06/14/2000
AGREEMENT
TIllS AGREEMENT, made this 14th day of June, 2000 by and between the Board of County Commissioners
of Monroe County, Florida (hereinafter referred to as BOCC) and Planned Parenthood of Greater Miami and the Florida
Keys, (hereinafter referred to as Planned Parenthood), a not-for-profit corporation incorporated in the State of Florida.
WHEREAS, the BOCC has approved for the Administrator to make limited, temporary office space available
to nonprofit organizations serving the County community on the condition that the organizations are responsible for
their own cleaning, telephone and similar costs and provide a reasonable payment to the County for the cost of
electricity; and
WHEREAS, the Planned Parenthood provides affordable reproductive healthcare to thousands of men and
woman;
WHEREAS, the BOCC has determined that it is in the best interests of Monroe County to enter into this
agreement;
NOW, TIIEREFORE, for and in consideration of the mutual covenants contained herein, the parties agree as
follows:
1. Co~~ and Sum. Jhis agn:ementis for the period commencing Au", lJ.'-\' I .2000 and
throug W l\ '3' 200# unless earlier tenninated pursuant to paragraphs..6l or 23 below. Planned
Parenthood hereby a~rees to pay the BOCC the sum of $100.00 per month for space at the Ruth Ivins
Center in Marathon, and the sum of $100.00 per month for space at the Department of Health Clinic
in Tavernier, for the utility consumption and upkeep costs (total of $200.00 per month).
2. Scope of Services. Planned Parenthood shall provide affordable reproductive healthcare, provide
breast, pelvic and testicular exams; Pap smears; diagnosis and treatment of STDs (sexually
transmitted infections); birth control methods at greatly reduced prices; pregnancy testing and
reproductive health education and counseling. Planned Parenthood shall install its own telephones,
supply its own office furniture and equipment, and provide for its own janitorial service.
3. BOCC Responsibility. The BOCC shall direct its Administrator, Department Heads, County Attorney
. and staff to provide certain facilities and support to Planned Parenthood as can be provided without
. requiring an increase in personnel or any purchase or lease of real property. The BOCC shall provide
to Planned Parenthood, within the aforementioned limitation, as well as all rules applicable to County,
without any cost to the county, the following:
a) Ruth Ivins Center - 78 square feet of dedicated space (room # 140), and utilization
of existing Health Department clinic space.
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'#:. ;i::C. .~:~~ Records - Access and Audits. Planned Parenthood shall maintain adequate and complete records for
~ ("oS .....J -:i~ a period of four years after completion of any event or program. The BOCC shall have access to the
o """ ~rl~ books, records, and documents of Planned'Parenthood. The access to and inspection of such books,
~ ~ -.:-i ~records, and documents by the BOCC shall occur at any reasonable time.
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~ g 5. Relationship of Parties. Planned Parenthood is, and shall be, in the performance of all works,
u.- services, and activities under this Agreement, an independent contractor and not an employee, agent
or servant of the BOCC. Planned Parenthood shall exercise control. direction, and supervision over
the means, manner personnel and volunteers through with it performs the work. Although this
Agreement is a cooperative agreement, similar in many respects (but not all) to a partnership, Plarmed
b)
Department of Health Clinic in Tavernier - 115 square fect of dedicatcd spacc. and
utilization of existing Health Department clinic space.
Parenthood shall have no authority whatsoever to act on behalf and/or as agent for the BOCC in any
promise, agreement or representation other than specifically provided for in this agreement The
BOCC shall at no time be legally responsible for any negligence on the part of Planned Parenthood,
its employees, agents or volunteers resulting in either bodily or personal injury or property damage to
any individual, property or corporation.
6. Modification. Additions to, modification to, or deletions from the provision of this contract may be
made only in writing and executed by the BOCC. No modification shall become effective without
written approval of both parties.
7. Breach and Penalties. The parties agree to full performance of the covenants contained in the
contract. Both parties reserve the right, at the discretion of each, to terminate the services in this
contract for any misfeasance, malfeasance or nonperformance of the contract terms or negligent
performance of the contract tenns by the other party. Any waiver of any breach of covenants herein
contained shall not be deemed to be a continuing waiver and shall not operate to bar either party from
declaring a forfeiture for any succeeding breach either of the same conditions or covenants or
otherwise.
8. Insurance Reauirements. Planned Parenthood shall carry, during the term of this agreement public
liability insurance, including bodily injury and property loss damage to cover all claims, demands or
actions by any person or entity in any way arising from the operation of the Agreement. Such liability
insurance shall meet the requirements of the Insurance Requirement Attachments hereto. Monroe
County shall be named as an additional insured under the insurance policy and such insurance shall be
primary and non-contributing with any insurance carried by the BOCC. Planned Parenthood shall
furnish the County with a certificate evidencing the insurance required by this paragraph at the time of
executing this Agreement.
9. Indemnification and Hold Harmless. Planned Parenthood shall indemnify and hold hannless the
BOCC, their departments, agencies, officials, employees, agents, servants and contractors against any
claims, liabilities and expenses (including reasonable attorney's fees) arising as a result of any direct
and/or indirect action of Planned Parenthood, its employees, agents, servants, volunteers and/or
contractors in the performance of the terms of this agreement or otherwise related to activity
conducted in the furtherance of this agreement except to the extent that, in the case of any act of
negligence, Planned Parenthood reasonable relied upon material or services supplied by the BOCC or
; any employee of the BOCC. Planned Parenthood shall immediately give notice to the BOCC of any
suit, claim or action made against it that is related to any activity under this Agreement and will
cooperate with the BOCC in the investigation arising as a result of any suit, claim or action related to
this Agreement.
10. Permits. Planned Parenthood shall secure all required permits and/or licenses necessary to carry out
any of the services rendered under this Agreement.
11. Laws and Regulations.
ill This Agreement shall be construed by and governed under the laws of the State of Florida
unless in an area of law pre-empted by iederallaw. Planned Parenthood agrees for venue of
any dispute to lie in Monroe County, Florida.
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Planned Parenthood shall comply with all laws, including but not limited to those listed in
Exhibit C.
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9 Planned Parenthood shall comply with all federal, state and local laws and ordinances
applicable to the work or payment for work thereof, and shall not discriminate on the
grounds of race, color, religion, sex, age or national origin in the performance of work under
this Agreement.
2
Q1 Any violation of said statutes, ordinances, rules, regulations and executive orders shall
constitute a material breach of this Agreement and shall entitle the HOCC to tenninate this
Agreement immediately upon delivery of written notice to Planned Parenthood.
12. Taxes. The HOCC is exempt from Federal, Excise and State of Florida Sales Tax.
13. Finance Charges. The HOCC will not be responsible for any finance charges.
14. Severability. If any provision of this contract shall be held by a court of competent jurisdiction to be
invalid or unenforceable, the remainder of this contract, or the application of such provision other than
those as to which it is invalid or unenforceable, shall not be affected thereby; and each provision of
this contract shall be valid and enforceable to the fullest extent pennitted by law.
15. Force Maieure. Planned Parenthood shall not be liable for delay in perfonnance or failure to perfonn
in whole or in part, the services due to the occurrence of any contingency beyond its control or the
control of any of its sub-contractors or suppliers, including labor dispute, strike, labor shortage, war or
act of war, whether an actual declaration thereof is made or not, insurrection, sabotage, riot or civil
commotion, act of public enemy, epidemic, quarantine restriction, accident, fire, explosion, storm,
flood, drought or other act of God, act of any governmental authority, jurisdictional action, or
insufficient supply of fuel, electricity, or materials or supplies, or technical failure where Planned
Parenthood has exercised reasonable care in the prevention thereof, and any such delay or failure shall
not constitute a breach of the Agreement Planned Parenthood shall notify the HOCC of any delay or
failure to perform within five (5) days of such action. Upon demand of the HOCC, Planned
Parenthood must furnish evidence of the causes of such delay or failure.
16. Assignment. Planned Parenthood shall not assign, transfer, sublease, pledge, hypothecate, surrender,
or otherwise encumber or dispose of this contract or any estate created by this contract or any interest
in any portion of the same, or permit any other person or persons, company or corporation to perform
services under this contract without first obtaining the written consent of the HOCC. In the event of
such consent, this agreement shall be binding upon Planned Parenthood's successors and assigns.
17. Disclosure. Planned Parenthood shall be required to list any or all potential conflicts of interest, as
defined by Florida statutes Chapter 112, Part III and the Monroe County Ethics Ordinance. Planned
Parenthood shall disclose to the HOCC all actual or proposed conflicts of interest, financial or
. otherwise, direct or indirect, involving any client's interest which may constitute a conflict under said
. laws.
18. Addition Conditions. Planned Parenthood agrees to accept additional conditions governing the use of
funds or performance of work as may be required by federal, state or local statute, ordinance or
regulation or by other policy adopted by the HOCC. Such additional conditions shall not become
effective until Planned Parenthood has been notified in writing and no such additional conditions shall
be imposed retroactively.
19. Indeoendent Professional Judgment. Planned Parenthood shall at all times exercise independent
professional judgment and shall assume full responsibility for the service to be provided and work to
be completed.
20. Care of Prooertv. Planned Parenthood shall be responsible to the HOCC for the safekeeping and
proper use of the property entrusted to Planned Parenthood's care, and to process all documents
necessary to continue, without interruptions, any maintenance or service contracts relating to such
equipment for its service life. Planned Parenthood shall provide services Monday through Friday,
8:00 am. - 5:00 p.m, and shall ensure that their patrons do not loiter or congregate on the Ruth Ivins
Center's property in Marathon, or the Department of Health Clinic's property in Tavernier.
21. Ethics Clause. Planned Parenthood warrants that it has not employed, retained or otherwise had act
on its behalf any fonner County officer or employee subject to the prohibition of Section 2 of
3
6-01-20003:16PM
FROM MONROE CTY FAC MAINT 305 295 3672
P_5
0rdiIJanCe No. 010-1990 Ot any BOCC officer or employee in violation of Section 3 of Ordinance No.
010-1990. For breach or violalion of this provision. the County may, in jts- diSCtdion. terminate this
contrac:t without liability aDd may also. in its discretiOn, deduct from the ~ or pun:base ~ or
otheIwise:recover, the fun aulO1Ul1 or any fee, commission.'pcrc:entaF. gift or cousidel'lltion paid to
the former PlaDncd Parenthood or BOCC ~cer or employee.
22. Notice.. Any notice required or permitted UDder this A8feemeBt shaD be in writin8 and hand..dclivered
or mailed, postage ~ by certified mail, return nxx:ipt mpM:Sted. to 1he other party as follow&:
To Planned Parenthood
Joan Sampiere
1699 SW 2'fA Avenue
Miami, FL 3314S
To Couof;y
Monroe County Faciliticsl\.4l1imPnllnce
3583 S. .Ao9$cve1t BoWcvard
Key West, FL 33040
23_
Termination. TermiDa1ion of this Agm:meat sbaU occur at the Natuml ending date, OJ' earlier- should
either party dctcnninc that there bas oocurred any materia) breach of ~ covenants herein cantOned,
or either party othexwi&e deems it in thdr best iiltercst 10 terminate. Terinmation may be with or
without c::ause., aod shall require written notice t.9 be given to the other party as follows:
a) In the event either p8Jty tettninates for.breach of contract, termination sbaII be effective at
such time as the terminating party sball declare i1i its act to tenninatc for cause, with a
minimnm of fourteen days notice in writing requited prior to effective teJmination.
b) In the event either party tenninates without cause, the termination sball not take effect until
at least sixty days subsequent 10 wri.Ucn notice to the other party, ~ the effective date of
termination shall be specified in said notic:e.
24. Full ~l1. This Agreement amstibJtes the eotiIe and full undetsIanctiDg between the parties
hereto and neither party sball be bound by any xepi.......u1litious. statements, pOllliscs or agreements
not expnsly set forth herein aud in duly cx.earted ~ ~patagJ3ph 6 hereof. .
~~~
III 2j MTNESS WHEREOF ~ the parties haYc cxecured this agreement the day and year first above
~o-k!C:. ~~
Dcpu1y Oerk
BOARD OF COUNTY COMMISSIONERS
OF MONROE' COUNTY. FI"ORlDA
~~~
By ,
. MayOJ'I ,
(SEAL)
Atu:st:
PLANNED pARENTHOOD OF GREATER MIAMI
AND TIm FLORIDA KEYS
~?R~" ~~
T~ ~ T:V~(U:O
~ ~PPRO 0 AS TO FOR
f~...,~<J ?1!o-z-. A GAL SUFFI E . 4
.H TON
HOLD HARMLESS AGREEMENT
This agreement entered into by and between MONROE COUNTY, FLORIDA, a
political subdivision of the State of Florida, hereinafter "COUNTY" and
----,
whose address is
hereinafter "EVENT SPONSORED;"
WIT N E SSE T H:
That for and in consideration of the understandings hereinafter set forth the
parties do agree and covenant as follows:
1. That in and for the consideration of permission to use certain pu hjj( roads
or other public property, more particularly described as follows: _
for the purpose of conducting a
event, more particularly described as follows:
on the day of
19 from until , the EVENT SPONSOR does hereby
agree to indemnify the COUNTY in toto for any and all claims or liabibties that
may arise out of the above described event.
2. That, in addition to indemnification described in Paragraph One, the EVENT
SPONSOR does hereby agree to hold the COUNTY harmless in all respects
concerning the event described in Paragraph One and will defend any ;,nd all
causes of action or claims and will, further, pay the cost of any attorn' 's fees
incurred by the COUNTY arising out of the event described in Paragr;lptJ ene.
MONROE COUNTY, FLORIDA
By:
County jJ,clJJjinistratOl
( Organization)
By:
of the above and duly authorized
to execute this agreement.
State of Florida
County of Monroe
SUBSCRIBED AND SWORN to
(or affirmed) before me on
(date) by
(name of affiant). He/she is personally known to me or hc.s
produced (type of identification) as identifje,;tiion
Notary Public
WpRKERS' COMPENSATION
IN~~RANC~ ~. EQUIREn.,~NTS
FPR
CQNT~QT
l' nl
EJ~lWE'N
MONROE CQU~Tv, FLQ"IDA
AND
Prior to the commencement of work. governed by this contract, the Contractor shall obtain WPJ'kers'
Compensation Insurance with limits sufficient to respond to Florida Statute 440.
In addition, the Contractor shall obtain Employers' Liability Insurance with limits of not less than:
$100,000 Bodily Injury by Accident
$500,000 Bodily Injury by Disease, policy limits
$100,000 Bodily Injury by Disease, each employee
Coverage shall be maintained throughout the entire term of the contract.
Coverage shall be provided by a company or companies authorized to transact business in the State of
Florida and the company or companies must maintain a minimum rating of A-VI, as assigned by the A.M.
Best Company.
If the Contractor has been approved by Florida's Department of Labor, as an authorized self-insurer, the
County shall recognize and honor the Contractor's status. The Contractor may be required to submit a
Letter of Authorization issued by the Department of Labor and a Certificate of Insurance, providing
details on the Contractor's Excess Insurance Program.
If the Contractor participates in a self-insurance fund, a Certificate of Insurance will be required. In
addition, the contractor may be required to submit updated financial statements from the fund upon
request from the County.
Administrative Instruction
#4709.2
WC1
WRK_COMP.DOC
VEHICLE LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
Recognizing that the work governed by this contract requires the use of vehicles, the Contractor, prior to
the commencement of work, shall obtain Vehicle Liability Insurance. Coverage shall be maintained
throughout the life of the contract and include, as a minimum, liability coverage for:
· Owned, Non-Owned, and Hired Vehicles
The minimum limits acceptable shall be:
$100,000 Combined single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be:
$ 50,000 per Person
$100,000 per Occurrence
$ 25,000 Property Damage
The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies
issued to satisfy the above requirements.
Administrative Instruction
#4709.2
VL1
VEH-LlAB.DOC
GENERAL LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT:
BETWEEN
MONROE COUNTY, FLORIDA
AND
Prior to the commencement of work governed by this contract, the Contractor shall
obtain General Liability Insurance. Coverage shall be maintained throughout the life of
the contract and include, as a minimum:
. Premises Operations
. Products and Completed Operations
. Blanket Contractual Liability
. Personal Injury Liability
. Expanded Definition of Property Damage
The minimum limits acceptable shall be:
$300,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be:
$100,000 per Person
$300,000 per Occurrence
$ 50,000 Property Damage
An Occurrence Form policy is preferred. If coverage is provided on a Claims Made
policy, its provisions should include coverage for claims filed on or after the effective
date of this contract. In addition, the period for which claims may be reported should
extend for a minimum of twelve (12) months following the acceptance of work by the
County.
The Monroe County Board of County Commissioners shall be named as Additional
Insured on all policies issued to satisfy the above requirements.
Administrative Instruction
#4709.2
GL1
GEN_L1AB.DOC
1996 Edition
MONROIE COUN-rv, FJ-ORIDA
RISK MANAGEMENT
POLICY AND PRpCEpURES
CONTRACT ~pr,n'~ISl'~ TION
MA~UA'-
I
WAIVER OF INSURANC~ ReQUIREMENTS
There will tl~ tim~s wh~n it will be necessary, or in the best interest of the CQ~nJy, to devi~te from the
stand~rd insurance requirements specified within this manual. Recognizing this potential, and acting on
the advice of the County Attorney, the Board of County Commissioners has granted authorization to Risk
Management to waive and modify various insurance provisions.
Specifically excluded from this authorization is the right to waive:
. The County as being named as an Additional Insured-If a letter from the Insurance
Company (not the Agent) is presented, stating that they are unable or unwilling to name the
County as an Additional Insured, Risk Management has been granted the authority to waive
this provision.
and
. The Indemnification and Hold Harmless provisions
Waivina of insurance provisions could expose the County to economic loss. For this reason, every
attempt should be made to obtain the standard insurance requirements. If a waiver or a modification is
desired, a Request for Waiver of Insurance Requirements fonn should be completed and submitted
for consideration with the proposal.
After consideration by Risk Management and if approved, the fonn will be returned, to the County
Attorney who will submit the Waiver with the other contract documents for execution by the Clerk of the
Courts.
Should Risk Management deny the Waiver Request, the other party may file an appeal with the County
Administrator or the Board of County Commissioners, who retains the final decision-making authority.
Administrative Instruction
#4709.3
WAIVER.DOC
1996 Edition
MONROE COUNTY, FLORIDA
Request For Waiver
of
Insurance Requirements
It is requested that the insurance requirements, as specified in the County's Schedule of Insurance
Requirements, be waived or modified on the following contract:
Contractor:
Contract for:
Address of Contractor:
Phone:
Scope of Work:
Reason for Waiver:
Policies Waiver
will apply to:
Signature of Contractor:
Approved
Not Approved
Risk Management:
Date:
County Administrator appeal:
Approved
Not Approved
Date:
Board of County Commissioners appeal:
Approved
Not Approved
Meeting Date:
Administrative Instruction
#4709.3
WAIV_REQ.DOC
,r':A'(-18-200[ 14: 53
P.02
...
.
/ifOl'U'Oe eowztfl policy
fo"
Requests fo, Office Spite.
by
Non-profk O"glUdzatl.olU
The purpose or this policy is to establish a procedure for processing requests from non-profrt organizations
desiring dffice space in County facilities. The Board of County Commissioner3 adopted this policy 0/1
November, 9. 1989.
GENERAL INFORMATION:
1. Orga~jzations shall complete the attached form andsubmil it to tl'le Faciiities MaIntenance Department at
3583: South Roosevelt Boulevard. Key West, Florida 33040; telephone number 3061292-4431 - fax
num~er 3051295-3672.
2. Once! the request for office space has been reviewed by statl', and it has been determined that appropriate
space is available, the Administration will prepare an agenda item for the next available meeting fOf the
Board of County Commissioners to consider staff recommendations and maKe a (11'\81 determination.
3. If appropriate omc& space is located, and approved by the Board of County Commissioners, the
orga~lzation will be required to:
a. Execute a one-year lease agreement with the County, with two (2) possible one-year extensions.
TJ1ereafter the organization wiD not be eligible to reapply for space for a periOd of a minimum of three
(3) years;
b. Pay a fee of $100.00 per month to the Monroe County Clerk of Courts (Finance Department) to cover
electricity costs;
c. J1rovide its own janitorial and telephone service.
CRITERIA:
The foIJowtng criteria are the basis for determining the a1iocation of office space:
!
1. 'The organization must provid& a County-wide service.
2. poes the organization presently receive funding from Monroe County? Yes 0 No2@
If so, is' the agency willing to reduce funding commensurate with cost savings as a result of being
located in a County facility? Yes 0 No 0 N / A
3. The organization must secure an in-kind match grant for the value of the space allocated. Please list
prant James Starr Moore Memorial FOlmd'lrlr;nnJ Lvdia B. Stokes FGltn.
4. ~Mrl the office space requested be needed on a temporary basis or for an extended period of time?
il"emporary Basis 0 Extended Basis fi How Long? ~ Y'" rI r c:::
r'IAY- Ul-200[ 14: 54
"",03
.
JVon-profit OrgAl'llzeatioll Request fr!r Office Space
Name of Organization:
Planned Parenthood of Greater Miami, Inc.
Contact Name:
Joan Sampieri
Non-Profit No: 59-1642041
Address: 1699 S. W. 27th Avenue I Miami, Florida 33145
Square Footage
Phone Number. (305) 285-5532 Requested: negotiate with health dept.
Fax Number:
(305) 285-5571
For How Long? 3 years
Location R~uired: Lower Keys 0 Middle Keys ~ upper Keys Rl
I
SDecial R~uirements:
We ar~ requesting space at the Ruth Ivens Center in Marathon and
the DqTT space in Tavernier.
Derr. .(- '\~I."T'~
Does this ~rganization r$ceiVe funding from Monroe County? Yes 0 N~
I
If so. what is the annual allocation? N/ A
j
If a Ieasy i. granted, please identity the program for which the value of the space allocated will be used as an
i~~ndg~tm~: Affordable reproductive health care.
Describe the County-wiele service your agency provides and the cost benefit to Monroe County taxpayers:
Planned Parenthood provides reproductive
exam; ; testicular exam; STD diaqnosis and
methods) at greatly reduced prices.
3fJr eOu.n:tfl Use OnlM
healthcare (Pap test; breast
treatment; contraceptive
"
AQproved by:
Risk Management Date:
,Facilities ~int: Date:
($ Fair Market Value for anocated space)
FYW Directdr. Date:
County Administrator: Date:
i
If approved, the organization be required to enter into a one-year lease with the COunty, with two (2) possible
one.year ~nsions, at which time the organiDtion will not be eligible to reapply for space for a period of a
minimum Qf three (3) years. All non-profit organizations who are provided office space will be required to
reimburse the County fer utilities in the amount of '$100.00lmonth. and must provide their own janitorial and.
telephone services.
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ALTERNATE KEY AND RE NUMBER. OF PROPERrY.
J : AflJ"(.\CANT'S SIGNATURE )( ..' .
;\: ~(ICJM..SECURlTY OR FlD NUMBER 5?- /~ ~ 2.i!J ~/. ,.~,.." ---""".'''';' -1.::;, "d' Cl'RRENTZONl~O
.~.: . !.Nsnw.,'r. BELOW THE NUMBER RF.QUESTED (ifappticable):....~.'!!:.t,.;.Jf;~;.;~!fJ':.~..~~ :'..1!t..:t.:'~.'."~.-.<.~";:::i.;.~~--':-~~"-::--~.~;---:
: ~OR ~ PUBUC SERVICE. MAMJFACIURJNG. .. .....,~.,,: ~".~...~. ".. :'. '. . .. '. A :.-, .
'.. .':ONl'RACTOR'SUCE..J\ofSE.ORRETAJL: ,/ '. ",>,..~..A':',;':A.L~' ..: ~7 ~#~~'
i fHr.'NUMBER OF EMPLOYEES: #/ /I ' . .;..: ~tLf ./J.~ . . -:!:
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.' 'ftYI~rLORMOTEL1.lCE..J\ofSE' ....' .':,:...;~ ~~. i . :
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~. : ,(,.~,~: ()f Stale HoreL '" RestaWallt Commission License mun accompIIIIY this application)
It ~~~%\URANT: Nlo"MBER OF SEATS: r<,..' , '~~. ""'.' ":;'~ .
i.:,." ;('''I\;'..lfSw: More! & RC31DW3IItCummissioa Licmseand copyofMoaraeC.oumy fiealah Dept.lraspcctioll must ~mpany application)
II ','l".~~)[NO MACHINES: MEItCHANDISE, .\MtJSEMaIT .
tt. ~~n.LAUNDRY (eom Opcnlted 5crvice) > · ' '
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PRt)..ESsrONAL LICENSE: You must include me number
'.'~' \'.!.)r Scare of Florida LIcense ur Repuation Number:
C:o;\'U~:c:ate of Com~ncy Number of Contradors
I;T'l1'S OF FLORJDA SALES TAX NUMBER
If' " ,'U HAVEk"ll OCCUPATIONAL UCENSE
:-R,(ll.1 ANY CITY IN M01'l"ROE COUNTY. ~.J / "
; i\;~aiRT LICENSE NUMBER .-' / .
WE MUST IlAVBA COpy OF YOUR CORPORATE PAPERS OR PROOF 0.'
FlL'Tl'IYOUS NAME BEING RECORDED WITH THE STATE OF FLORIDA
<II( t\ L SECURJTY OR RD NUMBER
!;'~SF;.tT BELOW THF. ~UMBER RF.QUESTED (If applicable):
.:\ H<t ..~ PL'BLlC SERVICE. MANtrFAcrTJRING.
,~d~U RACTOR'S LICENSE, OR RETAIL: Y.A
rHr,':UMBER OF EMPLOYEES: ~ 'v-
i., '\.', ',N APARTMENT. CONDO. HOUSE.
;{l' i:l~. OR MOTEL LlCE.~SE: 0
HH. :\UMBFR OF ROOMS A "#
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'K':,;":SIENT: _ NON-TRANSIENT:.,
" (',\" :)f State Hotel & Restaurant Corm"ission License must accompany this application)
:'';:'f'AURANT: NVMBf-.R. OF SEATS:
"!i,~ ,If S~ HOld & ReSUlurant Cummission License and copy of Monroe County Heahh Dept. In,pectwlI must acce,mpany applkatinn,
'. ~N;:,ilNG MACHINES: !'AERCHANDISE. AMUSEMENT
::'.",11 LAUNDRY (c\:in opcrnled service)
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Ma-IROE T t.ox COLLECTCR
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f Km:ht. CFe MONROE COUNTY. FLORIDA
. '. C'Lr.'C1l,Jf APPLICATION FOR )? \:<;;\\
":;119;-5060 OCCUPATIONAL TAX :l Tr:lIIs(~r
'\ .,,:.~l~\\~~~I-IJ~~ PLE..\sEPRI1'oIfORTYPE :J R~n':\N;d
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q~.3,DE ~.\ME-Lft:J~~ /J/ he> oa ~ r~~/,t'/t'L.f!f!-,; ~ -.-,.
fire _, ""d<< whi,h ,"', b"".." $10 ,. Imoun) 0 ~ hJ / 4rn / ~c : +- :.-, L
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If corporanon. also indude name of President or Vice President) ,
rYPEOf BL'SI~ESS._ ~Ll/"/'.)//..-b{~zZ!:':('... Ae~ /M _(!/dz_~ej- d0t~~~(]_.1?LLll24:."
Brien" describe nature O~~SI .5 (.),. r~ /1;;0 /?11'1'"u.J-~
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\CrUAL L()C.~fIOr\ OF BUSINESS /r u-rfi Tt.//#'-5 ( l' nn ~3.3d!..3 ~t' ..k ~ //.;.---
'-tAILING ,<\[)DRESS OF BUSINESS / t, f' f' .J c...J..2. '7 /k/e "'U!b~_.-#.I ~j,____. P/.:-.:33~~-
" 3USINESS PHONE NUMBER ~p..r ) d/ '7'. <715.-2.7 -------' .-----....-----.
~AME A."'iD ADDRESS OF PERSON RESPONSIBLE ~ -
FOR TANGIBLE PERSONAL PROPERTY TAX eL.,g/~</?A/A/7~~+ C!..eI. ..--_.
. ~~d" E" h"""A-"<<" ....0. I~ '79 .J..I ~~ ~-ie-.4
.#:(1 ?t't,~~,o< :, ~ PHONE NUM;;,(.d.2.. r.;y-r-S:$ .3 ~o._o___~!. o~ ~...~S-
. !KJ~lt'rr~s 6'M~}i(.'~ RESlD~C!! .J..f}E>RESS. - ---
:~,: PROPERTY OWNER'S NAME--fr7 o/7.e o~ ~V.-?Z\/ -..- __- ~ ~ ~....
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~, LEGAL DESCRIPTION Of PROPERTY_ .3.3.3 ~ t!:)~,e J; ~.5.flf~ w~ I m~/_i:~q .f?~2
.. ALTERNATE KEY AND RE NUMBER OF PROPERTY_~_ . - ---,----.-
.\f'Pr, .<ANT'S SIGNATURE X. .--- ,--------
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Cl'RRENT ZONlr-;O
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"'1. ,\;; HER Of MACH1~:
TYPE OF MACHINES:
:'i<~,;,-ESSIONAL LICENSE: You mUlit mclude the number
,. ",,':f SUIte of Florida License cr Registration N\lm~r
.: ....~";;;cate of Competenc}' Number of Comracto~
:;.... fiE OF FLORIDA SALES TAX NUMBER_
: j" 'v HAVE AN OCCUPATIONAL UCENSE
:'-.~:":.' 1 ANY CITY IN MO!\;"ROE COUNTY. ~ / ,q
, ,',. ;RT LICENSE NVMBER /' '
WE M{lST HAVE A COpy 0,(0' YOUR CORPORATE PAPERS OR PROOF 0..
Flt:TlTIOUS NAME BEJIlllG RECORDED WITH THE STATE OF FLORIDA.
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7437450
472835
2::: 13
At;
07,:21/20ao
STATE 4tF FLORIDA
DEPAATMe.T OF HEALTH
DIVISION 0' MEDlC~L QUALITY ASSURANCE
07~ -1 ~.: =1-:co:NO I
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GlSTEAEO NURSE
BELOW HAS MET ALL REQUIREMENTS OF
a AND RULES OF THE STATE OF FL~I[)A. QUALIFICATIaN(S):
TIONOATE:JULY31,2002 /"~~~~~~_
ViM............". ~_'-l)_Ef_GPRAC~_NIYt _-:::~
.....vn NY'" ~ -'-'
1104U
AN DRIVE
HAeM. ~t. 33011
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ROBe~ G. 8AOOKS. M,D. .
NI=lPI av &Q al:I"lIIlGE:n RV I A'" SecRETARY
.-
JEB BUSH
GOVERNOR
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Planned Parenthood@
of ~re~ter Miami, Inc.
Chairperson
Bruce Seabrook
Chairperson Elect
Paige A. Harper, Esq
Vice Chairperson
Christyno L Hayes. Esq
Blxie O'Connell
Secretary
Elspeth Hotchkiss
Treasurer
Lisa D. Napier, CPA
Board of Trustees
Ann De Velasco, RN.
Stephen J. Dresnick, MD, FACEP
Angie Fleites
W Tucker Gibbs, Esq
Nancy B. Hector
Gerald J Houlihan, Esq
S. Manjula Jegasothy, M.D.
Ana Martin-Lavielle, Esq.
William 1. Mixson. M.D
Nancy G. Pastroff, C.P.A.
Pamela I. Perry, Esq
Jean D. Shehan
Natalie F. Snyder, LCSW
Edward F. Swenson, Jr.
Suzzanne C. Thomson - Quintero, Esq.
Sally Z. Wiener, Esq
President / CEO
Joan Sampieri
Medical Director
Edward R. Watson, M.D.
August 7, 2000
Ann Mytnik, Contract Monitor
Public Facilities Maintenance
Public Works Division 3583 South Roosevelt Boulevard
Key West, FL 33040
Dear Ms. Mytnik:
Enclosed are the signed copies of the Lease Agreement for use of
county space at the Ruth Ivins Center in Marathon and the Department
of Health Clinic in Tavernier. Also enclosed are original certificates of
insurance and copies of licenses as requested in your letter.
I have signed the contract but at the request of our attorney, I am calling
to your attention several items in the contract:
. In Section 4 on page 1 - as you and I clarified, the language
regarding "books and records" means financial records. The
county will not have access to confidential patient medical
records.
· Our attorney would like the county to delete the words
"misfeasance, malfeasance or" from Section 7, page 2. He
would prefer to say "if same have not been cured within 30
days after receipt of written notice (or such longer period as
reasonably required to cure same."
. No'Exhibit C was included with the contract. Would you
please forward a copy.
. No copy of the Monroe County Ethics Ordinance was
included with the contract. Would you please forward a copy.
· At Section 20, page 3, we are agreeing in the contract to the
times indicated although the Oepartment of Health has
negotiated extended hours with us in order to better serve
Keys' residents. I will send you a copy of the Department of
Health Memorandum of Understanding.
. There is no Copy of Ordinance No. 010-1990 as referred to in
Section 21, page 4. May we please have a copy.
1699 S.W. 27 Avenue · Second Floor · Miami, Florida 33145 . (305) 285-5532 . Fax (305) 285-5571