CN-640000-HB401.pdf

This contract action has completed the Department’s routing process and has received the required approvals for execution.

CONTRACT SUMMARY

Division/CHD/Office: Administrative Services, Director’s Office

Provider Name: University of South Florida

Contract Number: HB401

Original Contract Amount: $85,930.00

Total Contract Amount (executed actions): 0.00

Original Contract Start Date: 04/01/2023

Original Contract End Date: 6/30/2023

New Contract End Date:

DESCRIPTION OF CONTRACTUAL SERVICES:

Staffing services to develop and administer future educational activities to the FDOH workforce. The purpose is to engage the public health workforce, the local health agency, and our partners in learning all activities at all levels (Undergraduate and Graduate; pre-professional and post-professional; credit-bearing and non-credit bearing); in team building to achieve shared objectives in leadership development; and in personal and collective self-care to build resiliency, coping skills, and mental well-being.

CONTRACT ACTION:

AMENDMENT(Y/N): N AMENDMENT AMOUNT:

CHANGE TO TERM(Y/N): START DATE: END DATE:

RENEWAL: N RENEWAL AMOUNT:

START DATE: END DATE:

DESCRIPTION OF CONTRACT AMENDMENT ACTION:

This contract complies with all of the following requirements:

• A statement of work

• Quantifiable and measurable deliverables

• Performance measures

• Financial consequences for non-performance

• Terms and conditions which protect the interest of the state

• All requirements of law have been met regarding the contract

• Documentation in the contract file is sufficient to support the contract and the attestation (examples:

business case; directive to establish contract; subject research and analysis, etc.)

• If the contract is established by way of a competitive solicitation as identified in section 287.057(1), Florida

Statutes, the costs of the contract are the most advantageous to the state or offer the best value

DocuSign Envelope ID: 79EE4323-0004-45A1-BACB-BAF9714A744B

HB401

5/17/2023 5/17/2023

Certificate Of Completion Envelope Id: 79EE4323000445A1BACBBAF9714A744B Status: Completed

Subject: Contract HB401: Has been sent to the provider for electronic signature

Source Envelope:

Document Pages: 33 Signatures: 2 Envelope Originator:

Certificate Pages: 5 Initials: 0 Rashena Itwaru-Womack

AutoNav: Enabled

EnvelopeId Stamping: Enabled

Time Zone: (UTC-05:00) Eastern Time (US & Canada)

Rashena.Itwaru-Womack@flhealth.gov

IP Address: 167.78.4.21

Record Tracking Status: Original

5/11/2023 2:39:49 PM

Holder: Rashena Itwaru-Womack

Rashena.Itwaru-Womack@flhealth.gov

Location: DocuSign

Signer Events Signature Timestamp Eric Kern ericmkern@usf.edu

Director, Sponsored Research

University of South Florida

Security Level: Email, Account Authentication (None)

Signature Adoption: Uploaded Signature Image

Using IP Address: 131.247.244.169

Sent: 5/11/2023 2:43:38 PM

Viewed: 5/11/2023 4:09:10 PM

Signed: 5/17/2023 1:57:33 PM

Electronic Record and Signature Disclosure:

Accepted: 5/11/2023 4:09:10 PM ID: 3bbed771-a3c9-462b-9b67-d972a666b22e

Mark Lander

Mark.Lander@flhealth.gov

Administrator

Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style

Using IP Address: 167.78.103.187

Sent: 5/17/2023 1:57:35 PM

Viewed: 5/17/2023 4:22:59 PM

Signed: 5/17/2023 4:25:21 PM

Electronic Record and Signature Disclosure:

Accepted: 7/11/2022 1:06:11 PM ID: dc9c403a-cfaf-46b3-becf-c5bd025d2147

In Person Signer Events Signature Timestamp

Editor Delivery Events Status Timestamp

Agent Delivery Events Status Timestamp

Intermediary Delivery Events Status Timestamp

Certified Delivery Events Status Timestamp

Carbon Copy Events Status Timestamp Christina Ciereck

Christina.Ciereck@flhealth.gov

Security Level: Email, Account Authentication (None)

Sent: 5/11/2023 2:43:36 PM

Viewed: 5/11/2023 2:47:38 PM

Electronic Record and Signature Disclosure:

Accepted: 9/19/2022 7:30:44 AM ID: a871ddfb-dd29-4793-a29b-c30e189db088

Carbon Copy Events Status Timestamp Robert Morales

Robert.Morales@flhealth.gov

Security Level: Email, Account Authentication (None)

Sent: 5/11/2023 2:43:37 PM

Viewed: 5/11/2023 3:02:34 PM

Electronic Record and Signature Disclosure:

Accepted: 12/8/2022 8:44:49 AM ID: 35ef01c3-219d-4b9a-aba3-04b5c5ee6865

Becky Keyes

Becky.Keyes2@flhealth.gov

Security Level: Email, Account Authentication (None)

Sent: 5/17/2023 1:57:35 PM

Electronic Record and Signature Disclosure:

Accepted: 5/16/2023 2:47:10 PM ID: 0673f77d-2548-4e8f-a03f-731c5ed0bb75

Witness Events Signature Timestamp

Notary Events Signature Timestamp

Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 5/11/2023 2:43:37 PM

Certified Delivered Security Checked 5/17/2023 4:22:59 PM

Signing Complete Security Checked 5/17/2023 4:25:21 PM

Completed Security Checked 5/17/2023 4:25:21 PM

Payment Events Status Timestamps

Electronic Record and Signature Disclosure

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Electronic Record and Signature Disclosure created on: 3/24/2017 1:05:43 PM Parties agreed to: Eric Kern, Mark Lander, Christina Ciereck, Robert Morales, Becky Keyes

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