGARDING THE
APPUCATION OF CHAPTER 119, FLORIDA STATUTES, TO
CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS
RELATING TO THIS AGREEMENT, PLEASE CCINTACT THE
VILLAGE CLERK, RECORDS CUSTODIAN FOR THE VILLAGE, AT
(561) 768-0685, OR AT Imcwilliams�tequesta.or�, OR AT 345
TEQUESTA DRIVE,TEQUESTA, FLORIDA 33469.
e
TEQUESTA POLICE DEPARTMENT
4 :r.,:. .ii
► MEMORANDUM ��
To: Michael Couzzo 'llage Manager
/
From: Jim McGre
Date: September 22, 2017
Subject: MOU for LE Agency Access to DAVID
This is a Memorandum of Understanding for Law Enforcement access to the Driver and Vehicle
Information Database System (DAVID). This MOU is for stating the conditions and limitations
under which Florida agrees to provide access to DAVID to the Tequesta Police Department. The
MOU also states the conditions and responsibilities of the Tequesta Police Department
employees and the Tequesta Police Department.
�SAFEp
FL �A MEMORANDUM OF UNDERSTANDING
••-•••••••••••••••-••• FOR LAW ENFORCEMENT AGENCY ACCESS TO
�"'�`E ��"Y� DRIVER AND VEHICLE INFORMATION DATABASE SYSTEM (DAVID)
Contract Number HSMV-
This Memorandum of Understanding (MOU) is made and entered into by and between
, hereinafter referred to as the Requesting Party, and the Florida
Department of Highway Safety and Motor Vehicles, hereinafter referred to as the Providing Agency,
collectively referred to as the Parties.
I. Purpose
The Providing Agency is a government entity whose primary duties include issuance of motor vehicle
and driver licenses, registration and titling of motor vehicles, and enforcement of all laws governing traffic,
travel, and public safety upon Florida's public highways.
In carrying out its statutorily mandated duties and responsibilities, the Providing Agency collects
and maintains personal information that identifies individua�s. This information is stored in the Department's
Driver and Vehicle Information Database system, commonly referred to as "DAVID." Based upon the
nature of this information, the Providing Agency is subject to the disclosure prohibitions contained in 78
U.S.C. §2721, the Driver's Privacy Protection Act (hereinafter "DPPA"), Section 119.0712(2), Florida
Statutes, and other statutory provisions.
The Requesting Party is a law enforcement agency operating under the laws and authority of the state
of Florida. As a law enforcement agency, the Requesting Party may receive personal information from DAVID
under the govemment agency exception provided in DPPA as indicated in Attachment I. The Requesting
Party utilizes DAVID information for the purposes of carrying out its statutorily mandated law enforcement
and prosecutorial functions.
This MOU is entered into for the purpose of establishing the conditions and limitations under which
the Providing Agency agrees to provide electronic access to DAVID information to the Requesting Party. Use
of the data by Requesting Party shall only be for a lawful purpose.
II. Definitions
For the purposes of this Agreement,the below-listed terms shall have the following meanings:
A. DAVID — The Providing Agency's Driver and Vehicle Information Database system that accesses
and transmits driver and vehicle information.
B. Driver License Information — Driver license and identification card data collected and maintained by
the Providing Agency. This information includes personal information as defined below.
C. Emergency Contact Information (ECI)— Information contained in a motor vehicle record listing individuals
to be contacted in the event of an emergency. Emergency contact information may be released to
law enforcement agencies through the DAVID system for purposes of contacting those listed in the event
of an emergency, as noted in Section 119.0712(2)(c), Ftorida Statutes.
D. Driver Privacy Protection Act(DPPA)—The Federal Act(see, 18 United States Code §2721, et seq.) that
prohibits release and use of personal information except as otherwise specifically permitted within the Act.
E. Law Enforcement Agency — Any state, county or city law enforcement agency, and state attorney offices
Page 1 of 9
DAVID(LEA)DaW Exchar�ge MOU(Rev.11-2016)
operating under the laws and authority of the state of Florida.
F. Insurance Record — Insurance informa6lon, such as Insurance Company name, policy type, policy
status, insurance creation and expiration date provided to the Requesting Party, pursuant to Section
324.242(2),Florida Statutes.
G. Par6es-The Providing Agency and the Requesting Party.
H. Personal lr�formation — As described in Chapter 119, Florida Statutes, and informafion found in the
motor vehicle�cord which indudes, but is not limited to, the subjecYs drive�identification number, name,
address, telephone number. social security number, medical or disability information, and emergency
contact ir�formation.
i. Pofit-of-Corrtact (POC) - A person(s) appointed by the Request�g Party as the administrator of the
DAVID program in their agency.
J. Providing Agency-The Fiorida Departrnent of Highway Safety and Motor Vehicles. The Providing Agency
is responsible for granting access to DAVID information to the Requesting Party.
K. Quarteriy Quality Control Review Report — Report compteted each quarter by the POC to monitor
comp6ance with this agreemerrt. The following must be included in the Quarterly Quality Control
Review Report
1. A compa�ison of the DAVID users by agency report with the agency user qsh
2. A lis6ng of any new or inactivated users since the last quarterly quality controf review;and
3. Documerrtation verifying that usage has been intemally monitor+ed fio ensure proper,authorized use
and dissemina�on.
L. Requesting Party - Any law enforcement agency that is expressly authorized by Section
119.0712(2), Florida Statutes, and DPPA to receive personal infom�ation oontained in a motor vehicle
record maintained by the Providing Agency.
M. Vehicle Infortnatlon — Title and registration data collec:ted and mairrtained by the Provlding Agency
for vehicles.
III. Lenal Authoritv
The Providing Agency maintains computer databases containing infoRnation pertaining to driver's
ticenses and vehicles pursuant to Chapters 317, 319, 320, 322, 328, and Section 324.242(2) Florida
Statutes. The driver license and motor vehicle data corrtained in the Providing Agency's databases is
defined as public record pursuant to Chapte� 119, Florida Statutes, and as such, is subject to public
disdosure untess otherwise exempted by law.
As the custodian of the stabe's driver and vehicle records, the Providing Agency is required to
provide access to records permitted to be disclosed by law, and may do so by remote electronic means,
pursuant to Sections 119.0712(2), 320.05, 321.23, 322.20, and 324.242(2), Florida Statutes, and applicable
rules.
Under this MOU, the Requesting Party will be provided, via remote electranic means, informa6on
pertaining to driver licenses and vehicles, including personal informadon authorized to be released pursuant
to Section 119.0712(2), Fiorida Sfatutes and DPPA. By executing this MOU, the Requesting Party
agrees to maintain the confiderrtial and exempt status of any and atl irifortnation provided by the Providing
Agency pursuant to this agreemerrt and to ensure that any person or entity accessing or utilizing said
information shall do so in compGance with Section 119.0712(2). Florida Statutes and DPPA In addition, the
Page 2 of 9
a►v�u��►�oare�o n�ou�ay.��-2o�e�
Requesting Party agrees that insurance policy i�ortnation shall be utilized pursuant to Section 324.242(2),
Fio�ida Statutes.
This MOU is govemed by the laws of the state of Florida and jurisdiction of any dispute arising from
this MOU shall be in Leon County,Florida.
IV. Statement of Work
A. The Providing Agency agrees to:
1. Allow the Requesting Party to electronically access DAVID as authorized under this ag�eement.
2. Provlde electronic access pursuant to established roles and times, which shall be uninterrupted
except for periods of scheduled maintenance or due to a disruption beyond the Providing Agency's
cantrol, or in the event of breach of this MOU by the Requesting Party. Scheduled mai�enance
wiil nortnaily occur Sunday momings between the hours of 6:00 A.M.and 10:00 A.M.
3. Provide an agency contact person for assistance with the implementation and administration of this
MOU.
B. The Requesting Party agrees to:
1. Util'¢e information obtained pursuarrt to this MOU, induding Emergency Co�ct Information (ECI),
only as authorized by law and for the purposes prescribed by law and as further descxibed in this
MOU. in the case of ECI, such ir�forma6on shall only be used for the purposes of notiffying a
person's registered emergency contact in the everrt of a serious injury, death, or other
Incapaatation. ECI shall not be released or utilized for any other purpose, Including devebping
leads or for crranninal investigative purposes.
2. Retain information obtained from the Providing Agency only if necessary for law enforcement
purposes. If retained. infarmation shall be safeguarcied in compliance with Section V. Safe�uaMino
Infortnation,subsection C.
3. Ensure that its employees and agerrts complywith Section V.Safeauardina Information.
4. Refrain from assigning, sub-contracting, or othervvise transferring its rights, duties, or obligations
under this MOU,without the prior written consent of the Providing Agency.
5. Not share, provide. or release any DAVID information to any other law enforcement. govemmental
agency,person,or entity not a party or otherwise subject to the terms and conditions of this MOU.
6. Protect and mairrtain the co�'iden6ality and security of the data received from the Providing Agency
in acxordance with fhis MOU and applicable state and federal law.
7. Defend, hold harmless and indemnify the Providing Agency and its empioyees or agents from any
and all daims, actions. damages, or losses which may be brought or alleged against its employees
or agerrts for the Requesting Part�s negligent, improper, or unauthor¢ed access, use, or
dissemination of information provided by the Providing Agency,to the extent aliowed by law.
8. Immediately inactivate use� access/permissions following termination or the determination of
negligent, improper, or unauthorized use or dissemination of information. Update user
access/permissions upon reassignment of users wlthin frve(5)business work days.
9. Complete and maintain Quarterly Quality Control Review Reports as defined in Section 11 —
Definitions—J,and utilizing the form attached as Attachment 11.
Page 3 of 9
a►�o�i►>oam�s Mou�ev.t�-so�s�
10. Update any changes to the name of the Requesting Party, its Agency head, its POC. address,
telephone number and/or e-maH address in the DAVID system within ten calendar days of
occurrence. The Requesting Party is hereby put on nodce that fallure to timely update this
inforrnation may adversely affect the time frames for rec:eipt of i�orma�on from the Providing
Agency.
11. Immediately comply with any restrict(on, limitafiion, or condition enacted by the Florida Legislature
fdlowing the date of signature of this MOU, affeccting any of the provisions herein stated. The
Requesfing Party understands and agrees that it is obligated to comply with the applicable
provisions of law regarding the subject matter of this Agreement at all times that it is receiving,
accessing,or utilizing DAVID iMorrnation.
12. Cooperate with the Providing Agency in Field Audits conducted pursuant to Section VI.B.,below.
13. Timely submit the reports and statements required in Sectfon VI. Comaliance and C�ntrol
Measures,below.
V. Safeauardinalr�formation
The Parties shall access, disseminate, use and malntain ail infamation received under this
Agreement in a manner that ensures its corifideritiality and proper ut�7ization in accordance with Chapter 119,
Florida Statutes, and DPPA information obtained under this Agreement shall oNy be disclosed to persons to
whom disclosure is authorized under Florida law and federal law.
My person who wilifuliy and knowingly violabes any of the provisions of this section is guilty of a
misderneanor oF the first degree punishable as provided in Sections 119.10 and 775.083, Fbrida Statutes.
In addidon, any person who willfuliy and knowingly discloses any i�ormation in violation of DPPA may be
subject to criminal sanctions and civil liability.
The Parties mutuallyagree bo the following:
A Information exchanged wiq not be used for any purposes not specificaAy authorized by this MOU.
Unauthorized use includes, but is not limited to, queries not reNated to a legitimate business purpose,
personai use,or the dissemination,sharing,copying.or passing of this lnformation to unauthorized persons.
B. The Requesting Party shall not indemnify and shail not be liable to the Providing Agency for any driver
I}cense or motor vehicle ir�fama�on lost, damaged, or destroyed as a result of the electronic exchange of
data pursuant to this MOU,except as otherwise provided in Sec�on 768.28,Florida Statutes.
C. My and aq DAVID-related i�ormation provided to the Requesting Party as a resuit of thls MOU,particularly
data from the DAVID system, will be stored in a place physically secure from access by unauthorized
persons.
D. The Requesfing Party shall comply with Rule 742, Florida Administrative Cade, and with Providing
Agency's security pofides, and employ adequate security measures to protect Providing Agency's
ir�ortnation, applications, data, resources, and services. The applicable Providing Agency security poliaes
shall be made available to Requesting Party.
E. When printed infortnation from DAVID has met record retention, it shall be destroyed by cross-cut shredding
or incineration in axordance with Florida law.
F. The Requesting Party shall maintain a list of ali persons authorized wwithhin the agency to access DAVID
infoRnation.The list will not be provided to the Providing Agency, but shall be subject to viewing during any
Page 4 of 9
navro n.en�o■m�s aiou�ev.,,,xws)
field audit conduded by the Providing Agency or in the event of a violation under Section VI.,D,af this MOU
for the purposes of ascertaining whether the person or persons involved have been removed from the list or
have othennrise had thei�DAVID access modified or lim'�ted.
G. Access to DAVID-related informafion, particularly data fiom the DAVID System, will be protected in such a
way that unauthaized persons cannot view,retrieve,or print the infortnation.
H. Under this MOU agreement,access to DAVID system shall be provided to users who are drect empbyees of
the Requesting Party and shall not be provided to any non-employee or contractors of the Requesting Party.
1. By signing this MOU,the Parties,through their signatories,affirm and agree b�maintain the confidentialily of
the information exchanged through this Agreement
VI, Comoliance and Control Measures
A �uarterly Quallty Controi Review Report—Must be completed, ufilizing Attachment II, Quarterly Quality
Control Review Report,within 10 days after the end of each quarter and maintained for two years.
B. Field Audits — Feid audits shall be conducted by the Providing �qency in order to ensure that MOU
requirements conceming intemal controls are being met Field audits shall be conducted on-site by
Providing Agency employees, who shall be designated as °Field Liaisons° for the purposes of this MOU.
Field Liaisons shal! be geographically located throughout the state. The Requesting Party shall cooperate
with the Feld Uaisons in conducting fleld aud'rts by granting access to systems and records related to this
MOU and assigning appropriate personnel to respond to informadon requests.
Audits shall be conducted a minimum of once, every two years. Field Liaisons shall contact the POC in
order to schedule the audik At the compietion of the audit, the Field Liaison will complete a report and
provide a copy to the Requesting Party within ninety (90) days of the audit date. Should the audit
report conclude that defiaencies or issues exist in regard to the Requesting Part�s intemal controls, or
access to or use of DAVID information, Providing Agency reserves the right bo take, based upon the
nature of the deficienci�ssues found, any or ail of the foliowing actions: audit more frequen�y than
once, every two years; and/or suspend or tenninate Requesting Partys access to DAVID information
untii such time as Reques4ng Party submits proof sa�sfactory to the Providing Agency that the
deficiencies/issues have been corrected.
C. Intemal Corrtrol Attestation — This MOU is cor�tingent upon the Requesting Party having appropriate
intemal controls in place at all �mes that data is being provided/received pursuant to this MOU to ensure
that the data is profiected from unauthorized access, distribution, use, modficapon, or disdosure. The
Requesdng Party must submit an Attestatbn statement no later than 45 days after receipt of the audit report
referenced in subsecction B., above. The Attestation shali indcate that the intemal controls over personai
data have been reviewed and evaluated in light of the audit findings and are adequate to protect the
personai data from unauthorized access,distribudon, use, modification,or disclosure. The Attestation shall
atso certify that any and all d�ciencies/issues found during the aud'd have been corrected and measures
enacted to prevent recurrence. The Providing Agency may extend the time for submission of the Attestation
upon written reguest by the Requesting Party. The Attestation must have an originaf signature of the Chief,
Sheriff, or State Attomey,or person designated by Letter of Delegation to execute contracts/agreements on
their behalf,may be sent via U.S.Mail,facsimile transmission,or e-mailed to the Provlding Agenc�s Bureau
of Records at the following address:
Department of Highway Safety and Motor Vehicles
Bureau of Records
2900 Apalachee Parkway,MS 89
Taliahassee,Florida 32399-0500
Page 5 of 9
DAVID(LEA)Dab E�shanpe MOU(Rev.17-201�
Fax:(850)617-5168
E-mail:DataListinqUnit(a�fihsmv.qov
D. Mnual Certification Statement - The Requesting Party shall submit to the Providing Agency an
annual statement indicating that the Requesting Party has evaluated and certi�es that it has adequate
controls in place to protect the personal data from unauthorized access, distribution, use, mod�cation, or
disclosure, and is in full compliance with the requi�ements of this MOU. The Requesting Party shall
submit this statement annually, within 45 days after the anniversary date of this MOU. (NOTE: During
any year in which a Field Audit is conducted, submission of the Intemal Control Attestation may satisfy the
requirement to submit an Annual Certification Statement.) Failure to timely submit the certification
statement may result in an immediate field audit and, based upon the findings of the audit, suspension
or termination of Requesting Pai-t�s access to DAVID information as indicated in subsection B.,above.
In addition, prior to expiration of this MOU, if the Requesting Party intends to enter into a new MOU,
a certfication statement attesting that appropriate controls remained in place during the final year of the
MOU and are currently in place shall be required to be submitted to the Providing Agency prior to
issuance of a new MOU.
E. Misuse of Personal Infonriation —The Requesting Party must notify the Providing Agency in writing of
any incident where determination is made that personal information has been compromised as a
result of unauthorized access, distribution, use, modification, or disclosure, by any means, within 30
days of such determination. The statement must be provided on the Requesting Party's letterhead and
include each of the following: a brief summary of the incident; the outcome of the review; the date of the
occurrence(s); the number of records compromised; the name or names of personnel responsible;
whether disciplinary action or termination was rendered; and whether or not the owners of the
compromised records were notified. The statement shall also indicate the steps taken, or to be taken,
' by the Requesting Agency to ensure that misuse of DAVID data does not continue. This statement shall
be mailed to the Bureau Chief of Records at the address indicated in Section VI. C., above. (NOTE:
If an incident involving breach of personal information did occur and Requesting Party did not notify
the owner(s) of the compromised records, the Requesting Party must indicate why notice was not
provided,for example"Notice not statutorily required.")
In addition, the Requesting Party shall compty with the applicable provisions of Section 501.171,
Florida Statutes, regarding data security and security breaches, and shall strictly comply with the
provisions regarding notice provided therein.
VII. As�reement Term
This MOU shall take effect upon the date of last signature by the Parties and shall remain in effect
for six (6) years from this date unless sooner terminated or cancelled in accordance with Section IX,
Termination. Once executed, this MOU supersedes all previous agreements between the parties regarding
the same subject matter.
VIII. Amendments
This MOU incorporates all negotiations, interpretations, and understandings between the Parties
regarding the same subject matter, and serves as the full and final expression of their agreement. This
MOU may be amended by written agreement executed by and between both Parties. Any change,
alteration, deletion, or addition to the terms set forth in this MOU, including to any of its attachments, must
be by written agreement executed by the Parties in the same manner as this MOU was initially executed.
If there are any conflicts in the amendments to this MOU, the last-executed amendment shall prevail. All
provisions not in conflict with the amendment(s)shall remain in effect and are to be performed as specified in
Page 6 of 9
DAVID(LEA)Deta Exchange MOU(Rev.11•2016)
this MOU.
IX. Termination
A. This MOU may be unilaterally terminated for cause by either party upon finding that the terms and
conditions contained herein have been breached by the other party. Written notice of termination shall be
provided to the breaching party; however, prior-written notice is not required and notice may be provided
upon cessation of work under the agreement by the non-breaching party.
B. In addition, this MOU is subject to unilateral termination by the Providing Agency without notice to
the Requesting Party for failure of the Requesting Party to comply with any of the requirements of this
MOU, or with any applicable state or federal laws, rules, or regulations, including Section
119.0712(2), Florida Statutes.
C. This MOU may also be cancelled by either party, without penalty, upon 30 days' advanced written notice
to the other party. All obligations of either party under the MOU will remain in full force and effect during
the thirty(30)day notice period.
X. Notices
Any notices required to be provided under this MOU may be sent via U.S. Mail, facsimile
transmission, or e-mail to the following individuals:
For the Providing Agency:
Chief, Bureau of Records
2900 Apalachee Parkway
Tallahassee,Florida 32399
Fax:(850)617-5168
E-mail:DataListingUnit(a�flhsmv.qov
For the Requesting Party:
Agency Point-of-Contact listed on the signature page.
XI. Additional Database Access/Subseauent MOU's
The Parties understand and acknowledge that this MOU entiUes the Requesting Party to specific
information included within the scope of this agreement. Should the Requesting Party wish to obtain access to
other personal information not provided hereunder, the Requesting Party will be required to execute a
subsequent MOU with the Providing Agency spec�c to the additional information requested. All MOU's granting
access to personal information will contain the same clauses as are contained herein regarding audits, repo�t
submission,and the submission of Certification and Attestation statements.
The Providing Agency is mindful of the costs that would be incurred if the Requesting Party was required
to undergo multiple audits and to submit separate certifications, attestations, and reports for each executed
MOU. Accordingly, should the Requesting Party execute any subsequent MOU with the Providing Agency for
access to personal information while the instant MOU remains in effect, the Requesting Party may submit a
written request, subject to Providing Agency approval, to submit one of each of the following covering all
executed MOU's: Quarterly Quality Control Review Report; Certification; and Attestation; and/or to have
conducted one comprehensive audit addressing internal controls for all executed MOU's. The Providing Agency
shall have the sole discretion to approve or deny such request in whole or in part or to subsequently rescind an
approved request based upon the Requesting Party's compliance with this MOU and/or any negative audit
findings.
Page 7 of 9
DAVID(LEA)Data Exehange MOU(Rev.11-2016)
XII. ppp�ication of Public Records Law
The Requesting Party agrees to comply with the following requirements of Florida's public records laws:
1. Keep and maintain public records required by the Department to perform the service.
2. Upon request from the DepartmenYs custodian of public records, provide the Department with a
copy of the requested records or allow the records to be inspected or copied within a reasonable
time at a cost that dces not exceed the cost provided in Chapter 119, Florida Statutes, or as
otherwise provided by law.
3. Ensure that public records that are exempt or confidential and exempt from public records
disclosure requirements are not disclosed except as authorized by faw for the duration of the
contract term and following completion of the contract if the contractor does not transfer the records
to the public agency.
4. Upon completion of the contract, Vansfer, at no cost, to the Department all public records in
possession of the Requesting Party or keep and maintain public records required by the public
agency to perform the service. If the Requesting Party transfers all public records to the Department
upon completion of the contract, the Requesting Party shall destroy any duplicate public records that
are exempt or confidential and exempt from public records disclosure requirements. If the
Requesfing Party keeps and maintains public records upon completion of the contract,the contractor
shall meet all applicable requirements for retaining public records. All records stored electronically
must be provided to the Department, upon request from the DepartmenYs custodian of public
records, in a fonnat that is compatible with the inforrnation technology systems of the Departrnent.
IF THE CONTRACTOR HAS QUESTIONS REGARDING THE
APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE
CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO
THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS
AT (850) 617-3101, OGCFiIingCc�flhsmv.gov, PUBLIC RECORDS
COORDINATOR, OFFICE OF GENERAL COUNSEL, 2900 APALACHEE
PARKWAY, ROOM A432, MS OZ, TALLAHASSEE, FL 32399
REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK
Page 8 of 9
DAVID(LEA)Dala Euhange MOU(Rev.11-2016)
IN WITNESS HEREOF,the Parties her�eto, have executed this Agreement by their duly authorized officials on the
date(s)indicated below.
REQUESTING PARTY: PROVIDING AGENCY:
Florida Deparbnentof HighwaySafetyand Motor
Vehicles
Agency Name 2900 Apalachee Parkway
Tallahassee, Florida 32399
Street Address
Suite
City State Zip Code
BY: BY:
Signature of Authorized Officiai Signature of Authorized Official
Lisa M.Bassett
PrintedlTyped Name PrintedlTyped Name
Chief. Bureau of Purohasin4 and Corrtracts
Title Title
Date Date
Official Agency Email Address
Phone Number
AgenaY Par�of-Cor�
Printedlfyped Name
Official Agency Email Address
/
Phone Number
Fax Number
Page 9 of 9
DAVID(I.EA)Dale Euhenpe MOU(laev.11-ZO18)
ATTACffiVIENT I
FLORIDA DEPARTMENT OF ffiGHWAY SAFETY AND MOTOR VEffiCLES Reqnest Far
Access to Drtver And Vehicle Information Database System(DAVID)
The Driver's Privacy Protection Act,18 United States Code sec6ons 2721("DPPA'�makes peisonal informatioa contained
in motor vehicle or driver license records confidential and exempt&om disclosnre.Personal information ia a motor vehicle
or driver license record includes,but is not limitod to,an individual's social secucity number,driver license or idenrificafion
number,name,address and,medical or disability infocmation.Petsonal information does not include information celated to
driving violations and driver status.Personal infomoation from these n�cords may onty be released to individuaIs or
organizations that qualify uader one of the exemprions provided in DPPA,which are liste.d on the back of this form.
I am a representative of an organization mquestmg personal infoimation for one or more records as described below.I
declare that my organizadon is qnalified to obtain peisonal information under eacemption nutnber(s)
.as listed on page 2 of this form.
I understand that I shall not use or redisclosc this personal informa6on except as provided in DPPA and that any use or
redisclosure in viola6on of these statutes may snbject me to criminal sanctions and civil liability.
Complete the following for each D�PA acemption being ciauned. (attached additional page,if necess�ry):
DPPA Description of How Requesting Party Description of how Data will be used:
Exemption Qualifies for Exemption:
Claimed:
Obtaining petsonal information under false pretenses is a state and federal crime.Under peaalties of perjnry,I declare
that I have read the foregoing Request For Exempt Personal Information ia A Motor Vehicle/Driver License Record and
that the facts stated in it are�ve and correct
Signature of Authorized Official Title
Printed Name Name of Agency/Entity
Date
Page 1 of 2
(OZ/201'n
Pu�suaat to sectioa 119.0712(2),F.S,personal information in motor vehicle and driver licxose recocds can bc releesod for th�following
purposes,as outlined in 18 United States Code,secdon 2721.
Pecsonal informatioa nferred to in subsection(a)shall be disclosed for use in coffiection with mafters of motor vehicle or driver safety
and theft,motor vdricle emissions,motor vehicle product alteiations,rxalls,or advisories,perfoimance monitoring of motor velucles and
dealecs by motor vehicle manufact�uets,aod temoval of non-owner noonds firom the original owner reco�ds of moLar vehicle
manufacturers to carry out the pu�poses of ddes I and IV of the A�i Car TheR Act of 1992,the AuDomobile Information Disclosure Act
(15 U.S.C.1231 et seq.�the C(ean Air Act(42 U.S.C.7401 et seq.),and chaptecs 301,305,and 321-331 of title 49,and,sabject to
subsectioa
1.For nse by a�ry govemmart agency,including any couct or law enforcement agency,in canying out its functions,or any private pecson
or entity acting on behalf of a Fedelal,State,or lacal agency in canyin8 out its fanctions.
2 F�use in connecdon wiW metters uf motor vehicle or drivex safety and the$motor velticle emissions;motor velucle product
alteratioffi,recalls,or advisori�perfotmance monitoring of mowr velricles,motor vehicle parts and dealer�motor vehicle mac�Cet
research activities,including sutvey reseai+ch;and removal of non-owner rxotds from We original owner records of motor vehiele
man�factorers.
3.For use in the normal conrse of M�siness by a le�timate business or its egcnts,employees,or contractors,but only-
(a)to verify the acewac.y of pecsonal infom�ation submitted by the individual to the business or its agents,employees,or eontraetors;and
(b)if such iuformation as so submitted is not oornxt or is no longer coatict,to obtaia the corrxt informatioq but only for tl�pucposes of
P��g�b3'�P�g legal remedies against,or recovering on a debt or security interest against,the individuai.
4.For�se in comection with any civil,criminal,admiaistrative,or afiihal proceeding in any Federal,Stade,or local court or agency or
before aay self-regulatory body,iucluding the servico of process,investigation in saticipation of litiga600,and the execu�ion or
enfo�ement of jud�ents and ordecs,or pursuant to an ocder of a Federal,Siate,or local court
5.For use in resea�ch acdvides,and for use in producingstatistical neporls,so long as the peisonal informatioa is not pubiished,
re�isclosed,or used to coatact individuels.
6.For use by any insucer or insuisnce support organi�ation,or by a self-ias�ed entity,or its agents,employees,or contractors,in
co�ecaon a+ith claims inves6gatioa activities,anti&and activities,rating or uaderwriting.
7.For use in providing notice to the owners of towed or impounded vehicles.
8.For�se by atry liceased private investigative agency or Bcxnsed security seivicc for a�ry Pucpose permitted under ti�is yvbsectioa.
9.For i�se by an employer or its agent or insurer to obtaia or verify informetion relating to a holder of a com�t►ercial drive�s licease that is
required nnder chapter 313 of title 49.
10.For use in conaxtion with the operation of private toll transportation facilities.
11.For aay other use in response to�equests for individual motor veluck ncords if the State has obtained the express consent of the
pe►son to whom such peiso�L information perteins,
12 For bullc distribution for siavrys,markaing or solicitations if t6e State has obtained the express consent of the person to whom such
pe�sonal information pertains.
13.For use by airy requestec,if We nquaster demonshates it has obtained�e written consent of the individual to whom the info�rion
P��-
14.For any other use specifically aumorized uader the law of the State that holds the�d,if aich use is related to the ope�atioa of a
motor vehicle or public safety.
Page 2 of 2
(02/2017)
i � �
QUARTERLY QUALITY CONTROL REVIEW REPORT
Point of Contacts(POCj can do the followin�to satisfy the MUU Quarte�ly Quality Control Review:
➢ Compare the DAVID Users by Agency reportveith the agency user lis�t.
o Reconcile any differe�ces to ensure state and agency records are coRs'�stent.
� Keep a record of any new or inactivated users slnce the last Quarterly Quality Control Review.
o Update any users/1�ser informatiori as needed,document the reason for the change in
access,and the date the change is made.
➢ Monitor usage to ensure proper,authorized use and d'issemination.
o Randomly select a sample of users and run an audit report for a period during the
quarEer. Look for any misuse,including,but not Ilmited to reason codes,running
siblings,spouses,ex-spouses,celebrities,and political figures. Look at the times of day
the data was accessed,repeated runs of same record,and unexplained access to the
Emergency Contact Information.
o Rlease note:DHSMV highly recommends tfie agency aud'rt users as frequently as
possible to ensure misuse is not occurring.
➢ Complete the below report and ensure all actions are documerrted.
Quarter: Year;
Total active users in DAVIO:
Total active users in agency records:
Users inactivated du�ing quarter:
Users audited during quarter:
Total cases of misuse found:
Total cases of misuse reported to DHSNN:
POG Signature Date
POC Name P�inted:
Revised 6/26/14
PUBLIC RECORDS. In accordance with Sec. 119.0701, Florida Statutes,
CONTRACTOR must keep and maintain this Agreement and any other
records associated therewith and that are associated with the
performance of the work described in the Proposal or Bid. Upon request
from the Village's custodian of public records, CONTRACTOR must provide
the Village with copies of requested records, or allow such records to be
inspected or copied, within a reasonable time in accordance with access
and cost requirements of Chapter 119, Florida Statutes. A CONTRACTOR
who fails to provide the public records to the Village, or fails to make them
available for inspection or copying, within a reasonable time may be
subject to attorney's fees and costs pursuant to Sec. 119.0701, Florida
Statutes,and other penalties under Sec. 119.10, Florida Statutes. Further,
CONTRACTOR shall ensure that any exempt or confidential records
associated with this Agreement or associated with the performance of the
work described in the Proposal or Bid are not disclosed except as
authorized by law for the duration of the Agreement term, and following
completion of the Agreement if the CONTRACTOR does not transfer the
records to the Village. Finally, upon completion of the Agreement,
CONTRACTOR shall transfer, at no cost to the Village, all public records in
possession of the CONTRACTOR, or keep and maintain public records
required by the Village. If the CONTRACTOR transfers all public records to
the Village upon completion of the Agreement, the CONTRACTOR shall
destroy any duplicate public records that are exempt or confidential and
exempt from public records disclosure requirements. If the CONTRACTOR
keeps and maintains public records upon completion of the Agreement,
the CONTRACTOR shall meet all applicable requirements for retaining
public records. Records that are stored electronically must be provided to
the VILLAGE, upon request from the Village's custodian of public records,
in a format that is compatible with the Village's information technology
systems.
IF CONTRACTOR HAS QUESTIONS REGARDING THE
APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO
CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS
RELATING TO THIS AGREEMENT, PLEASE CONTACT THE
VILLAGE CLERK, RECORDS CUSTODIAN FOR THE VILLAGE, AT
(561) 768-0685, OR AT Imcwilliams@tequesta.or�, OR AT 345
TEQUESTA DRIVE, TEQUESTA, FLORIDA 33469.
�� ����
�:;,1� ,
_ �
� .
�`_�
Mento�'�t�t�lt[»1 Utilities Deprrrtilie�it
�I�o: Alichael Couzru. Villa��� ��lana��er
From: Sam I[ead�'. Dr��uty Director ot�Utilities
Datc: 8/8/17
Subject: �1'ade Consulting Agreement
I respectfully present the follo�ving Comprehensive Analysis to the Village Manager.
The agreement is for a third-party assessor to come in and do audit related to our
environmental testing procedures. The audit is a demonstration of our lab's competency to
carry out specific tasks related to the conduct of testing for which we hold our NELAC
certification.
Cost approximately$3,000.00.
i �\ � : . _ . . _ . . i
� � C(J`I� l��J I li�II I��(�t� ��
�'� /`G�IJ� {O�II,UI.II�i�,lr�';
-- -- ------ ._ ___ - ----- --- -
Phone: 913.449.5223 • Email: info@MichelleFromKS.com • www.,`tichellcFromKJ.com
Date Prepared: June 30, 2017
Prepared by: Michelle L. Wade, Principal
Assessors: Michelle L. Wade (Lead)
Laboratory: Village of T'equesta Water Treatment Facility
901 N. Old Dixie Hwy.
Tec�tiesta, Florida 33469
Contact: Michael Sudell
Phone: 561-768-0490
msudel I�utequesta.org
Scheduled Assessment Date: August 25, 2017
Villa�e of Tequesta Water Treatment Facilitv (E�6679) agrees to the follo�vina tenns and
conditions in regards to laboratory assessment services provided to the laboratory in
accordance with the Wade Consulting and Solutions (WCS) contract with the Florida
Department of Health:
• Laboratory aQrees to�av 100% of final invoice, which will be provided with their
assessment report within 30 days of receipt; and understands that WCS will not provide a
Fnal corrective action review if�avment is not received.
• Laboratory understands that tinal invoice may differ from original quotation depending
on variances in travel prices after quotation date, as well as variances in time charged that
may occur dependin�on the laboratories individual circumstances. WCS will make
every effort to identify this infonnation and provide it to the laboratory during the on-site
assessment.
• Laboratory understands while they are the client of WCS, WCS is oblieated to provide
services in accordance with the contract WCS holds with the Fiorida Department of
Health.
• Laboratory understands that the assessment provided by WCS may not find 100%of
deficiencies the laboratory currently has. A failure to find and/or list det7ciencies by
WCS does not mean that WCS condones any actions by the laboratory and the laboratory
is encouraged to correct deticiencies through their corrective action process if found.
• Laboratory agrees to provide WCS with access to all records pertaining to their
application with the Florida Department of Health for laboratory accreditation.
Page I of 2
1 T\ lD. 1� � - . _ . . -_ , _ , .
tc't��� c.i_ i: ir ��i�;�;C.
! i:;"i;'i.,: ti(Q`1:,-1?�iri3_,I�>�•
--_._ _ _- - - -- _--- ---
Phone: 913.4425223 • Email: infoC�MichellcFromKS.cum • www.,�tichcllcFromK5.com
• Laboratory understands that they may be asked to provide WCS with copies of laboratory
policies, procedures, and records
• Laboratory understands that WCS can not provide consulting services ro the laboratory
during the course of the on-site assessment, or for a minimum of two years followin�the
completion of the assessment process.
• Laboratory a��rees to not hold WCS liable for any findings, or lack there of, that WCS
may or may not tind during the assessment process.
• Laboratory understands that WCS is actin� in an impartial capacity, providing assessment
services on behalf of the Florida Department of Health, and that the laboratory is required
to follow all Florida Statutes and Regulations that pertain to laboratory accreditation.
I Michael Couzzo agree on behalf of the Village of Tequesta
(Printed) (Laboratory Name)
to the above terms and conditions.
� � 7
(Sib ature) ( ate
�����tf,{,(� �vVuaLi 06/30/217
Wade Consulting and Solutions (Date)
Principal
Pa�e 2 of?
PUBLIC RECORDS. In accordance with Sec. 119.0701, Flo�da
Sfatutes, CONTRACTOR must keep and maintain this Agreement
and any other records associated the�ewith and that are associated
writh the perfoRnance of the work described in the Propasal or
Bid. Upon request from the Village's custodian of public records,
CONTRACTOR must p�ovide the �llage with copies of requested
records, or allow such records to be inspected or copied, within a
reasonable time in accordance with access and cost requirements of
Chapter 119, Florida Statutes. A CONTRACTOR who fails to
provide the public records to the vllage, or fails to make them
avaiNable for inspection or copying, within a reasonable time may be
subject to attomey's fees and costs pursuant to Sec. 119.0701,
Florida Stafutes, and othe� penames under Sec. 119.10, Florida
Statufes. Further, CONTRACTOR shall ensure that any exempt or
conf�dential records associated with this Agreement or associated
with the perFormance of the work described in the Proposa! or Bid
are not disdosec!except as authorized by law for the duration of the
Agreement term, and following completion of the Agreement if the
CONTRACTOR does not transfer the records to the Village. Finally,
upon completion of the Agreement, CONTRACTOR shall transfer, at
no cost to the Vllage, all public records in possession of the
CONTRACTOR, or keep and maintain public records required by the
Village. If the CONTRACTOR transfers all public records to the
Village upon completion of the Agreement, the CONTRACTOR shall
destroy any duplic:ate public reoords that are exempt or confidential
and exempt from public records disdosure requirements. If the
CONTRACTOR keeps and maintains public records upon
completion of the Agreement, the CONTRACTOR shall meet all
applicable requirements for retaining public records. Records that
are stored elechonical�y must be provided to the VILLAGE, upon
request from the Village's custodian of public records, in a format that
is compatible with the vllage's ir�formation technology systems.
IF CONTRACTOR HAS QUESTIONS REGARDING THE
APPLICATION OF CHAPTER 119, FLORIDA
STATUTES, TO CONTRACTOR'S DUTY TO PROVIDE
PUBLIC RECORDS RELATtNG TO THIS AGREEMENT,
PLEASE CONTACT THE VILLAGE CLERK, RECORDS
CUSTODIAN FOR THE VILLAGE, AT (561) 768-0685,
OR AT ImcwilliamsCc�tequesta.ora. OR AT 345
TEQUESTA DRIVE, TEQUESTA, FLORIDA 33469.
�
.
. . .
�_ _.�
P�tonc'9134:`).5723 • Einail� iu(�� ��li�_h�l'�.,ii��n�}:�,��n�� - �.,.�.� Vi�6�l��.�ii"n����.:�ii.
Laboratory Name: Vilfage of Tequesta
Laboratory FL ID #: E�6679
Cstimated l tours �)uutc
P►-eassessmeilt: ? Cost�Hour: S>0.00 Total: $]00.00
Travel: S Cost Hour: S2�.OU Total: 5200.00
On-Site: =1 Cost Hour: S 12�.00 Total: S�0�.00
Rcport: � Cust Hc�ur: 5�0.00 Total: S 100.00
Correcti��c �ction � Cost I I��iu-: S>0.00 Total: S 100.00
Re��ie���:
Total: S 1.000.00
l:stimated T►-a�cl
1�tilca,Je: 100 0.» Total: S>j.00
:�irfarc: 5�7�.00 Total: S�7�.00
Ba��a��e Fees na Total: na
Car Rental: S1?�.00 Total: 512�.00
Hotel: � days: 1 Rate Day 517�.00 TotaL 517�.00
Per Diem: ;� days: I.� Rate�Day 5�0.00 Total: 5120.00
[ncidcntals: (Ti�s/Tollsilntc�7�cl Acccss!�arkin��) Tolal: 5100.00
Tutal: S 1,1�0.00
Final L-stimate Tutal: S2.1�0.00
Quote prepared by�Iichclle L. �Vade �-�0-17
�
•
. . �
Phonr. `)13.4�9.�223 • Email: infc�.��'A1ichdlcfromKS.com • 1��w�v.AtichdlchromKS.com
CO\FLICT OF I\TEREST STATE�IEVT
I �Vc thc undcrsigncd Laboratory Asscssmcnt Tcam hcrcby afGrm that 1 COIIflICI of�
interest does not exist, neither past nor present, bel�Veell I�l� L1I�Otill0l'y CVl1IU1t1011 TC1111
and /or its cm��loyccs and Villa�e of Tequesta �Vater Treatmeut Facilitv. This
affinnation is true �►nd ron-ect to the b�st of my/our knowledge. informaiion, and belief.
Print namc Si�,nature Datc
Michelle L. Wade ����� 06/30/2017
Mt�slon: Riek Scott
Ga�r�qi
To protect Crontote&improve Na healt� ��
uf aP paoFh in FqrK1a mrough integtated
st�ta,camty u communiy eitorts. John N.Armstrong,MD, FACS
�„1E A 1'1'H State Stirgeon General&SeCretary
GHL
Ylslon:7�be Ihe HeskhiestState e�1he NaGon
Septsmber 3, 2013
Michells L. Wade
Principaf Consultant
Wade Consulti�g &Sfllutions
99Q E 1�$7 Rd.
i..awrence, KS 68046
Re: Contract COP4S
Ms. Wade,
Please see for your recards, the�nclosed signed original contract COP4S. The document was
executed �y Vctor Johnson, our Division Oirector af Emergency Preparedness ancf CQmmunify
Support on August 23, 2013.
Th�e Bureau of Labaratories looks farwarci to our collaborative efforts on this irnportant initiative.
If you have not a[ready completed the deliverables specified in the contract, please submit_ The
contract can't be implemented uritil th�y have k�en recsived.
ff you have any questions please contact Ste�e Arms at 9Q4-791-15Q2 0�Steve ArmS@doh.state.fl.us.
Sincerely,
' '+. '' �? —�___.�.
�__ i,_ _,,{ �_;,_ ;:�1,�;.�
Regina Taylor �` -'"�'---
Adm�n�strative Service Director
Florid�Departtnent of Fleallh www.Flar(dasM�akh.com
Civ�ion cA Emergency Prepere0ness E Cammuniry Suopat TwiTiERHeanhYFik
Bureau of Public FfeelUt ldbordbDrSe9,J�r.ksonrille FACEBGOIc�fLDapertrnenlmtleallh
121 i N PesA S0.�eet�Jeclt9onville,FL 32202-3920 'f0i ITUBE fldoh
PHCNE 90afi 91•1500•FAX 904fT81-156 i
M199ion: Rick 8cott
Fo pm�ci PramafE 8 cns+;ow tlw headh Go�rnor
of all peopL=in Flaride Udcugh iMeg:aled �'1
state,r�unty S cnmmunilp ef`rxts • :I •_ .1�h�H. Armatrang,MD, FACS
flGt�i 1 Il Shdie Surg=rxi Genneral d 5ar.retary.
VFslort:To te the Heafthiest State n che Nation
July 11, 2013
To whom it may co;�cem,
While f am out on medical feave, Caral Brazet has n�y authorizafion to certify, sign and submit contract
invoices fo� p2yn�ent, fo ensure our obli+�atians remain current until my ret�m.
��
Regina T ylor
Administrative Senrice Directar
RTlcb
cc: Susanne Crowe, MHA, La��oratory Director
Marie-Claire Rowlinson, PhD, (ABMM) Assistant Laboratory Director
Florida D�partmont of Hep�th
�:vrtiun of Emer�3n�y Przpa2dnass.q Gommunity Supporl wMr+w•FlorFdasll�:Itiueam
8ureeu of rutlir H.ral�1 L2bordfoti55,Jacksonvlll� NlITTEP.He�IthyFL�+.
1_1 T t•!Peai Stree!•dacf.sonv�e.FZ 3r102-3?26 FACES�h?K.FLD?cu�trne n[ofiieaflh
PHrJNE 90aA91-350D•FkX�lT91-t�7
YOUTUBE.3doh
Rick Scc�tt
NiisalQn: Go�
To pr�;ad,pra�rx�te&�mprc�ve 5�e he.�tlh ��
cf all pgoplg rf Fbrlda Ihfqyh nl2g�t2d
s�aki,munC+B rAmmu�i(y eKoRs, � John N.Armatrong,HID�FAC$
��A,� 5tdta 5ur�aun General d Seaeiary
�'1f-.
VfsloR:Ta he the Ho�tthiesl S:ate in Ihe Na4on
July 11, 2013
To whom it may canc�rn,
VU�ile I arn aut on medical leave, Carol Brazet has my authorization to certify, sign and submit contract
invaices for payment, to ensure our abligations rem�in current until my return.
��� ��
Regina T ylar
Administrative Service Director
RT/cb
cc: Susanne Crowe, NlHA, Laboratory D�rector
Marie-Claire Rawfinson, PhD, (ABMti4)Assistant Laboratory Director
Florfda D�partrn�nt of Hgalth
www.F l o►id a a H o a i th.a o r�
Division otEmergen�Prepar�dness 8 Cummimry Supp�vt PAlITTeR�H�2flhyFLA.
3ureau of Publi�Healih Lahoratorias .lackscnvilk� f.4�EE�0�:FLDeR�r4�wntolFleallh
I�F7 N Pe3d Sheet•Jactsanu�e.FL 3224��52F Y�RUBE:fidoh
PyQNE 40er7g 1.�590�f��:90af;9�-15s7
a����
CFDA Na LA STA'�E Qti RIARIDA �Nott�qi�at
L'SFANa 1� DEPARTMENIITOIrHEALTS
b7AINQARD COAI'17tACT
TEDS G'OMRAGT is entadd inlo 6a�voea the St�ee of Florid�.Depshmcnt of Hnld�.fwei�x iefa�od ou m 8u dqpara�nm�errd
W�de Co�aed Sohnion� he�isfared to�s the por�drr.
THeP�A�Oa�
b T�PRO�o��
A. To pro�+�ie4�M�noe w�h the oa��ed in Atfachmerd L
e. RequT�ot�T.O��Flaride�(F�
To provide ur�s ot de�ables,indudtrq�repo�ls.tb��s.and d�aRs as apedied in AaadLnent I,to be reaehed and aooepled by the
ppntntct n�er pior b pa�rt�nt To comply wih fhe o�ia and b�al dale by whid�aich�must bs mat ior oompklfon�f this
oo�hact as epedfled M Sec�n 1�l. P�ayraPh A of thia oonU�Ct. To s��mit bA� for Rees or o�er oon�bn tor se�foes or
expemes in w�aemB tat a p�per pre-au�t and po�-a�t th�eof.wn«e app6cable.to�nrt a�ls 1br arhr tra+ref�in
800ondanCe with§112081,FS.1'he depaebneM me'►,if�ed in J4thd►rnent 1.est�lsh rales lower{hen Ih9 u�rnlam pr0uided in
§112�t,FS.To awow publk ao�oess to eM docune�,s.PaPers.l�arc,a athe�r ma�rials s�je�t to the Provieb�s o1 Chaipoer 110.FS�
rrmde ar reo�rad b�r a,e p�ov�in oor�e�otlan wwa1,tMs oontrad.n ia eoqxassly ur�ood ti+�t I�e p,nvWe�s re�t te c�r�y,Mn,
11�prorieion sha8 aonst�ibe an hmne�abe hreach of�ad.
C. To the Fotbwir+g Gowrntng i�r
1. S�to d FlaidA Law
a. Tl�e�oasb�ct is e�oeauted and eirtler+ad ir�o In Qre Sfale at Flodda,and at�ll be aonsbtrod.Pa�med.arb endo�9d in�[�spocbt in
a�o�dalsoe wi�t ltse �Ns� fulea, au� ropulri� Of thC 3tale Of Ftolida. Ead1 psfty shall pe�omt ds ob�a6or�e heie4n �1
aaooNanos vrl�i 1he teRr�s and oondqions af the conbact.
b. tfthts aontr�q is valued i�t 1 ndlUon�ormore.tl�e prn�rider agreas to�fraln irom arry of the�ed busGssa�s with
tl+e Goremmenb of 9udan and Itan as�in s.215A73,F.8. Puisua�t to s.287.i36(Sy.F.B.,tlte�hment slmfi befng a
ch+il aclian a�inst snY�M�Y 11�t fs1Ye1Y oe�tl�es�s aashis on U�e Soutinirred Canp�vdrth 11eWitles in Suden or the I�
P�an Energy Sec6or l.i�s. T�e prorida agteea ihet th6 d9pe�fOn►eM eh��ake dvll edion epair�st Ihe pmMder ac�in
s.287.135(�(a)�F.S.�if the prov�er f�dts to derrronstr�e that the d�mi�ot idse a�dfica�n�erras mede(n enar.
2. Fedared Law
a. R tNs oorMraol c�onfa�s teder�l tunds,Ute piorbde�shaA cort�ply+akh the pravislans of AB CFR.Part 74,a�dlbr 46 CFR.Part�2,
and a0�7�1e�ul�ia�a ae epec�ed In Att�d�►�nt I.
b. If�is 8groement�tlederal funds emd mone 11mn 52.OQ0 ot i�eder+al t�mds wiq be used ibr�or repahs��te prcaW�
ahaY com�y wuh the prv�eior�s ad the Copelau�d°MWOd�bsd�'Ad(18 U.S.C.8T4 pnd 40 U.S.C•2760}.as stepplemented by
Dep�hne�af Labor re�s(Z9!�R P�13,`CoMradors and Sub�onb�oc�ars on Pub�c 8u�ding or Pubtlo Woffc Finanoed in
Whole Or tn PBrf byr L0�Or�3�froM M9 Unlled 3tsteay. The ad prnh�s p�ovide��fnom 6�d�9.b!► am�means. anY
Penon e�oyed i�the�ion�oar�te�ai.or iepe�oi Wblic wvrk.to�ire vP�Y D�of lhe Oompensetion to wf�iah helahe
Is Otl�9e einiBed. lU et�ed W�ns na�at be neporied to the dep�trrxrd.
a N Ode a�reanent indudes t�adetal funds end eeid fiueds wiN be uted tw the perio�msnca of�. �rerMal� or
resea�h wolk,lhe ptovider d�ap c5orr�iy wMh 37 CFI�Part 401.'Rights to Inwe�rtions Ma�bY F�lit O�m�d Sme1
Bueb�aea Fimrs lk�der GovertuusMed Grenl�.Conh�Cts and Coop�tive Agreeir�s.•
d. If Asis c��s fede�sl fur�ds and Is o�rer=f00.000� the provider shatl oomply a�th �I�Ibia a4and8+da.Orf�DrB. Or
repulations iseuad under¢306 d tlte Clwn Air A�ct.ee amended t42 U�S.C_ t&i7(h)et a�.).§5�af tlte Clsa�V1fa0x Ad.as
amended t33 U.S.C.13�et aeq.)�Exea/�e Order 11738,and ErnkoiarseMd PooleCda+A9enq►�'�ule�ns(40(�R Part 16?-
The pnaNider shaC r�eport eny�ialatlaw o�Q�s aboore 10 tlt��h�rd.
.. If�u. conAscc aortdd��e rede�a a,�g in ezoess or S�oo.000. t�s pro� �, a� to c�c �n, �r�aie �e
C�n Rege�irg Lobhying fatm,AMadment�,M a Oksd�ue of LobbyMg�4�nei�as fotm.Sbndmd Farm LI-�-.i�requ4+40.
it r�r bs obisined br+�At the oor�Atanager.Ap�forms as�quired by�e f�n Regardir�Lob�y form must
be compteled asd�elurt�ed b tlte oont�act mana�et.
f. trat tie ernploy�na�Nwri�ad abe�.The deparMtent shN oonsider empbyment ot amu�horiaed�a yiolalfon of§$274A(e�of
the i�ation and Nahs�Ad t8 U.&.C.1324 s}and sedior�101 dthe(nurdgrotioA RC1prm end CoMrol Ad of 1986.$uch
vbl�bn el�,a be ca�e for ur�lat�canoeration a lhls ooNrad by�se aep�.-rne prapr�de�agreas a ut�be tho u.s.
DepaAm�d of NanalatM 3ec�tjls�1/erNy►sys4ern�I�tbsJ�e-vaih.usds.avv/�m�1D t�ify Mte err�plOYment a6gm�d ell�
�hirod Ourfng A�e�tenn by the Prorider.The Pror�der shaQ also indude e�equiren�etd in wboonEMefs 1l�t tlte
euboontrscior ahap utlpze tt�e E V�Myr sYaEern 10 verih 1hs emP���D�Y d sU �ned by the suboonbaclo�
during Ihe conb�t 1em�+. Conlracbo�t mea5�g Me ierms and c�ns d O�e E-Ve�ifjr 9yslem aro deemed 10 be in oanp�tnoe
vdlh tMs p�arision.
g. Tbe provlder�hpl��orrsply mdtl�P�afdeM's F�eecuti�re Otder 11Z�6,Equal Empbyment OpporaptMsr(�0 Flt 12319.1�5,3 G7�
196�-1966 Corrtp,.P• 33e).as an�e�ded by President's Exsoudvs�rder 11375,end as�bI►�at 41 CFR
Pert�.
h. The�ovide�'a�any�ors agrae to canply wNh Pro-G�Idren Ad of 1N4. Pub6C L�w 143-27T,+ahich �squires 1�a1
em0l�ing rwt be pBrmi�ed in prq portion of sry h�door facfehl tmed fa 1he provisian af fedeiap�r lundod aer�ias�rs�heedlh.
da�r care.ea�►d�kNwod aeaelopment educatlon a�rsy aer�Fces on a rou�rte or re�er besis.to cfdldren�!o age 18.Fa�ure
b cornpy wi�the Provisions of tl�e law may�It in the�of cheil n►or'etsiy p�lt!►aE up to�i.D001��sd►violatlon
endl�u+e unpo�ifion a an adn�stretfire�o�der on me��.
1 �f�
07I11
t. FiIPAIa whene app&�ble, �e powde� wiu oompi�r wr, tne rl�tl, �Soe Po�iliitp +boovunt�iliqr Act a� vre� as e��
�Pro�rtot�ad lheraund�(46CFR PaR!164.�62�Ond 18�.
1- Prouide��requ�ed to aubnR a w s bo the oepsrtrnaM of Finar�iai services(�FS�ele�Yr D���^9 bu�o�as w�th d,e
Sale of F1o�i�vts the Yendot IfNebtll�st_,�lAvendoranNkuidaol�.com. Arry�erd c�ngss aha0 be Parfo[nled tltrou�h
ihis w�bsiDe:howaver.If p�oyider r�b dta�igs 11�FEID.th�►rnuat oont�d tlts DfS Ye�or OmMds�nen Ssdion at�850I
413�19.
k if the piovider is detami�xd to be a subredpierd of Tederal fax�s�Ihe proYider rwll comphr w�h 4re requu�nerns of the American
f�eooveryt end ReYrresLnent Ad(N�and iha Faderal Fun�ng Aoo�ab�r and T�nsp�arn�r Ad.b�r obt�ln4 •DUNS
(pe�a Uni�81 Nunbe�h�9 S�3tem)rNimber!nd r�gfele�ing t�fhe federal Cenhsd Contractor Ragiat►Y(CCR1, Fb peymer�+�)
be issued ur�61 d�e p�ovider hw aubmit�ed e�va�d DUN6 t�ur�and evid�noe oT regl�tra6on{i.e.s pr�nEed aop�►oi tt�e oomple�ed
CCR registre�on) in CCR lo thc deperbnent. To obtetn � and �, +risit end
�Y-
Q A��ci�,i�ords.ard R�cords ReleMEon
1. To es�h �sd meintsin bo0ks. necond:, erd doaar�nit ('�ndtding ekctroNc sto�ge meda) in acoorda�oe a� �aU�►
aa�ed �tlnp Dra�ues and pra�Oss� whkh w�Y �d p�oper�r reAect s� �en�es arM �en�d�ras of t�ds
Prouided by the�trr�t�mder this oontrad
2. To rehin �( d,eaM e�eoonds, MarsclW remrds� suppato�Q �, atai�stical reaords. and any dher doambnA� �tg
el�o�d�storape mad�PerYcro�d to thk v�rad ior a period d ebc(�ysers vlEer ten�on a u+e oo�rad,or if an au�t hes
c��ma�a�r��n��oc���c��a a���,a►��oo�ar�aa be rees�+ed w�a��eaoiuno�or
a�e a�l�ding.or ar�l�On�id,n�y be b�an the�errm of tl�oonlred.
3. llpon oompletion ar termin:dion vf 1he corfiad end at the � of the de�brre�, ihe pro+tide�wi0 o�a1e w� the
deperbnerd fo �e the dup6catbn and bansfer of any seid rec�bs or dacu�ds during the iequiisd re�e�lial period ss
epec�lied G1 Sedial�.Per�repft D3.above.
4. To a�sswe that the�e ieoo�ds shaq be s�at aA�tl�nes� h�speceEon. review� or Sudil bp Federel, alate, or other
5. Pe1��audho�ed byYlhe �Fede�al�ors.pta'scrsM to 4�CFR.Pert 9L,38(�(1p),sha9 ha+ae t�aooess io
and ihe right b e�tNne any or p�o�ders aordr�aa!ar,d�alea reaords end doa.ner�ts.�ag�dle�s of the rorm in wtdch kapl.at ao
reaaor�s�mea�or�s bn��nicorc�e an r�atnad
8. To provlde a�ntnd�l�nd c�rt�eflCs eu�6t to!he d�An�nt ss a�d in Al�dr�nt I�A and�o ensure�et a0 re�ied p�uiy
traroadions ar+e disdoead to fie autila
7. ro i�ud.thess atonn,ent�orwa sualt and reoad k4�ng r�r.menta�aA appro�rea subooror�ls and�si�r�.
6. If Exhibk 2 of Ihis coMrad 6�es fiat 1he pravider is a rsdpieM or�fe�C the provider wilt perfOrm tAe cetp[Er+ed�d
and oompffanoe audN� in aaoadanoe wiM the 51n�le Audk Ad Art�redmenls of 18�a�d ON�Ci�ular t4-133� 9�dJbr ast�ion
216.97 F�aaido�.q epp�6Cpb�e and con6orm 1�Y�e�r�en�:
a Dvamonta�ai. To mai�ln bpaale au�oam4Gg d rarern�w and�es of fur�ds u�tder d�Qontroct and each CSFA or
CFDA nun�ber ider�d on Ex�it 1 a�hed haeb in accada�a�+�h 8e�e�apY�ePt����9 P��4��
E�lures vYttich suppott prot�er�e.�fiAties not �olely auM�d ur�Uas oordraat rra�at be aqocaled In a000tdar�ce adth
BPP� 18A�M9. ful9i iutd regul�� 8�d tl19 A1I01�tl011 r11�d1CdOfOQy 114�it A8 �el'It� eRd �Up�ed bY 00�6�t
EYId1:11C9.
Prowde�nwst msin�in su�,t eoan�n nt eU ezp�n�es haaoed(e,p.imioioes.cancaled d�dca.pe�l det�. bank
�@�p1�.�)w�der�i6 o0ntf�Ct whlCh i'vid9�1C0a t11�t�tW�BS�
1) iitowable wtder tlte conbad and epp8�abk laws,nda and�;
2� ne�orw�le:�d
The� �d�n is�aubJa�t��revkw�by► Oe�uhnad m�dlar the Siate qe�f Rr�and�l Uilioer su�d 1he
P�'o+�4er wIN�n�comOhr��Y�1�or doqJ�tlon.
b. F�m�ial Report. To aubmit aa aru�ual�repor!�in9.b�►Gne itam,aq experaiitures made as a d�resutt af sen�it�s
P��Dh�e f�nQ o�tlde Cont�d to�e D�rimBnt wlthin 4S days oF the end oi ihe con6act. If 1hk is p muN�jre�
conba�t,the piavide�is iequired tio wbmit a te�t w�45 daya of the arul vf eech y�eer of tlte oordrad- Each report me�st be
acaampanisd thr a st�n�erd si�ned b�r�i�iuidu�w�h leg�l a�oriby b bind radpiant or su�pient by�tl�et Sh�e
To�e Y�at�re�d�ume�corflrad e�ures is r�rtdCed to�,e D�r6merd+�&hin a5 d�ts of the
e�r8er of th�e�on d.or�mi�fion of.dds Co�cd.
E. I�ordEo�t�p b�►fhs Depaubae�rt
TO Pern7R p�ons dut�►�0�►ths d�eatment to i�pect any records�p�en•d0arner�ts�far�iEiea.goods,m�d serrioes a1 tl�e
p�ovlder. wf�fch are wlava�K to tlds aonVad. and bAerviea►arry dbnts amd anploytes of the P�der 10 st�uoe tlse depa�nent d
sa�ory�tom�anoe ot 1he�erms and oon�Ons o►M�rs aoNrad. Fo�owing sucfi a+ralua6on�a depa�a,�ad wip de�t�1he
provW�r a Mx�ton r�wt of$s finc�r�s�w81�nduds wrluen teoommendalbns w�ih repard ta the p�ovlde�a parlan�anoe d fhe f�ms
and cor�tiotes o!tl�s aonbact.The�vvider w61 coned all rt�oled daficie�fos ida�dAed bir ths dep�rn�t rr�hir+the spec�ed p�eiod d
lirne cd�afh tn Ihe The proriders�aBure tn aom�ct noted de/idencies may.at ihe sob a�e�adcbiw�e dMa�elion of
�e dep�rtmera, reai,�c In any a,e cr any anrneie�an or e,e Oo� (1) 1he P�beina desmed tr� br�fi or delwlt of oas
oaKract C�tlie�ne of paymeMs to the p�widef bY 1he dePerbnent arsd(3)tlie te�minoltiorf of tMs oontcaCt tor aause.
F. b�demmiio�on
NOTE: Paragr�pF► LF.1. and IF.2 a�e not app�kedle to oontrads e�saRed bet�aeer afade a�aruaes or aibdh�iOns, es deined b�
§788.28.F&
1. The prorider�be Bab1r Tor�d shaB i�demnilY,�,end hold hanrie�the d�rar�eM a�d a4 of�s al6oers.e�entS.8�td
employee�it�om sil detmsr suRs.j�.or d�ss,�e�+�roal Or OtliO�wi�e snd�e�omeys'tees and costs,
2 contr.ats COP
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07I11
This oonUact may be�rrninated by either parly upon no less th2n Ihirty(30)calendar days notice in wri6ng to the oUier party,wilhout
cause, unless a iesser 6me is mutua�y agreed upon in wrfing by boih parties. Said notioe sha�� be de�i�rered by oertifled mail, retum
recelpt requested,or in person with proof of defiUay.
2. rermination Because of Lack of Funds
In the eve�tt furtids to finanCe this Contracc become una�ailebie,ihe department mey lertnioate the contrad upon no less ihan�lvgrrl�-four
(24}hours aotioe in writing to the provider.Said no6ce shail be deliver�d by cert�fled mail,retlim receipt requested,a�in person with proof
of detivery.The department shall be Ihe finel authority as to Ihe availability and adequacy af funds. I�the event of termination of this
corrtract,the ptovider wil)be campensa0ed for ar►y work 5atisFadoriy completed prior ta notlflcation ef tertninaUon.
3. Terminatiott for&each
This cor�ract may be termi�ated fur the provider's rwrt-performance upon no less ihan hnran�Oc+r(24J hours notloe En wrifing to the
provider. If 8ppl'icable, the cfepartment may employ the defaulf provls;ons in Chapter 64A-1.006 {3), FAC. Waiver af brea�h of arry
prrwisions of fhis contract shalt not be deemed to be a waiver of any other breach and shall not be construed lo he a modilication of Ihe
terms of lhfs oonlraCt•T�e provi�lOr�s herein do not limit the departmenYs right to remedies af law or in equity.
4. Terrninalion for Faaure to Sa6slactarily Aertortn Pnor Agreement
�ailure�o have perfom�ed any contractual obligations with the department in a manner safisfaaory te fhe departrner�t will be a sufficient
�ause for terminalion.Tp be terminatad as a provider under this provision,the provider must have: (1) previously failed to sat�s►8ctar�y
perfortr�in a aontrad wilh ttie deparlment, been notified by the depertment of tl'�e unsatisfactory performance,and failed to oorred the
unsatisfactary pe�fotmanoe to ihe satisfacUon of the departmen�or(2)had a vor�tract terminated by th6 dBpaAmer�t for C2use_
C. Renegotiatlon or iModifrCspon
Mudlflcat6ons of provislor►s of thls oontract shall anly be valid when Ihey have been reduoed to wri6ng and du(y signed by both pa�ties.The
rate of payrner�t and dollar amourn may be adjushd retroaatively to reNeU priCe level increases and changes in U�e rate of payment when
these have been estebished Ihrough the appropriatio�s process and subsequeritly idenYfied in the dBpaAmenYs opereling budget.
i}. O�Ilcial Payee and RepreserrfaNves{Narnes,Addresses and TNephone Nurnberaj
1. The narr�e(pravider name as shown an page�of ttus contract)and 3. The name,address,and tetephone number af the oonttact
maiGng address of the offiaal payee to whorn tlae paymer�t�all be manager for Ihe departrm�d for this contract is�
made is:
WadQ Consultinq and SQIuUons Res�irta Tavlor
Michelle L Wade 1217 N.Pea�!Sheet
990 E 1587 Rd. JackeorniUe.FL 322Q2
Lawrence.KS 68046 904-T91-1709
2 The name of the oonlsd persan and street address where Tmandaf 4. The narne,address,and telepha�number of the prowde�'s
and admirdstrative reootds are mamtained is representati+re responsible for administration of the pavgram
Michelle L Wade underth'rsc,onbact is:
Nlicheile L Wade
990 E'1387 Rd. 890 E�587 Rd.
l.awrence.KS 66046
L reo e. 604
- - 913-448dr223
5. Upon cha�ge af raprasentaiU�res(�arnes,addrssses,telephone numl�ers)by either par�y,notice shall be provided in wreting tn the other
perty and said no�ificatiort attad�ed io uriginels M Ihis oontract,
E. AU Terms 8nd COnditions InC!Ud9d
This oontract and its attachmenls as neferer�ced,1 ooniain all the Cerms and condNions agreed upo�by ihe parties.Ther�2re no pro�isions,
terms, conditions, or obligaUons other than Uwse oontamed herein, and this aontract shaU supersede ae previous comrnunications,
rep�esentations,or agreements,either ver6el or written belvreen�e pa�s.If any�erm or provision of Ihe ooetraCt iS found to be Illegal or
unenforCeeb�e,the remainder af the opnb�dCt shall remain in tull foroe and effed and such lerm or pro�irsion sha11 be stricken.
I have read lfie ebove cootrect and undersffind eacL section end parRgr4ph.
IN 1�I�i7NESS 7�lEREOF,thc panics hcreta havc caused this 21 page contract to be eztcutecl by thelr understgn�b officials as duly au[horined.
P�Ov�pER: n 1 io STATE QF FLOWDA EPARTMB[VT OF tIBALTH
SIGNA"fUR.E: � � � �,���� ___ _ S[G�IATURE:
PRQY'['rFYPE NAM11E:MICI'IL'IIE!L.Wade PRIVT�YPE YAM11E:V'C Johason
TI7LE:Divisian Di c Emergency Preparedness and
Y]T6E:PrinCi I Cpnsul�artt Communi Su
Dn_��.(� 1?y DarE� -- ��t Z 12.�, --
Srare Acsnc�29-DIG IT FLAIIt COQE:
F�osa,��a��ii(oa SS[Yr SiSA2-8236
PROY[DER FfSCAL YFAR E�D[A'C D�ITE:
6 convaa�CaP4R
Attachment I
a sERvrc�s To sE�o�n�a
1. Defirdtion of Terrr�s
a. A�.r.r.red�aBon: Tturd-perty atte�tation r+�ated to an environmental �esting
I�orabry oonveying famal demonstratton ot ite competenoe to c�rty out�ec�c
taaks�ed to the aor,aud ofi the te�tinA�or wr,icn it ho�ds oertific�.aso.the
p�ocess by wh�Ch an agency or organi�atio� e�ralu�es and �cogn�es a
laboratory as meeUng certain predeterrr�ned qualific.a�iot�s or sisrtds�r+�.
b. Hccr+editatio� Body: Autftn�ati�re body that perEomns aoa+e�tion or
oertification of envuonmental tiestirtg laborato�ies.
� Analyt�e: A substanoe, organism, phyaicaf parameter or ch�nical cor�stitueM
tha�t�k�einA measured with a me�od, en� at th�context�for which cer�flc�tlon Is
ofF�+ed.
d. �1: FO�R1 DF� 97�, �I��n �OT �011 O� EIIYIr011�
Testirig Laborata3es,° July 2Q44 adopted by reference in 84E�1.102(1), �Iorida
A�nisbra�ve Cods. Appfication focm and 64E-1:
irttp:rna,Nw.don.state.fi.u�lEmd.at�Cerwvac�rCertMm
e. Assessme�k Pra�ss undertaken by or on beha�of an accreditation body to
asse�s the compete�nc� of a Iabo�story, based on p�rtkuFar standend(s)�
regt�ations, oertitied test methods ar�dJor other nom�ativ�e docun�eM�s and ior
definsd Fields of Accrs�tation; someltimes t�lled an tt�tion.
f. Assessor: PeBon assi�ned by or c� behalf ot an a�q'a�ta�� bod�r to
�fortn, abone or as paR of an assessment team, an assess�ner�t oi a iaboratary
to detertnine its r�pabiGty and capacity for m�irt9
requi�+em�ts by examinir�the reco�and o�her physical evidence for�t�t one
of the Fields of Acaedtation for which oertflc�tion has bee��quesbed-
g. Cer�on: R��ds�tory reca9Ndon given tfl a labor'atory that meets rr�rwrwm
qual�y�d an�yNcal p�Forrr�arxe standards.
h. Correc�lve Actlon Plan(PI�of CvrrectloR}: The actions t�cen to ellmir�a�s the
causse ofi sn exl�ting defiu�ency, nonoonfotmity, defect ar other undesi�le
situation in ader to �+event neciut+ence. Propoead Plar�s of Correct�on are
submil�ed bryt t�ient laboratori�a in response bo defic�encies cibed during an
essessr�rt on Form I�I 1137, referenced �t Fbrida Adminishative Code
Chapber 64E 1.104(3).
i. Detidency:M assesement oondusion referereoed to a laboratory�e�on
sta�rd and supported by objectiv�e evidenoe that fdentitles � devia�on irom a
laboratory oertficaAbn standand r�quirement.
j. D�artrr�t rne oepsrtment of HeenN
k. ELCP:Enviroronental Laborar�ory Certiflc�tian Program
I. EPA: The United Stabe�Environ�neMai Pro�Agency
m. Fietds of Aaxe�ation: Thase iVlaMx-Method,�►nalyte cornbir�ations far a�hich
the Depenrnent ofll�rs certificalio�end by which labaatories are ce�ied.
n. Mstruc The sUD�rate of a test samp�e furthe�' defirted in lhie context for
oertiffcatton ptu�po�es a�
7
Cont�ct�ICflP4R
Atta�hment I
(1) Drinkir� Water Matri�c: any aqueous sample that has been
aeslgnat8d a potiab�e or�I potabN arater sou�ce.
(2) Non-Potab�ee W�r MaM�c any aqueous aemple exduded from the
c�efmitlon of DriNartg �1Fa�er matrfic. This indudes souroe water,
gnot�d�rster, e�ts, water treab�risnt chemicsls, and Toxidky
Cha�acteristic L�chi�Pt+oc�edure-(TCL�or other extrac�s.
(3y Solid and Chemical Mlateria� Matrix tndudes eabs, eedfine�s,
sludges, produds and by-prodtu�s of an ir�igl proc�ss that r�esulEs
In a matnlx�ot preWously de�ned.
(4} Blological Tissue Matrbc any semple of a �I ori8� such as
fish tissue, s�ellt�sh, or plant material. Such samples�all be grouped
according to origin.
(5) Air emd Emissione M�trbc whole gas or vapor �amples mdtidirlg
those contauned In flexlble or rigid wadl oo�tairters and the ext�ed
conc�nd'�ted ar�lytes of ir�terest irom a gas ar vapor ihat are oollected
rvith a�orbeM tube, impir�ger soM�tion,filt�r,or other devioa
o. AAethod: An adop�ort of a scientific ted�mique for pecformirtg a spec�Fc
me�tu�ment. as documer�ed � a f�oratoq► SOP or as p�lished by a
rec�gr�ed authority or a body ot pnooedures and techniques tor performing an
activitY (e.g., sampling, chemical amalysis� quant�n). systemet��Y
praseribed in the order in which fhey arE to be execx�ted, aru! fn this oontext, fa�
whiCh�fiCation is ofre�'ed.
p. NE1�1C:Nstio�Ernrmonmental Laboratory Accred�tion Confenenoe
q. NELAP: f�kttional Ertv�onmental Labor2�to�y A�on Program
r. Standar+d C�ai�g Procedura {SOP): A written document which deta�e Nre
rttethod o�an operation�artalysis ar acHon wt�e techniques an8 prooedt�'+es ane
�1'wY pr�e�c�ibed and rfiich is aooep�ted as the method tor pe�focmi� oe�tain
routine or nepeMi+re tasks.
s. TNI: The 1VELAC Ir�tituhe
2. Gerler�sl D�fion
a Gerreral StartemeM: The Provi�er sh�dl c�or�dud periodic on-site inspedior�s
(as�ts) of ern+frvnmental b�ting laboraborie� �elcing cert��ation by the
Fforida Oepattment a�f Flea�it's Envlro�mental Labor�tory Certi�tor� Proaram
for debermining the Iaborato�ies'oomp6ance w�th appllcable Isw� snd regula�lons.
After rsc:slpt and pra�i��of en application for ini�al or additlor�o��on or
lor ret�ewal af aru�t�al certi�CaEion,the Department w�l prati+lde the laboratory a li�f
oi app�ov�ed provldera. VN�en the Provider no6fies the Depat1meM of an
upc�nin�arr�t ta be conduc�ed af a dient�aboratay on the DepeiMmerrt's
behalf, the Depm'trnent vv�l fotward the app�Ca�on i�rtortnation to the Provider for
review and use in its assesament of fhe laborakory.
b. Pwt�w�ity:
(1j Chapters 119 and 12a, Sections 403.0825.403.883 and 403.8635.
Florida StaRute9
(2) CF�pter 54E-1,Florida A�dmn�tra�ive Code
(3) Title 40 Code vf Feder�l Regule�tior�s. Patts 141 snd 142
s
C.ot�cdMC�P4R
Attachment I
c. ScaQe of Service: This shali be a 3-year na-cost oor�ract to provide periodic
on-slte ir�spectivns (assessrnent�? a�f ernrironmental testir� laboratories seeldrtg
or mair�taining c�iflc�on by the Flarida Deparhnent of HeaHh Ernironmental
La6ore�ory Certffic�tion Progrem for the purpose ai deberminir� the I�aratories'
oompllance v�th applicable laws and regula�ions at�d e�g�ity ta be cert�ed.
d. M�jor Program Goats: To oertiffy competent end quaYf'red d�ki� water and
environmental tiestir�labora�ories. A major oompon�t of this proc�ess is the on-
s�e assessment of laborabo�y facpl�es, rr�a�tagement, perea�r�l� q�1�Y SYs��B
and anslyticaf edi++ities ac�oMir� tc� appicable �s. rules artd rtatio�al
acaet�io�stan�rds usfig techrdc�lgt quaN�ed assesso�s.
3. Cqent E..aboratories to be Served
a. General Desaip�io�and Approx6na�e Nurnbers Cun�ntly Certified
(�) LaboratorYTYPe
(� Commerae1: 190
(In Watier�d W�ter.15Q
(� S`tate:29(12 are locabed in c�ounty heaMh departrr�erd facii�es)
(A►) universtty: t2
(v) Fedefal; 7
(vi) Reaeard�=2
(2y Matr�s Cefified
tr� o����water.zaa
{i� Nort-Potable wat�r:.319
(ilij Soid end Ct�Allateri�s' 181
(i►r) BioloDical Tiasue:22
(� Air and Err�One:20
(3) Scienti8c Di�ipliries Ce�tified
(i� Chert�try:31d
cm ��r-x�s
ci� Ra�herni�r 2�
(iv)Tvxi�r.19
(4} Si=e ofi I.aboratory{matroc�nettrodsj
(i} 1-'i0: 155
{6j 11�0: 155
{i�} �50:a0
{$} In-State vs_Ot�-0fstabe Lacstion
(} In-Stata:278
{� Out-of�e: 112
{6) Mob1s Laboretories: 10
b. Cl�ent el��i6ty: The Dep$itment rgt8olB the euth�ty and right to de�eirmll'1e the
el�ibpity of labw�ories tc be assessed besed on pm+ent c�ertifice�on snd compfis»oe
status.
c. Clrent Detertronation: The De�arhr�tt's ELCP wNl perfodicaMy notlfy dient
labor�torles wt�e� an on-s(te aseassment 1�du� In ganeral.thia wil be 2 y�ear�a�
the last iull assessme�t wa6 aompl�ad. The TNI �t�ndarde spe�ty that a
9
Cont�tcbNCOP�4tt
Attachmeat I
reassessment Bhall be oonduded ev�ery 2 y�esrs �lus or rYdnus 6 months and th�
schedule wdl be usad.
B. MANNERAND LOCATION OF SERVICE PROVISION
1. Servtoe Teske
a. Task List
(1) Aft,e� beir�g setec�ed by a client laboraboty to condud � ons�ts
essessment, the Provider st�9 re�riew ffiry applicetion the laboraitory
t�as se�rriaed tor cer�tic�tlan aa a�igned by the Depardner�t and as
�asary fo dstermine on-sibe esse�ent rteeds.
(2j The Provider shall assernble an assessment t�m appropriate for
the s¢e and scope of the labor�tory to be as�esaed oomPrehensiveh►
and v►+ithin a r�sonable number cf oon� workdays.Asseasment
t�ms shaB inckide a qualified le�d �sor and mey Induc�
acid�ional qu�d a�s, technicsd specialists, ar►d, if e�ud�o�d
b�y the labo�tory befng a�ed, observ�ers. Based on the type o�f
assessmenE�d the soope af aareditation aF the dient faboratory,the
lead a� shall ertsure the aasesstr�ent tearn has suft�ent
personr�el, knowledge� skiDs� b�irtin9. q��� Pe�'��
8ttributes, and sufNdent o�ar�Zatiorret authorlty and fieedom �o
perfotrn aesigned du�es. The Pc�o�ider aha� allo�w the ELGP Progrem
Acknir�trator b ass�n Departmer� staf�to partldpate � ar obaerv�e
any asaessment perfomred by the Provide�.
(3) The �ovkler shaM sc��edule aR assessrr�eM w�h ihe c�ent
laboratwy w�tttin 15 c.alend�r dsys afier receiving notifrcatioA from 1t1e
dient labcratory d��t ths Provtder has beeR aelected to pe�form ihe
assessmer�t for comp6ance with the requaecr�en�s of the leboratory's
c�ertific�ion. The a�sessmerit sHall be conduc�ed no lafi� than 60
cafendar�ys i�ollwuin0 the sched��p. At fhe tirr� aF sc�uling, tha
Provlder�ali rtctify the Qeparhrtent of the asaessments sd�eduled.
{4) The Provlder shall ocnduci comprehensive o�s(te laboratory
essessrr�ents to de�ertnir�e oanp6ance with tlte applicable provisiorts of
Florida AdminisUative Code Chapter 64E-land the 200C! NEIAC
standa�ds adopled by re�enenc�e ther+efn. The � shai(
enoompass ef( Fields of Aca�ec�itation for which the labaratay seNcs
initial or r+ecerttticatbn. Ccmple�on of e�ppl�ians previously
SubmitEsd shaaill ordy be for the Fislds vf Accx+edRa�ion sougftt.
(5) The Provider 9hall prepare and Issue a �epo�t {the on-sita
a�easment report) �mentin9 anY deflcc�x�es disc�ovet�ed by the
a�ssment team duNng the car�duct of tl�e on-sne ass�ent end
lir�cing by refienerwe �ch of these deNciencies di�ectty to the
a�ble NELAC (2003)and TNl (Z009y Standard. OetiMdencies sha�
al�o be cited for the labordtory's tailure to follow certitied test method
spe+ciC�ions; the�e�ier�s also shall be Gnlaed to 1he ap�able
NELAC �20ai) and TN1 (2009) Standard as arelt as to the applicable
� fiBBt tt1A�f7od SpeC�1C8�10t16. O�F81�@�It1A�1t f�lb��3 MUBT It'IB@R�
]0
Coanac�COP4R
Attachment 1
epedf�tivns givan in TNI �tdard EL-V2M1-20�8 ar� EL-V2M3-
Z0� and 64E-1.104(5j, FAC, h�clu�ing the use af tt�e form apecifled
by this rula. T't� e�merfis in Appendix A must aleo � In�d, az
applicable. Uport neguest artd within 7 busa�ess deys of�r�equest,the
Provider must supply the Dep�rtrnenrt with satny and aU materisis
gathered and used durin� a leboratory aseessme�. These materials
may ic�dude but are not limiteal to cheddists, oort+espondenoe. yua8[Y
manuals� laborat4ry data, conflict of ir� fom�s, and co�'ide�ial
busirress ir�farrr�ation forms.
(8) The Provider shaN requlre t�e labaatory as�essed to r+espond,
using the form �ecified by Chapbar 64E-1.104, within 30 c�lendar
d�ys of its reoeipt o� the on-slts a9sessment ne�ort by submitting a
ProPo�ed Plan � Canec�On (i.e.� cor�edive acfiion plen) tor eadi
def�ie�r�dent�ied in the on-site assessnner�report
(7} The Provider shap reviear the �boratory's Plans vf Correcxfon a�ed
rr�ake wrltten recommenda�ons to the De�rtrnent as to e�ch Plan's
aoce�iety for coRedion af the ated deftciency.
(8) The Providar shall ena�e the lead as�essor and ather as�ame�
team members ar�e ava�le. at no cost to the U�Kment, tor
interviews related ta(nternal aud�s,auch as thaR conducted annualy of
th�e ELCP and extemal e�raluations of the Departrnent, such as
cAnducted by en eoctwnal orgeutiz�iott to detemdne 1he coniormarioe
to qu�ive amd qualitative specific�tiana of NEI.AP ancUar EPA, or
#o resol�e legel mette�s ar ather�ispuces resc�from ob�v�ions
docunnertted on an assessment rePort prepau+ed bY the Pro�ridear,
b. Taek Lirrdba
(1) Du� th� condud cf an on-s�e aa�easment, the Prvvid�'s
a�asessment team shaA oMy addness s� app�afion trortt the dient
Iabor�tay i� �t hres been previously reoeivad and r8vtew�ed by the
�
(2� The Pravider sl�ll ensure that norte of the asses�o� ��ssigns to
an on-s�s aseessment of a c6e�t labo�tory on the Depea�tment's
bet�atlf has pr'ovided c�onsultan�y to the laborator�► or provides
consultancy Lo the labo�tory duru�g ar�ber the ort�te aseessment for
ar�t rriedter related tio U�e a�sesSnleM.
(3} The Providet sl'tall ensu�e that none of the assessors R asst�ra to
any on-site sasessment of e ctiertit laboratflry on the Departrnent's
behaPf is a sta{t or contraa�nployee of any laborarory certiheat by d�e
�
(4) If, prio� to �n as�essrnent, dte Pravider cartnot assembls an
assessment tea�m that has suRicient persormel, kriowledge� �Ci11s,
tral�n8, qua6ticahlona, and pe�onal adtn'�S desCribed in this
contr� to encompass all Fielda of Aocr+editation for whidt the
laboratory aeeks cert�ica�ion or rece�tif�caticrt, 1he Provider sh�l
assess the dient faboratory only for those Fields af Acxxadi�tlon for
11
C.o�P�4tt
Attachment I
which its assessors do har�e the require�d knowledge, skills, training,
qualificati�ns, and personai attributes. The Provider shall also reveal
th�e limitation to the r�ient laboratary priar to the assessm�nt.
(5) The Provider shall notify the ELCP Prflgram Administrator and the
client labaratory if nat all Fiefds of Accreditatian for which the client
laboratory is cert'�'ied or seeking recertification were assessed during
an vn-site assessment.
(6) At the clasing conference of an assessmerrt, the Provider's
assessors may inform the cliant labaratory of revommendations
regarcling the potential Reed for a foltaw-up assessment, but the
Department has the final decisian-makin� authority with �egard to any
potential enforoemer� activities, such as fvllow up assessments far
non-oompliance.
{7) The Qepartment will, at its discretion, continue to perForrn
assessments of client laboratories for contract oversight, qual�ty
assurance, enforcement, assessmer� backtog reductivn and other
re�sons deemed necessary for the effective flperatian of the ELCP.
2. Staffing RequiremeMs
a_ Staffing Levels: The Provider will ma'iritain adequate staffing IeY�ls to faCllitate
provision of the services described under this oontract, including technical,
adminisfrati�e, and clerical support.
b. Professiqnal Qualifications artd Personal Attributes: Assessors emplayed or
contracted by the Provider must meet o� exceed the requirements in TNI
Standsrd EL-V2M1-2009 and EL-V2M3-2009 and, if assessing cNent(abaratories
certified in the Orinking Water matrix, Chapte�111, Sections 4.1 and 42 af EPA's
Manual for the Certification of Laboratories Analyzing Drink�ng Water, Fif�h
Editiorr, availabls at
htt�:!lwater_ena.Qovlscitech/rfrinkinQwaterllabcert/index cfm#two. In addition, the
Provide�s assessors s��ll:
(1) Be familiar with the relevant regulations, ceRification prooedures,
and certification requiremsnts;
(2) Have a thorough knawledge of the relewant assessment methods
and assessmer�t documents;
(3} Be thoroughly famifiar with the various forms of r�eoor�ds (hardcopy
and electronic} used by environmental laboratories;
(4} Be thoroughly cognizant of data reporting, analysis, and reduction
t�ctmiques and prooedures;
(5y Have a warking knowledge and be conversant with the specific
tests or types of tests for which the certification is sought and, where
relevarn,with the assaciated sampling and preservatian prooedures;
(8) 6e able to oommunicate e�ffectively, both orally and in writing;
(7) Exhibit sound judgment and appropriate conduct when perForming
duties associeted with this contract;
12
Contra�Ct#CQP4R
Attachment 1
(6) Sign a statement belbre oonduc�ng an assessrr►ent ce�tify�g th�t
no cot�fAct�interest e�asts and provicle any suppa'W�g informaiion as
requined by the ELCP. Fallure to provide thi� informatiort makes the
prvposed a�essor ineligible tQ peutldpsbs in the aesessmenk
c. Staifing Cha�es: TF�e Provider nwst verify any rrenaly hired or car�trac�ed
�r's creden�als accora�ng bo c�it�ia desc�ed in sec.�ons 2.(b) and tcj
abov�e and s�,bmit sucn docx�r,errted v�tio� ta tne Departmerns Ei.cP for
aPproval 6efore tlte a�essor t�nduds an assess�nent on beha� c�f �'ie
Department, The Provider must also subrtdt dotx,menb�tion to the Departrnent
shvwing tl�e a�se�sor has experience caFnduding on-sit�e lebora�ory es�ssrnenls
to de�ermine ootnplia�t�e vwd� the 200Ci NELAC standards adopted by r�e�tce
int,o the rules�ned in Florida Admh�sVati�e C.ode Chapter 6dE-1 as well as
daa�nentatbn at�esdng as to wftether or rrot ihe assessor hss ev�er been
in+rest�eted by arry state or f�al Ine�Ctors General or oth� Irnrestigatory
en�des �d ir�diCating wheM�er the alteg�ns w�ere aubstantiafied. !f any
saseasor or lead essessor ur�der this oonVact has a�har�ge In drrumstanoe.the
ProNlder must(mmediaEely notNy the ELCP in w�iting_ If neoessary�the EI.CP may
request�t sta�that oomp6es with cona�c�requirements.
d. SubConlractors: The Pno�ider is res�or�e for assurinA tl�at ae
suboontracto� and stq�s adf�re to the provisions of this cor�traa. 'Fhe
Provider may,onh►w�th prior vvr�n a�rovad of tfie Depertme�rt, enter i�o w�itten
sub�for pe�fortrianoe af epec�ic servioes under the contrad.
3. Servioe Loc�tion end Tanes
a_ 8ervioe De�aery Loc�tions:
(1) For on-s�e aa�eesments: Vaa�ies, deper�ng on Gier� I�oratory
location.
(2) For deli�rerabfes: �r�eau of Publ�C Healtlt Laboratories EL.CP. 1217
N.Pead Str+ee�JadcsornrGle, FL 32202_
b. Sen�ve Time�: As determfiecf in advanoe of the on-site a��s�ent by
agreement belween the Prov�der and c6eM I�tboratory.
c. C�rrges in Location: i'he Department st�ll rr�alnta� 1he rigM to add or
r�no�ve servloe loc;adio�s as dicxabed by labora�ary certi�tfon st�us.
4. D�verab�es
a Sen►iae Units: an-s�te a�essmen�s conduded of d9e�t laboratories on the
DepartmenYs behaH
b_ Reports:
(1) W�thin 7 bt��ess days of e request from the Depsrttrierrt. the
Prorr�der must supply the Departrr�ent with amr and all msteriats
galher�ed �nd used dur� a �aboratay assesament. These materiafs
may indude buE are not lim�ed to c�ec.ktlsts, oornespondenoe� qus�itY
manuals, le�bo�#ory data, conf6�� of i�erest forms, and oon�l�dal
budr�ss infwmetlan fomts.
(2) The Pnoa�der sNatl eubmlt to 1he �eparbnent an itemized report af
recommenda�ions to sipptoae or disapprove !he propo�ad �
ac�ioc�a wld�� 20 calendar days�r+ec�eipt af the laborato�y's Plar�s of
13
C,oanad�QP4R
Auachme�I
C�n. Any reoomme�tbn to �jed a �bor�ory's ptoposed
Plan of CaRec�ion for a specfic d�cy m�t be avoompanied by
the ra�ona�e.
(3) The Provider shall issue vn-site assesam�t neports. induding
Itemiz�d defldenaes, to dl�t lebaratories witfiin 30 calend�r days of
the Rnal day of the on-ske a�smer�t and send elec�ronic oopies
simultaneously tio the Dep�rhnerri.
c. Records er�d Docurtrentalion:
(1y Upon executlon o# this Corrtracx, the Provider ehBB submk to the
DepartmeM tltie NEL�4P assessor tech�robgies table, �4ppendlx B,
oompfeted to indica�s the apecitic matricea and technologies for which
each of the Pravf�s�'s assessors is quali�ied to ca�dud or�-site
ass�ent� on the Departmerrt's behalf. (Th� apreadshest is
avaNable u�pan�uest in MS Excef format from the ELCP.)
{2y Upon ew�x�ion of fhis oontrect, the Ptovider shaN submit to d�e
Oep��t any attcf ap SOPs used by the Provide� In the o�of
any ediviaes pu�uent to fhis o�ct.
{3) Upon execxdion of this corrtract, tl�e Provider shaN aubmit to tt�
Oepattirent a ywiQet� atte� as t� arhether or �t any af the
Provldera employ�ed or contrecbad � has etier been
inv�estiga�d bY�e Departrnent's or by another Inspedor Ceneral ar�d
had U�e aqegaliorm�ubstaMiated.
5. PeKormar�ce Spec��ic;atlo�s
a. Dutc�omes and �utPuba: The Provtder will ad�i�e a sadafa�tory or better
� of 9596 on tfinely �d�,6ng and oompletion of on-�e assessrnei,ts,
completeness,lhorou9hneas.and�mely sc�m�sion of tlefnrerables. The Provid�
mt�et nd uae u�qusfiRed sssessors to c�nduct a�essments of dient I�
on�he Department's beh�df.
b. Monitoring and Evaluation AAethodology: The Depar�ment shaN review and
evsluAte the Provider's performat�ce under the �ms of this cordrad. AAonitorir�
$hall be c�nducted tlxuou8h direct cor�Ct wiih the Provider and Provider
representauve� b!► Phone, ema�� �, revisw of deii�erablea arul interaaia�
du� on-s�e visits_ As ra�ed in sec�ion B.1.a.(�, DeparVnent sta�f may direcdy
observe ar�aUor par�ate in an on-sits aaseasment �o�duded by the Pravider.
1'he Oepartment may oonduct on-�ite aasassmenis af c�ient laboratories for the
p�upo�es of esi�nat�g the ef�cacy of the Provider'a sssessment{sy.This incl�es
but ts not limlted to timelir�, �e oi que6hed sssessars, oompleteness af
assessmerd, ared thora�hr�ees � asses�ner�t. Arty 1nauRic�er�cy noted by
Depatimerrt staff and Pnavide4's response shall 1ae used in the evaluatbn. The
Deparhnent's detennlnatlon of scxeptable perfom�anoe ahatl be ooru�usive.
c. Pei�ormanoe�itions:
(1) Timeliness: the abiity of the ProVider to schedule assess�,
Pe�m a�sment, issue r+eports, and respor�d to r�eq��est wilhm the
timeframes spedfied in the contrac�.
{2j Qu�aGfied aaseasor_ an aeseasor who meeb fhe proiessiot�al
quslifications, peraot�al attributss, and who he�s the apec�ic la�cvuledqe
14
Ca�tract�COP4R
Atta�hment I
ot the dient laboratoris�'�Fiel�of Accredlt�foR es specified in
this contrad.
(3) Complefeness: tw�ar well tt�e Prorr�der addresses all reque+ed
elemec�s of the as�easment� irtduding the qua6ty sys�n�d technicai
aspeces of 1he laboratory.
{4) Thora�hness: within reasonable t�ne and oost r�firs�ts. the
depd�af datail to wFdch the Providers essesses the laborabary.
d. Performance Failurs Provision�:
(1) Should the Provider � to meet delh�erabies �uiremenls, use
unqua��ied assea�ors or othen+�se fat� to pe�fam as�essments
�ir� to the tenns af thEs c�trad, � w�l be nece�ary for the
Dep�prrent to c�nduct en �t of the dient laboratary or
laboratorie�affected at no c�ost to the dieM labor�tory.
(2) In d�s eveM, the provkler sh�t be liable fo� aB associebad �sts
irxyuRed by the Departmer�t,inc��la6ar and travel exper�ees.
6. Provider Responeiblities
a. Pro�ider Unique Ac�vitbes' Condud on-site as�essmett�s of dfeM leborato�ies,
indudng all nece�ary pr� and pos�-as��essme�t adlv�Ies. These adiv�ies
Indude, but are rrot Bmited to. Plarm6�g, sched�ng. team assembly, doanne�t
review, tra�re� bo and ii�cm tNe service loc�or�a, � �+epara�on and
completiiort� on-site assessmeM, repordng ar�d oaredive sdion rovlew as
desc�ed in this cor�trsct
b. Coordnation with Other ProvMerslEr�s: The Provider shall coord'a�ate 1he
�8sessmant wilh lhe dient I�b�artory so as to adtieve the tirr�e�est arld most
cost-�fective rt�eart� of servioe delivery th� alao mee4s the needs of the
laboratory to maitttein ovmpiF�noe w�h the r�ui�+emer�s of the cert�c�tl� issued
by ttee Deparbnent This should be accomp�shed wilh reaeor�ably mirnmal
disruption ot routine labo�atory oparefions. The Provider may coondhtate +aith
other provitiers as neoessary to achlevs tl�ese�oals.
7. Departme�rt Responaib�i"�s
a. DOF�Obt�tlons:
t�} rne a�v�n �,m�a�d��n,as ne�red,a�r o�
provide�s �misAy quadi�ed urtder this oonVad and no�fj► Poterrtisl
c�ent laborabaies in a m�nner so as to albw for�mey selec�ior� ot a
Pr+o�vider or Prvvlders and sub�squent comaetion of a requtred on�te
a�sessmertt
{2) The QeparfineM wiq Trreinta�l 8 datab�se and �eca�+ds reladir� to
ttte oe�ns a cBsnt Iaboreto�ies.
(3) The Departmer� wi6 corrtinue to receive, review and evalu�s
�+esulfs of Profic�ency Te�sdng for oerti�ed labor�tories and to mair�tain
reoords or the re�ults.
(4) The Dep�nerrt wil malae clierrt labo�reb�ted r+eoorda
available for the Provlder to�+e�view M preparat�n for and compfetion d
an aese�ment
�s
c�na�eco�
Attac�ment I
{5) !n tl� int�+ests vF labo�ory quality improvemeM and to promote,
pEabect end irttprave the publtc he�Rh, tl�e aepertrnent wil pnovide
bechMcal donsu� and �ance to oe�tifled ar�d appicarrt
laboratories as we0 as to the ge�eral pu�lc upat reqt,�t
(6) The performanoe ot'�flrt-performa�ce of any a�inritied in tF�s s�-
�ecdon shall rrot apeviate the Provitler of responsib�it�l u� f�tis
C+oMI'aCt.
b. DU�I Qe�eerrr�ir�oitior�s:
(1) The DepartmeM w1A make arry emd � determa�■e�ions tQ graM
der�y, su�end, reduce, linnit or r�instat� a dler� ial�retary's
oertification.
(2) The Oepartrr�ent wiN be solely respons�ble for dete�r�ng arhethcx
to subject a client iabora�ory to admin�iwe disciplinary actbn under
Chapter 120, �laida Statubes.
(3) The D�rtment w18 determine whe�her en applic�ation may be
��d thro�h a review of documentation in tieu of an additional
fltt-�te��sessme�t and wal c�vnd�t the re�view.
C. METHOO OF PAYME�'T
Thi9 is a rr��ti-year no-oost cvnhact.The dient laborakory sha�pay the Pravider�
aocorder,oe witli prices and terms a�r+eed upon betw+een tl�e two peutl�.
D. SPECUtL PROVISIONS
1. Renewal: Thls�ntr�may be �new+ad for a period that may not exaeed 3 years or
tFte term of tt�e ori�nal oont�ad, wEdcfiev� period is tonger. The renewal ehall be in
mait6ig and s�jeat to the same terms and�se!�3h in the original co�t.The
r+enewal shap be confin�e�t upa� �ory perioRnartoe evaluatlo�s by the
Depattment. The renewa� may not indt�de sny oomperls8tion tor c'�osts assoCiated a�th
the�newal.
2. Refenanoe: Request tor Applic�tia� (RFA) DOH13-Q09 and Provi�ter's response ane
iac�orhorabed tterea�by referenoe.
End of Text
16
Attachment I
APPENDIX A
1. Report Header-The�boratory r�ame, ph�rsiced address and maihrig address, Florida
s��tif'u�tio�ncanber, n�mes of the assess�nent fieam,ss�ess�ner�k dabes�arid categorles
�d.
2. Introdt�dion-A st�emer�t that the on-site asse8smer�t aras pedorn�ed to determine the
labaredory's compfianoe+aith cha�er 64E-1 FAC.
3. Def�er�cies-Re#e�s to the acoompar►yir�fam refer�nced�rule G4E 1.t 04(�y, FAC�
a�rrenUy OH f 137� if srry deFc�enc�es that require a Plan of Comection are ra�ed duri�g
the arsite assess�ne�. Each de�idency must c�a�tain an approp�ate dtatlon to ihe
NELAC and/or TNI Standard that was violated.
4. Techn�c�l D"mec�Aanagers-Ll�ta 1he�nes and t�les of the La6oratayt DirBCtor�
Technic�tt Direcbor{s}�Qp Oificer,sc�perviso�,ebc.
5. Commerna-Inc�udes in n�raf+ve fqmet�ny af Mse fellawing lhat ere app4ceble:
a. Ir�fcrmation that substa�tes, supplements,or au�nen�s de�der�cies noted on
ihe fot»t refer�in nde 64E-1.1 p4(5y,FAC, cxm+ently DH 1137.
b. The i�ntlfier ar�d ef�ective date of the I�boratory Q�t AAanual reviewed(if
applicablej du�g fhe as�essment
c. A�st oi aN labo�tory personnel intervlewed or who pa�tidpa�ed in the
ass�uneM.
d. Fields at Aoa�tativn that a�e reoommended fd'c�e�tiRcation vrith r�ard to any
ap�BCation addr+essed duric�the assessme�.
e. Flelds at Ac.cr+�d'�tlon that require infti�d r,alibr.rtions.IOOCs, I�l.s, or vther
laboratory�ta nat available�ring t�on-ai6e asseasmer�t, i�eny,U�at must be
submilbed�order to obtain ar ma�ttain oeA�icafio�t. A reasonable Ume des�ine
ior oorr�ance should also be sRedfled.
f. in the event the fabor•a�ory�sagrees wifh the d�frCie�cies of tfte�ess�or(s),9u7d
1he Lead Aasesso�adheres to the original de�c;ie�;the defidenc�es w�h
wFdch the laboretiory takes exosption shell be doa.mnented and irtc�ded in the
report
g. Ottter commer�ts and tedirtical rec:mrune�s6iorts thet vulll improve 18boratoryl
perforn�ance and dat�quaNty witl�in the cor�raints af alba�ed c�su�ancy and
respective af any cordiict of int�+est.
h. Obsole�e cert�lcations for whicfi the laboratory man�ement may have raquested
re��ulutshmeM, indu�ng the ef�ec:ti++e date_
6. Cor�lusions—Indudes recomrr�endatiorts reg�ding U�e laaboratory's oomplisnoe arith the
prov�sfons of chapter fi4E-1� FAC.
��
CoatractYCOP4R
Attachment I
APPENDIX B
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.,::Y.�� �.f,`•�::_ .'-.t:. .•utr�4..':� ,,w- � t,�.. .`:�li'..:fi �.r.9PM".: . �' y. _ _ �1
JTeCh:•.� �. .M`��n�o�s``�is. ��DoW3:NP,�I
N1�rne Or
E� �g X X X X X 1�'
AmperprnetrBC Tdration(e,g.,EPA 330.1�SM4300CL D,
AAqP $M4500CL02
AS S e. . EPA BQ7.0 NY-�
ASC Sdn�a�CeB Counter e. . EPA 9ai.1
Anodic StriPP�r�Vol�anet�►ie.�.. Pel�est t0o�,EPA
ASY 7472
AUTO Auto e, EPA 353.2,SM4504NO3-
6ETA Be�a S e. .,EP�►900.0
Be�Ganur�a Ccinddence 3cmtJlt�ion Counter{a.g.,
BGCS E'PA 80'1.0
Calo�rnetric or�mOmetric(e.g,EPA 1010,
SI�A1550B
COND Coriductanoe e. . EPA 12Q.1 5�126106
COUL Cculanstric TitiraBon e. .,EPA 9076 5000
Atomic Abso�tlan-Cold Vapv�SPec�ane�Y(e-0•,EPA
CVAA.S 2�45.1 3M3112
A�Fluore�ae-Cold Vapor Spec�+ar�ebrY(�9•�
CYAFS EPA 1831
A�omfc Emia�ion-Dired Current Plawna S�
DCP,AES e. . ASTM D+4190-94
OPP DifleterN�al Pufse Po s. . EPA 7196
AOomEc Ab�orption-Flame SpednOmeOrY(e•9•.
FAAS ShA31116
,�oo��,�-�sa�►�ar c�.e•,
FAES SM3SOQNa B
tlltraviolet or Vlslbla Mc�Fluaresoer�ce
�LUOR S e. . EPA 445.0 908.1
C�ALV Gahra�c�obe e. EPA405.1 SAA62108 �iA27106
t�s Cfuort�atn9rePhY-�[ec:tron Ca�ur�e D�n(e.g.,
�3C-ECD EPA 608 8081
C� Ges Chrornatography-Pho�oion�ne foniz�tlon
PIDVFID De�ectiOn e. .,AAA VPH
Oaa Chrornatography-�Gonduc�iviZY
OC-ELCD � e. . EPA 6G1
GC- c�as criracmarographY-�
ELCDfPID lPhc�o�fon Da�ion e. . 8021
Oes Chivma�o8naphy-Flame bnt�a�tion Detection{e.g.,
CiGFID �A 8016 8100
Ces C�+om�ography-Fla�r�e Pho�ome�ric Detec�on
GGFPD e. ..EPA8Z2 8141
pes Chromalo�rephy-Fou�fer Tr8n8fonm Inirared
C3Cr�TIR e. . �A 84�F0
GC- Cas Ch�orrtabogrephy-IN��-Hi�h
HRMS ResOh�tion e. . EPA 1613
t3ae Chron�phJ►-Mass Sp�ometry(e.g., EPA
fiC-aIS 625 82T0
18
Co�COP4R
Attachme�rt I
APPENDDC B
.._ . .. . __ . .. �- --- -... . _ - . - -. - -
. . _. _.._...._ . .. - -.. �_
.,.-ca,-:r• _ i.-.:ti�'y- '•���.�: _ �. .. . . • ': ��_�. S:y ia"�,� �- ''R.
:T' .T"� .; .+ f �,tiest�r�lfto"ds as =GVi1' .NP'_Vlr<��5�: �BT��i�E �
OC-All&
MS Oas Ch -Tandem Mass
Gas Ch��aphY-Nitrv9eMPtrosptwrus Detet�ion
C3GNPD (e.g., EPA 507.8070y
08s Ch�t�r�hy-PF�otoionizatf�on Qebedion{e.g.,
�C-PIO EPA 6Q2
AlaNc AbsarptFon-Graphit�Fumace SpectromekY
C3FAAS e. , SM3113 EPA 2�.8
ORAV t3ravf e. SM2640C EPA 1664A
Gamn�Specbrom�ry-High Reso�on(e.g., EPA
GS-HR 901.1
C3amn�SpecVc�r�e�hy-Low Resolutio�(e.g., EPA
GS-LR 901.0
Abomic�-Nydride Gena�ffii0n Spec�rometrY
HCAAS e. ,SAA3114B
HPLCr 1-�gh Pe�forrna�oe 1.6quid Chromats�g�'aphy-
E1EC 9ecb�d�emic� e. . EPA 605
HPLC- High Perforrnanoe Liquid Chromatc�graphy-
FLUOR U�/1ris�le Molecul�r Ftuor8�oe1'ioe
Hi�h Pe�ffln�ce Liquid Chrort�tog�aPhY-l�ed
HPLC-IR Mdeai�ar
HPLG High Pe�iorma�c�Liquid Chromatngraphy-Asass
P@MS ParEick 8�m
HPLC- Htgh Per�ortr�roe l.bquid ChromatograPhY-Mass
TSAA�S
HPLC- High Pertonnance Liquid Chrarnatography-Tar�em
ArtS-aAS lfless
High Per6ormanoe Liquid Ctaw�ography-
HPLC-UV UltravfoleW�ible Mol�ular
bn Chnonnat�graphy-Etectrocor�duc�vity(e.g., �PA
ICrCONQ 3Q0.0,314.0
fon Chromatngraphy-Mass SpsdromeaY(e.g.� EPA
lC-M3 331.
iC-NIS-
MS Ion C -Tandem Mass S
lon Cfuomatog�+a�r-W(e.g.,�A 7199,SM350�
ICrUV C
Abmic Emisffion-Inductively Coupled Plasma
ICP,�IES e. _ EPA20Q.7 6010
Msas Spectrflmetry-Inductively Coupled Plasma(e.�,
ICP-MS EPA Z00.8 �02
lan Selac�ve Elec�rude(e.g•.SNMSOOFI+B,SM4500E-
ISE C
IMM Im e. . EPA 4�-series methods
IR IrthBred e. .,EPA 418.1 3MSSZOC
LSC L uld SdM�ion Caur� e. . EPA 906.0
LP LBsar PhOs e. AS77lA D�517
NAA Neutron AcEivadOn e. EPR 9022
PC Proportiortal Counkr(e.g..EPA 900.0.90:i.0,904.0}
14
Ca�aect#COP4R
Attachment 1
APPENCNX B
'-Tedt:� ..fI _._.. --�,.... _ . _..: . -- -- • -.--�. : - � . ,- ;s;.
- - - ie�th�ErneAhods:as.exa�ri `�' '�DYY;. �NPiN: �� -BT :AE_ S
PqW Pheze Conl�ast M' e. iot Ai'bome Asbestos
Miaoellaneous Physicai Properties(e.g., EPA�030.
9058 SM2iS08
PLM Pote�ized ht M' e. . for Bulk A�esPos
POL Po�rog�phk Probe
SEM Scanr� Elac�vn M'
T�n�Mic�osoopy(ag.,EPA 100.1.
TEM 1002
TITR 7itrbnetry-Y�eual IndicaEor tSAA4500C1-B.SM23�40C}
Totel Orga�ic Carbon-F1ame lonizatien Detecbr(e.g.,
TOC-FID SM5310C
TOtal Or+ganic Carbon•Nondispersive Infrared Defec�or
TOC-IR e. . SM5310B
TOC-IJV Total ic Carhon-W
TURB T ' s. , EPA 180.1 ShA21306
Total Organ�C Hallde(also CoulomeMc Td�lion+a�th
TOX EPA 1690 9020?
UItr�vEolet or Y�ble IJblea�lar Abeorplion Speetrort�ry
W VIS e. . EPA 420.1
X-Ray Flt�nce�ecbrometry(e.g., EPA 82�,
XRF �7
XRT X T�sr�rr�ssior►
Other Other SPEqFY:
CF-Ql. Clua -Qu�ita�ive � . SM9d?�8/P A
ChromOfiuorogeroc-Qu�(e.g.,
CF-QN COLSURElAAPN
Ch�amogenidMPN-Qu�tatlye te.g..S'1�9223B�IAAPN
C-QN Tot ColHorm
Chramogenid�Quanti�ray{e.g.,SAA9223E3�QlJANTITRAY
C-QT�QN TOt.Cpliloi'im
F6�.E-QL Femteldetlon 6cOth-QuaW�i+re e. SMD'Z21 B
F6-PAE-
QE, Fernter�tiat Broth PA -Q�v�e s. . SM9221 D
FB-PAF-
QL FermeMadon Broth P FI ic-Qu�iCatiue
Fem�tadon&bthtF�uonogenic-Dttgn�e�e.g.,
FB-F-QN SAA9d21
FernneMation Broth-�uantita�ve(e.g.,SAA9221�,
F6-0N SM9Z30B
FB-A7-
QN �tlsl�tlon 1 -Qt�ntidtive e. , SM9X21
FFIFV FIld�atbrdFMMSdFNVia e. EPA 1823
�HPCr
ON en -Cuant�atirre e. . SirnPlate
FktorogenicNlAPN-Q�itabv�e(e.g.,
F-QN SM92Z3BlQUANTTTRAY E colh
20
Coana�OP4R
Attachm�t [
APPENDIX B
" . . . .. .. _.._...___"". . .. .y ..j. _. . . . . .. �-.... . - . . �,:��.'_,zY i
T�, T :Deedti �t�t m�dsas. ,oW:'NP..1A1' :�II•. :AE; s ��
F-QT-QN e. .,En
AAF-QL I�Aembrane Filbration-Q�al'�etive e. . SfUt92226
MF E-QL 1Aembrane Filb�tion+Ferrr�tion Broth-Quali�re
MF�QN 1Aembr�tne FNtratlon-Quantitabwe e. SM92220
NiF 2S- Membr�rre F�tratbni2-S�eP?-4uan�tative{e.g.�
QN SM9222C}
MF-AA�1- Wtembrarre Fdtratlon(m-EI)-Ouantitative(e.g.,EPA
QN 1800
AAembrane F�tradon+Fluo�gernc-Qua6tatl�e(e.g,
MF-F-QL NA4MUG
Nlembrane Fdtra�on+Fluorogenic-Quantitabhre(e.g..
MF-F-QN �PA 1�Q4
Mf-
AATEG hle�te FdtraUon{m TEC)-QuantRadve(a.g., EPA
QN 1603
PCt-2S-
QN Pla ue Coun 2 -QuaMi�afive e. ., EPA 1601
P4-SL- P�tque CouMs(Sin91e LaYer)-Qt�titafiive(e.g.,EPA
N 1602
PP-QN Po�P1ate-Q�tive e. . SN192158
SPrQN S Plabe-Quantit�+e e_ S'RA8216C
BioTox 7 T Aarte and Chronic
Membrane Fi n&oth-Quan�tive
MF-E-QN � . SM9230C
Fem�entia�on Broth+�F�ic-Qt�ativ�e(e.g..
FB-F-QL EC�Mt1�
•add initsis�cey at bottonn ot tabie
ONY=Drtnkir�q Water m�b'oc
NPW=Non-PaCabie WaEer rr�rbc
SCaA=9�f'ids and Chemic�l Ma�matrbc
gr=efao�r��
AE=AI�and Er�B r�uc
21
CamacdtCOP4R
STATE OF FLORIDA
DEPARTMENT OF HEALTH
CONTRACT RENEWA�#R1
ORIGINAL CONTRACT#COP4R
This renewal�is e�ered into beiween the Sfate of Florida. Department of He�th�hereinafber
�efeRed to as the�epartment'and Wade Consultlng and Solutlons,hereinafter referred to as
`Provider�.
The Departmerri is exercising(ts opUon to renew this corrt�aa as m�uaUy agreed to by both
ParGes begKning on July 1,2016 and ending on June 30�2019.
All terms and oonditlons of the contrad as amer�ded�+emain in foroe and effect for fhis renewel.
IN WITNESS WHEREOF,the parties have executed this renewal by tlieir undersigned oft'icials es
duly authorized,
Provider: Wade ConsulGng and STATE OF FLORIDA
Saludons DEPARTMENT OF.MEALTH
��-,-
SIGNED BY:�.��_I�..��„� ,{p,� SIGNED BY:'�� ;'�v
NAM: �p_t�.�11� L.1Nc.c��t NAME:Cerina Blackmore. DVM. PhD
Dlpl ACVPM
T1TLE: �r ► r��_a lx..� ��•vt�..c�•I��.v-�}� 1111.E:ACli11�.Di�edOr. DivlSiOn�
Disease C � rol and e I Pr e
DATE:_ �I 3�'�1� DATE:� (
FEDERAL ID NUMBER:
_ . 1��G 7,=�231f► .
�
� ;�V�zde C�nst�lt+���and So:u[i�msi
STA�E OF �L�R+DA
DEPA�TM�NT G�F HFAL7'H
A{V4�NDtv1�NT#A-Z
Tl��is ame�dm�n#: entered into between the S�aEe of Florida, Department o#Health. ne+�eina�er-
r��errec+to 2s#he�De�artment°�n�i Vtlade Cons�!Iting and SoEutivns. he�inafiter refprred`co as
`��ovia��'', �r�ends�ontra�`#COP4R_
The D�pertmznt and Provider amand ihis corttrac#to ci�rify the parti�s' r�spo�►sibiii�ies geing
forrvara.
1. Pa�hs 7 thrvugh 16, 4ttachmer�t i: are de�aise in thair entirety and repiacsd wl;�� rE�rissG
Attachment I.
2. �'age 1?, A�oendix A to At�achmEnt �, is d�leted in its entrery and replac�d w�th the
r�•.r'ss�d Apoendix A ta At�achment!.
;; Ra�es 18 thro�.:gh 21,Hopend+x L to Attachm2nt I, are deleted ir. their entirety a�d
r�7iac�w:th trc� r�t�'ssed,�p�sr,dix�to Attnchmen� I.
�. Th;s arnen�m�;�t��ri�� begin on the clate ihe ameRdmert r�as be�n signed �y both partizs.
All provisions in t1�e contraci and any attachmanis.her2to ir conflict vaiih lh�s amendm�n:sha�l
'�e and are hereby chang�d to confarm �vitn�tis amsndment_
A!! oro�isions n�T in conflict with this amendment ar�sti(1 i�ef#e�,i ar.d ar�fo be pe:fiormet! aE cftiF
?��re► spsci{pd.n Et1e C0�?traC�.
i his a��endmzr,t and a(i i�s at�achment�are here�y rnade a par�o�ths contract_
IN����1 i R'ES�THEREOF, th2 par�ies hereio t�ave c�useti this 45 page amendm2nt to be
�xect.�ted h;their officials ther�unta duty autt��orszeci.
t�rptirid2r: STATE OF �LORIOt�t
DEPARTf+A�NT�F HEA.IT� �
SIGt�ED BY� � j.. J . �=''�;� < < � ,
' � Ji�t:'.� .1�.�� SlGNED BY: t��i � h 1� ���,�7�t- .G'�..�-"'"'
NAt��: Michelle L. Wade NAME: Ca�na 3lackrr�are, I�VM. Ph.�.. Dip�
F,C1/��M
�ETLE. Pr;nci�al Cn�sulian� TITLE: Actin,� Girector, Di�llslo�l oT [�JSeaSa
Control and He�lt� Protectiar,
DA.1'E: �1��r ��� �ATE: �+�tf/��b
r
FE�ERAL ID NUMBER:
513-92-823fi
t:tJt't'-K
Attachment I
A. SERVECES TQ 8E PRQVIDED
�
1. p�finition af Tem►s
a. Acc�editation:Thifd-party attestetion related to an environmenta{testing
taboratory conveying#orma!demonstration of its oompetance to caRy out specE�ic
tasks�{afed to the conduct ot the testing fior which tl�e labc�rratory hotds
certi�cation. Also, the process by whicfi ac�egerwyt or orgar�ization evaluates and
recogn'¢es a taboratory as maeting oertain predetermined quai�ications ar
standarda.
b. Accreditation 6ody: Authoritafire body that pertarms accreditation or
certifrc�on of environrner�tat test�ng laboratories. ln the state aF Ft�oda,tlie
Departme�is tfie sccreditation body.
c. Anatyte;A substance,organisrn,�t�ysical parameter or c�em+cal constitt�ent
that is being measured with a method, a►�d in thiQ catte�d,for which aertfiqtion is
offered.
d. Application: Form OH 17fi2, 'Apptication for CeRiFication at Environmerttal
Testing l.abvratories,"Juty 20Q4 adapted by reference in 64E-1.102(1j, Flortcfa
Administrativ�ee Code. App�rcation form and 64E-1:
�1lwww.doh.state.t;.us/lablEnvLabCertlVVaE�c�,�,rt �
e. Assessmer�t: Pursuent to Flori,da Administrative Cade Rule B4E-1.104, a
compkte and detailed inspectlon that fs conducte�on�ite at the labo►atory's
premises where snvironmental testing takes plaae. It is!he same as the f�m"an-
site inspection"as specif+ed in Ftorida AdministraW�Cvde Rufe 84E-�.144
� Assessor. Person assigr�ed by or ort behalT o�f an aca�editatio�body to
perEom�, alane er as part of an aasessr►�errt iearn, an assessmerrt of a Eaboraiory
to determine its capabiGty anQ capacity far mee�ng caRi�cation or accxadstation
requKemenfs by examirang the records and other physical evi�erke for each one
of d�a Fields of Accreditatio�r far which certlfecation has been requested or held.
g. Certificaaon: Reguiato.ry rec�nition ghren to a laboratory that meets minimurr:
quafiiy and arialytical pe�formance standards pu�suarrt ta Fbrfda AdministraMie
Code Rule 64E-1.102.
h. Defleiency:An assessment conclusion referenced to e faboratory oanitka�on
standaai and supporte�by ot�ecEive evtdenoa tirat id�fies a deviation from a
�aborafory certification starxlat�requirement,
i. Fields of f►ocreditation:Those Matrbc-AAethod Anatyte cambir�ations for wt�ich
tha Department offers cerfificatior►and by which laborataries are cartified.
j. Matrix:The substrafie of a test semple furtF�r defined in this context fo�
cettficetien purposes as-
1) Air and Emissions M�atrbc:whole gas oc vapor samples ineluding
thnse contained in flexible o�rigid wa�containera and the exlr�cte�
7
COP4R
Attachment!
concentrated analy+tes of interest ffom a gas or vapor that ere coNected
with a sorbent tube, imRinger solut�on,ftlter, or other device.
2) Biotogical 7issue Matrix any sampte vf a bioiogxaf origin such as
fish tissue,sheltfish, er ptant matena�. Such samples rnust 6e groupett
accordfng to origin.
3) Drinking Water Matri�c: any aqueaus sample fhat has been
des�gnatea!a potabEe cr poter�qal potabl�water souroe.
4) Non-Potakk:fe Wate�Matrix� ar�y aqueous sampte excluded trom�he
definition of Drinking Water matrix. This it�ludas sou�ce water,
gna.mdwa�t�r,ef�uents,water treatment d�emicals, and Toxidty
Characteristic Leaching Prvicedure-(TCI.P)o�other�xtracts.
5} Solid and Chemical Materiais Matrix: indudes sods, sediments,
sl�dges, p�oducts and by-praducts of an industria{process that results
in a matrix not previously defFned.
!c. f►�efhai:An adoption af a scier�tfic technlqqe for pe�Eerming a spe�C
m�asurer»errt,as documented in a la�oratory SOP or as pubtished by a
recognized authorfty or a body of procedur+es and techniques for performing an
adivity(e.g., sampling, diemica!analysis,quantiF'ication},systemstically
presented in the order ict which th�y are to be executed,and in this eontext,4or
which certificadon Es offered.
1. Plan of Cort�ection;7he adions taken to etfminate the causes of an exis#ing
deildencY, nonconfamity.defect cr otF�e�undesirabte situstion in a�der to preveM
recumence. Proposed P1ans af CaErection are submitted by cl"rent labaratories in
response to deficiencies ated d�ring an assessrherrt on Forrn DH 1137,
referenced in Florida Administr�ti+re Code Rute 84E-3.104(51_
rn. Standart�Opet�tit�g Procedur�e{SOP):A written documer�t which detaifs it�e
method aF an operatlon,analysis pr action w�ase techniques and proc�ures are
tharoughly presaibed and which is accepbed as the melha!far perfornt'r.�g certain
+'outlne or repetitive tasks.
2. General Statemenk The DeErartment's Environmenfal l.aboratory Ce�ti�on
Rrogram(ELCP}cettifies competent and quaftf+ed cirrinki�g watef and envirornnental
t3siing taboratories. A ma}or component of this prooess is the assessment of�aboretory
faaii�tes, management, personnel, quaN'ty systems and as�aEytical adiv�ies acca►dlFlg to
appticable statutes, rules and naUonal accxed�atio�standar�ds using techMcalfy quaNf'+ed
as.4essors. This contrad provides fo�ssseasmerrts of ernitonmental testing laboratones
seeking arx#meintaining cer#ification by the De3partmerst far detertnining the labarato�ies'
compliance with appltcable lavrs aml regufations.
a. i�' : Se�tions 403.0625,403.8f 3 artd 403.8635. Flarida S#abu�es;
Fiarids Administr�ive Code Chapter 64E-i; and Trtle 4Q Code of Fecie�al
Regulations, Parts 141 and t42.
S
COP4R
Attachment I
b_ Clisrn etts�ibi'Eitv: The DepartmeM retalns the authority and right to determine
the et�gibiliry of laboretories to be assessed based on tunertt cerlification and
compliance status.
c. Client DetermanatEon: The OspartmeM's ELCP will periodically natify clier►t
faboratcries when an assessment is due. in general, this nofification wiH b� 0 8
mar�ths after the tast fuH assessment was completetf. Florida A�in�strativ�e Code
Rale 64E-1.1Qd spe�i�ies that an assa$smer�t must be conductec!at feas#every
two years, and thfs schech,le wiq be used.
e. MA{�iNER AND LOCATIOM OF SERVICE PROV{SION
t. S�o�of U�/m�k: Provider wili pmvide assessmenta of envirorementai testing
l�baratories seeking and maintatnir�g c�rtficafion by the Department for
detennining the Iaboratories'comptiamce with applicabls laws and regutations.
a. T isl: Provider will perform the foUvwing:
1) Complete amd submit to the Department the National ErnrironrnentaF
Laboratary Accrecfitetion Progr2m (NECAP) assesso� #echnotog'ses
tab(e, attached as Appendix B, to Mdic�te the specific r.�atrices and
tecf�nalogies for which each of Provider's assessora is qualified to
conduct assessments a� the Deparb�n+ent's behalf. (Btank copies of
Appendix B ere ava8able upon �equest from �e DepaitmeM.) Due to
the Departraent upon execu6on oi!he contrad.
2} Submk alt SOPs appticable #a Provide�s pe�forrnance ur+des th:s
co�acx to the Departrner�t upon execueion of the contract
3) Submii a written attestatio� that none of Provkter's eenployed or
contracted aasessors who wiil work on ihis coMract, are or have been
investigated by 8 state o*federal inspedor general withhln the iast seven
years. Oue to the Oepartment upon execution of the contract snd Jt�iyy
1 each year af the contract.
4) Llpdate the NELAP assessor technol�gies table, if Provider needs
to includs addfional quaNflcatians for iis assessors or fio indude
addkional essessocs. Subrn�t to the Department all training course
materiats uaed to quaCdy the assesscr for each add�ional technology
updated. Ensure n�aasessor is asslgned to eo�dud ar�y assessment
far an additional lechnology until the Department ElCP approves ttee
trainin�cowrs�e materisls and U�e assessur for the additivnal technology.
Indude a!! of the fotlowing training course materiaf elemeMs �or
Department approval:
a) Bastc theor�t�cal and operadng pcinc'�ple$of the
ana�yticat technology;
b} lnstr[tmertta6on, apparatus, and safiware reqt�red;
9
�OP4R
Attachment t
cj CriticaE ste�s and process8s af the analydcal technology
that rnus!be axecuted to snsure quality data;
d) Rel�vant quaGty cor�trol i�icators and expe+�ea
acxsptance aite�ia;
e� AAajor sources af error, a►td how ta caMrof:hem;
f� ��aPProPrisfe proc�dures and practices for the
anatytical te�hndogy, plus�rays to detect impropsr
prectices;
g) Key infomtation requlred to dxumeM comp�etely the
reported resut�;
h) Essentia�elements[or assessing data generateti;
i) Exer�ises in tt�eveluation af raw data to reported
;esutts:
j) Fnal examinatian that erisures tra€nee's und�sfa�di�g
ot alt the above efements; and,
k) Cer�ticate of sa�sfactnry cornpiebon signed by the
trainer or othsr cesponsibie party.
5) Review apphcations assigned to tt by ihe Department to i�clude in
the upcoming assessmeM of a dier�t laboratory that selects Provider.
Review the c1ieM tabaratory's scope of cert'fication provided by the
�epartmertt,lor acCredited atu! pending anatyt�s artd test metttods, in
afder to deterrnina asaessmerrt �eeds in terms of tRe number af
assessors needed and the time n�eded off-site and o�-site at the c}ie�t
laboratory to conduc:t the assessment oornpletely.
S} Evaluate and increase if needed the previausty determir�ed
assessment r�eeds apprcpr�ately if Provider iMenda to address
applications ass(gned or submitted afler #he dabe of schedulin� t�
assessment. Contad the Oepartment to verlfy the elig�ility of the
a�p8cation for indusion in the asseasment. Ettsure that assessments
for any addiponaf cerqtications conducted by Provider of tl�e dier�f
iaboratory do not compromise the assessment team composition or the
nurnber of workday5 rr.quiCed to a3sess the Iaboratory's ex�stic►g Certitied
Fields oi Accxed'rtation oomprehensively.
7) Utilize an appropriate assessrrterrt team fpr the size of the ciie�st
laboratory to be assesaed_ The team must indude the f�lowing:
a) A quafified lead assessor, and,
b) May include addi�ional quatified essesso=s,technlcal
spec'�f'ists,and observers if authorized by!he d'�ent
10
COP4R
Attachme�t t
labaratory to ensure the assessmer�t team has sufficient
personnel, knovrledge, skiqs, haininp.qust�lca�ons.
persanat attribuEes,and�utficient organ�Zational
authority and freectom#o pertonn assigned duties.
B) Permit designateck Oepartmerd staff ta partidpata irt ar flbserve any
asseSsm�erYt Pecfomt@d.
9) Subm� a written statement befv:e conducting an assessm�r�
certity',r�g that no contlld of inierest exists betvMeen Pro+rider and eny of
the assesscrs to be inciuded in an assessment and the di�t laboradory.
Provide a�y suppofing ir�ortnation as required by the Department on
any poterttial con�ict af inierest. Feiture to provide this information
r�akes the proposed asse�so� inefig�'b!e to pa�ticipate in the
assessmer�t. The writtert statement must is►ducle that:
a) �e of the assigned assessors hsve pcov�dsd,
prevides, o�wilt provide cansukancy to the c�ent
, laboratory before, durirtg.a after the assessment for
any matter re�ated to the assessmerf;and,
b) None ot the assigned assessw�s is a staff or contrad
ecnptoyee aF arry taboratory cerflfred by the Department
through the ELCP.
10) Notify the Depertmerrt within one busir�ess day if arty assessor or
1�ad assessor ander this contrad has e.change in his or her status as it
pertafis to a potentia!c�nfl'�cc af interest as stated herein. fmmedately
have tt�at assessor stap Qerformance under this contract vntil the
DeparUnerrt provi�s written guidance on how to proceed.
11} Schedule an ussessment with tl�e c(ient iaboratory vrithin i 5
cale�dar days a#�er receiving notificadan from the client tabarat�ry thaf
Provider has baen seiecte� to perform the assessment for comp�ance
with the requ�tements of the dient laboratory's cert'�'ication. Coor�dinete
the assessme�E with the dierrt fabaratory to maiMain compliancae with
the ret�uirements of the certiHcatiort issued by the DPpartmer�E and to .
CorWud the assessmeM wlth �asanably minimal disnrption of routine
labo�atory operations.
�2� Not�fy the Depart�ent when an assessment is SC11eduled 8t the :
same t�e that the cllent faboratary is nodfied Co�duct the asse9sment
at least 60 days after the dete aF schedu6ng. �
13) Conduct assessments of client laboratories for the fietds of
Accreditation on thefr seo�es of certi('�ca#on and in the app!'rcatians to ,
detemtine compiiance with the appficable provistons of Flo�ida
Administretive Cade Chaptet 84E-1. E�suna each essessm�t:
11
COPdR
Attachment 1
a} Encompasses a!!Feids of Acaedatation for whicf�the
cNent taboratory 888ks i►�tia{l��ir�on ot
recert�'rcaG'o�n;ar�d,
b) M9onitors.and evaluates ad etemertte of the m�thods,
NELAC an�TNI Stes�dards, tor each quakty system
marrix, test metl,od, and analyte. Ertisure this indudes,
but is not�rni��to sample cplledpn,�xeparatfon,
equiprnerrt.analysls, repo�ting,quaHty coMrol, artd
P�o�ien�y testing.
�4) Prepare and issus an assessmeat report for each Gient laboretory
documenting any and aA ceficiencles discavered during the assessment
and Gnking by reference each of th+�e defiaenaes dlr+ec�iy to ihe
NELAC and TNI Standarrls as incorporated into Florida Administrativ�e
Code R�le 64E-1. Cite deficiencies f�Ehe cI�M taborator�s f�ture to
�ot�ow ceriified test mefhod spedficetions ar�d Nr�k to the appltcable
NELAC and TN! Standard as we(i as to the applicsble test method
sAe�cafions. Use the form specified in Florida Admfnistrativ�e Code
Rule 64E-1.1Q4(5)fior dxumenting the deefiiicienc.'ses In the assessmerd
report. Ensure each defidency in the assess►nent cepart pertaMs to the
requiremeMs given in NEtAC and TNI Standards as irtcorporated snto
Florlda Admir�istrative Code Ral� 64E-1. lnclude the appldcabb
elements{ir�ed in Appendix A in the assessment report.
i5} Include in the assessmenf �pott, and notity the EtCP Program
Administrator arid the cllent laeoratory in writing, if r�ot aN Fields af •
Accreditation for which tne ctien# ta�boraiory ts certified or seeking
recertiffcation we►e able fo be assessed durirtg an assessment.
96} SuPp{Y the D�a�mertt wlth any aru3 atl materials gatt�ered ar.d
used during an assessment,with�n s�ven busMiess days ot e�eq�st by
the Qepartment. Ensure these materials may inctade,but are not Nmlted
to c�eddists,correspo�dence:qualityy rnanuafs�leboratory cfata,conflic;
oi intetest forms; at�d confidentiat business information tatms.
t 7) Issue assessr:tieM reports.including itemiZed deficiendes,to Wient
laboratvries within 30 calsrtdar days of the �nal day oi the on-sihe
assessrr�r�t arid send electronic copies siarultaneousty to the
Depa[tment.
18) Instruct the client(al�oratory assessed to respond, tising�e form
specifisd by Florida Admin�sErative Code Rule 84E-1.iO4, w(thin 30
caNn�ar days o? ita receipt of the assessment report by subrru'tting a
proposed P�an of CaRec�ion erxi corn�ta�►date, for each deiiciency
�dernfiea;n n,e asaesameM report.
19) Review the dient labwata'Y'g Proposed comecxive adions and
completion dates� arTd make written recemmendaHcns to the
flepartmerrt as t�whether th�Propased PEan of Conection witl comect
eac�de�fciency.
�z
OpP4R
Attachment I
20) Submit the itemized repa�t af reoommendations to 1he Q�paKme�rt
for appro�at a�Ong with fmal cert�'�cafion recemmendat�ons. within 30
t�endar days of reoeipt ot the labosatory's PEans of C�e�dion,or wi#t►in
one business ciay ot receiving paYment trom the client labaatory:
whichev�er cwnes IaEer, Aabmpany any tecommehdafevn to �ej�ct a
laboratory's proposed Plan of Correction for a sp�ecfic defiaency w�th
the written rabfonale for the re�ection.
21) Ensure tha#assessors are avaitabls,at na ccst to the Dspartment,
when8ver intemaf audits, exter�al audits, legai matt�rs, or resolutior�s
of ot�er disputes require thefr presence.
2. St��n�Req�irernents:
a_ Statfing l.evets: Prwide�wi11 ma'�ntaia adequate stef�i�g tevels to far.ititste
prov�s�n afi the seni�ces descnbed under this coM�. including technical,
admini�trat�ve,and cterical support. Provider wfll ensure that atl employecl or
contrade�assessors are not under investigatiort or have been investigated withln
�e last se��en ye�s by a siate or federal inspector generat.
b. Professionat Qualifiicafions and Personsi Attributes: Assessors empbyed or
cantracted by Pcavider must meet or sxr.esd the requirements in TIJI Standard
EL-V2M1-2009 end�L V2M3-2409 and, �assessing diettt latwtatories oerti�eci
in tl�e Drtnking YVater rnatru4 Cf�ter Ilt,Sections 4_1 and 4.2 of the United States '
Ernrironmental Protection Agency's(EPA)Manual for the Certiflcat)on of
Laboratories Analyzing Drinki�Water, Fifth Editlon, avaBable at
httn•.!lwat�eua.aov/s citechid rinki nuwaterllabce�ndex.dm#two.
c. Statfinp Changes: Provider must verily any�ewiy hired or cantracted
assessor's uedential�accordMg te c�iteria described in sec;tions 2.(b)abrnre and
submi#ss�ch dacume�ted verificatian to the Department#ar approvaf before ths
assessot conduds ac�assessment on behalf of the Qepartment.
d. Subcontractors: Provider is responsibfe for assuring that all subcontractors
and suppliers adhere#o the provisions oF this contrad. Prcvider may,aNy w)th
anor writtert approval of the Department,enter into written subcnntracts tor
performance of specific servioes under the contract.
3. ServiCB Loca+.'ion and TImeS:
a Service De&very locabons: F�assessments:Va�ies, depending on client �
laboratory ixatio�.
b. 5erv€c:e Tirnes: As determinad in advance of the assessment hy agreement
between P�ovider er►d the dient talwt�tory.
4. O�partme�t Respa�sibilities: 'fhe Departmer�wiN pertor.n the f�cltowirxa throughout
�e terrn of thls contract:
23
COP�R
Attachment!
a. Maintain and publish,e re8ist�Y of eniities quali�ied to peiform assessrnerrts
and notify potentiai dient aboratortes in a manner so as to aIIQw tor timety
r.ornpletian of a requ�ed assessmertt.
b. Malntaln a database and recards relating t�the c�rrfifications of cCsrrt
laborotorfes.
c. Continue ta receive, review, and evatuate resuits of Profciency T�ng fo�
c�riified laboraEories ar�d to maintain records af the resu{ts
d. RAa(ce GieM labo�atory-relaEed records avaltat�ii�for Provider to review in
�reparai3on far and compte6on of an assessment
e. Pravide technical and generai assistance to labaratories,anc!the public, In the �
iMeresfs of(abord�ory quafit�r impravement and to promote,proted and improve
the publlc t�lih. '
f Review and evatuate Provider's recommendalions for addi�anat laboratory
certl�icat�on when the apprca�tion ar�d requined fee are►eceived and processed
less than 30 calendar days priar to Provider's assessmen!dates.
g. Evah+ate all training caurse materials e�sed to quaGfy additiohal technoiogy
updates for assessors.
h• Detetm�ne whefher an applicapon may be addressed through a revlew o�F
documerofat�on in�ieu of an additiona)assessmerrt and wi�conduct thet review.
i. Make�ny and all detarmittations to grant deny,st�spend, reduce,limit ar
r�instate a c�lent labvratory's oerttficatior�.
. Solely responsibte for deterrnirming whe2her to setD�ect a dient taboretQry to
edmir�istratirre disciplinary actlon under Chapter 12Q, Florida S#atutes.
C. METHOD OF PAYMENT'
This is a mul�-year r�o-cost contrad. TTie cfient taboraiory wiY pay Pravi�er in
accordance wwithh prices and terms agreed upon Oetween Provider ano the client
labaatory.
D. SPECtAI PRdViSIONS
1. Rertawal: This cantract may be renewed for a p�od that rnay not exceed three
�ears or the temr of the ariginat contract,whicheve�petioct is lottger. The renewal rnust
be in m�ing and sc�bject to the same terms and cor�o�s set fo,th in the original
contracC. The renewa!wi8 be cdntingent upan setisfactory perferrnance evaivatfons by
the DaPartmer�t. The ronew�t must not include eny compensa#on for cosis assoclated
vrith the ro+tewal.
2. Reterer�ce: Request for Applicatlon(RFA)DOH t 3-009 and ProvEders response are
inco�porated herei�by referencxr.
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' .Attt8�13.t�Rt�
��Q���'ext ,
. �
�
��'AP4Et
Attachment i
,aaP�vax a
9. Report Header-The laboratory name, phyr�ical address and ma�ling addr�ss, Fiorida
certiEication number. �ames ofthe assessment team, ass�ssme►1t dates, and categoriea
assessed.
2. Introdwxion-A�atement that the arsi�e assea�nent was pe;iormed to detemtkte the
tabaatory's compGartce w�h chapter 64E-1 FAC.
3. Deficie�cies-Refers to the accompanylr�g form referenced in n,le 64E-1.104(5), FAC,
aurernty Di�f 113T� if any deflaenctes that require a Plen of Comection are notect du�g
ttte on�s�e assessmenG Each detldency must c�ntain an appropriate citatiorti#o�e
NEIAC andJor TN15tand�ard that was violatpd.
4. Technical Direda�+�Menagers-Usts the name.s and titles of the Laboratory Director,
Technical Cliredor(s),Q4 Officer, supervisars,etc.
5. CommeMs-Inctudes in nacratnre farmat any of the following thai are appticable:
a. tnformatio�that substa�#iabas. a�pplsmerns, or augmer�s defic�encies noted an
the form r�ierenoed in rule 84E-9.1p4{5�, �AC,curr�Mly DH 1137.
b. 7t�e identifiar and ef�ecfive date of the i�boratory Qus�ty Manuai reviewed(�
spplicabie}during the assessment.
c. A Itsst af a!i laboratory peraonnel interviewed or who particlpated in the
assessme�n.
�. Ftefds of Accreditatian that are reco�nended for cer�cation with regard to any
appticatiat addressed durN�g the assessment.
e. Fields of Accneditation that requi�irHUa!ca�ibrabons. IDOCs. MOLs, or other
labaratary ciata not availabfe durin�the on-site assessmerrt, if any,that must 6e
submitted in order ta obtain or maintain certi'�cation. A reaso�abie time deadEine �
for c�mplia+tt�shauld alsa be spe�ed.
f. !n t�e event the laboratory disagrees vwth the deficier�cies af the asssssor(s), and
the Lead Assessor adheres to the cuigirrdil deficier�Cies; the deficie�cies with
whiCh the leborabry takes axcepttor�shall be dxumer�ted and indud�d in the
report.
g. Other canments and te�hrNcal r+ecommpnda�ons that wiU improve laboratory ,
performance and data quaii�r within the constrairrts of allaw�ed consuftancy arid
respective of any oonfGc;t af irrterest
h. Obsdete ce►tificatior►s for which the Eeboralory management may have requested
ratinqtHshment,indudirtg the effective date.
8. ConGusions—Indu�es recommendations�egercling the laboratory's compGance wnh the
provisiflns of chapter 64E-1, FAC.
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