FY2002 04/17/2002
CLERK OF THE CIRCUIT COURT
MONROE COUNTY
BRANCH OFFICE
MARATHON SUB COURTHOUSE
3117 OVERSEAS mGHWAY
MARATHON, FLORIDA 33050
TEL. (305) 289-6027
FAX (305) 289-1745
MONROE COUNTY COURTHOUSE
500 WHITEHEAD STREET, SUITE 101
KEY WESl; FLORIDA 33040
TEL. (305) 292-3550
FAX (305) 295-3663
BRANCH OFFICE
PLANTATION KEY
GOVERNMENT CENfER
88820 OVERSEAS mGHWAY
PLANTATION KEY, FLORIDA 33070
TEL. (305) 852-7145
FAX (305) 852-7146
MEMORANDUM
DATE:
July 30, 2002
TO:
Angela Adams
Monroe County Health Department
Pamela G. Hanc(\~
Deputy Clerk CY
FROM:
At the April 17, 2002, Board of County Commissioner's meeting the Board granted
approval and authorized execution of a (Core) Contract between Monroe County, State of
Florida, Department of Health and the Monroe County Health Department for services provided
in Monroe County, FY 2001/2002.
Enclosed please find five duplicate originals of the above mentioned, executed on behalf of
Monroe County, for your handling. Please be sure that the fully executed "Monroe County
Clerk's Original" and the "Monroe County Finance Division's Original" are 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
File /
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 2001-2002
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, 2001.
RECITALS
A. Pursuant to Chapter 154, F.S" the intent of the legislature is to "promote,
protect, maintain, and improve the health and safety of all citizens and visitors of this state
through a system of coordinated county health department services."
8. County Health Departments were created throughout Florida to satisfy this
legislative intent through "promotion of the public's health, the control and eradication of
preventable diseases, and the provision of primary health care for special populations,"
C. Monroe County Health Department ("CHD") is one of the County Health
Departments created throughout Florida, It is necessary for the parties hereto to enter into
this Agreement in order to assure coordination between the State 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, 2001, through September 30, 2002, 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 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 that protect the health
of the general public through the detection, control, and eradication of diseases that 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/AIDS,
immunization, tuberculosis control and maintenance of vital 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:
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.
;, The State's appropriated responsibility (direct contribution excluding any state fees,
Medicaid contributions or any other funds not listed on the Schedule C) as provided in
Attachment II, Part II is an amount not to exceed $ 4,008,476 State General
Revenue, Other State Funds and Federal Funds listed on the Schedule C). 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,
other cash or local contributions) as provided in Attachment II, Part II is an amount
not to exceed $360,699 (amount listed under the "Board of County Commissioners Annual
Appropriations section of the revenue attachment).
2
bo Overall expenditures will not exceed available funding or budget authority,
whichever is less, (either 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. Where applicable, such fees shall be automatically adjusted to at least the Medicaid
fee schedule. Fees are listed in Attachment II Part II of this contract and in the
Environmental Health Fee Schedule that is provided by the Environmental Health Program
Office, The estimated annual environmental health fee revenues accruing to the County
Health Department Trust Fund are listed on Attachment VI.
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.
eo The name and address of the official payee to who payments shall be made is:
County Health Department Trust Fund
Monroe County
POBox 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 Count Yo The
director/administrator of the CHD shall insure that non-categorical 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 (This is the standard quality assurance "County-State Goal Achievement" reporl
located on the Deparlment of Health Intranet).
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
3
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 Health 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 IV.
c. The CHD shall maintain books, records and documents in accordance with those
promulgated by the Generally Accepted Accounting Principles (GAAP) and Governmental
Accounting 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 subject 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:
i. The revenue and expenditure requirements in the Florida Accounting
System Information Resource (FLAIR).
II. 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 treasurero 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.
4
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
count Yo 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
the funding requirements of each participating governmental entity in the following year.
However, in each such case, all surplus funds, including fees and accrued interest, shall
remain in the trust fund until 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 II, Part I of this contract, with special capital
projects 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 record keeping 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 OMS 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 information concerning a recipient of
services except as allowed by federal or state law or policy,
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,
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
5
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 456.057, 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 security
requirements and shall comply with any applicable professional standards of practice with
respect to client confidentiality.
I. 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.bo 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:
i. The DE385L 1 Contract Management Variance Report and the DE580L 1
Analysis of Fund Equities Report;
ii. A written explanation to the county of service variances reflected in the
DE385L 1 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 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.
6
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:
i. March 1, 2002 for the report period October 1, 2001 through
December 31,2001;
II. June 1, 2002 for the report period October 1,2001 through
March 31,2002;
III. September 1, 2002 for the report period October 1,2001
through June 30, 2002; and
iv. December 1,2002 for the report period October 1,2001
through September 30, 2002.
7. FACILITIES AND EQUIPMENT. The parties mutually agree that:
ao 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.
bo 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.
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.
bo 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.
7
Co 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.
90 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,
2002, it is agreed that the performance and payment under this Agreement are contingent
upon an annual appropriation by the legislature, in accordance with section 28700582,
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 ManaQers. The name and address of the contract managers for
the parties under this Agreement are as follows:
For the State:
For the County:
Christopher R. Smith
Name
James Roberts
Name
Senior ManaQement Analyst Supr.
Title
County Administrator
Title
POBox 6193
GATO BuildinQ, 1100 Simonton St
Key West, Fl 33040
Add ress
Key West, Fl 33040
Address
305/293-7539
Telephone
305/292-4441
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.
8
In WITNESS THEREOF, the parties hereto have caused this JL page agrej!ment to
be executed by their undersigned officials as duly authorized effective the 17.t:A. day
of April, 2002,
BOARD OF COUNTY COMMISSIONERS
FOR
MONROE
COUNTY
STATE OF FLORIDA
DEPARTMENT OF HEALTH
SIGNED BY:
~
SIGNED BY: ~LJ' ~~~
NAMEpoJohn O. Agwunobi, M.D.,M.B.A.
TITLE:
DATE:
TITLE:
DATE:
Secretary
g. u. .01.--
1>.,,-. SIGNED~~Q.~
NAME: R. C. Rutherford, M.~~::'~ ;/
TITLE:
CHD Director/Administrator
11 2.. cUt 'Z..
DATE: L\-/ ~ /0 ;;Z
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ATTACHMENT I
MONROE COUNTY HEALTH DEPARTMENT
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 Personal Health
Coding Pamphlet (DHP 50-20), Environmental Health Coding Pamphlet (DHP 50-21) and FLAIR 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 64D-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 DHM 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 Health 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,
Chronic Disease Program
Requirements as specified in the Community Intervention
Program (CIP) and the CHD Guidebook,
8.
Environmental Health
Requirements as specified in DHP 50-4* and 50-21*
9.
HIV/AIDS Program
Requirements as specified in Florida Statue 384.25 and
64D-3.016 and 3.017 FAC, and the CHD Guidebook. Case
reporting on CDC Forms 50.428 (Adult! Adolescent) and
50.42A (Pediatric). Socio-demographic data on persons
tested for HIV in CHD 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/AIDS
office within 5 days of the initial post-test counseling
appointment or within 90 days of the missed post-test
counseling appointment.
ATTACHMENT I (Continued)
9.
HIV/AIDS Program
Requirements as specified in Florida Statue 384,25 and
64D-3.016 and 3.017 FAC. and the CHD Guidebook, Case
reporting on Centers for Disease Control Forms 50.428
(AdulU Adolescent) and 50.42A (Pediatric). Socio-
demographic data on persons tested for HIV in CHD 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/AIDS office within 5 days of the initial post-
test counseling appointment or within 90 days of the missed
post-test counseling appointment.
10,
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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1. GENERAL REVENUE-STATE
015011 ALG/Cont to CHD Primary Care (050329) 17,256 0 17,256 0 17,256
015011 ALG/Primary Care (050331) 243,157 0 243,157 0 243,157
015012 G/A Epilepsy Services (050082) 0 0 0 0 0
015048 ALG/Cont to CHD STD Program (050329) 21,016 0 21,016 0 21,016
015050 ALG/Contributions To CHD (050329) 1,283,038 0 1,283,038 0 1,283,038
015050 ALG/Cont to CHD Mig Lbr Camp San (050329) 0 0 0 0 0
015050 RED Legislation - GAP Grant - Immun, (Cat 050310) 0 0 0 0 0
015050 ALG/Cont to CHD-Sovereign Immunity (050329) 0 0 0 0 0
015050 RED Legislation - GAP Grant - (Cat 050310) 0 0 0 0 0
015050 ALG/Cont to CHDs-Dental Program (Cat. 050329) 20,000 0 20,000 0 20,000
015050 ALG/Cont to CHDs Immun Outreach Teams (050329) 6,360 0 6,360 0 6,360
015050 ALG/Cont to CHDs Comm TB Program (050329) 90,039 0 90,039 0 90,039
015050 ALG/Cont to CHDs Indoor Air Assist (050329) 0 0 0 0 0
015050 ALG/Cesspool Identification and Elimination (Cat. 05032 128,707 0 128,707 0 128,707
015050 Contr to CHDs - Duval Teen Pregnancy Prev 0 0 0 0 0
015050 CA TE-Environmental Community-Escambia (052250) 0 0 0 0 0
015050 Community Env Hlth Advisory Board Pilot Prjt 0 0 0 0 0
015050 Early Dtn & Screening of Breast Cancer in Haitians 0 0 0 0 0
015050 First Step - Mothers & Infants Programs 0 0 0 0 0
015050 Primary Care Outrch Prgm-Sun coast Hosp-Pinellas (0522 0 0 0 0 0
015050 Greenwood Community Health Resources Center 0 0 0 0 0
015050 Roosevelt Sands Comm, Healthcare Ctr,-Monroe (052250 100,000 0 100,000 0 100,000
015050 Interdisciplinary Manages Care Serenity House 0 0 0 0 0
015050 Rafael Penalver Clinic Minority Outreach Pgm 0 0 0 0 0
015050 Medivan Project/Elderly Interest-Broward (052250) 0 0 0 0 0
015050 Healthy Beaches Monitoring 25,904 0 25,904 0 25,904
015065 ALG/Cont to CHD AIDS Prev & Surv & Field Staff (0503 105,802 0 105,802 0 105,802
015065 ALG/Cont to CHD AIDS Pat Care (050026) 384,663 0 384,663 0 384,663
015115 ALG/School Health Svcs (051106) 0 0 0 0 0
015115 Volunteer School Health Nurse Grant 0 0 0 0 0
015123 ALG/Family Planning (05000 I) 60,731 0 60,731 0 60,731
015124 ALGIIPO-Healthy StartlIPO (050707) 0 0 0 0 0
015124 ALG/IPO-Infant Mortality Project 0 0 0 0 0
015124 ALGIIPO - Outreach Social Workers 0 0 0 0 0
015124 ALG/MCH-Healthy StartlIPO (050870) 0 0 0 0 0
015124 ALG/MCH Outreach Social Workers 0 0 0 0 0
015124 ALG/MCH-'nfant Mortality Project 0 0 0 0 0
015137 ALG/Cont to CHDs Mtml & Chid H1th Field Staff Cost ( 0 0 0 0 0
015137 ALGIIPO Healthy Start Resource Moms & Dads (050707) 0 0 0 0 0
015137 ALG/Community Health Initiatives (052250) 0 0 0 0 0
015137 ALGIIPO-Healthy Start-Data Collect. Prj Staff (CAT, 05 0 0 0 0 0
015140 ALG/School Health Supplemental (051106) 122,731 0 122,731 0 122,731
GENERAL REVENUE TOTAL 2,609,404 0 2,609,404 0 2,609,404
2, NON GENERAL REVENUE - STATE
015000 Transfer 440 0 440 0 440
015010 ALG/Contr. to CHDs-Rebasing (050329) Tobacco TF 21,864 0 21,864 0 21,864
015010 ALG/Contr. to CHDs - FY 1999-00 Holdback 0 0 0 0 0
2. NON GENERAL REVENUE - STATE
015010 Enhanced Dental Services (050329) Tobacco TF 0 0 0 0 0
015010 Fla Hepatitis & Liver FaiL Prey & Cnrl(050329)Tobacco T 190,000 0 190,000 0 190,000
015016 G/A Epilepsy Prey and Educ (050083) /Epilepsy TF 0 0 0 0 0
015020 Tmfers Inter Agency 0 0 0 0 0
015026 ALG/Cont to CHD Bio-Medical WastelDEP (050329) IA 3,892 0 3,892 0 3,892
015072 ALG/Cont to CHD Safe Drinking Water-DEP (050329) A 0 0 0 0 0
015084 Varicella Immunization Requirement (050329) Tobacco T 3,404 0 3,404 0 3,404
015172 Full Service Schools - Tobacco (102258) Tobacco TF 61,720 0 61,720 0 61,720
015174 Basic School Health - Tobacco (051106) Tobacco TF 40,839 0 40,839 0 40,839
015170 Tobacco Coordination 51,277 0 51,277 0 51,277
010304 Stationary Pollutant Storage Tanks 74,380 0 74,380 0 74,380
015121 Super Act Reimbursements 1,660 0 1,660 0 1,660
001009 Debit Memo-Bad Checks 0 0 0 0 0
015029 Tranfers Intra Agency 0 0 0 0 0
NON GENERAL REVENUE TOTAL 449,476 0 449,476 0 449,476
3, FEDERAL FUNDS - State
007030 Migrant Labor Sanitation 0 0 0 0 0
007044 Prey Hlth Blk Grt/Rape Awareness 0 0 0 0 0
007049 FG TF/ALGI Contr to CHDs-STD Prg-Infertility Prg 0 0 0 0 0
007049 FG TF/ALGI Contr to CHDs-STD Prg-Syphilis Eliminat 0 0 0 0 0
007049 FG TF/ALGI Contr to CHDs-STD Program 2,000 0 2,000 0 2,000
007049 ALG/Contr to CHD-STD-Medical & Lab Svc Tmg Ctr 0 0 0 0 0
007051 FG TF WIC Admin Transfer (050329) 201,555 0 201,555 0 201,555
007056 FG TF Health Program for Refug, (180000) 0 0 0 0 0
007063 Prey Hlth Blk GrtlHERR-Chronic Disease Init. 0 0 0 0 0
007064 FGrrF AIDS Seroprevalence 0 0 0 0 0
007064 FGrrF AIDS Surveillance 0 0 0 0 0
007065 FG TFI AIDS Prevention 173,599 0 173,599 0 173,599
007066 FG TFlRyan White-Consortia 457,236 0 457,236 0 457,236
007066 FG TFlRyan White-Emerging Communities 0 0 0 0 0
007066 FG TFlRyan White 0 0 0 0 0
007066 FG TFlRyan White- AIDS Drug Assist Prog,-Admin, 22,443 0 22,443 0 22,443
007067 Tuberculosis Control - Federal Grant 0 0 0 0 0
007068 FGTFlFederal Grants-AIDS Inmate Intervention 0 0 0 0 0
007069 Minority Involvement in HIV/AIDS Program 0 0 0 0 0
007084 Immunization Special Project 3,075 0 3,075 0 3,075
007084 FG TF/ALG/Contr to CHDs-Immunization Action Plan 10,898 0 10,898 0 10,898
007084 Immunization Supplemental-200 I 0 0 0 0 0
007084 FG TFlImmunization-Project Field Staff 0 0 0 0 0
007084 Immunization Action Plan-WIC Immunization Linkage 0 0 0 0 0
007085 Breast and Cervical Cancer-Client Services 0 0 0 0 0
007085 Breast and Cervical Cancer-Admin/Case Management 0 0 0 0 0
007127 ALGIMCH-MCH Blk Grt.-Child Health 11,446 0 11 ,446 0 11,446
007127 ALGIMCH-MCH Blk Grt-Child Health Ages 0-1 Yr, 0 0 0 0 0
007132 ALGIMCH-MCH Blk Grt,-Dental Projects 0 0 0 0 0
007133 ALGlFamily Planning Title X-Sterilzations 7,000 0 7,000 0 7,000
007133 FGTFlFamily Planning - Title X 54,584 0 54,584 0 54,584
3, FEDERAL FUNDS - State
007133 ALG/Grants & Aids-Fam Ping Svcs-Title X Special Initi 0 0 0 0 0
007133 ALG/Fam Ping-Title X-Duval The Bridge 0 0 0 0 0
007133 ALG/Grants & Aids-Fam Ping-Special Contracts-Title X 0 0 0 0 0
007134 ALG/MCH-MCH Blk Grt IPO/Outreach Soc Wrkrs 0 0 0 0 0
007134 ALG/MCH-MCH Blk Grt-Outreach Soc Wrkrs 0 0 0 0 0
007134 ALG/MCH-MCH Blk Grt,-IPO Infant Mort, Proj, 0 0 0 0 0
007134 ALG/IPO/MCH-Infant Mortality Project 0 0 0 0 0
007134 ALG/IPO-MCH Blk, Grt,-IPO-Gadsden Sch Clinic 0 0 0 0 0
007134 ALG/MCH Blk Grt-Healthy StartJIPO 0 0 0 0 0
007134 ALG/IPO-MCH Blk Grt- Healthy StartJIPO 0 0 0 0 0
015075 T ANF Abstinence Education 0 0 0 0 0
015075 Abstinence Education Program Fed Grants TF 0 0 0 0 0
015075 Refugee Center Reimbursement 0 0 0 0 0
015075 Car Seat Reimbursement. 0 0 0 0 0
015075 Kidcare - Title XIX 50,000 0 50,000 0 50,000
007010 Beach Water Sampling Study 0 0 0 0 0
015075 ALG/Fam Ping - Pregnancy Prev-TANF 13,927 0 13,927 0 13,927
015075 G/ A Epilepsy Services- T ANF 0 0 0 0 0
015075 Full Service Schools-TANF 6,732 0 6,732 0 6,732
015075 ALG/School Health-Supplement- T ANF 11,581 0 11,581 0 11,581
007051 WIC Infrastructure Grant - 200 I 0 0 0 0 0
007021 Medicaid Waiver Revenues 0 0 0 0 0
015060 Entrant Reimburement Transfer 0 0 0 0 0
007000 WIC Special Project 0 0 0 0 0
007077 Public Health Prepare & Response For Bio-Terrorism 0 0 0 0 0
FEDERAL FUNDS TOTAL 1,026,076 0 1,026,076 0 1,026,076
4, FEES ASSESSED BY STATE OR FEDERAL RULES - STATE
001026 Returned Check Ser Fees 0 0 0 0 0
001091 Fed, Rule Comm Disease 0 0 0 0 0
001092 Environmental Health Fees 175,738 0 175,738 0 175,738
001092 OSDS Repair Permit 0 0 0 0 0
001092 OSDS Permit Fee 0 0 0 0 0
001092 Aerobic Operating Permit 0 0 0 0 0
001092 Septic Tank Site Eva]uation 0 0 0 0 0
00] 113 Mobile Home and Parks 21,471 0 21,471 0 21,471
001132 Food Hygiene Permit 15,345 0 15,345 0 ]5,345
001135 OSDS Variance Fee 250 0 250 0 250
001136 I & M Zoned Operating Permit 0 0 0 0 0
001139 Migrant Housing Permit 0 0 0 0 0
001140 Biohazard Waste Permit 4,231 0 4,231 0 4,231
001142 Non SDW A Lab Sample 0 0 0 0 0
001144 Tanning Facilities 1,943 0 1,943 0 1,943
001145 Swimming Pools 10,4]9 0 10,419 0 10,419
001149 Body Piercing ],012 0 1,012 0 1,012
001165 Private Water Constr Permit 0 0 0 0 0
001166 Non-SDW A System Permit 0 0 0 0 0
001166 Public Water Constr Permit 0 0 0 0 0
4, FEES ASSESSED BY STATE OR FEDERAL RULES - STATE
001166 Public Water Annual Oper Permit 0 0 0 0 0
001170 Lab Fee Chemical Analysis 0 0 0 0 0
001211 Safe Drinking Water 0 0 0 0 0
010403 Fees-Copy of Public Doc 529 0 529 0 529
015052 Transfers-Mobile Home/RV Park 0 0 0 0 0
FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 230,938 0 230,938 0 230,938
5, OTHER CASH CONTRIBUTIONS - STATE
090001 Draw down from Public Health Vnit 0 0 0 0 0
OTHER CASH CONTRIBUTIONS TOTAL 0 0 0 0 0
6, MEDICAID - STATE/COUNTY
001056 CHD Incm:Medicaid-Pharmacy 0 0 0 0 0
001080 CHD Incm:Medicaid-Other 0 0 0 0 0
001081 CHD Incm:Medicaid-EPSDT 0 0 0 0 0
001082 CHD Incm:Medicaid-Dental 0 0 0 0 0
001083 CHD Incm:Medicaid-FP 5 45 50 0 50
001084 CHD Incm:Medicaid-Physician 656 850 1,506 0 1,506
001085 CHD Incm:Medicaid-Nursing 0 0 0 0 0
001086 CHD Incm:Co-lnsurance 0 0 0 0 0
001087 CHD Incm:Medicaid-STD 0 0 0 0 0
001088 CHD Incm:Med Reimb AZT Disp Fee 0 0 0 0 0
001089 Medicaid AIDS 10,282 13,316 23,598 0 23,598
001147 Medicaid HMO Rate 0 0 0 0 0
001148 Medicaid-HMO Admin 0 0 0 0 0
001181 CHD Incm:Medicaid Transportation 0 0 0 0 0
001191 CHD Incm:Medicaid Maternity 0 0 0 0 0
001192 CHD Incm:Medicaid Comp, Child 12,998 16,835 29,833 0 29,833
001193 CHD Incm:Medicaid Comp, Adu]t 0 0 0 0 0
00] ]94 CHD Incm:Medicaid Sonagram 0 0 0 0 0
00]208 Medipass $3.00 Adm, Fee 982 1,272 2,254 0 2,254
MEDICAID TOTAL 24,923 32,318 57,241 0 57,241
7, ALLOCABLE REVENUE - STATE
001029 Third Party Reimbursement 0 0 0 0 0
005040 Interest Erned State Investment 98,573 0 98,573 0 98,573
005041 Interest Erned Local Investment 0 0 0 0 0
007010 V,S, Grants Direct to CHD 0 0 0 0 0
008094 Grnts/Contracts other Agencies Direct 0 0 0 0 0
010300 Sale of Goods and Services 10,755 0 10,755 0 10,755
010301 Exp Witness Fee Consultnt Charges 17 0 17 0 17
010402 Recycle Paper Sales 0 0 0 0 0
010403 Fees-Copies of Documents 0 0 0 0 0
010405 Sale of pharmaceuticals 0 0 0 0 0
011007 Cash Donations Private 847 0 847 0 847
011098 Donation School Based Clinic 0 0 0 0 0
011099 Other GrantsIDonations Direct 0 0 0 0 0
7. ALLOCABLE REVENUE - STATE
011522 Other Grant DOE 0 0 0 0 0
012020 Fines and Forfeitures 0 0 0 0 0
012021 Return Check Charge 0 0 0 0 0
018001 Refunds, Salary 9 0 9 0 9
018003 Refunds, other Personal Services 0 0 0 0 0
018004 Refunds, Expenses 259 0 259 0 259
018005 Refunds Grants to Local Gov't 0 0 0 0 0
018006 Refunds, Operating Capital Outlay 0 0 0 0 0
018010 Refundso Special Category 0 0 0 0 0
018011 Refunds, Other 0 0 0 0 0
018099 Refunds, Certified Forward 0 0 0 0 0
029010 Sale of Fixed Assets 0 0 0 0 0
037000 Prior Year Warrant 138 0 138 0 138
038000 12 Month Old Warrant 289 0 289 0 289
ALLOCABLE REVENUE TOTAL 110,887 0 110,887 0 11 0,887
8, OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND - STATE
State Pharmacy Services 0 0 0 67,044 67,044
State Laboratory Services 0 0 0 79,589 79,589
State TB Services 0 0 0 0 0
State Immunization Services 0 0 0 135,301 135,301
State STD Services 0 0 0 0 0
State Construction/Renovation 0 0 0 0 0
WIC Food 0 0 0 615,455 615,455
ADAP-AIDS Drug Assistance Program 0 0 0 0 0
Other (specify) 0 0 0 0 0
Other (specify) 0 0 0 0 0
Other (specify) 0 0 0 0 0
OTHER STATE CONTRIBUTIONS TOTAL 0 0 0 897,389 897,389
9, BOARD OF COUNTY COMMISSIONERS ANNUAL APPROPRIATIONS - COUNTY
008030 Grants-County Tax Direct 0 290,000 290,000 0 290,000
008034 Grants Cnty Commsn Other 0 70,699 70,699 0 70,699
BOARD OF COUNTY COMMISSIONERS TOTAL 0 360,699 360,699 0 360,699
10. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION - COUNTY
001004 Child Car Seat Prog 0 0 0 0 0
001060 Vital Statistics Fees Other 0 600 600 0 600
001074 Adult Enter. Penn it Fees 0 0 0 0 0
001077 Primary Care Fees 0 11,021 11,021 0 11,021
001093 Communicable Disease Fees 0 49,465 49,465 0 49,465
001094 Environmental Health Fees 0 1,500 1,500 0 1,500
001114 New Birth Certificates 0 10,440 10,440 0 10,440
001115 Death Certificates 0 56,274 56,274 0 56,274
001116 Computer Access Fee 0 0 0 0 0
001117 Vital Stats-Adm, Fee 50 cents 0 362 362 0 362
001195 Primary Care Transfer Fees 0 0 0 0 0
10. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION - COUNTY
001196 Water Analysis-Potable 0 0 0 0 0
001062 Rabies Vaccine 0 0 0 0 0
001062 Rabies Vaccine 0 0 0 0 0
FEES AUTHORIZED BY COUNTY TOTAL 0 129,662 129,662 0 129,662
11, OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY
001072 Ryan White Title I 0 0 0 0 0
001073 Ryan White Title II 0 0 0 0 0
001075 Ryan White Title 1Il 0 451,348 451,348 0 451,348
001090 Medicare 0 589 589 0 589
001190 Health Maintenance Organ, (HMO) 0 0 0 0 0
008010 Grants Contracts Frm Cities Direct 0 20,000 20,000 0 20,000
008031 County AIDS Education 0 0 0 0 0
008033 County Contributions For Facilities 0 0 0 0 0
008050 Grants-Cnty Sch Board Direct 0 35,000 35,000 0 35,000
010302 Sale of Goods and Services to State Agencies 0 367,236 367,236 0 367,236
008095 Grants Cnty Sect 403.102 Air Pol 0 0 0 0 0
008099 Reimb/Rebate Local Govn't 0 0 0 0 0
090002 Draw down from Public Health Unit 0 0 0 0 0
011001 Healthy Start Coalition Contributions 0 220,000 220,000 0 220,000
OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 0 1,094,173 1,094,173 0 1,094,173
12, ALLOCABLE REVENUE - COUNTY
001029 Third Party Reimbursement 0 200 200 0 200
005040 Interest Erned State Investment 0 0 0 0 0
005041 Interest Erned Local Investment 0 0 0 0 0
007010 U,S, Grants Direct to CHD 0 0 0 0 0
008094 Grnts/Contracts other Agencies Direct 0 0 0 0 0
010300 Sale of Goods and Services 0 0 0 0 0
010301 Exp Witness Fee Consultnt Charges 0 0 0 0 0
010402 Recycle Paper Sales 0 0 0 0 0
010403 Fees-Copies of Documents 0 0 0 0 0
010405 Sale of pharmaceuticals 0 0 0 0 0
011007 Cash Donations Private 0 0 0 0 0
011098 Donation School Based Clinic 0 0 0 0 0
011099 Other Grants/Donations Direct 0 0 0 0 0
011522 Other Grant DOE 0 0 0 0 0
012020 Fines and Forfeitures 0 0 0 0 0
037000 Prior Year Warrant 0 0 0 0 0
018001 Refunds, Salary 0 0 0 0 0
018003 Refunds, other Personal Services 0 0 0 0 0
018004 Refunds, Expenses 0 0 0 0 0
018005 Refunds Grants to Local Gov't 0 0 0 0 0
018006 Refunds, Operating Capital Outlay 0 0 0 0 0
018010 Refunds, Special Category 0 0 0 0 0
018011 Refunds, Other 0 0 0 0 0
018099 Refunds, Certified Forward 0 0 0 0 0
12, ALLOCABLE REVENUE - COUNTY
029010 Sale of Fixed Assets 0 0 0 0 0
038000 12 Month Old Warrant 0 0 0 0 0
001026 Returned Check Fee 0 0 0 0 0
001010 Recovery-Bad Checks 0 0 0 0 0
012021 Return Check Charge 0 0 0 0 0
010409 Sale of Goods and Services Outside State Government 0 0 0 0 0
COUNTY ALLOCABLE REVENUE TOTAL 0 200 200 0 200
13, BUILDINGS - COUNTY
Annual Rental Equivalent Value 0 0 0 225,000 225,000
Maintenance 0 0 0 20,000 20,000
Utilities 0 0 0 50,000 50,000
Other 0 0 0 0 0
Other (specify) 0 0 0 0 0
Other (specify) 0 0 0 0 0
Other (specify) 0 0 0 0 0
BUILDINGS TOTAL 0 0 0 295,000 295,000
14. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND - COUNTY
Other County Contribution (specify) 0 0 0 0 0
Other County Contribution (specify) 0 0 0 0 0
Other County Contribution (specify) 0 0 0 0 0
Other County Contribution (specify) 0 0 0 0 0
Other County Contribution (specify) 0 0 0 0 0
OTHER COUNTY CONTRIBUTIONS TOTAL 0 0 0 0 0
RAND TOTAL CHD PROGRAM 4,451,704 1,617,052 6,068,756 1,192,389 7,261,145
COMMUNICABLE DISEASE CONTROL:
Immunization (101) 3,75 0 4,267 43,701 43,701 43,70 I 43,701 0 174,804 174,804
STD (102) 2,00 75 1,600 28,496 28,496 28,496 280496 0 113,984 113,984
A,I.D,S, (103) 15,00 261 7,154 440,465 440,465 440,464 440,464 478,985 1,282,873 1,761,858
TB Control Services (104) 2,00 550 1,600 30,729 30,729 30,728 30,728 0 122,914 122,914
Comm, Disease Surv. (106) 0,75 0 600 12,307 12,307 12,308 12,308 49,230 0 49,230
Hepatitis Prevention (109) 2,00 0 1,600 43,178 43,178 43,178 43,178 0 172,712 172,712
Vital Statistics (180) 1.50 0 0 15,268 15,268 15,267 15,267 61,070 0 61,070
OMMUNICABLE DISEASE SUBTOTAL 27,00 886 16,821 614,144 614,144 614,142 614,142 589,285 1,867,287 2,456,572
PRIMARY CARE:
Home Health (215) 0,00 0 0 0 0 0 0 0 0 0
W,I.C, (221) 6,00 2,217 10,685 80,777 80,777 80,776 80,776 0 323,106 323,106
Family Planning (223) 4,50 589 3,900 91,353 91,353 91,353 91,352 0 365,411 365,411
Improved Pregnancy Outcome (225) 0,10 25 80 475 475 475 475 0 1,900 1,900
Healthy Start Prenatal (227) 3,50 240 17,525 51,000 51,000 51,000 51,000 119,000 85,000 204,000
Comprehensive Child Health (229) 0,79 20 636 24,000 24,000 24,000 24,000 16,835 79,165 96,000
Healthy Start Infant (231) 4,95 367 16,075 42,047 42,046 42,046 42,046 93,185 75,000 168,185
School Health (234) 9,00 0 137,580 131,789 131,789 131,789 131,789 35,000 492,156 527,156
Comprehensive Adult Health (237) 2.50 320 2,000 40,047 40,047 40,046 40,046 0 160,186 160,186
Dental Health (240) 0,00 0 0 23,750 23,750 23,750 23,750 0 95,000 95,000
Chronic Disease Services (210) 1.25 85 1,000 2,288 2,287 2,287 2,287 0 9,149 9,149
Tobacco Prevention (212) 1.00 0 0 21,250 21,250 21,250 21,250 0 85,000 85,000
RIMARY CARE SUBTOTAL 33.59 3,863 189,481 508,776 508,774 508,772 508,771 264,020 1,771,073 2,035,093
ENVIRONMENTAL HEALTH:
Water and Onsite Sewage Programs
Private Water System (357) 0,00 0 0 0 0 0 0 0 0 0
Public Water System (358) 0,00 0 0 0 0 0 0 0 0 0
Individual Sewage Disp, (361) 12,00 1,000 5,000 247,709 247,708 247,708 247,708 743,747 247,086 990,833
Group Total 12,00 1,000 5,000 247,709 247,708 247,708 247,708 743,747 247,086 990,833
Facility Programs
Food Hygiene (348) 0,75 50 250 4,763 4,763 4,763 4,763 0 19,052 19,052
Group Care Facility (351) 0,25 65 200 3,500 3,500 3,500 3,500 0 14,000 14,000
Migrant Labor Camp (352) 0,00 0 0 0 0 0 0 0 0 0
Housing,Public Bldg Safety,Sanitation (353) 0,00 0 0 0 0 0 0 0 0 0
Mobile Home and Parks Services (354) 0,50 50 225 5,741 5,741 5,741 5,741 0 22,964 22,964
Swimming PoolslBathing (360) 2,00 578 1,468 32,029 32,029 32,028 32,028 20,000 108,114 128,114
Biomedical Waste Services (364) 0.30 50 75 3,696 3,696 3,696 3,696 0 14,784 14,784
Tanning Facility Services (369) 0,01 3 8 254 254 254 253 0 1,015 1,015
Group Total 3,81 796 2,226 49,983 49,983 49,982 49,981 20,000 179,929 199,929
Groundwater Contamination
Storage Tank Compliance (355) 3.50 350 700 50,960 50,960 50,960 50,959 0 203,839 203,839
Super Act Service (356) 0,00 0 0 0 0 0 0 0 0 0
Group Total 3,50 350 700 50,960 50,960 50,960 50,959 0 203,839 203,839
Community Hygiene
Rabies Surveillance/Control Services (366) 0,07 2 15 671 671 671 670 0 2,683 2,683
Arbovirus Surveillance (367) 0,25 0 187 2,331 2,331 2,331 2,331 0 9,324 9,324
Rodent! Arthropod Control (368) 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
Emergency Medical (346) 0,00 0 0 0 0 0 0 0 0 0
Lead Monitoring Services (350) 0,00 0 0 0 0 0 0 0 0 0
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 Nuisance (365) 0,50 25 300 1,490 1,490 1,490 1,489 0 5,959 5,959
Water Pollution (370) 0,50 0 400 3,390 3,390 3,390 3,390 0 13,560 13,560
Air Pollution (371) 0,01 0 4 111 111 110 110 0 442 442
Radiological Health (372) 0,05 0 0 766 766 765 765 0 3,062 3,062
Toxic Substances (373) 1.00 25 25 11 ,865 11,865 11,865 11,865 0 47,460 47,460
Group Total 2.38 52 931 20,624 20,624 20,622 20,620 0 82,490 82,490
NVIRONMENT AL HEALTH SUBTOTAL 21.69 2,198 8,857 369,276 369,275 369,272 369,268 763,747 713,344 1,477,091
SPECIAL CONTRACTS:
Special Contracts (599) 1.50 0 0 25,000 25,000 25,000 25,000 0 100,000 100,000
PECIAL CONTRACTS SUBTOTAL 1.50 0 0 25,000 25,000 25,000 25,000 0 100,000 100,000
OT AL CONTRACT 83.78 6,947 215,159 1,517,196 1,517,193 1,517,186 1,517,181 1,617,052 4,451,704 6,068,756
ATTACHMENT V
MONROE COUNTY HEALTH DEPARTMENT
DESCRIPTION OF USE OF CHD TRUST FUND BALANCES
FOR SPECIAL CAPITAL PROJECTS, IF APPLICABLE
(From Attachment II, Part I)
1. $600,000
Construction/Renovation/Furnishings/Equipment. The anticipated completion
date is no later than September 2003.
2. $215,000
ComputerlT echnology Equipment
3. $105,000
Vehicle purchases
DESCRIPTION OF SPECIAL CONTRACTS
(From Attachment II, Part III)
(1 )
$100,000
Roosevelt Sands Community Health Care Center (CHIGR)
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 of 599 and include some contracts formerly handled at the district
offices such as epilepsy, Project WARM, community planning and special family planning and
teen mother projects.
ATTACHMENT III
MONROE COUNTY HEALTH DEPARTMENT
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, DH
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 1964, as amended, 42 U.S.C., 2000 Et seq., which
prohibits discrimination on the basis of race, color or national origin in programs and
activities receiving or benefiting from federal financial assistance.
2. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794, which prohibits
discrimination on the basis of handicap in programs and activities receiving or benefiting
from federal financial assistance.
3. Title IX of the Education Amendments of 1972, as amended, 20 U.S.C. 1681 et seq., which
prohibits discrimination on the basis of sex in education programs and activities receiving
or benefiting from federal financial assistance.
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 activities 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
MONROE COUNTY HEALTH DEPARTMENT
FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT
Facility Owned By
Description Location
GA TO Building 1100 Simonton Street Monroe County
Key West, FL 33040
Health Care Center 1200 Kennedy Drive Lower Keys Medical Center
Key West, FL 33040
Roosevelt Sands Center 105 Olivia Street City of Key West
Key West, FL 33040
Ruth Ivins Center for 3333 Overseas Highway Monroe County
Public Health Marathon, FL 33050
Monroe County Health 148 Georgia Avenue Monroe County
Department Tavernier, FL 33070
Venetian Plaza 85960 Overseas Highway Private Party
Village of the Islands
Islamorada, FL 33036
ATTACHMENT VI
MONROE COUNTY HEALTH DEPARTMENT
ESTIMATE OF ENVIRONMENTAL HEALTH FEES
FISCAL YEAR 2001 - 2002
n.Revenue
<. <...
ruingtQCHD
DE Trust. FtJl"ld
PUBLIC SWIMMING POC>LS.ANDBATHING PLACES
1. Annual Permit - Up to (and including) 25,000 gallons 75.00 67.50 XX-360 001145 3021
1 a. Transfer to headquarters 7.50 99-910 001205
2. More than 25,000 gallons 160.00 144.00 XX-360 001145 7085
2a. Transfer to headquarters 16.00 99-910 001205
3. Exempted Condo Pools (over 32 units) 50.00 45.00 XX-360 001145 313
3a. Transfer to headquarters 5.00 99-910 001205
OTHER FEES
Collected by the 13 delegated counties
Broward, Dade, Duval, Hillsborough, Lee, Manatee,
Collier, Palm Beach, Pinellas, Polk, Sarasota, Volusia, Escambia.
Permits and variances for Okaloosa, Santa Rosa, Walton, Bay,
Homes, and Washington Counties are processed by Escambia
County and variances and permits for Pasco County are processed
by Pinellas County are processed as follows:
1. Plan review (new construction) 275.00 275.00 XX-360 001092
2. Plan review for modification of original construction 100.00 100.00 XX-360 001092
3. Plan/application review for bathing place development 275.00 275.00 XX-360 001092
4. Initial operating permit 125.00 125.00 XX-360 001092
5. Variance applications 240.00 216.00 XX-360 001092
5.a. Transfer to Headquarters 24.00 99-910 001205
All other counties are to send the fee to Bureau of Water
Programs in Tallahassee or the Environmental Engineering
section in Orlando as follows:
1. Plan review (new construction) 275.00 275.00 00-000 001044
2. Plan review for modification of original construction 100.00 100.00 00-000 001044
3. Plan/application review for bathing place development 275.00 275.00 00-000 001044
4. Initial operating permit 125.00 125.00 00-000 001044
5. Variance applications 240.00 240.00 00-000 001044
MOBILE HOME & RECREATIONAL VEHICLE PARKS
(FEES ARE PRORATED ON A QUARTERLY BASIS)
1. Annual permit for 5 to 14 spaces 50.00 45.00 XX-354 001113 3650
1 a. Transfer to headquarters 5.00 99-910 001113
3.50 per
2. Annual permit for 15 to 171 spaces space XX-354 001113 14171
2a. Transfer to headquarters 10% 99-910 001113
3. Annual permit for 172 and above spaces 600.00 540.00 XX-354 001113 3,650
ATTACHMENT VI
MONROE COUNTY HEALTH DEPARTMENT
ESTIMATE OF ENVIRONMENTAL HEALTH FEES
FISCAL YEAR 2001 - 2002
t;;~~.,~~
<.//....
ORG rUi~tgFWn?HD
rus .d
3a. Transfer to headquarters 60.00 99-910 001113
MIGRANT LABOR CAMPS I
1. Annual permit for facilities with 5-50 occupants 125.00 125.00 XX-352 001139
2. Annual permit for facilities with 51-100 occupants 225.00 225.00 XX-352 001139
3. Annual permit for facilities with over 100 occupants 500.00 500.00 XX-352 001139
BIOMEDIC~L WASTE..GENERATORS I
1. Initial permit 55.00 55.00 XX-364 001140
2. Renewal of annual permit(except physician office generating
less than 251bs/30 days) postmarked by October 1 55.00 55.00 XX-364 001140 4231
2. Renewal of annual permit(except physician office generating
less than 251bs/30 days) postmarked after October 1 75.00 75.00 XX-364 001140
3. Storage facilities permit postmarked by October 1 55.00 55.00 XX-364 001140
3. Storage facilities permit postmarked after October 1 75.00 75.00 XX-364 001140
4. Treatment facilities operating permit by October 55.00 55.00 XX-364 001140
4. Treatment facilities operating permit after October 1 75.00 75.00 XX-364 001140
5. Transporter registration (one vehicle) postmarked by 10/1 55.00 55.00 XX-364 001140
5. Transporter registration (one vehicle) after 10/1 75.00 75.00 XX-364 001140
6. Transporter registration additional vehicle 10.00 10.00 XX-364 001140
TANNING FACILITIES
1. Annual license fee 150.00 135.00 XX-369 001144 1321
1a. Transfer to headquarters 15.00 99-910 001144
2. Fee for each additional device 55.00 49.50 XX-369 001144 622
2.a. Transfer to headquarters 5.50 99-910 001144
3. Late fee 25.00 25.00 XX-369 001092
BODY PERIERCING
1. Annual Licence Fee 150.00 135.00 XX-364 001149 1012
1a. Transfer to headquarters 15.00 99-910 001149
2. Temporary Establishment 75.00 67.50 XX-364 001149
2a. Transfer to headquarters 7.50 99-910 001149
3. Late fee 100.00 100.00 XX-364 001149
FOOD ESTABLISHMENTS
1. Annual Permit for Fraternal/Civic 160.00 144.00 XX-348 001132 1534
1a. Transfer to headquarters 16.00 99-910 001132
2. Annual Permit School Cafeteria Operating for
9 months or less 130.00 117.00 XX-348 001132 1534
2a. Transfer to headquarters 13.00 99-910 001132
3. Annual Permit School Cafeteria Operating for more
ATTACHMENT VI
MONROE COUNTY HEALTH DEPARTMENT
ESTIMATE OF ENVIRONMENTAL HEALTH FEES
FISCAL YEAR 2001 - 2002
~ ............................... .... - ~!!~~t;:!~';-v.,u~
DE . Accruing,tQCHD
AMOU . ., ,.' Trust Fund
than 9 months 160.00 144.00 XX-348 001132
3a. Transfer to headquarters 16.00 99-910 001132
4. Annual Permit for Hospital/Nursing Food Service 210.00 189.00 XX-348 001132 1841
4a. Transfer to headquarters 21.00 99-910 001132
5. Annual Permit for Movie Theaters 160.00 144.00 XX-348 001132 460
5a. Transfer to headquarters 16.00 99-910 001132
6. Annual Permit for Jails/Prisons 210.00 189.00 XX-348 001132 460
6a. Transfer to headquarters 21.00 99-910 001132
7. Annual Permit for Bars/Lounges (Drink Service Only) 160.00 144.00 XX-348 001132 9516
7a. Transfer to headquarters 16.00 99-910 001132
8. Annual Permit for Residential Facilities 110.00 99.00 XX-348 001132
8a. Transfer to headquarters 11.00 99-910 001132
9. Annual Permit for Child Care Centers without C&F license 85.00 76.50 XX-348 001132
9a. Transfer to headquarters 8.50 99-910 001132
10. Annual Permit for Limited Food Service 85.00 76.50 XX-348 001132
10a. Transfer to headquarters 8.50 99-910 001132
11. Annual Permit Other Food Service 160.00 144.00 XX-348 001132
11 a. Transfer to headquarters 16.00 99-910 001132
12. Plan Review $35/hour $35/hour XX-348 001092
13. Food Worker Training 10.00 10.00 XX-348 001092
14. Request for Inspection 40.00 40.00 XX-348 001092
15. Reinspection (after the first reinspection) 30.00 30.00 XX-348 001092
16. Late Renewal 25.00 25.00 XX-348 001092
17. Alcoholic Beverage Inspection Approval 30.00 30.00 XX-348 001092 281
ONSITE SEWAGE DISPOSAL PROGRAM (OSTDS)
1. Application for permitting of an onsite sewage 25.00 23.00 XX-361 001092 15599
treatment and disposal system which includes
application and plan review for new and repair permits
1a. Transfer to headquarters 2.00 99-910 001203
2. Site evaluation for a new system 60.00 55.20 XX-361 001092 6685
2a. Transfer to headquarters 4.80 99-910 001203
3. Site evaluation for a system repair or modification of system 40.00 36.80 XX-361 001092
3a. Transfer to headquarters 3.20 99-910 001203
4. Site re-evaluation, new or repair or modification 40.00 36.80 XX-361 001092
4a. Transfer to headquarters 3.20 99-910 001203
5. Permit for new systems, or modification to system 55.00 50.60 XX-361 001092
ATTACHMENT VI
MONROE COUNTY HEALTH DEPARTMENT
ESTIMATE OF ENVIRONMENTAL HEALTH FEES
FISCAL YEAR 2001 - 2002
"
Est.iAnn..Revenue
l*llim~ijiP IIV~ .,JIIII= qpp~ AccruingtoCHD
/u Trust Fund
5a. Transfer to headquarters 4.40 99-910 001203
6. New system or system modification installation inspection 55.00 50.60 XX-361 001092
6a. Transfer to headquarters 4.40 99-910 001203
7. Research fee to be collected in addition, and concurrent with 5.00 5.00 99-91 0 001201
the permit for a new system installation fee until 6/30/2002.
8. Repair permit issuance which includes inspection 50.00 41.40 XX-361 001092 4001
8a. Transfer to headquarters 3.60 99-910 001203
8b. Transfer to headquarters for training center 5.00 99-910 001067
9. Inspection of system previously in use 50.00 46.00 XX-361 001092 40006
9a. Transfer to headquarters 4.00 99-910 001203
10. Reinspection fee per visit for site inspections after system 25.00 23.00 XX-361 001092 2228
construction approval
10a. Transfer to headquarters 2.00 99-910 001203
11. Installation reinspection of non-compliant system per 25.00 23.00 XX-361 001092
each site visit
11 a. Transfer to headquarters 2.00 99-910 001203
12. System abandonment permit, includes permit 40.00 36.80 XX-361 001092
issuance and inspection
12a. Transfer to headquarters 3.20 99-910 001203
13. Annual operating permit fee for systems in 1M and 150.00 138.00 XX-361 001092 667
equivalent areas, and for systems receiving commercial waste
13a. Transfer to headquarters 12.00 99-910 001203
14. Amendments or changes to the operating permit during 25.00 23.00 XX-361 001092
the permit period per change or amendment
14a. Transfer to headquarters 2.00 99-910 001203
15. Aerobic treatment unit operating permit (biennial) 100.00 92.00 XX-361 001092 103456
15a. Transfer to headquarters 8.00 99-910 001203
16. Tank manufacturer's inspection per annum 100.00 50.00 XX-361 001092 228
16a. Transfer to headquarters 50.00 99-910 001203
17. Septage disposal service permit per annum 50.00 46.00 XX-61 001092 439
17a. Transfer to headquarters 4.00 99-910 001203
18. Additional charge per pumpout vehicle 25.00 23.00 XX-361 001092 439
18a. Transfer to headquarters 2.00 99-910 001203
19. Portable or temporary toilet service permit per annum 50.00 46.00 XX-361 001092 211
19a. Transfer to headquarters 4.00 99-910 001203
20. Additional charge per pumpout vehicle 25.00 23.00 XX-361 001092 105
ATTACHMENT VI
MONROE COUNTY HEALTH DEPARTMENT
ESTIMATE OF ENVIRONMENTAL HEALTH FEES
FISCAL YEAR 2001 - 2002
==~.H Est.AI"II"I."Revenue
- ...... AccrulngtQ CHD
Trust Fund
20a. Transfer to headquarters 2.00 99-910 001203
21. Septage stabilization facility inspection fee per annum 150.00 138.00 XX-361 001092
21 a. Transfer to headquarters 12.00 99-91 0 001203
22. Septage disposal site evaluation fee per annum 100.00 92.00 XX-361 001092
22a. Transfer to headquarters 8.00 99-91 0 001203
23. Aerobic treatment unit maintenance entity permit per annum 25.00 23.00 XX-361 001092 667
23a. Transfer to headquarters 2.00 99-910 001203
24. Variance application for a single family residence per 150.00 75.00 XX-361 001135
each lot or building site
24a. Transfer to headquarters 75.00 99-910 001204
25. Variance application for a multi-family or commercial 200.00 100.00 XX-361 001135
building per each building site
25a. Transfer to headquarters 100.00 99-910 001204
26. Inspection for construction of an injection well (FL Keys) 125.00 125.00 XX-361 001092 228
Performance-based Treatment Systems
1. Application for permitting of a new performance-based 125.00 115.00 XX-361 001092
treatment system, which includes application and plan review
1 a. Transfer to headquarters 10.00 99-910 001203
2. Permit for new performance-based treatment system 125.00 115.00 XX-361 001092
2a. Transfer to headquarters 10.00 99-910 001203
3. Installation inspection for new performance-based systems 75.00 69.00 XX-361 001092
3a. Transfer to headquarters 6.00 99-910 001203
6. Research fee to be collected in addition, and concurrent with 5.00 5.00 99-910 001201
the permit for a new performance-based system installation fee
4. Repair permit issuance which includes inspection 125.00 115.00 XX-361 001092
4a. Transfer to headquarters 10.00 99-910 001203
5. Inspection of system previously in use 25.00 23.00 XX-361 001092
5a. Transfer to headquarters 2.00 99-910 001203
6. Reinspection fee per visit for site inspections after system 25.00 23.00 XX-361 001092
construction approval
6a. Transfer to headquarters 2.00 99-910 001203
7. Installation reinspection of non-compliant system per 50.00 46.00 XX-361 001092
each site visit
7a. Transfer to headquarters 4.00 99-910 001203
8. System abandonment permit, includes permit 75.00 69.00 XX-361 001092
issuance and inspection
ATTACHMENT VI
MONROE COUNTY HEALTH DEPARTMENT
ESTIMATE OF ENVIRONMENTAL HEALTH FEES
FISCAL YEAR 2001 - 2002
~ Ann,,' Rever'lue
crulng toCHD
TrustFUnd
8a. Transfer to headquarters 6.00 99-910 001203
Biennial Operating Permits 100.00 92.00 XX-361 001092
9a. Transfer to headquarters 8.00 99-910 001203
10. Review of application due to proposed amendments or 75.00 69.00 XX-361 001092
changes after initial operating permit issuance.
10a. Transfer to headquarters 6.00 99-910 001203
11. Variance application for a single family residence per 150.00 75.00 XX-361 001135
each lot or building site
11 a. Transfer to headquarters 75.00 99-910 001204
12. Performance-based Treatment System Maintenance 25.00 23.00 XX-361 001092
(Per annum)
12a. Transfer to headquarters 2.00 99-910 001203
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 XX-357 001166
Construction Permit - Limited Use
1 a. Transfer to headquarters 7.50 99-91 0 001166
2. Second Year Public Water Annual Operation Permit-
Limited Use 70.00 63.00 XX-357 001166
2a. Transfer to headquarters 7.00 99-910 001166
4. Multi-Family Water Construction Permit - serving 3 or 4 40.00 36.00 XX-357 001165
non-rental residences
4a. Transfer to headquarters 4.00 99-910 001165
5. Initial Operating Permit Fee After March 31 of Any Year 35.00 31.50 XX-357 001166
5a. Transfer to headquarters 3.50 99-910 001166
6. Non-SDWA Lab Sample (Sample Collection/Review
of Analytical Results/Health Risk Interpretation):
Delineated Area 50.00 50.00 XX-357 001142
Bacterial Sample Collection 40.00 40.00 XX-357 001142
Chemical Sample Collection 50.00 50.00 XX-357 001142
Combined Chemical microbiological 55.00 55.00 XX-357 001142
ATTACHMENT VI
MONROE COUNTY HEALTH DEPARTMENT
ESTIMATE OF ENVIRONMENTAL HEALTH FEES
FISCAL YEAR 2001 - 2002
Est. Ann. Revenue
Accru:rtgF~Q..CH,D
Tru und
7. Reinspection of multi-family Water System 25.00 25.00 XX-357 001092
8. Reinspection of Public Water System 40.00 40.00 XX-357 001092
9. Delineated Area Clearance Fee 50.00 50.00 XX-357 001092
10. Limited Use Commercial Registered System 15.00 15.00 XX-357 001092
11. Limted Use Commercial Public Water System 25.00 25.00 XX-357 001092
Operating Permit Family Day Care Establishment
12. Limted Use Commercial Public Water System Operating Permit 15.00 15.00 XX-357 001092
Family Day Care Establishment After March 31 of Any Year.
Safe Drinki"g Water Act (Delegated Counties)
1. Construction permit for each Category I through III treatment
plant, as defined in Rule 62-699.310, F.A.C.., with treatment
other than disinfection only.
a. Treatment plant - 5 MGD and above 7,500.00 7,500.00 XX-358 001211
b. Treatment plant - 1 MGD up to 5 MGD 6,000.00 6,000.00 XX-358 001211
c. Treatment plant - 0.25 MGD up to 1 MGD 4,000.00 4,000.00 XX-358 001211
d. Treatment plant - 0.1 MGD up to .025 MGD 2,000.00 2,000.00 XX-358 001211
e. Treatment plant - up to 0.1 MGD 1,000.00 1,000.00 XX-358 001211
2. Construction permit for each Category IV treatment plant, as
defined in Rule 62-699.310, F.A.C.., with treatment other than
disinfection only.
a. Treatment plant - 5 MGD and above 7,500.00 7,500.00 XX-358 001211
b. Treatment plant - 1 MGD up to 5 MGD 6,000.00 6,000.00 XX-358 001211
c. Treatment plant - 0.25 MGD up to 1 MGD 4,000.00 4,000.00 XX-358 001211
d. Treatment plant - 0.1 MGD up to .025 MGD 2,000.00 2,000.00 XX-358 001211
e. Treatment plant - 0.01 up to 0.1 MGD 1,000.00 1,000.00 XX-358 001211
f. Treatment plant - up to 0.01 MGD 400.00 400.00 XX-358 001211
3. Construction permit for each Category V treatment plant, as
defined in Rule 62-699.310, F.A.C.., - Disinfection Only
a. treatment plant - 5 MGD and above 5,000.00 5,000.00 XX-358 001211
b. Treatment plant - 1 MGD up to 5 MGD 3,000.00 3,000.00 XX-358 001211
c. Treatment plant - 0.25 MGD up to 1 MGD 1,000.00 1,000.00 XX-358 001211
d. Treatment plant- 0.1 MGD up to .025 MGD 500.00 500.00 XX-358 001211
e. Treatment plant - up to 0.1 MGD 300.00 300.00 XX-358 001211
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 XX-358 1211
ATTACHMENT VI
MONROE COUNTY HEALTH DEPARTMENT
ESTIMATE OF ENVIRONMENTAL HEALTH FEES
FISCAL YEAR 2001 - 2002
b. Serving a non-transient non-community public water systems
c. Serving a non-community public water system
5. Construction permit for each public water supply well.
a. Well located in a delineated area pursuant to Chapter 62-524,
FAC..
b. Any other public water supply well.
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. 1 MGD and above
b. .1 MGD up to 1 MGD
c. 0.01 up to.1 MGD
d. Up to 0.01 MGD
7. Minor modifications to systems that result in no change in the
treatment or capacity.
a. .1 MGD and above
b. Up to 0.1 MGD
8. Fines and Forfeitures
9. General Permit Fee for any General Permit not specifically listed:
a. General Permits requiring Progfessional Engineer or Professional
Geologist certification
a. General Permits not requiring Progfessional Engineer or
Professional Geologist certification
350.00
250.00
350.00
250.00
XX-358
XX-358
500.00
250.00
500.00
250.00
XX-358
XX-358
nn. Revenue
uing tQ CHD
Trust Fund
001211
001211
001211
001211
2,000.00 2,000.00 XX-358 001211
1,000.00 1,000.00 XX-358 001211
500.00 500.00 XX-358 001211
100.00 100.00 XX-358 001211
300.00
100.00
300.00
100.00
XX-358
XX-358
XX-358
XX-358
XX-358
Variable
Variable
100.00
250.00
100.00
250.00
100.00
100.00
XX-358
001211
001211
012020
001211
001211
001211