FY2001 02/21/2001
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BRANCH OFFICE
3117 OVERSEAS HIGHwAY
MARAlHON, FLORIDA 33050
TEL. (305) 289-6027
FAX (305) 289-1745
CLERK OF mE CIRCUIT COURT
MONROE COUNTY
500 WHITEHEAD STREET
KEY WEST, FLORIDA 33040
TEL. (305) 292-3550
FAX (305) 295-3660
J ~,
BRANCH OFFICE
88820 OVERSEAS HIGHWAY
PLANTATION KEY, FLORIDA 33070
TEL. (305) 852-7145
FAX (305) 852-7146
MEMORANDUM
DATE:
March 12, 2001
TO:
Angela J. Adams
Monroe County Health Department
Pamela G. Han"~
Deputy Clerk V
'It'.
FROM:
At the February 21, 2001, Board of County Commissioner's meeting the Board granted
approval of the annual Core Contract between Board of County Commissioners and the Florida
Department of Health, Monroe County Health Department, for services provided in Monroe
County.
Enclosed please find three duplicate originals, executed on behalf of Monroe County, for
your handling. Please be sure that the fully executed "Clerk's Original" is returned to our
office as soon as possible. Should you have any questions please feel free to contact our office.
Cc: County Administrator wlo document
County Attorney
Finance
FileV'"
CONTRACT BETWEEN
Monroe COUNTY BOARD OF COUNTY COMMISSIONERS
AND
STATE OF FLORIDA DEPARTMENT OF HEALTH
FOR OPERATION OF
THE Monroe COUNTY HEALTH DEPARTMENT
CONTRACT YEAR 2000-2001
This agreement ("Agreement") is made and entered into between
the State of Florida, Department of Health ("State") and the
Monroe County Board of County Commissioners
("County"), through their undersigned authorities, effective
October 1, 2000.
RECITALS
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A. Pursuant to Chapter 154, F. S., the intent~~ tfi.e
legislature is to "promote, protect, maintain, and ~:t1%O~
the health and safety of all citizens and visitors ~;fs.:.thm
state through a system of coordinated county :<~~ldi
department services. I' "f/ ? ca
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B. County Health Departments were created throughout
Florida to satisfy this legislative intent through
"promotion of the public 1 s health, the control and
eradication of preventable diseases, and the provision of
primary health care for special populations. "
C.
is one of
Florida.
into this
the State
MQ!lro~ County Health Department ("CHD I ,)
the County Health Departments created throughout
It is necessary for the parties hereto to enter
Agreement in order to assure coordination between
and the County in the operation of the CHD.
NOW THEREFORE, in consideration of the mutual promises
set forth herein, the sufficiency of which are hereby
acknowledged, the parties hereto agree as follows:
1. RECITALS. The parties mutually agree that the forgoing
recitals are true and correct and incorporated herein by
reference.
2. TERM. The parties mutually agree that this Agreement
shall be effective from October 1, 2000, through September
30, 2001, or until a written agreement replacing this
Agreement is entered into between the parties, whichever is
later, unless this Agreement is otherwise terminated pursuant
to the termination provisions set forth in paragraph 8,
below.
3. SERVICES MAINTAINED BY THE CHD. The parties mutually
agree that the CHD shall provide those services as set forth
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on Part III of Attachment II hereof,. in order to maintain the
following three levels of service pursuant to Section
154.01(2), Florida Statutes, as defined below:
a. "Environmental health services" are those services which
are organized and operated to protect the health of the
general public by monitoring and regulating activities in the
environment which may contribute to the occurrence or
transmission of disease. Environmental health services shall
be supported by available federal, state and local funds and
shall include those services mandated on a state or federal
level. Examples of environmental health services include,
but are not limited to, food hygiene, safe drinking water
supply, sewage and solid waste disposal, swimming pools,
group care facilities, migrant labor camps, toxic material
control, radiological health, occupational health.
b. "Communicable disease control services" are those
services which protect the health of the general public
through the detection, control, and eradication of diseases
which are transmitted primarily by human beings.
Communicable disease services shall be supported by available
federal, state, and local funds and shall include those
services mandated on a state or federal level. Such services
include, but are not limited to, epidemiology, sexually
transmissible disease detection and control, HIV IAIDS,
immunization, tuberculosis control and maintenance of vi tal
statistics.
c. "Primary care services" are acute care and preventive
services that are made available to well and sick persons who
are unable to obtain such services due to lack of income or
other barriers beyond their control. These services are
provided to benefit individuals, improve the collective
health of the public, and prevent and control the spread of
disease. Primary health care services are provided at home,
in group settings, or in clinics. These services shall be
supported by available federal, state, and local funds and
shall include services mandated on a state or federal level.
Examples of primary health care services include, but are not
limited to: first contact acute care services; chronic
disease detection and treatment; maternal and child health
services; family planning; nutrition; school health;
supplemental food assistance for women, infants, and
children; home health; and dental services.
4. FUNDING. The parties further agree that funding for the
CHD will be handled as follows:
2
4. FUNDING. The parties further agree that funding for the
CHD will be handled as follows:
a. The funding to be provided by the parties and any
other sources are set forth in Part II of Attachment II
hereof. This funding will be used as shown in Part I of
Attachment II.
i. The State's appropriated responsibili ty
(direct contribution excluding any state authorized
fees or "OTHER" state revenues) as provided in
Attachment II, Part II is an amount not to exceed $ _
4,199,494. The State's obligation to pay under this
contract is contingent upon an annual appropriation
by the Legislature.
ii. The County's appropriated responsibility
(direct contribution excluding any fees or "OTHER"
local revenues) as provided in Attachment II, Part II
is an amount not to exceed $ 339,000
b. Overall expenditures will not exceed available funding
(ei ther current year or from surplus trust funds) in any
service category. Unless requested otherwise, any surplus
at the end of the term of this Agreement in the County Health
Department Trust Fund that is attributed to the CHD shall be
carried forward to the next contract period.
c. Either party may establish service fees as allowed by
law to fund activities of the CHD. These fees are listed in
Attachment II Part II. Where applicable, such fees shall be
automatically adjusted to at least the Medicaid fee schedule.
d. Either party may increase or decrease funding of this
Agreement during the term hereof by notifying the other party
in writing of the amount and purpose for the change in
funding. If the State initiates the increase/decrease, the
CHD will revise the Attachment II and send a copy of the
revised pages to the County and the Department of Health,
Bureau of Budget Management. If the County initiates the
increase/decrease, the County shall notify the CHD. The CHD
will then revise the Attachment II and send a copy of the
revised pages to the Department of Health, Bureau of Budget
Management.
e. The name and address of the official payee to who
payments shall be made is:
3
County Health Department Trust Fund
Monroe County
P.O. Box 6193
Key West, FL 33041-6193
5. CHD DIRECTOR/ADMINISTRATOR. Both parties agree the
director/administrator of the CHD shall be a State employee
or under contract with the State and will be under the day-
to-day direction of the Deputy State Health Officer. The
director/administrator shall be selected by the State with
the concurrence of the Ccmty. The director/administrator of
the CHD shall insure that noncategorical sources of funding
are used to fulfill public health priorities in the community
and the Long Range Program Plan. A report detailing the
status of public health as measured by outcome measures and
similar indicators will be sent by the CHD
director/administrator to the parties no later than October 1
of each year.
6. ADMINISTRATIVE POLICIES AND PROCEDURES. The parties
hereto agree that the following standards should apply in the
operation of the CHD:
a. The CHD and its personnel shall follow all State
policies and procedures, except to the extent permitted for
the use of county purchasing procedures as set forth in
subparagraph b., below. All CHD employees shall be State or
State-contract personnel subject to State personnel rules and
procedures. Employees will report time in the Client
Information System/Health Management Component compatible
format by program component as specified by the State.
b. The CHD shall comply with all applicable provisions of
federal and state laws and regulations relating to its
operation with the exception that the use of county
purchasing procedures shall be allowed when it will result in
a better price or service and no statewide Department of
Heal th purchasing contract has been implemented for those
goods or services. In such cases, the CHD
director /administrator must sign a justification therefore,
and all county purchasing procedures must be followed in
their entirety, and such compliance shall be documented.
Such justification and compliance documentation shall be
maintained by the CHD in accordance with the terms of this
Agreement. State procedures must be followed for all leases
on facilities not enumerated in Attachment VI.
c. The CHD shall maintain books, records and documents in
accordance with those promulgated by the Generally Accepted
Accounting Principles (GAAP) and Governmental Accounting
4
Standards Board (GASB), and the requirements of federal or
state law. These records shall be maintained as required by
the Department of Health Policies and Procedures for Records
Management and shall be open for inspection at any time by
the parties and the public, except for those records that are
not otherwise subject to disclosure as provided by law which
are subj ect to the confidentiality provisions of paragraph
6. i., below. Books, records and documents must be adequate
to allow the CHD to comply with the following reporting
requirements:
~. The
the Florida
(FLAIR) .
revenue and
Accounting
expenditure requirements in
System Information Resource
~~. The client registration and services reporting
requirements of the minimum data set as specified in
the most current version of the Client Information
System/Health Management Component Pamphlet;
iii. Financial procedures specified in the
Department of Health's Accounting Procedures Manuals,
Accounting memoranda, and Comptroller's memoranda;
iv. The CHD is responsible for assuring that all
contracts with service providers include provisions
that all subcontracted services be reported to the
CHD in a manner consistent with the client
registration and service reporting requirements of
the minimum data set as specified in the Client
Information System/Health Management Component
Pamphlet.
d. All funds for the CHD shall be deposited in the County
Health Department Trust Fund maintained by the state
treasurer. These funds shall be accounted for separately
from funds deposited for other CHDs and shall be used only
for public health purposes in Monroe County.
e. That any surplus/deficit funds, including fees or
accrued interest, remaining in the County Health Department
Trust Fund account at the end of the contract year shall be
credited/debited to the state or county, as appropriate,
based on the funds contributed by each and the expenditures
incurred by each. Expenditures will be charged to the
program accounts by state and county based on the ratio of
planned expenditures in the core contract, then funding from
all sources is credited to the program accounts by state and
county. The equity share of any surplus/deficit funds
accruing to the state and county is determined each month and
at contract year end. Surplus funds may be applied toward
5
the funding requirements of each participating governmental
enti ty in the following year. However, in each such case,
all surplus funds, including fees and accrued interest, shall
remain in the trust fund and shall be accounted for in a
manner which clearly illustrates the amount which has been
credited to each participating governmental entity. The
planned use of surplus funds shall be reflected in Attachment
I I, Part I of this contract, with special capital proj ects
explained in Attachment v.
f. There shall be no transfer of funds between the three
levels of services without a contract amendment duly signed
by both parties to this contract and the proper budget
amendments unless the CHD director/administrator determines
that an emergency exists wherein a time delay would endanger
the public's health and the Deputy State Health Officer has
approved the transfer. The Deputy State Health Officer shall
forward written evidence of this approval to the CHD within
30 days after an emergency transfer.
g. The CHD may execute subcontracts for services necessary
to enable the CHD to carry out the programs specified in this
Agreement. Any such subcontract shall include all
aforementioned audit and recordkeeping requirements.
h. At the request of either party, an audit may be
conducted by an independent CPA on the financial records of
the CHD and the results made available to the parties within
180 days after the close of the CHD fiscal year. This audit
will follow requirements contained in OMB Circular A-133 and
may be in conjunction with audits performed by county
government. If audit exceptions are found, then the
director/administrator of the CHD will prepare a corrective
action plan and a copy of that plan and monthly status
reports will be furnished to the contract managers for the
parties.
i. The CHD shall not use or disclose any
concerning a recipient of services except as
federal or state law or policy.
information
allowed by
j. The CHD shall retain all client records, financial
records, supporting documents, statistical records, and any
other documents (including electronic storage media)
pertinent to this Agreement for a period of five (5) years
after termination of this Agreement. If an audit has been
initiated and audit findings have not been resolved at the
end of five (5) years, the records shall be retained until
resolution of the audit findings.
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k. The CHD shall maintain confidentiality of all data,
files, and records that are confidential under the law or are
otherwise excepted from disclosure as a public record under
Florida law. The CHD shall implement procedures to ensure
the protection and confidentiality of all such records and
shall comply with sections 384.29, 381.004, 392.65 and
455.667, Florida Statutes, and all other state and federal
laws regarding confidentiality. All confidentiality
procedures implemented by the CHD shall be consistent with
the Department of Health Information Security Policies,
Protocols, and Procedures, dated September 1997, as amended,
the terms of which are incorporated herein by reference. The
CHD shall further adhere to any amendments to the State's
securi ty requirements and shall comply with any applicable
professional standards of practice with respect to client
confidentiality.
1. The CHD shall abide by all State policies and
procedures, which by this reference are incorporated herein
as standards to be followed by the CHD, except as otherwise
permitted for some purchases using county procedures pursuant
to paragraph 6.b. hereof.
m. The CHD shall establish a system through which
applicants for services and current clients may present
grievances over denial, modification or termination of
services. The CHD will advise applicants of the right to
appeal a denial or exclusion from services, of failure to
take account of a client's choice of service, and of his/her
right to a fair hearing to the final governing authority of
the agency. Specific references to existing laws, rules or
program manuals are included in Attachment I of this
Agreement.
n. The CHD shall comply with the provisions contained in
the Civil Rights Certificate, hereby incorporated into this
contract as Attachment III.
o. The CHD shall submit quarterly reports to the county
that shall include at least the following:
~ .
Report
Report;
The
and
DE385L1 Contract Management
the DE580L1 Analysis of Fund
Variance
Equities
ii. A written explanation to the county of service
variances reflected in the DE385L1 report if the
variance exceeds or falls below 25 percent of the
planned expenditure amount. However, if the
cumulative amount of the variance between actual and
7
planned expenditures does not exceed one percent of
the cumulative expenditures for the level of service
in which the type of service is included, a variance
explanation is not required. A copy of the written
explanation shall be sent to the Department of
Health, Bureau of Budget Management.
p. The dates for the submission of quarterly reports to the
county shall be as follows unless the generation and
distribution of reports is delayed due to circumstances
beyond the CHD's control:
~. March 1, 2001 for the report period
October 1,2000 through December 31, 2000;
ii. June 1, 2001 for the report
October 1,2000 through March 31, 2001;
period
iii. September 1, 2001 for the report period
October 1, 2000 through June 30, 2001; and
~v. December 1, 2001 for the report period
October 1,2000 through September 30, 2001.
7. FACILITIES AND EQUIPMENT.
that:
The parties mutually agree
a. CHD facilities shall be provided as specified in
Attachment IV to this contract and the county shall own the
facilities used by the CHD unless otherwise provided in
Attachment IV.
b. The county shall assure adequate fire and casualty
insurance coverage for County-owned CHD offices and buildings
and for all furnishings and equipment in CHD offices through
either a self-insurance program or insurance purchased by the
County.
c. All vehicles will be transferred to the ownership of
the County and registered as county vehicles. The county
shall assure insurance coverage for these vehicles is
available through either a self-insurance program or
insurance purchased by the County. All vehicles will be used
solely for CHD operations. Vehicles purchased through the
County Health Department trust fund shall be sold at fair
market value when they are no longer needed by the CHD and
the proceeds returned to the County Health Department trust
fund.
8. TERMINATION.
8
a. Termination at Will. This Agreement may be terminated
by either party without cause upon no less than one-hundred
eighty (180) calendar days notice in writing to the other
party unless a lesser time is mutually agreed upon in writing
by both parties. Said notice shall be delivered by certified
mail, return receipt requested, or in person to the other
party's contract manager with proof of delivery.
b. Termination Because of Lack of Funds. In the event
funds to finance this Agreement become unavailable, either
party may terminate this Agreement upon no less than twenty-
four (24) hours notice. Said notice shall be delivered by
certified mail, return receipt requested, or in person to the
other party's contract manager with proof of delivery.
c. Termination for Breach. This Agreement my be terminated
by one party, upon no less than thirty (30) days notice,
because of the other party's failure to perform an obligation
hereunder. Said notice shall be delivered by certified mail,
return receipt requested, or in person to the other party's
contract manager with proof of delivery. Waiver of breach of
any provisions of this Agreement shall not be deemed to be a
waiver of any other breach and shall not be construed to be a
modification of the terms of this Agreement.
9
MISCELLANEOUS. The parties further agree:
a. Availability of Funds. If this Agreement, any
renewal hereof, or any term, performance or payment
hereunder, extends beyond the fiscal year beginning July 1,
2001, it is agreed that the performance and payment under
this Agreement are contingent upon an annual appropriation by
the Legislature, in accordance with section 287.0582, Florida
Statutes.
b. Modification. This Agreement and its Attachments
contain all of the terms and conditions agreed upon between
the parties. Modifications of this Agreement shall be
enforceable only when reduced to writing and signed by all
parties.
c. Contract Managers. The name and address of the
contract managers for the parties under this Agreement are as
follows:
For the State:
For the County:
Diana M. Mellon-Lacey
Name
James Roberts
Name
Senior Management Analyst Sup.
Title
County Administrator
Title
~lnn ~nllp~p Rn~n
P.O. Box 6193
Address
Key West, FL 33043-6193
(305) ?9~-7!1~~
Telephone
K~ WE-st. fT. 33040
Ad ress
(305) 292-3423
Telephone
If different contract managers are designated after execution
of this Agreement, the name, address and telephone number of
the new representative shall be furnished in writing to the
other parties and attached to originals of this Agreement.
d. Captions. The captions and. headings contained in
this Agreement are for the convenience of the parties only
and do not in any way modify, amplify, or give additional
notice of the provisions hereof.
10
In WITNESS THEREOF, the parties hereto have caused this
page agreement to be executed by their undersigned officials as
duly authorized effective the 1st day of October, 2000.
BOARD OF COUNTY COMMISSIONERS
STATE OF FLORIDA
FOR
Mnnrnt::li
COUNTY
DEPARTMENT OF HEALTH
SIGNED BY'
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SIGNED
BY: ~~~
NAME: &eo"Jc R. NcuJcVJ r
TITLE: 1-141."'-
Fe.. {,WI.(. lAY
NAME:
Robert G. Brooks
TITLE:
Secretary
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DATE:
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SIGNED BY :~ '( \l '\ r... -
NAME: S~ve MP.SotJ
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TITLE:
CHD ~~Lc~8r/ Administrator
2./,Z.ODI
DATE:
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11
ATTACHMENT I
PROGRAM SPECIFIC REPORTING REQUIREMENTS AND PROGRAMS REQUIRING
COMPLIANCE WITH THE PROVISIONS OF SPECIFIC MANUALS
Some health services must comply with specific program and reporting requirements in
addition to the CIS/HMC minimum data set and the SAMAS 2.2 requirements because of federal
or state law, regulation or rule. If a county health department is funded to provide one
of these services, it must comply with the special reporting requirements for that
service. The services and the reporting requirements are listed below:
Service
Requirement
1.
Sexually Transmitted Disease
Program
Requirements as specified in FAC 640-3
and F,S,384 and the CHD Guidebook
Internal Operating Policy STD 6 and 7,
2.
Dental Health
Monthly reporting on DH Form 1008*.
3.
Special Supplemental Nutrition
Program for Women, Infants
and Children.
Service documentation and monthly
financial reports as specified in OHM
150-24* and all federal, state and county
requirements detailed in program manuals
and published procedures.
4.
Healthy Start/
Improved Pregnancy Outcome
Requirements as specified in the Healthy
Start Standards and Guidelines 1998 and as
specified by The Healthy Start Coalitions
in contract with each county health
department.
5.
Family Planning
Periodic financial and programmatic
reports as specified by the program office
and in the CHD Guidebook, Internal
Operating Policy FAMPLAN 14*
6.
Immunization
Periodic reports as specified by the
department regarding the surveillance/
investigation of reportable vaccine
preventable diseases, vaccine usage
accountability, the assessment of various
immunization levels and forms reporting
adverse events following immunization and
Immunization Module quarterly quality
audits and duplicate data reports,
7.
CHD Program
Requirements as specified in HRSM 150-3*
and HRS.M 50-9*.
8.
Chronic Disease Program
Requirements as specified in the Community
Intervention Program (CIP) and the CHD
Guidebook,
9.
Environmental Health
Requirements as specified in DHP 50-4* and
50-21*.
ATTACHMENT I (Continued)
10.
HIV/AIOS Program
Requirements as specified in Florida
Statue 384.25 and 640-3.016 and 3.017
F.A.C. and the CHO Guidebook. Case
reporting on COC Forms 50.42B (Adult/
Adolescent) and 50.42A (Pediatric).
Socio-demographic data on persons tested
for HIV in CHO clinics should be reported
on Lab Request Form 1628 or Post-Test
Counseling Form 1633. These reports are
to be sent to the Headquarters HIV/AIOS
office within 5 days of the initial post-
test counseling appointment or within 90
days of the missed post-test counseling
appointment,
11.
School Health Services
HRSM 150-25*, including the requirement
for an annual plan as a condition for
funding,
*or the subsequent replacement if adopted during the contract period,
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This is a working - "'py of the ATTACHMENT II. It is nr'" 'l valid Contract Copy
MONROE COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County Health Department
STATE
1. GENERAL REVENUE
015050 ALG/Contributions To CHD (050329) 1,197,646 0 1,197,646
015011 ALG/Cont to CHD Primary Care (050329) 17,256 0 17,256
015065 ALG/Cont to CHD AIDS Prey & Surv & Field Staff (050329) 105,802 0 105,802
015050 ALG/Cont to CHD Mig Lbr Camp San (050329) 0 0 0
015050 ALG/Cont to CHD Home Hlth Pilot Proj (050329) 0 0 0
015050 ALG/Cont to CHD-Sovereign Immunity (050329) 0 0 0
015050 ALG/Cont to CHDs Pinellas Indigent Dent! Clinic-UF (050329) 0 0 0
015050 ALG/Cont to CHDs-Dental Program (Cat. 050329) 40,000 0 40,000
015050 ALG/Cont to CHDs Immun Outreach Teams (050329) 6,232 0 6,232
015050 ALG/Cont to CHDs Comm TB Program (050329) 107,366 0 107,366
015050 ALG/Cont to C1-lDs Indoor Air Assist (050329) 0 0 0
015050 ALG/Cesspool Identification and Elimination (Cat. 050329) 128,707 0 128,707
015048 ALG/Cont to CHD STD Program (050329) 21,016 0 21,016
015037 ALG/Cont to CHDs Mtml & Chid Hlth Field Staff Cost (050329) 0 0 0
015050 Epidemiology Tming & Clinical Supp-Wakulla (CAT. 050329) 0 0 0
015123 ALG/Family Planning (050001) 60,731 0 60,731
015123 ALG/Family Planning Planned Parenthood NE FL (CAT. 0500(1) 0 0 0
015123 ALG/Family Planning (CAT. 05000 I) - Alachua Colposcopy 0 0 0
015065 ALG/Cont to CHD AIDS Pat Care (050026) 384,663 0 384,663
015115 ALG/School Health Svcs (05 I 106) 31,920 0 31,920
015140 ALG/School Health Supplemental (05 I 106) 122,731 0 122,731
015124 ALG/IPO-Healthy Start/I PO (050707) 171,881 0 171,881
015124 ALG/1PO-lnfant Mortality Project (CAT. 050707) 0 0 0
015124 ALG/IpO - Outreach Social Workers (CAT. 050707) 0 0 0
015137 ALG/IPO Healthy Start Resource Moms & Dads (050707) 0 0 0
015137 ALG/Community Health Initiatives (052250) 0 0 0
015137 ALG/1PO-Healthy Start-Data Collect. Prj Staff (CAT. 050707) 0 0 0
015124 ALG/MCH-Healthy Start/I PO (050870) 11,891 0 11,891
015124 ALG/1PO Outreach Social Workers (CAT 050870) 0 0 0
015124 ALG/MCH-Infant Mortality Project (CAT. 050870) 0 0 0
015123 Planned Parent Hood - Collier and Sarasota (CAT. 050329) 0 0 0
015012 G/ A Epilepsy Services (050082) 0 0 0
015011 ALG/Primary Care (050331) 223,310 0 223,310
015050 CATE-Environmental Community-Escambia (052250) 0 0 0
015050 New Horizons/Health Prevention-Dade (052250) 0 0 0
015050 1nterdiscip. Mngd Care Initiative-Flagler & Vol usia (052250) 0 0 0
015050 Isabel Collier Read Prentl Care Clinic-Collier & Lee(052250) 0 0 0
015050 Primary Care Outrch Prgm-Sun coast Hosp-Pinellas (052250) 0 0 0
015050 Dunbar Health Center-Lee (052250) 0 0 0
015050 Roosevelt Sands Comm. Healthcare Ctr.-Monroe (052250) 100,000 0 100,000
015050 Medivan Project/Elderly Interest-Broward (052250) 0 0 0
015050 Healthy Beaches Monitoring 0 0 0
GENERAL REVENUE TOTAL 2.731,152 0 2,731,152
2, NON GENERAL REVENUE
015010 ALG/Contr. to CHDs-Rebasing (050329) Tobacco TF 21,864 0 21,864
015072 ALG/Cont to CHD Safe Drinking Water-DEI' (050329) Adm TF 0 0 0
015026 ALG/Cont to CHD Bio-Medical Waste/DEI' (050329) /Adm TF 4,071 0 4,071
015170 Tobacco Coordination (106014) Tobacco TF 51,637 0 51,637
015172 Full Service Schools - Tobacco (102258) Tobacco TF 67,318 0 67,318
015174 Basic School Health - Tobacco (051106) Tobacco TF 8,919 0 8,919
015016 G/A Epilcpsy Prcv and Educ (050083) /Epilcpsy TF 0 0 0
015084 Varicella Immunization Requiremcnt (050329) Tobacco TF 3,582 0 3,582
015010 ALG/Contr. to CHDs - FY 1999-00 Holdback 2,446 0 2,446
015020 Food and Waterborne Disease Program (050329) Adm TF 0 0 0
This is a working IH'OY of the ATTACHMENT II. It is no" '1 valid Contract Copy
MONROE COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County Health Department
STATE
2. NON GENERAL REVENUE
015010 Pasco CHD Dental Program (050329) Tobacco TF 0 0 0
015010 Enhanced Dental Services (050329) Tobacco TF 0 0 0
015010 Fla Hepatitis & Liver Fail. Prev & Cnrl(050329)Tobacco TF 190,000 0 190,000
010304 Stationary Pollutant Storage-DEP 0 0 0
015121 Super Act Reimbursements 0 0 0
015113 SPL Prgm Reimb ofCHD 0 0 0
NON GENERAL REVENUE TOTAL 349,837 0 349,837
3. FEDERAL FUNDS
015075 Refugee Center Reimbursement 0 0 0
015075 Car Seat Reimbursement. 0 0 0
015075 KidCare Outreach Program 63,333 0 63,333
007010 Beach Water Sampling Study 17,091 0 17,091
007065 FG TFI AIDS Prevention 172,910 0 172,910
007066 FG TF/Ryan White 456,263 0 456,263
007066 FG TF/Ryan White 0 0 0
007066 FG TF/Ryan White- AIDS Drug Assist Prog.-Admin. 22,443 0 22,443
007062 FG TFI AIDS Epidemiological Research Study 0 0 0
007049 FG TF/ALGI Contr to CHDs-STD Prg-Infertility Prg 0 0 0
007049 FG TF/ALGI Contr to CHDs-STD Prg-Syphilis Elimination 0 0 0
007049 FG TF/ALGI Contr to CHDs-STD Program 0 0 0
007067 Tuberculosis Control - Federal Grant 0 0 0
007084 Immunization Special Project 3,014 0 3,014
007084 FG TF/ALG/Contr to CHDs-Immunization Action Plan 5,558 0 5,558
007085 Breast and Cervical Canecr-Clicnt Services 0 0 0
007085 Breast and Cervical Cancer-Admin/Case Management 0 0 0
007084 FG TF/ALG/Contr to CHDs-Project Field Staff 0 0 0
007084 Immunization Action Plan-WIC Immunization Linkage 0 0 0
007133 ALG/Family Planning Titlc X-Sterilzations 1,625 0 1,625
007127 ALG/MCH-MCH Blk Grt.-Child Health 11,446 0 11,446
007134 ALG/MCH-MCH Blk Grt Outreach Soc Wrkrs 0 0 0
007134 ALGIMCH-MCH Blk Grt-Outreach Soc Wrkrs 0 0 0
007134 ALG/MCH-MCH Blk Grt.-1PO Infant Mort. Proj. 0 0 0
007132 ALG/MCH-MCH Blk Grt.-Dental Projects 0 0 0
007134 ALG/IPO/MCH-1nfant Mortality Project 0 0 0
007134 ALG/1PO-MCH Blk. Grt.-1PO-Gadsden Sch Clinic 0 0 0
007127 ALG/MCH-MCH Blk Grt-Child Health Ages 0-1 Yr. 2,753 0 2,753
007134 ALG/MCI-Il3Ik Grt-Healthy Start/I PO 29,400 0 29,400
007134 ALG/1PO-MCH Blk Grt- Healthy Start/I PO 37,189 0 37,189
007063 Prev Hlth Blk Grt/HERR-Chronie Disease 1nit. 0 0 0
007133 ALG/Grants & Aids-Fam Ping Svcs-Title X 49,344 0 49,344
007133 ALG/Fam Ping-Title X-Duval The Bridge 0 0 0
015075 ALG/Fam Ping - Pregnancy Prev-TANF 13,927 0 13,927
007133 ALG/Grants & Aids-Fam Ping-Special Contracts-Title X 0 0 0
007030 Migrant Labor Sanitation 0 0 0
007056 FG TF Health Program for Refug. (180000) 0 0 0
007068 FGTF/Federal Grants-AIDS Inmate Intervention 0 0 0
007069 Minority Involvement in HIV/AIDS Program 0 0 0
007064 FGrrF AIDS Seroprcvalence 0 0 0
007064 FGrrF AIDS Surv/Scrop 0 0 0
007051 W1C Infrastructure Grant 2000-200 I 0 0 0
007051 FG TF WIC Admin Transfer (050329) 213,896 0 2 I 3,896
007135 T ANF Abstinence Education 0 0 0
007135 Abstinence Education Program Fed Grants TF 0 0 0
015075 G/A Epilepsy Services-TANF 0 0 0
This is a working uy of the ATTACHMENT II. It is nr ,valid Contract Copy
MONROE COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County Health Department
STATE
3. FEDERAL FUNDS
007049 ALG/Contr to CHD-STD-Medical & Lab Svc Trng Ctr 0 0 0
015075 Full Service Schools-TANF 6,732 0 6,732
015075 ALG/School Health-Supplement-T ANF 11,581 0 11,581
007058 FGrrF Diabetes Control 0 0 0
007044 Prev Hlth Blk Grt/Rape Awareness 0 0 0
FEDERAL FUNDS TOTAL 1,118,505 0 1,118,505
4. FEES ASSESSED BY STATE OR FEDERAL RULES
001091 Fed. Rule Comm Disease ~50 0 850
001092 Env ironmcntal Hcalth Fees 181,000 0 181,000
001113 Mobile Home and Parks 16,000 0 16,000
001132 Food Hygiene Permit 13.000 0 13,000
001092 OSDS Rcpair Permit 0 0 0
001092 OSDS Permit Fee 0 0 0
001211 Safe Drinking Water 0 0 0
001136 1 & M Zoned Operating Permit 0 0 0
00]092 Aerobic Operating Permit 0 0 0
00 I 092 Septic Tank Site Evaluation 0 0 0
001139 Migrant Housing Permit 0 0 0
001140 Biohazard Waste Permit 4,000 0 4,000
001166 Non-SDW A System Permit 0 0 0
001142 Non SDW A Lab Sample 0 0 0
001144 Tanning Facilities 1,400 0 1,400
001145 Swimming Pools 36,000 0 36,000
001166 Public Water Constr Permit 0 0 0
001165 Private Water Constr Permit 0 0 0
001166 Public Water Annual Oper Permit 0 0 0
001170 Lab Fee Chemical Analysis 0 0 0
001026 Returncd Chcck Scr Fccs 0 0 0
010403 Fees-Copy of Public Doc 550 0 550
015055 Registar Fees (Ch. 382.34) 0 0 0
001135 OSDS Variance Fee 300 0 300
015052 Transfers-Mobile HOllle/RV Park 0 0 0
001149 Body Piercing 135 0 135
FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 253,235 0 253,235
5. OTHER CASH CONTRIBUTIONS
090001 Draw down from Public Health Unit -492,076 0 -492,076
OTHER CASH CONTRIBUTIONS TOTAL -492,076 0 -492,076
6. MEDICAID
001056 CHD Incm:Medicaid-Pharmacy 0 0 0
001080 CHD Incm:Medicaid-Other 0 0 0
001081 CHD Incm:Medicaid-EPSDT 0 0 0
001082 CHD 1ncm:Medicaid-Dental 0 0 0
001083 CHD Incm:Mcdicaid-FP 0 0 0
001084 CHD ]ncm:Medicaid-Physician 3,500 0 3,500
001085 CHD Incm:Mcdicaid-Nursing 0 0 0
001086 CHD Incm:Co-lnsurance 0 0 0
001087 CHD Incm:Medicaid-STD 0 0 0
001088 CHD Incm:Med Reimb AZT Disp Fee 0 0 0
001089 Medicaid AIDS 12,000 0 12,000
001147 Medicaid HMO Rate 0 0 0
001148 Medicaid-HMO Admin 0 0 0
This is a working - -uy of the ATTACHMENT II. It is no" " valid Contract Copy
MONROE COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County Health Department
STATE
6. MEDICAID
001181 CHD Incm:Medicaid Transportation 0 0 0
001190 Health Maintenance Organ. (HMO) 0 0 0
001191 CHD Incm:Medicaid Maternity 0 0 0
001192 C1.ID 1ncm:Medicaid Compo Child 0 0 0
001193 CHD Incm:Medicaid Compo Adult 100 0 100
001194 CHD Incm:Medicaid Sonagram 0 0 0
001208 Medipass $3.00 Adm. Fee 3,120 0 3,120
MEDICAID TOTAL 18,720 0 18,720
7. ALLOCABLE REVENUE
011007 Cash Donations Private 300 0 300
001029 Third Party Reimbursement 0 0 0
010301 Exp Witness Fee Consultnt Charges 10 0 10
005040 Interest Erned State Investment 100,000 0 100,000
005041 Interest Erned Loeal Investment 0 0 0
007010 U.S. Grants Direct to CHD 420,928 0 420,928
008094 Grnts/Contracts other Agencies Direct 0 0 0
011098 Donation School Based Clinic 0 0 0
011099 Other Grants/Donations Direct 2,000 0 2,000
012020 Fines and Forfeitures 0 0 0
018001 Refunds, Salary 1,290 0 1,290
018003 Refunds, other Personal Services 0 0 0
018004 Refunds, Expenses 1,581 0 1,581
018006 Refunds, Operating Capital Outlay 0 0 0
018010 Refunds, Special Category 0 0 0
018011 Refunds, Other 0 0 0
018099 Refunds, Certified Forward 0 0 0
037000 Prior Year Warrant 718 0 718
038000 12 Month Old Warrant 0 0 0
010300 Sale of Goods and Services 1,000 0 1,000
010402 Recycle Paper Sales 0 0 0
010403 Fees-Copies of Documents 0 0 0
010405 Sale of pharmaceuticals 0 0 0
011055 Other Grant DOE 0 0 0
012021 Return Check Charge 100 0 100
018005 Refunds Grants to Local Gov't 0 0 0
029010 Sale of Fixed Assets 0 0 0
ALLOCABLE REVENUE TOTAL 527,927 0 527,927
8, OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND
State Pharmacy Services 0 49.178 49,178
State Laboratory Services 0 89,515 89,515
State TB Services 0 0 0
State Immunization Services 0 63,063 63,063
State STD Services 0 0 0
State Construction/Renovation 0 0 0
WIC Food 0 677,389 677,389
ADAP-AIDS Drug Assistance Program 0 643,916 643,916
Other (specify) 0 0 0
Other (specify) 0 0 0
Other (specify) 0 0 0
OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND TOTAL 0 1,523,061 1,523,061
TOT AL STATE CONTRIBUTIONS 4,507,300 1,523,061 6,030,361
This is a working 'lY of the A TT ACHMENT II. It is nr' 'valid Contract Copy
MONROE COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County Health Department
COUNTY
1. BOARD OF COUNTY COMMISSIONERS ANNUAL APPROPRIATIONS:
008030 Grants-County Tax Direct 274,000 0 274,000
008034 Grants Cnty Commsn Other 65,000 0 65,000
BOARD OF COUNTY COMMISSIONERS ANNUAL APPROPRIATIONS TOTAL: 339,000 0 339,000
2. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION:
00 I 077 Primary Care Fees 12,000 0 12,000
001093 Communicable Disease Fees 48,000 0 48,000
001094 Environmental Health Fees 25,000 0 25,000
001114 New Birth Certificates 8,000 0 8,000
001115 Death Certificates 45,000 0 45,000
001116 Computer Access Fee 0 0 0
001060 Vital Statistics Fees Other 800 0 800
001004 Child Car Seat Prog 0 0 0
001074 Adult Entcr. Permit Fecs 0 0 0
001195 Primary Care Transfer Fees 0 0 0
001117 Vital Stats-Adm. Fee 50 cents 425 0 425
001196 Water Analysis-Potable 0 0 0
FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION TOTAL 139,225 0 139,225
3, OTHER CASH AND LOCAL CONTRIBUTIONS
001072 Ryan White Title 1 0 0 0
001073 Ryan White Title II 0 0 0
001075 Ryan White Title III 0 0 0
090002 Draw down from Public Hcalth Unit 265,060 0 265,060
001090 Mcdicare 2,000 0 2,000
008050 Grants-Cnty Sch Board Direct 35,000 0 35.000
008010 Grants Contracts Frm Cities Direct 10,000 0 10,000
008033 County Contributions For Facilities 0 0 0
010302 Sale of Goods and Services to State Agencies 270,000 0 270,000
008095 Grants Cnty Sect 403.102 Air Pol 0 0 0
008099 Rcimb/Rebatc Local Govn't 0 0 0
008031 County AIDS Education 0 0 0
OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 582,060 0 582,060
4. ALLOCABLE REVENUE
011007 Cash Donations Privatc 0 0 0
001029 Third Party Reimbursement 0 0 0
010301 Exp Witncss Fee Consultnt Charges 0 0 0
005040 Interest Erned State Investment 0 0 0
005041 Interest Erned Local Investment 0 0 0
007010 U.S. Grants Direct to CHD 0 0 0
008094 Grnts/Contracts other Agencies Direct 0 0 0
011098 Donation School Based Clinic 0 0 0
011099 Other Grants/Donations Direct 0 0 0
012020 Fines and Forfeitures 0 0 0
018001 Refunds, Salary 0 0 0
018003 Refunds, other Personal Services 0 0 0
018004 Rcfunds, Expenscs 0 0 0
018006 Rcfunds, Operating Capital Outlay 0 0 0
018010 Refunds, Special Category 0 0 0
018011 Refunds, Othcr 0 0 0
018099 Rcfunds, Certified Forward 0 0 0
037000 Prior Year Warrant 0 0 0
038000 12 Month Old Warrant 0 0 0
This is a working "Y of the A TT ACHMENT II. It is no' 'valid Contract Copy
MONROE COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County Health Department
COUNTY
4. ALLOCABLE REVENUE
010300 Sale of Goods and Services 0 0 0
010402 Recycle Paper Sales 0 0 0
010403 Fees-Copies of Documents 0 0 0
010405 Sale of pharmaceuticals 0 0 0
011055 Other Grant DOE 0 0 0
012021 Return Check Charge 0 0 0
018005 Refunds Grants to Local Gov't 0 0 0
029010 Sale of Fixed Assets 0 0 0
COUNTY ALLOCABLE REVENUE TOTAL 0 0 0
5. BUILDINGS:
Annual Rental Equivalent Value 0 225,000 225,000
Maintenance 0 20,000 20,000
Utilities 0 50,000 50,000
Other 0 0 0
Other (specify) 0 0 0
Other (specify) 0 0 0
Other (specify) 0 0 0
BUILDINGS TOTAL 0 295,000 295,000
6. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND
Other County Contribution (specify) 0 0 0
Other County Contribution (specify) 0 0 0
Other County Contribution (specify) 0 0 0
Other County Contribution (specify) 0 0 0
Other County Contribution (specify) 0 0 0
OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND TOTAL 0 0 0
TOTAL COUNTY CONTRIBUTIONS 1,060,285 295,000 1,355,285
GRAND TOTALCHD PROGRAM 5,567,585 1,818,061 7,385,646
This is a working cop" of the ATTACHMENT II. It is not a v-did Contract Copy
JuJNROE COUNTY HEALTH DEPARTMEJ,.
Part III. Planned Staffing, Clients, Services, And Expenditures By Program Service Area Within Each Level Of Service
October 1,2000 to September 30, 2001
A. COMMUNICABLE DISEASE CONTROL:
Immunization (I 0 1) 3.50 0 11,000 45,250 45,250 45,250 45,250 52,000 129,000 181,000
STD (I 02) 2.00 80 1,600 24,500 24,500 24,500 24,500 10,000 88,000 98,000
A.I.D.S. (103) 13.50 600 6,000 390,000 390,000 390,000 390,000 0 1,560,000 1,560.000
TB Control Services (104) 1.75 1,100 2,100 27,500 27,500 27,500 27,500 4,000 106,000 110,000
Comm. Disease Surv. (106) 0.60 0 850 9,500 9,500 9,500 9,500 34,000 4,000 38,000
I Icpatitis Prevention (109) 2.00 0 1,280 52,500 52,500 52,500 52,500 20,000 190,000 210,000
Vital Statistics (180) 3.00 0 0 30,000 30,000 30,000 30,000 60,000 60,000 120,000
COMMUNICABLE DISEASE SUBTOTAL 26.35 1,780 22,830 579,250 579,250 579,250 579,250 180,000 2,137,000 2,317.000
B. PRIMARY CARE:
Chronic Disease Services (210) 1.25 50 1,100 16,000 16,000 16,000 16,000 16,000 48,000 64,000
Tobacco Prevention (212) 0.00 0 0 0 0 0 0 0 0 0
!'!ome Health (215) 0.00 0 0 0 0 0 0 0 0 0
W.l.c. (221) 5.25 2,500 12,500 57,500 57,500 57,500 57,500 15,000 215,000 230,000
ramily Planning (223) 5.00 800 3,900 66,250 66,250 66,250 66,250 25,000 240,000 265,000
Improved Pregnancy Outcome (225) 0.20 25 550 2,250 2,250 2,250 2,250 0 9,000 9,000
Healthy Start Prenatal (227) 3.75 375 21,000 50,000 50,000 50,000 50,000 0 200,000 200,000
Comprehensive Child Health (229) 0.50 40 150 20,000 20,000 20,000 20,000 20,000 60,000 80,000
Healthy Start Infant (231) 2.30 175 15,000 29,000 29,000 29,000 29,000 16,000 100,000 116,000
School Health (234) 8.25 0 90,000 92,000 92,000 92,000 92,000 35,000 333,000 368,000
Comprehensive Adult Health (237) 1.75 350 2,200 30,000 30,000 30,000 30,000 12,000 108,000 120,000
Dental Heal th (240) 0.01 0 0 10,000 10,000 10,000 10,000 0 40,000 40,000
PRIMARY CARE SUBTOTAL 28.26 4,315 146,400 373,000 373,000 373,000 373,000 139,000 1,353,000 1,492,000
C. ENVIRONMENTAL HEALTH:
Private Water System (357) 0.00 0 0 0 0 0 0 0 0 0
Public Water System (358) 0.01 5 300 300 300 300 200 1,000 1,200
Individual Sewage Disp. (361) 12.00 1,700 7,500 275,000 275,000 275,000 275,000 470,000 630,000 1,100,000
rood Hygiene (348) 0.75 SO 250 8,500 8,500 8,500 8,500 4,000 30,000 34,000
Group Care Facility (351) 0.35 113 200 4,000 4.000 4,000 4,000 0 16.000 16,000
Migrant Labor Camp (352) 0.00 0 0 0 0 0 0 0 0 0
Housing,Public Bldg Safety,Sanitation (353) 0.02 4 4 ISO 150 150 ISO 0 600 600
Mobile Home and Parks Services (354) 0.75 50 250 7,500 7,500 7,500 7,500 7,500 22,500 30,000
Swimming Pools/Bathing (360) 1.00 160 600 12,000 12,000 12,000 12,000 40,000 8,000 48,000
Biomedical Waste Services (364) 0.30 50 75 4,500 4,500 4,500 4,500 12,000 6,000 18,000
Tanning Facility Services (369) 0.02 5 10 300 300 300 300 0 1,200 1,200
Rabies Surveillance/Control Services (366) 0.07 1 30 1,000 1.000 1,000 1,000 1,000 3,000 4,000
Arbovirus Surveillance (367) 0.00 0 0 0 0 0 0 0 0 0
Rodent! Arthropod Control (368) 0.00 0 0 0 0 0 0 0 0 0
Storage Tank Compliance (355) 3.00 400 800 37,500 37,500 37,500 37,500 0 150,000 150,000
Super Act Service (356) 0.00 0 0 0 0 0 0 0 0 0
Occupational Health (344) 0.00 0 0 0 0 0 0 0 0 0
Consumer Product Safety (345) 0.00 0 0 0 0 0 0 0 0 0
This is a working co...-' of the ATTACHMENT II. It is not a --'did Contract Copy
MONROE COUNTY HEALTH DEPARTME1'l f
Part III. Planned Staffing, Clients, Services, And Expenditures By Program Service Area Within Each Level Of Service
October 1,2000 to September 30, 2001
C. ENVIRONMENTAL HEALTH:
Emergency Medical (346) 0.00 0 0 0 0 0 0 0 0 0
Lcad Monitoring Services (350) 0.01 0 0 250 250 250 250 0 1,000 1,000
Public Sewage (362) 0.00 0 0 0 0 0 0 0 0 0
Solid Waste Disposal (363) 0.00 0 0 0 0 0 0 0 0 0
Sanitary Nuisancc (365) 1.50 30 80 35,000 35,000 35,000 35,000 140,000 0 140,000
Water Pollution (370) 0.80 0 1,400 12,000 12,000 12,000 12,000 0 48,000 48,000
Air Pollution (371) 0.00 0 0 0 0 0 0 0 0 0
Radiological Health (372) 0.00 0 0 0 0 0 0 0 0 0
Toxic Substances (373) 1.00 145 145 16,500 16,500 16,500 17,085 66,585 0 66,585
ENVIRONMENTAL HEALTH SUBTOTAL 21.58 2,709 11,349 414,500 414,500 414,500 415,085 741,285 917,300 1,658,585
D. SPECIAL CONTRACTS:
Special Contracts (599) 1.50 0 0 25,000 25,000 25,000 25,000 0 100,000 100,000
SPECIAL CONTRACTS SUBTOTAL 1.50 0 0 25,000 25,000 25,000 25,000 0 100,000 100,000
TOT AL CONTRACT 77.69 8,804 180,579 1,391,750 1,391,750 1,391,750 1,392,335 1,060,285 4,507,300 5,567,585
ATTACHMENT III
CIVIL RIGHTS CERTIFICATE
The applicant provides this assurance in consideration of and for the purpose of
obtaining federal grants, loans, contracts (except contracts of insurance or
guaranty), property, discounts, or other federal financial assistance to programs or
activities receiving or benefiting from federal financial assistance. The provider
agrees to complete the Civil Rights Compliance Questionnaire, HRS Forms 946 A and B
(or the subsequent replacement if adopted during the contract period), if so
requested by the department.
The applicant assures that it will comply with:
1. Title VI of the Civil Rights Act of
seq" which prohibits discrimination
origin in programs and activities
financial assistance.
1964, as amended, 42 U,S.C., 2000 Et
on the basis of race, color or national
receiving or benefiting from federal
2. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C.
which prohibits discrimination on the basis of handicap in programs
activities receiving or benefiting from federal financial assistance,
794,
and
3. Title IX of the Education Amendments of 1972, as amended,
seq" which prohibits discrimination on the basis of
programs and activities receiving or benefiting from
assistance.
20 U,S.C, 1681 et
sex in education
federal financial
4, The Age Discrimination Act of 1975, as amended, 42 U.S.C. 6101 et seq., which
prohibits discrimination on the basis of age in programs or activities
receiving or benefiting from federal financial assistance,
5. The Omnibus Budget Reconciliation Act of 1981, P.L. 97-35, which prohibits
discrimination on the basis of sex and religion in programs and acti vi ties
receiving or benefiting from federal financial assistance,
6. All regulations, guidelines and standards lawfully adopted under the above
statutes. The applicant agrees that compliance with this assurance
constitutes a condition of continued receipt of or benefit from federal
financial assistance, and that it is binding upon the applicant, its
successors, transferees, and assignees for the period during which such
assistance is provided. The applicant further assures that all contracts,
subcontractors, subgrantees or others with whom it arranges to provide
services or benefits to participants or employees in connection with any of
its programs and activities are not discriminating against those participants
or employees in connection with any of its programs and activities are not
discriminating against those participants or employees in violation of the
above statutes, regulations, guidelines, and standards, In the event of
failure to comply, the applicant understands that the grantor may, at its
discretion, seek a court order requiring compliance with the terms of this
assurance or seek other appropriate judicial or administrative relief, to
include assistance being terminated and further assistance being denied,
ATTACHMENT IV
FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT
Facility
Description
Location
Owned By
Public Service Building
5100 College Road
Key West, FL 33040
Monroe County
Roosevelt Sands Center
105 Olivia Street
Key West, FL 33040
City of Key
West
Ruth Ivins Center for
Public Health
3333 Overseas Hwy
Marathon, FL 33050
Monroe County
Monroe County Health Dept.
148 Georgia Avenue
Tavernier, FL 33070
Monroe County
Health Care Center
1200 Kennedy Drive
Key West, FL 33040
Lower Keys
Medical Center
Venetian Plaza
85960 Overseas Highway
Village of the Islands
FL 33036
Private Party
ATTACHMENT V
DESCRIPTION OF USE OF CHD TRUST FUND BALANCES
FOR SPECIAL CAPITAL PROJECTS, IF APPLICABLE
(From Attachment II, Part I)
$600,000 Construction/Renovation/Furnishings/Equipment
This project will be completed no later than September 2003
DESCRIPTION OF SPECIAL CONTRACTS
(From Attachment II, Part III)
Please list separately
Special contracts are contracts for services for which there are no comparable
services in the county health department core programs; no service codes in
Departmental coding manuals; projects that are locally designed and have no
standard statewide set of services and therefore cannot be accounted for
within existing county health department programs. These contracts are coded
to FLAIR Level 5:599 and include some contracts formerly handled at the
district offices such as epilepsy, colposcopy, Project WARM, community
planning and special family planning and teen mother projects.
A TT~. ....HMENT VI
ENVIRONMENTAL HEALTH - ESTIMATED ANNUAL FEE REVENUES
FISCAL YEAR 2000 - 2001
EFFECTIVE 07/01/2000
DESCRIPTION FEE DEPOSIT Est. Annual Revenue
AMOUNT AMOUNT Accruing to CHD TF
PUBLIC SWIMMING POOLS AND BATHING PLACES
1. Annual Permit - Up to (and including) 25,000 gallons 75.00 67.50 10328
1 a. Transfer to headquarters 7.50
2. More than 25,000 gallons 160.00 144.00 24768
2a. Transfer to headquarters 16.00
3. Exempted Condo Pools (over 32 units) 50.00 45.00 900
3a. Transfer to headquarters 5.00
OTHER FEES
Collected by the 12 delegated counties
Broward, Dade, Duval, Hillsborough, Lee, Manatee,
Collier, Palm Beach, Pinellas, Polk, Sarasota, Volusia, Escambia.
Variances for Okalossa, Santa Rosa, Walton counties
are processed by Escambia County as follows:
1. Plan review (new construction) 275.00 275.00
2. Plan review for modification of original construction 100.00 100.00
3. Plan/application review for bathing place development 275.00 275.00
4. Initial operating permit 125.00 125.00
5. Variance applications 240.00 216.00
5.a. Transfer to Headquarters 24.00
All other counties are to send the fee to Bureau of Facility
Programs in Tallahassee or the Environmental Engineering
section in Orlando as follows:
1. Plan review (new construction) 275.00 275.00
2. Plan review for modification of original construction 100.00 100.00
3. Plan/application review for bathing place development 275.00 275.00
4. Initial operating permit 125.00 125.00
5. Variance applications 240.00 240.00
MOBILE HOME & RECREATIONAL VEHICLE PARKS
(FEES ARE PRORATED ON A QUARTERLY BASIS)
1. Annual permit for 5 to 14 spaces 50.00 45.00 2790
1 a. Transfer to headquarters 5.00
3.50 per
2. Annual permit for 15 to 171 spaces space 10510
2a. Transfer to headquarters 10%
3. Annual permit for 172 and above spaces 600.00 540.00 2700
3a. Transfer to headquarters 60.00
MIGRANT LABOR CAMPS
1. Annual permit for facilities with 5-50 occupants 125.00 125.00
2. Annual permit for facilities with 51-100 occupants 225.00 225.00
3. Annual permit for facilities with over 100 occupants 500.00 500.00
**Must use County Health Department IBI (01-67)
Page 1
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DESCRIPTION FEE DE 31T Est. AnnualRevenue
AMOUNT AMOUNT Accruing to CHD TF
BIOMEDICAL WASTE GENERA TORS
1. Initial permit 55.00 55.00
2. Renewal of annual permit(except physician office generating
less than 251bs/30 days) postmarked by October 1 55.00 55.00 4015
2. Renewal of annual permit(except physician office generating
less than 251bs/30 days) postmarked after October 1 75.00 75.00
3. Storage facilities permit postmarked by October 1 55.00 55.00
3. Storage facilities permit postmarked after October 1 75.00 75.00
4. Treatment facilities operating permit by October 55.00 55.00
4. Treatment facilities operating permit after October 1 75.00 75.00
5. Transporter registration (one vehicle) postmarked by 10/1 55.00 55.00
5. Transporter registration (one vehicle) after 10/1 75.00 75.00
6. Transporter registration additional vehicle 10.00 10.00
TANNING FACILITIES
1. Annual license fee 150.00 135.00 945
1 a. Transfer to headquarters 15.00
2. Fee for each additional device 55.00 49.50 445
2.a. Transfer to headquarters 5.50
3. Late fee 25.00 25.00
BODY PERIERCING
1. Annual Licence Fee 150.00 135.00 135
1 a. Transfer to headquarters 15.00
2. Temporary Establishment 75.00 67.50
2a. Transfer to headquarters 7.50
3. Late fee 100.00 100.00
FOOD ESTABLISHMENTS
1. Annual Permit for Fraternal/Civic 160.00 144.00 1296
1 a. Transfer to headquarters 16.00
2. Annual Permit School Cafeteria Operating for
9 months or less 130.00 117.00 1170
2a. Transfer to headquarters 13.00
3. Annual Permit School Cafeteria Operating for more
than 9 months 160.00 144.00
3a. Transfer to headquarters 16.00
4. Annual Permit for Hospital/Nursing Food Service 210.00 189.00 1512
4a. Transfer to headquarters 21.00
5. Annual Permit for Movie Theaters 160.00 144.00 288
5a. Transfer to headquarters 16.00
6. Annual Permit for Jails/Prisons 210.00 189.00 378
6a. Transfer to headquarters 21.00
7. Annual Permit for Bars/Lounges (Drink Service Only) 160.00 144.00 8064
7a. Transfer to headquarters 16.00
8. Annual Permit for Residential Facilities 110.00 99.00
8a. Transfer to headquarters 11.00
9. Annual Permit for Child Care Centers without C&F license 85.00 76.50
9a. Transfer to headquarters 8.50
**Must use County Health Department IBI (01-67)
Page 2
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DESCRIPTION FEE DEPOSIT Est. Annual.Revenue
AMOUNT AMOUNT Accruing to CHD TF
10. Annual Permit for Limited Food Service 85.00 76.50
10a. Transfer to headquarters 8.50
11. Annual Permit Other Food Service 160.00 144.00
11 a. Transfer to headquarters 16.00
12. Plan Review $35/hour $35/hour
13. Food Worker Training 10.00 10.00
14. Request for Inspection 40.00 40.00
15. Reinspection (after the first reinspection) 30.00 30.00
16. Late Renewal 25.00 25.00
17. Alcoholic Beverage Inspection Approval 30.00 30.00 300
ON SITE SEWAGE DISPOSAL PROGRAM (OSTDS)
1. Application for permitting of an onsite sewage 25.00 23.00 16100
treatment and disposal system which includes
application and plan review for new and repair permits
1 a. Transfer to headquarters 2.00
2. Site evaluation for a new system 60.00 55.20 6900
2a. Transfer to headquarters 4.80
3. Site evaluation for a system repair or modification of system 40.00 36.80
3a. Transfer to headquarters 3.20
4. Site re-evaluation, new or repair or modification 40.00 36.80
4a. Transfer to headquarters 3.20
5. Permit for new systems, or modification to system 55.00 50.60
5a. Transfer to headquarters 4.40
6. New system or system modification installation inspection 55.00 50.60
6a. Transfer to headquarters 4.40
7. Research fee to be collected in addition, and concurrent with 5.00 5.00
the permit for a new system installation fee until 6/30/2002.
8. Repair permit issuance which includes inspection 50.00 41.40 4140
8a. Transfer to headquarters 3.60
8b. Transfer to headquarters for training center 5.00
9. Inspection of system previously in use 50.00 46.00 41400
9a. Transfer to headquarters 4.00
10. Reinspection fee per visit for site inspections after system 25.00 23.00 2300
construction approval
10a. Transfer to headquarters 2.00
11. Installation reinspection of non-compliant system per 25.00 23.00
each site visit
11 a. Transfer to headquarters 2.00
12. System abandonment permit, includes permit 40.00 36.80
issuance and inspection
12a. Transfer to headquarters 3.20
13. Annual operating permit fee for systems in 1M and 150.00 138.00 690
equivalent areas, and for systems receiving commercial waste
13a. Transfer to headquarters 12.00
14. Amendments or changes to the operating permit during 25.00 23.00
""Must use County Health Department IBI (01-67)
Page 3
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DESCRIPTION FEE DEPOSIT Est. Annual Revenue
AMOUNT AMOUNT Accruing to CHD TF
the permit period per change or amendment
14a. Transfer to headquarters 2.00
15. Aerobic treatment unit operating permit per annum 150.00 138.00 106503
15a. Transfer to headquarters 12.00
16. Tank manufacturer's inspection per annum 100.00 50.00 250
16a. Transfer to headquarters 50.00
17. Septage disposal service permit per annum 50.00 46.00 460
17a. Transfer to headquarters 4.00
18. Additional charge per pumpout vehicle 25.00 23.00 460
18a. Transfer to headquarters 2.00
19. Portable or temporary toilet service permit per annum 50.00 46.00 230
19a. Transfer to headquarters 4.00
20. Additional charge per pumpout vehicle 25.00 23.00 115
20a. Transfer to headquarters 2.00
21. Septage stabilization facility inspection fee per annum 150.00 138.00
21a. Transfer to headquarters 12.00
22. Septage disposal site evaluation fee per annum 100.00 92.00
22a. Transfer to headquarters 8.00
23. Aerobic treatment unit maintenance entity permit per annum 25.00 23.00 690
23a. Transfer to headquarters 2.00
24. Variance application for a single family residence per 150.00 75.00
each lot or building site
24a. Transfer to headquarters 75.00
25. Variance application for a multi-family or commercial 200.00 100.00 500
building per each building site
25a. Transfer to headquarters 100.00
26. Inspection for construction of an injection well (FL Keys) 125.00 125.00 250
Performance-based Treatment Systems
1. Application for permitting of a new performance-based 125.00 115.00
treatment system, which includes application and plan review
1 a. Transfer to headquarters 10.00
2. Permit for new performance-based treatment system 125.00 115.00
2a. Transfer to headquarters 10.00
3. Installation inspection for new performance-based systems 75.00 69.00
3a. Transfer to headquarters 6.00
6. Research fee to be collected in addition, and concurrent with 5.00 5.00 .
the permit for a new performance-based system installation fee
4. Repair permit issuance which includes inspection 125.00 115.00
4a. Transfer to headquarters 10.00
5. Inspection of system previously in use 25.00 23.00
5a. Transfer to headquarters 2.00
6. Reinspection fee per visit for site inspections after system 25.00 23.00
construction approval
6a. Transfer to headquarters 2.00
7. Installation reinspection of non-compliant system per 50.00 46.00
**Must use County Health Department IBI (01-67)
Page 4
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FEE DEPlJSIT Est. Annual Revenue
DESCRIPTION
AMOUNT AMOUNT Accruing to CHD TF
each site visit
7a. Transfer to headquarters 4.00
8. System abandonment permit, includes permit 75.00 69.00
issuance and inspection
8a. Transfer to headquarters 6.00
9. Annual operating permit fee for performance-based 200.00 184.00
treatment system. Fee charged second year of operation
9a. Transfer to headquarters 16.00
10. Review of application due to proposed amendments or 75.00 69.00
changes after initial operating permit issuance.
10a. Transfer to headquarters 6.00
11. Variance application for a single family residence per 150.00 75.00
each lot or building site
11 a. Transfer to headquarters 75.00
FEE COLLECTED AT HEADQUARTERS - Onsite Sewage
1. Application for innovative product approval 500.00 For headquarters use only
2. Application for registration including initial examination 75.00 For headquarters use only
3. Initial registration 100.00 For headquarters use only
4. Renewal of registration 100.00 For headquarters use only
5. Certificate of authorization each two-yar period 250.00 For headquarters use only
DRINKING WATER
1. First Year Public Water Annual Operation Permit and 75.00 67.50
Construction Permit - Limited Use
1 a. Transfer to headquarters 7.50
2. Second Year Public Water Annual Operation Permit -
Limited Use 70.00 63.00
2a. Transfer to headquarters 7.00
4. Private Water Construction Permit - serving 3 or 4 40.00 36.00
non-rental residences
4a. Transfer to headquarters 4.00
5. Initial Operating Permit Fee After March 31 of Any Year 35.00 31.50
5a. Transfer to headquarters 3.50
6. Non-SDWA Lab Sample (Sample Collection/Review
of Analytical Results/Health Risk Interpretation):
Delineated Area 50.00 50.00
Bacterial Sample Collection 40.00 40.00
Chemical Sample Collection 50.00 50.00
Combined Chemical microbiological 55.00 55.00
7. Reinspection of Private Water System 25.00 25.00
8. Reinspection of Public Water System 40.00 40.00
9. Delineated Area Clearance Fee 50.00 50.00
10. Limited Use Commercial Registered System 15.00 15.00
11. limted Use Commercial Public Water System 25.00 25.00
Operating Permit Family Day Care Establishment
12. Limted Use Commercial Public Water System Operating Permit 15.00 15.00
**Must use County Health Department IBI (01-67)
Page 5
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DESCRIPTION FEE DEPuSIT Est. Annual Revenue
AMOUNT AMOUNT Accruing to CHD TF
Family Day Care Establishment After March 31 of Any Year.
Safe Drinking Water Act (Delegated Counties)
1. Construction permit for each Category I through III treatment
plant, as defined in Rule 62-699.310, FAC.., with treatment
other than disinfection only.
a. Treatment plant - 5 MGD and above 7,500.00 7,500.00
b. Treatment plant - 1 MGD up to 5 MGD 6,000.00 6,000.00
c. Treatment plant - 0.25 MGD up to 1 MGD 4,000.00 4,000.00
d. Treatment plant - 0.1 MGD up to .025 MGD 2,000.00 2,000.00
e. Treatment plant - up to 0.1 MGD 1,000.00 1,000.00
2. Construction permit for each Category IV treatment plant, as
defined in Rule 62-699.310, FAC.., with treatment other than
disinfection only.
a. Treatment plant - 5 MGD and above 7.500.00 7,500.00
b. Treatment plant - 1 MGD up to 5 MGD 6,000.00 6,000.00
c. Treatment plant - 0.25 MGD up to 1 MGD 4.000.00 4,000.00
d. Treatment plant - 0.1 MGD up to .025. MGD 2,000.00 2,000.00
e. Treatment plant - 0.01 up to 0.1 MGD 1,000.00 1,000.00
f. Treatment plant - up to 0.01 MGD 400.00 400.00
3. Construction permit for each Category V treatment plant, as
defined in Rule 62-699.310, FAC.., - Disinfection Only
a. treatment plant - 5 MGD and above 5,000.00 5,000.00
b. Treatment plant - 1 MGD up to 5 MGD 3,000.00 3,000.00
c. Treatment plant - 0.25 MGD up to 1 MGD 1,000.00 1,000.00
d. Treatment plant - 0.1 MGD up to .025 MGD 500.00 500.00
e. Treatment plant - up to 0.1 MGD 300.00 300.00
4. Distribution and transmission systems, including raw water
lines into the plant, except those under general permit.
a. Serving a community public water system 500.00 500.00
b. Serving a non-transient non-community public water systems 350.00 350.00
c. Serving a non-community public water system 250.00 250.00
5. Construction permit for each public water supply well.
a. Well located in a delineated area pursuant to Chapter 62-524,
FAC.. 500.00 500.00
b. Any other public water supply well. 250.00 250.00
6. Major modifications to systems that alter the existing treatment
without expanding the capacity of the system and are not
considered substantial changes pursuant to
Rule 62-4.050(7) below.
a. MGD and above 2,000.00 2,000.00
b. .1 MGD up to 1 MGD 1,000.00 1,000.00
c. 0.01 up to.1 MGD 500.00 500.00
d. Up to 0.01 MGD 100.00 100.00
7. Minor modifications to systems that result in no change in the
treatment or capacity.
**Must use County Health Department IBI (01-67)
Page 6
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DESCRIPTION FEE Dc.- vSIT Est. Annual Revenue
AMOUNT AMOUNT Accruing to CHD TF
a. .1 MGD and above 300.00 300.00
b. Up to 0.1 MGD 100.00 100.00
8. Fines and Forfeitures Variable Variable
**Must use County Health Department IBI (01-67) Page 7
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