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Item C25 BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: December 21, 2005 Division: Budqet and Finance Bulk Item: Yes ~ No Department: Grants Staff Contact Person: David P. Owens AGENDA ITEM WORDING: Approval of amended Attachment D to contract with Guidance Clinic of the Middle Keys, which concerns subcontracted Baker/Marchman Act transportation. ITEM BACKGROUND: Attachment D that was approved at October meetinq was copy of last year's; new aqreement for transportation was under neqotiation at that time. PREVIOUS RELEVANT BOCC ACTION: approval of contract at October 2005 meetinq. CONTRACT/AGREEMENT CHANGES: see attached comparison STAFF RECOMMENDATION: Approval. TOTAL COST: 847,054.00 COST TO COUNTY: 847,054.00 BUDGETED: Yes ~ No 0 SOURCE OF FUNDS: ad valorem taxes/qeneral fund REVENUE PRODUCING: Yes No ~ AMOUNT PER MONTH YEAR O';''''URCHASING D RISK MANAGEMENT D APPROVED BY: COUNTY ATTY DIVISION DIRECTOR APPROVAL: DOCUMENTATION: INCLUDED: DISPOSITION: AGENDA ITEM #: 1 2 3 4 5 6 max new no two from GCMK GCMK fuel and maint GCMK fuel and maint GCMK not addressed cost 140.00 430.00 115.00 145.00 385.00 385.00 225.00 385.00 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CONTRACT SUMMARY Contract # Contract with: Guidance Clinic of the Middle Effective Date: 10/01/05 Kevs Expiration Date:9/30/06 Contract Purpose/Description: amendment to Attachment D, which concerns Baker/Marchman Act subcontract of transportation services. Contract Manager: David P. Owens (Name) 4482 (Ext. ) OMB/Grants (Department) for BOCC meeting on 12/21/05 Agenda Deadline: 12/06/05 CONTRACT COSTS Total Dollar Value of Contract: $847,054.00 Budgeted? Yes[g] No D Account Codes: Grant: $0.00 County Match: $~ Current Year Portion: $847,054.00 001-03230-530340- 001-01509-530340- 001-01526-530340- 001-01508-530340- 385,961.00 46,179.00 86,287.00 328,627.00 Estimated Ongoing Costs: $_/yr Not included in dollar value above ADDITIONAL COSTS For: e . maintenance, utilities, 'anitorial, salaries, etc.) CONTRACT REVIEW County Attorney Division Director Changes o/rJt~ Needed /. V} YesD NoD YesD NoG1 YesD NoD YesD No~ Risk Managem~~ o.M~purchas~ Comments: OMB Form Revised 9/11/95 MCP #2 AMENDMENT TO AGREEMENT This Amendment to Agreement is made and entered into this 21st day of December, 2005, between the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, hereinafter referred to as "COUNTY," and The Guidance Clinic of the Middle Keys, Inc., hereinafter referred to as "PROVIDER. " WHEREAS, the COUNTY and the PROVIDER entered into an agreement on October 19, 2005, regarding the provision of mental health services, including sub-contracted Baker Act and Marchman Act transportation services, for citizens of Monroe County; and WHEREAS, PROVIDER has negotiated a new sub-contract for Baker Act and Marchman Act transportation services, and, WHEREAS, the COUNTY desires to amend said agreement to include the new Baker Act and Marchman Act transportation sub-contract; NOW, THEREFORE, 1. The contract is amended by substituting the Baker Act and Marchman Act contract document dated October 1, 2005 as Attachment D in place of the contract document dated September 15, 2005. 2. All other provisions of the contract dated October 19, 2005, not inconsistent herewith, remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed as of the day and year first written above. (SEAL) ATTEST: DANNY L. KOLHAGE, CLERK BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA By By Deputy Clerk Mayor/Chairman Guidance Clinic of the Middle Keys, Inc., (Federal ID No. By Name and Title \:IiI W'fIf'''' .... GUIDANCE CLINIC OF THE MIDDLE KEYS, INC. 3000 41 ST STREET, OCEAN MARATHON, FL 33050 (v) 305/434-9000 1 (f) 305/434-9040 October 1, 2005 Evan Guttman Elanjess LLC 800 Catherine Street Key West, FL 33040 RE: LETTER OF AGREEMENT Dear Mr. Guttman: The Guidance Clinic of the Middle Keys, Inc. (GCMK), hereby enters into an agreement with Elanjess LLC to provide coordination and transportation services for Baker Act/Marchman Act (BA/MA) clients throughout Monroe County and tolfrom Miami-Dade County as required. The effective term of this agreement is October 1, 2005- September 30, 2006. GCMK will supply Elanjess with two vehicles, one Chevrolet Caprices meeting Elanjess maintenance specifications; to be stationed in Key West at an Elanjess location and a Ford Taurus to be stationed in Marathon at GCMK headquarters. GCMK will pay for the fuel and maintenance of the two vehicles used for BA/MA transportation. Elanjess will coordinate the maintenance for the Caprice located in Key West. Invoices for routine maintenance (labor and parts) on the Caprice will be forwarded to GCMK Transportation Director for payment. Elanjess will not charge an extra fee for coordinating the maintenance of the vehicle. Elanjess must obtain prior approval from the GCMK Transportation Director to initiate major vehicle repairs. GCMK will coordinate the maintenance for the Taurus located in Marathon. GCMK will maintain insurance on the Caprice and Taurus. Elanjess will be named as an "additional insured" for these two cars. Elanjess will report and document accidents involving GCMK vehicles and incidents involving clients to the proper authorities and immediately thereafter contact GCMK. All Elanjess drivers operating GCMK vehicles will hold a minimum of a Class D Florida Driver's License and be approved for GCMK insurance coverage. Upon execution of this agreement, Elanjess will fax to GCMK Transportation Director a current list of drivers - including a copy of the driver's license and social security number for each driver - for approval to operate GCMK vehicles. Prior to adding a driver, Elanjess will fax to GCMK Transportation Director or designee a copy of the driver's license and Partially funded by the Florida Oepartment of Children & Families, District 11 ~'('H1LDREN I2l &. FAMILIES 1 social security number of the person. GCMK will initiate procedures to add the driver to GCMK vehicle insurance. Elanjess cannot use the driver until it has received written notification that the driver has been added to the GCMK insurance coverage. Additionally, Elanjess will fax a copy of picture identification and social security number for each escort to GCMK Transportation Director or designee. Elanjess cannot use the escort until it has received written notification that the escort has been approved by GCMK. GCMK will supply Elanjess with a cell phone. Elanjess will follow the transportation protocol and complete the documentation provided as Attachment 1-3 herein. The following fee structure is established for the period of the agreement: Maximum # Roundtri s* 40 Elanjess Pa ment $115 $115 $145 $145 $145 $385 $385 $385 Client Picku Point Client Dro -off Point Key West Key West Marathon Marathon Key West Marathon Marathon Key West Marathon Ke Lar 0 Marathon Miami-Dade County Ke Lar 0 Miami-Dade Count Ke West Miami-Dade Count GCMK Preauthorization Required for All Trips Below Approval for below fees will be granted only when the Marathon BAlM A vehicle is engaged with another BA/MA tri that would reclude another icku within a reasonable eriod of time. Maximum Car Client Pickup Elanjess # Roundtri s Location Point Client Dro -off Point Pa ment 3 Key West Marathon & Not1h Key Largo $225 5 Key West Marathon & Not1h Miami-Dade Count $385 300 25 Timely payment for services rendered is ensured by adherence to the following invoicing procedures: · Elanjess will submit two statements/invoices per month; one covering the trips made from the first through the fifteenth and one covering trips made from the sixteenth through the end of the month. Elanjess will send statements/invoices to GCMK within 5 business days after the end of the billing period. · Elanjess will include required documentation with each statement/invoice. · Elanjess statements/invoices for BAfMA trips will be submitted to the attention of GCMK Stabilization Unit Director. · GCMK Stabilization Director will review statement/invoice, mediate any discrepancies with Elanjess, and forward approved invoice to GCMK Finance Department. · GCMK will mail payment to Elanjess within 7 working days (Finance Department) upon receipt of statement/invoice by the Stabilization Unit Director. Partially funded by the Florida Department of Children & Families, District 11 ~t"HILDREN 121 &. FAMILIES 2 This agreement will begin on October 1, 2005 and will terminate on September 30, 2006. The agreement can be cancelled by either party with 60 days written notice. GCMK and Elanjess enter into this agreement including Attachments 1-3 by affixing signatures below: mie Pipher, MS ice President of Operations, GCMK Attachments: 1. GCMK Transportation Protocol 2. GCMK Transportation Record and Payment Authorization Sheet 3. Statement Partially funded by the Florida Oepartment of Children & Families, District 11 ~\(\HI'LDREN 121 &. FAMILIES 3 ATTACHMENT 1 GUIDANCE CLINIC OF THE MIDDLE KEYS TRANSPORTATION PROTOCOL: THE TRANSPORTATION OF BAKER ACT AND MARCHMAN ACT CLIENTS A. Client Related Rules: 1. Confidentially of a client and client related information shall be maintained at all times. 2. Each client shall be treated with respect and dignity at all times. 3. No information with client information shall be leave the clinic unless part of a client transfer packet to a designated facility. (No driver/escort shall maintain a personal copy of the Transportation Record and Payment Authorization Sheet.) 4. Client transportation within Monroe County may be conducted with a driver and an escort. 5. Client transportation outside of Monroe County must be made with one driver and one escort. 6. A client must be observed for any unusual behaviors including hurting self/others or sudden medical conditions. Report/respond to conditions immediately to the Nurse on Duty. 7. At the time of pick up for a Baker Act or Marchman Act client, a driver must obtain the original Baker Act or Marchman Act paper work from the Pick Up facility. If the original paper work is not available the driver must immediately report this information to the GCMK Nurse on Duty for further instructions. 8. A female client requires a female escort or a female driver. 9. A parent is not allowed to travel in the Baker Act vehicle with a Baker Act or Marchman Act minor. Parents may follow in another car. 10. Only one client may be transported at a time in the Baker Act vehicle. 11. Clients are not to smoke in the car. 12. Clients are not to be placed in handcuffs or any type of restraints for any reason by a driver or escort - or to be placed in the vehicle by others (i.e. Law Enforcement) in handcuffs or any type of restraints 13. A client's movement is not to be impeded with any physical restraint unless directed by a nurse/MD/law enforcement officer. 14. If a client is violent during transport and poses a treat to safety, stop the vehicle and call 911, than notify the Nurse on Duty of the situation. 15. A client shall not be left alone in the vehicle during the trip for any reason. 16. A client shall be under the observation of the driver or escort at all times during the transport. 17. Client is encouraged to use restroom facilities prior to departure. If the trip is generated from Key West and a stop is required, the GCMK may be used for that purpose. 18. A client may not use aluminum/metal cans. Items for drinking shall be provided only in a plastic container. 19. Clients may not have any metal utensils, glass or other hard products such as \\Stash\srmgmt\Baker Act\05-06\05-06 BA MA rules I .doc rvsd: 07/21/05 - J - pencils or pens. 20. A client may not shop during a stop. All efforts should be made to avoid stops. If a stop is required, it should be short and without delay. 21. If a client must use a public facility, the client must be escorted to the restroom and the driver must remain outside the restroom door until the client leaves the restroom. The driver will remain in conversation with client while the client is in the restroom. B. Coordination of Transportation Rules: 1. Transportation arrangements for Baker Act and Marchman Act clients are under the direction of the Unit Nurse on Duty/GCMK per contractual arrangement Elanjess LLC. No other agency is authorized to contact Elanjess directly for transportation. 2. Final decision for a driver to transport is made by the nurse on duty. The nurse may request a BAL be conducted or send a drivers/escort home if he/she has a concern. 3. All trips will be made within the approved fee structure. 4. All trips will be made using the closest vehicle and the shortest distance unless preauthorization is obtained from the Unit Nurse on Duty at the GCMK. 5. Clients may be picked up at only approved locations. The GCMK Nurse on Duty will communicate the pick up location. Approved locations will include: Hospitals, Detention Facility Mental Health Clinics, Anchor Away With a GCMK staff member 6. At Depoo: Call security with phone located on the first floor. 7. At GCMK: Use the telephone call box next to the elevator. 8. At GCMK, staff members shall place the client in the vehicle for departure and will assist the client from the vehicle at time of arrival. 9. The facility responsible for the departing client for a trip longer than 2 hours shall provide a brown bag snack. All minors shall be supplied with a snack for any trip over 1 hour. 10. When a driver reports a client is too dangerous to transport, the nurse on duty shall work with the Sheriff's department to transport the client the client to the nearest emergency room. 11. If a client absconds at time of or during transport, immediately report the information to the GCMK Nurse on Duty. Do not go after the client. 12. "Jail Hold" clients from the Monroe County Detention Facility shall be picked up from the Sallyport area only. To access the Sallyport area, the driver must drive the car within 1 foot of the Sallyport entrance. If the door does not open, the escort must use the speaker mounted on the wall next to the Sallyport entrance to request entrance. Once inside, Detention Facility staff will bring the client to the car. When the client is inside the car and the doors are locked, the Sallyport area exit doors will open. 13. The driver/escort must determine from the Pick Up facility if the client has been searched and encourage staff to conduct a search prior to transport. If \\Stash\srmgmt\Baker Act\05-06\05-06 BA MA rulesl.doc rvsd: 07/21/05 - 2 - the client is not searched prior to transport, the driver must communicate this information to the Duty Staff Member prior to opening the client door at the Designation point. 14. Driver/escort must respond to the pick up point within 1 hour and 15 minutes. C. Reimbursement related rules 1. All cancelled and otherwise diverted trips will be reported on the Transportation Record and Payment Authorization Sheet. 2. Transportation Record and Payment Authorization Sheets and a Statement of services rendered will be faxed to the Stabilization Unit Director on the first and sixteenth of each month. 3. If the driver arrives without the original Baker or Marchman Act paperwork, Elanjess will obtain the paper work without charge to the GCMK. \\Stash\srmgmt\Baker Act\05-06\05-06 BA MA rules I.doc rvsd: 07/21/05 - 3 - A TT ACHMENT 2 GUIDANCE CLINIC OF THE MIDDLE KEYS 3000 41sT ST. Ocean Marathon, FL 33050 Voice 305-434-9000 . Fax 305-434-9040 TRANSPORTATION RECORD AND PAYMENT AUTHORIZATION SHEET Transportation Type: o Baker Act o Marchman Act Date: Client Name: DOB: Time Called: Time of Pick Up: Time of Drop Off: Time van returned to Duty: Vehicle: KW vehicle Mar vehicle Place of Pick Up: (Where did you pick up the Client: Facility Name/City) Authorized Staff Signature at Pick Up Facility: Time: Destination: (Where did you take the Client: Facility Name/City) Authorized Staff Signature at Designation Facility: Time: (Staff member accepting client) Driver Name: Escort Name: Beginning Miles: Pick Up Miles: Drop Off Miles: Ending Miles: FOR GCMK USE ONLY: Amount to be paid: Stabilization Unit Director Signature: ATTACHMENT 3 Statement Date: Elanjess LLC 800 Catherine St. Key West, Florida 33040 Stabilization Unit Director Guidance Clinic of the Middle Keys 3000 41 sl St. Ocean Marathon, FL 33050 Re: Baker Act and Marchman Act transportation The following is a break down for trips from to Date Name Pick Up Cost Vehicle Designation 1 2 3 TOTAL Elanjess LLC Representative Signature GCMK CFO Signature ~V/V0/~VUi) ~il.~{ ~j\A ~Un4JqMU4U liCfilK llZJ 002 1=t~.ch.,..,,+D GUIDANCE CLINIC OF THE MIDDLE KEYS, INC. 3000 41sT STREET, OCEAN MARATHON, FL 33050 (v) 305/434-9000 / (f) 305/434-9040 September 15, 2005 Darren Guttman Elanjess LLC a.k.a. Jessrica Corp. 800 Catherine Street Key West, FL 33040 RE: LETTER OF AGREEMENT Dear Mr. Guttman: The Guidance Clinic of the Middle Keys, Inc. (GCMK), hereby enters into an agreement with Elanjess LLC to provide coordination and transportation services for Baker Act/Marchman Act (BAlMA) clients throughout Monroe County and to/from Miami-Dade County as required. The effective term of this agreement is October 1, 2005 -September 30, 2006. GCMK will transfer ownership of the 1995 Chevrolet Caprice to Elanjess. Elanjess will supply an additional car with the same safety features. One vehicle will be stationed in Key West at an Elanjess location and the other will be stationed in Marathon in a designated parking space at GCMK headquarters. GCMK will continue to be responsible for the cost of fuel and Elanjess will be responsible for any and all upkeep and maintenance of the two vehicles used for BAlMA transportation. Elanjess is also responsible for tolls, cell phone/beeper and vehicle insurance expenses. Elanjess will not charge an extra fee for coordinating the maintenance of the vehicle. Elanjess will maintain ownership and insurance on both of the designated vehicles and GCMK will be named as an "additional insured" for both cars on Elanjess's vehicle policy. All Elanjess drivers operating designated BAlMA vehicles will meet Florida State license requirements. Elanjess will ensure the minimum liability insurance requirement of $100,000 per person and $200,000 per incident. Elanjess will report and document accidents and incidents involving clients to the proper authorities and immediately thereafter contact GCMK. Elanjess will supply a designated cell phone for each of the two Baker Act vehicles. Elanjess drivers will have one of these cell phones available for each BA/MA run. Elanjess will communicate the cell phone number to GCMK's Charge Nurse that will be used during each BA/MA run. Elanjess will follow the most current copy of the Transportation Protocol and complete the documentation provided as Attachment 1-3 herein. 1 Partially funded by the Florida Department of Children & Families, District 11 ~'(HI'':pnEN \2l $. FAMILIES ~_v/vu/~vv~ ~~.~o J'^^ ~Vilq0q~UqU \,\.,lYJn 4ZI 003 The following fee structure is established for the period of the agreement: Maximum ..JtJ30undtrips * Elanjess Payment Per Trip Client Pickup Point 325 ANY In-COLmty Trips $140 $430 85 ANY Out-of-County Trip~ Timely payment for services rendered is ensured by adherence to the following invoicing procedures: · Elanjess will submit two Statements per month; one covering the trips made from the first through the fifteenth and one covering trips made from the sixteenth through the end of the month. Elanjess will send Statements to GCMK within 5 business days after the end of the billing period. · Elanjess will include the required Transportation Record and Payment Authorization Sheet for each trip indicated on the Statement · Elanjess Statements for BAlMA trips will be submitted to the attention of GCMK Stabilization Unit Director. · GCMK's Stabilization Director will review Statement, mediate any discrepancies with Elanjess, and forward approved invoice to GCMK's Finance Department. · GCMK (Finance Department) will mail payment to Elanjess within 7 working days upon receipt of Statement by the Stabilization Unit Director. This agreement will begin on October 1, 2005, and will terminate on September 30,2006. The agreement can be cancelled by either party with 60 days written notice. GCMK and Elanjess enter into this agreement including Attachments 1-3 by affixing signatures below: ~~- Darren Guttman Elanjess LLC Attaohments: 1. GCMK Transportation Protocol 2. GCMK Transportation Record and Payment Authorization Sheet 3. Statement 2 LU/VU/~UVU J~.ilO ['^A ~U~q0q~UqU ~,UlU\ 14]004 ATTACHMENT 1 GUIDANCE CLINIC OF THE MIDDLE KEYS TRANSPORTATION PROTOCOL: THE TRANSPORTATION OF BAKER ACT AND MARCHMAN ACT CLI ENTS A. Client Related Rules: 1_ Confidentiality of a client and client related information shall be maintained at all times. 2. Each client shall be treated with respect and dignity at all times. 3. No information with client information shall leave the clinic unless part of a client transfer packet to a designated facility. (No driver/escort shall maintain a personal copy of the Transportation Record and Payment Authorization Sheet.) 4. All drivers and escorts must be approved by the Transportation Department of the GCMK prior to accepting a driving assignment. 5. Client transportation within Monroe County may be conducted with a driver and an escort. 6. Client transportation outside of Monroe County must be made with one driver and one escort. 7. A client must be observed for any unusual behaviors including hurting self/others or sudden medical conditions. ReporVrespond to conditions immediately to the Nurse on Duty. 8. At the time of pick up for a Baker Act or Marchman Act client, a driver must obtain the original Baker Act or Marchman Act paper work from the Pick Up facility_ If the original paper work is not available the driver must immediately report this information to the GCMK Nurse on Duty for further instructions. 9. A female client requires a female escort or a female driver. 10. A parent is not allowed to travel in the Baker Act vehicle with a Baker Act or Marchman Act minor. Parents may follow in another car. 11. Only one client may be transported at a time in the Baker Act vehicle. 12. Clients are not to smoke in the car. 13. Clients are not to be placed in handcuffs or any type of restraints for any reason by a driver or escort. 14.A client's movement is not to be impeded with any physical restraint unless directed by a nurse/MD/law enforcement officer. 15.lf a client is violent during transport and poses a treat to safety, stop the vehicle and call 911, then notify the Nurse on Duty of the situation. 16. A client shall not be left alone in the vehicle during the trip for any reason. 17. A client shall be under the observation of the driver or escort at all times during the transport. 18. Client is encouraged to use restroom facilities prior to departure. If the trip is generated from Key West and a stop is required, the GCMK may be used for that purpose. 19.A client may not use aluminum/metal cans. Items for drinking shall be provided only in a plastic container. 20. Clients may not have any metal utensils, glass or other hard products such as Sr mgntJl04/05 BA MA Rules.doc .v~ v....~ ",VV"J ~,u. VV I'll.1\. ooJVo.J"'tu'i;]V"tV u\"llU\ I{fJ 005 pencils or pens. 21. A client may not shop during a stop. All efforts should be made to avoid stops. If a stop is required, it should be short and without delay. 22.lf a client must use a public facility, the client must be escorted to the restroom and the driver must remain outside the restroom door until the client leaves the restroom. The driver will remain in conversation with client while the client is in the restroom. B. Coordination of Transportation Rules: 1. Transportation arrangements for Baker Act and Marchman Act clients are under the direction of the Unit Nurse on Duty/GCMK per contractual arrangement Elanjess LLC . No other agency is authorized to contact Elanjess directly for transportation. 2. Final decision for a driver to transport is made by the nurse on duty. The nurse may request a BAL be conducted or send a drivers/escort home if he/she has a concern . 3. All trips will be made within the approved fee structure. 4. All trips will be made using the closest vehicle and the shortest distance unless preauthorization is obtained from the Unit Nurse on Duty at the GCMK. 5. Clients may be picked up at only approved locations. The GCMK Nurse on Duty will communicate the pick up location. Approved locations will include: Hospitals Detention Facility Mental Health Clinics Anchor Away With a GCMK staff member 6. At OePoo: Call security with phone located on the first floor. 7. At GCMK: Use the telephone call box next to the elevator. 8. At GCMK, staff members shall place the client in the vehicle for departure and will assist the client from the vehicle at time of arrival. 9. The facility responsible for the departing client for a trip longer than 2 hours shall provide a brown bag snack. All minors shall be supplied with a snack for any trip over 1 hou r. 10. When a driver reports a client is too dangerous to transport, the nurse on duty shall work with the Sheriff's department to transport the client the client to the nearest emergency room. 11. If a client absconds at time of or during transport, immediately report the information to the GCMK Nurse on Duty. Do not go after the client. 12. "Jail Hold" clients from the Monroe County Detention Facility shall be picked up from the Sallyport area only. To access the Sallyport area, the driver must drive the car within 1 foot of the Sallyport entrance. If the door does not open, the escort must use the speaker mounted on the wall next to the Sallyport entrance to request entrance. Once inside, Detention Facility staff will bring the client to the car. When the client is inside the car and the doors are locked, the Sallyport area exit doors will open. 13. The driver/escort must determine from the Pick Up facility if the client has been searched and encourage staff to conduct a search prior to transport. If the client Sr mgntJ/04/05 BA MA Rules.doc 2 LU/V0ILVVO lD:Ul ~AA SU~4j4~U4U GCnlK I4J 006 is not searched prior to transport, the driver must communicate this information to the Duty Staff Member prior to opening the client door at the Designation point. 14. Driver/escort must respond to the pick up point within 1 hour and 15 minutes. C. Reimbursement related rules 1. All cancelled and otherwise diverted trips will be reported on the Transportation Record and Payment Authorization Sheet. 2. Daily inspection checklist will be maintained for all Baker Act vehicles and sent monthly to the GCMK Transportation Coordinator. 3. Transportation Record and Payment Authorization Sheets and a Statement of services rendered will be faxed to the Stabilization Unit Director on the first and sixteenth of each month. 4. If the driver arrives without the original Baker or Marchman Act paperwork, Elanjess will obtain the paper work without charge to the GCM K. Sf mgnt//04/05 BA MA Rules.doc 3 LV/V~(~VV~ ID:UZ VAA JUb4J4UU4U GCnlK I4J 007 ATTACHMENT 2 GUIDANCE CLINIC OF THE MIDDLE KEYS 3000 41sT ST. Ocean Marathon, FL 33050 Voice 305-434-9000 . Fax 305-434-9040 TRANSPORTATION RECORD AND PAYMENT AUTHORIZATION SHEET Transportation Type: 0 Baker Act o Marchman Act Date: Client Name: DOB: Time Called: Time of Pick Up: Time of Drop Off: Time van returned to Duty: Vehicle: 0 KW Caprice o Mar Caprice o Crown Victoria Place of Pick Up: (Where did you pick up the Client: Facility Name/City) Authorized Staff Signature at Pick Up Facility: Time: Destination: (Where did you take the Client: Facility Name/City) Authorized Staff Signature at Designation Facility: (Staff member accepting client) Time: Driver Name: Escort Name: Beginning Miles: Pick Up Miles: Drop Off Miles: Ending Miles: FOR GCMK USE ONLY: Amount to be paid: Stabilization Unit Director Signature: LV/V~/~UUU LO;U~ rAA dU~4d4HU4U GCftlK l4J 008 ATTACHMENT 3 Statement Date: Elanjess LLC 800 Catherine S1. Key West, Florida 33040 Stabilization Unit Director Guidance Clinic of the Middle Keys 3000 41 sl S1. Ocean Marathon, FL 33050 Re: Baker Act and Marchman Act transportation The following is a break down for trips from to - Date Name Pick Up Cost Vehicle --- Designation 1 2 3 - .. - - -- - -~,-'"- -.-- ~'--"- -- ~-~",._--~ -- TOTAL - L--. - ---,._--,~ Elanjess LLC Representative Signature GCMK CFO Signature