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FY2010 10/21/2009DANNY Le KOLHAGE CLERK OF THE CIRCUIT COURT DA TE: October 29, 2009 TO: Tina Boan, Sr, Budget Director ATTN: Lisa Tennyson, Grants Manager FROM: Pamela G. Han oc C. At the October 21, 2009, Board of County Commissioners meeting the Board granted approval and authorized execution of the Fiscal Year 2010 Contracts with non - profit organizations funded through recommendations of the Human Services Advisory Board (HSAB), the Substance Abuse Policy Advisory Board (SAPAB), and the Board of County Commissioners. All of the HSAB Combined Agreements (as listed in the attached) are enclosed, except for Monroe County Education Foundation for Monroe Youth Challenge that was not included with the other documents, for your handling. Should you have any questions, please feel free to contact our office. cc: County Attorney Finance File Human Service Organization Cont racts for Fiscal Year 2010 MC . Educ. Fdtn -- Keys Center /PACE - - - r 59,000 DATE* BOCC ** Contract Agency HSAB Amt Amt Amt Amount AIDS Help 25,500 0 0 -- 25, 500 American Red Cross 5 0 0 5 Boys and Girls Club 38,500 30,000 0 68, 500 Domestic Abuse Shelter 30, 000 0 0 30,000 Easter Seals Society 10,000 0 0 10,000 . Fla. Keys Area Health Education Ctr 35 p 0 35,000 Florida Keys Children's Shelter 146 0 0 146,500 Florida Keys Health Start Coalition 5 0 0 Florida Keys Outreach Coalition 36,700 � 0 0 . 5 0 000 1 36 Good Health Clinic 35 000 0 0 35 Grace Jones Day Care Center 17,500 0 0 17 Guidance Clinic /Care Center 600 1000 0 520 1, 060, 520 Hel line Hospice of the Florida Keys -- 4 1 500 145, 000 0 0 0 0 4 500 Keys Area Interdenom Resources 10,000 p 0 145 10,000 Literacy Volunteers 4 0 0 4 Monroe Assoc for Retarded Citizens 1 146 p 0 146,500 MC . Educ. Fdtn -- Keys Center /PACE - - - r 59,000 - , - - - 0 i.v,v 0 , 59,000 Paradise Interfaith Network/Inde . Ca 7 500 0 0 7,500 Rural Health Network 60 000 0 273,600 -- 333,600 Samuel's House 77 000 0 0 77, 000 Star of the Sea Foundation . 10 000 � 0 0 10,000 U.S. Fellowshi of Fla. -Heron /Peacock 4 0 0 48,500 Wesley House Womankind 126 500 � 0 0 126 HSAB combined Sub -total 709000 p o 70,000 2,562,320 -- BOCC Direct- funded Sub-total ub -total ' 384,800 TOTALS 1, 768,200 I 35 000 1,143,920 1 29947,120 * funds budgeted; however, contract will be approved at future date '* no contracts necessary; operate as county programs AGREEMENT This Agreement is made and entered into this 21st day f October, 2 y � 009, between the BOARD OF COUNTY COMMISSIONERS OF M B r -, ONROE COUNTY, FLORIDA, hereinafter referred to as "Bo oa d or County, and HOSPICE OF THE FLORIDA KEYS, INC. hereinafter referred to as PROVIDER. a WHEREAS, the PROVIDER is a not - for - profit corporation established fort ' home health care, and he provision of WHEREAS, it is a legitimate public purpose to provide facilities and se home health care, now, therefore, services related to IN CONSIDERATION of the mutual promises and covenants contained herein ' as follows: it �s agreed FUNDING 1. AMOUNT OF AGREEMENT. The Board, in consideration of h t e PROVIDER substantially and satisfactorily performing and carrying out the duties of the Board as to rovidin facilities and services for home health care for persons living n Monro p g to the PROVIDER the sum of ONE H g oe County, Florida, shall pay HUNDRED, FORTY -FIVE THOUSAND AND NO/100 DOLLARS ($145,000.00) for fiscal year 2009 -2010. Z. TERM. This Agreement shall commence on October 1, 2009 and ter ursuant to other rninate September 30, 2010, unless earlier terminated p provisions herein. 3. PAYMENT. Payment will be made periodically, but no more frequently hereinafter set forth. Reimbursement re q Y than monthly, as quests wiI! be submitted to the Board via the Clerk's Finance Office. The COUNTY shall only reimburse, subject to the funded amounts below, those reimbursable expenses which are reviewed and approved as complying with Monroe County Code of Ordinances, State laws and regulations and Attachment A - Expense Reimbursement Requirements. Evidence of payment by the PROVIDER shall be in the form of a letter summarizing the expenses, with supporting documentation attached. The letter le of should contain a notarized certification statement. An example a reimbursement request cover letter is included as Attachment B. Th organization's final invoice must be received within thirty days termination date of this contract shown in Article 2 above. Y Y after the After the Clerk of the Board examines and approves the request for or reimbursement, the Board shatl reimburse the PROVIDER. However, the total of said reimbursement expense payments in the aggregate sum shall not exceed the total amount shown i during the term of this agreement. n Article 1, above, 4. AVAILABILITY OF FUNDS. If funds cannot be obtained or ca level sufficient to allow for continued reimbursement not be continued at a ement of expenditures for services specified herein ton this agreement may be terminated immediately at the o termination delivered to the P P o f the Board by written notice of , PROVIDER. The Board shall not be obligated to pay for an servic or goods provided by the PROVIDER after the PROVIDER has r y es termination, y q law. unless otherwise required b I received written notice of 5. CLAIMS FOR FEDERAL OR STATE AID. PROVIDER and Co unty agree that each shall be, and is, empowered to apply ose of this , ,and obtain federal and state funds to further the purp Agreement, provided that all applications, requests, rant proposals,, y p 9 p P s, and funding solicitati shall be approved b each arty prior to submission. contract - Hospice FY10; page 1 6. PURCHASE OF PROPERTY. All property, whether real or personal p urchased wi th funds provided under this agreement shall become th e the property of Monroe County and shall be accounted for pursuant to statutory requirements. RECORDKEEPING 7. RECORDS. PROVIDER shall maintain all books, records, and documents direct! pertinent to performance under this Agreement in accordance with generally y principles consistent! lied. Each g y accepted accounting Y applied. party to this Agreement or their authorized representatives shall have reasonable and timely access to such records of each other art to this Agreement P Y g ent for public records purposes during the term of the Agreement and for four ears following rng the termination of this Agreement. If an auditor employed by the County or Clerk determines that monies paid to PROVIDER pursuant to this Agreement were spent for purposes not authorize this Agreement, the PROVIDER shall repay t P d by p y e monies together with interest calculated pursuant to Sec. 55.03, FS, running from the date the monies were paid to PROVIDER. 8, PUBLIC ACCESS. The County and PROVIDER shall allow and ermit reasonable a letters P a ccess to, and inspection of, all documents pap tters or other materials in its possession or under its control subject to the provisions of Chapter 119, Florida Statutes, and made or receive unction with this d by the County and PROVIDER in conjunction s Agreement; and the County shall have the right to unilaterally cancel this Agreement upon violation of this provision by PROVIDER. 9. COMPLIANCE WITH COUNTY GUIDELINES. The PROVIDER must furnish to t provided prior he COUNTY the following (items A -I must be P p or to the payment of any invoices): (a) IRS Letter of Determination indicating 501(c)(3) status; (b) List of the Organization's Board of Directors of which there must be five or more; for each board member please indicate when elected to serve and the length of term of servic . 9 c) Evidence of annual election of Officers and Directors; (d) Unqualified audited financial statement from most recent fiscal ear for all that expend $150,000 a year or more; if qualified, � Y organizations Y include a statement of deficiencies with corrective actions recommended /taken; (e) IRS Form 990 from most recent fiscal year for all organizations; (f) Organization's Corporate Bylaws, which must include the org anization's ' and membership composition and rotes g s mission, board p s for election of officers; (g) Organization/ s Policies and Procedures Manual which must include hiring staff, drug and alcohol free workplace 9 policies for all p ace provisions, and equal employment Opportunity provisions; (h) Specific description or list of services to be provided under this contract (see act with this grant see Attachment C); (i) Initial Performance Report describing services provided during he ' g prior fiscal year. The performance reports shall include statistical information regarding the types and frequencies of services provided, a profile of clients (including esider served, and outcomes achieved. g cY) and numbers (j) Final Performance Report describing services rendered during he current s after the c g grant period (to be furnished within 30 days contract end date.) The performance reports shall include statistical information regarding the types and frequencies of servi profile of clients (including esident an q ces provided, a 9 y) d numbers served, and outcomes achieved. (k ) Cooperation with County monitoring visits that the Count year; and Y may r equest during the contract (1) Other reasonable reports and information related to comp P nce with applicable laws, contract provisions and the scop of services that the County may request during the contract year. RESPONSIBILITIES contract - Hospice FY10, page 2 10. SCOPE OF SERVICES, The PROVIDER, for the consideration named covenants a and satisfactorily � and agrees with the Board to substantially a torily perform and provide the services outlined in Attachment C to residents of Monroe County, Florida. 11, ATTORNEY'S FEES AND COSTS. The County and PROVIDER agree that in the event any cause of action or administrative proceeding is initiated or defended by an art relative to Ag reement, the enforcement or interpretation of y party g ,the prevailing party shatl be entitled to reasonable attorneys fees, court costs, investigative, and out -of- pocket exp enses, as an a g party, and shall include actor p and against the non-prevailing attorn "s fees, courts costs, investigative, and i out -of- pocket expenses n appellate proceedings. Mediation proceedings initiated and conducted ucted pursuant to this Agreement shall be in accordance with the Florida Rules of Civil Procedure and usual and customary procedures required by the circuit court of Monroe County. Y 12. BINDING EFFECT. The terms, covenants, conditions, and rovisions of this Agreement shall bind and inure to the benefit of the Count s ty and PROVIDER and their respective legal representatives, successors, and assigns. 13. CODE OF ETHICS. County agrees that officers and employees of the Co I with the unty recognize and will be required to comply Y standards of conduct for public officers and employees as delineated in Section 112.313, Florida regarding, ardin but no ' gifts; doing business one's g, t limited to, solicitation or acceptance of g 9 s ness with ones agency; unauthorized compensation; mis of public position, conflicting employment or contractual relationship; nd disclosure use of certain information. p� a or 14. NO SOLICITATION/ PAYMENT. The County and PROVIDER warrant that in r to itself, it has neither employed nor retained an company � respect Y p y or person, other than a bona fide employee working solely for it, to solicit or secure this Agreement and that it has n paid or agreed to pay any y person, company, corporation, individual, or firm, other than a bona fide employee working solely ,n for it, any fee, commission, percentag gift, or other contingent upon or resulting from the award g g � consideration 9 or making of this Agreement For the breach or violation of the provision, the PROVIDER agrees that the Count shall have the right and at i y to terminate this Agreement without liability is discretion, to offset from monies owed, or otherwise recover, the full amount of such fee, commission, percentage, gift, or consideration. 15. INDEPENDENT CONTRACTOR, At all times and for all oses ur hereunder, PROVIDER is an independent contractor and not an employee of thp p e eunder, the the Board No statement contained in this agreement shall be construed so as to find the PROVIDER employees, contractors, servants or agents to be employ or any of its 9 p yees of the Board. COMPLIANCE ISSUES 16. COMPLIANCE WITH LAW. In providing all services ursuant to this PROVIDER shall abide by all statutes ordinance p agreement, the s, rules and regulations pertaining to or regulating the provision of such services, including those now in effect and hereinafter violation of said statutes ordinances rules e�nafter adopted. Any es and regulations shall constitute a material breach of this agreement and shall entitle the Board to terminate this contract immediately written notice of termination to the PROVIDER. med�ately upon delivery of 17. PROFESSIONAL RESPONSIBILITY AND LICENSING. The PROVIDER shall assure that all professionals have current and appropriate professional licenses and professional liability insurance coverage. Funding by the Board is contingent upon retention of ` or licen p appropriate focal, state and /or federal certification and/or sure of the PROVIDER'S program and staff. 18. NON - DISCRIMINATION. County and PROVIDER agree that t against an 9 here will be no discrimination a g y person, and it is expressly understood that upon a determination b a court of competent jurisdiction that discrimination has occurred this Agreement y terminates without any further action on the art o 9 ement automatically p f any party, effective the date of the court contract - Hospice FY10; page 3 order. County or PROVIDER agree to comply with all Federal and Florida statutes and all local ordinances, a.s applicable, relating to nondiscrimination. These include but are not limi • ted to. 1) Title VI of the Civil Rights Act of 1964 (PL 88 -352) which prohibits discrimination on the basis of race, color or national origin; 2) Title IX of the Education Amendment of 1972 as am which ended (20 USC ss. 1681 -1683, and 1685-1686), c prohibits discrimination on the basis of sex; 3 Section 504 of the Rehabilitation Act of 1973 as a } mended (20 USC s. 794), which prohibits discrimination on the basis of handicaps; 4) The Age Discrimination Act of 1975 a USC ss. 6101 -6107) which prohibits discrimination amended (42 on on the basis of age; 5) The Drug Abuse Office and Treatment Act of 1972 (PL 92 -255), as amended, relating to nondiscrimination on Comprehensive Alcohol the basis of drug abuse; 6) The Com p o Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (PL 91 -616), as amended, relating to nondiscrimination on The Public he basis of alcohol abuse or alcoholism • 7 c Health Service Act of 1912, ss. 523 and 527 (42 USC ss. 690dd 3 and 290ee -3), as amended, relating to confidentiality of alcohol and drug abuse patient records; 8) Title VIII of the Civil Rights Act of 1968 (42 USC s. et se as am q )� ended, relating to nondiscrimination in the sale, rental or financing of housing; 9) The Americans with Disabilities Act of 1990 (42 USC s. 1201 Note), as maybe amended from time to time, e, relating to nondiscrimination on the basis of disability; 0) Any other nondiscrimination provisions in any Federal or state statutes which may apply to the parties to, or the subject Agreement. matter of, this AMENDMENTS, CHANGES, AND DISPUTES 19. MODIFICATIONS AND AMENDMENTS. Any and all modifications of the and /or reimbursement of services shall be accomp lished services p ed by an amendment, which must be approved in writing by the COUNTY. 20. ADJUDICATION OF DISPUTES OR DISAGREEMENTS. Count and P disag reements shall be Y PROVIDER agree that all disputes and disc 9 attempted to be resolved by meet and confer sessions between representatives of each of the parties. If no resolution can be within 30 days after the first meet and confer session agreed upon ,the issue or issues shall be discussed at a public meeting of the Board of County Commissioners. If the issue or issues are then an a still not resolved to the satisfaction of the parties y party shall have the right to seek such relief or remedy as may be provided by this Agreement or by Florida law. 21. COOPERATION. In the event any administrative or legal proceeding . against either 9 p g rs instituted a 9 party relating to the formation, execution, performance or breach of Agreement, County and PROVIDER agree to participate,, this p p , to the extent required by the other party, in all proceedings, hearings, processes, meetings, and other activities related to the substance of this Agreement or provision of the services under this Ag reement. art to th g County and PROVIDER specifically agree that no party s Agreement shall be required to enter into any arbitration proceedings related to this Agreement. ASSURANCES 22, COVENANT OF NO INTEREST. County and PROVIDER cov enant presently has any interest, and shall not acquire an that neither q y interest, which would conflict in any manner or degree with its performance under this Agreement, and that only nter and receive benefits as recited in this Agre ement. Y est of each is to perform 23. NO ASSIGNMENT. The PROVIDER shall not assig this ag approval of g 9 nt except in writing and with the prior written a pp the Board, which approval shall be subject to such conditions and provisions as the Board may deem necessary. This assig ry agreement shall be incorporated by reference into any 9 and any assignee shall comply with all of the provisions herein. Unless expressly provided for therein, such approval imp an obligation pp shall in no manner or event be deemed to im p Y g upon the Board in addition to the total agreed upon reimbursement amount for the services of the PROVIDER. contract - Hospice FY10; page 4 24. NON - WAIVER OF IMMUNITY. Notwithstanding the rovisions of Florida Statutes, the participation of the Count Sec. 768.28, ty and the PROVIDER in this Agreement and the acquisition of any commercial liability insurance coverage, self- insurance coverage, or local government liability insurance Poo( coverage be deemed a waiver of immunity to the extent of liability coverage, nor shall any contract entered into b the Count b contain any provision for waiver. Y y e required to 25. ATTESTATIONS. PROVIDER agrees to execute such documents as the Crime County may reasonably require, to include a Public Entity Y e Statement, an Ethics Statement, and aDrug- Free Workplace ce Statement. 26. AUTHORITY. Each party represents and warrants to the other that Ag reement h the execution delivery and performance of this A 9 ha been duly authorized by all necessary County , and corporate action, as required by law. INDEMNITY ISSUES 27. INDEMNIFICATION AND HOLD HARMLESS, The PROVIDER covenan is and agrees to indemnify and hold harmless Monroe County and of County Commissioners from any and all claims for bodily injury (including death), personal injury, and property damage ' and an ot p Y 9 (including property owned by Monroe County) y er losses, damages, and expenses includin attorneys fees} which arise out of, in connection with, including th or by reason of services provided by the PROVIDER occasioned by the negligence, errors, or other a wrongful PROVIDER'S employees, agents s. or volunteer 9 a or omission of the 28. PRIVILEGES AND IMMUNITIES. All of the privileges and immunities ' exemptions from laws, ordinances and r g ties from liability, rules and pensions and relief, disability, workers' compensation, and other benefits which apply to the activity of officers a ents or when � g � employees of any public agents or employees of the County, performing their respective functions under this Agreement within the territorial limits of the Count shall f extent to the performance of such functions apply Y to the same degree and ons and duties of such officers, agents, volunteers, or employees outside the territorial limits of the County. 29. NO PERSONAL LIABILITY. No covenant or agreement agreement f g contained herein shall be deemed to be a covenant or a 9 o any member, officer, agent or employee of Monroe County in his or her individual capacity, and no member, officer, a personally on th � � gent or employee of Monroe County shall be liable P y s Agreement or be subject to any personal liabilit or accountability by reason of the execution of this Agreement. y 30. LEGAL OBLIGATIONS AND RESPONSIBILITIES: Non-Delegation or Statutory Duties. This Agreement is not intended of Constitutional . ng entity from any obligation or responsibility imposed ended to, nor shall it be construed as, relieving an participating u on the Y performance p e entity by law except to the extent of actual and timely p ce thereof by any participating entity, in which case the performance may be offered in satisfaction of the obligation or responsibility. Agreement is not intended to nor shall g Further, this it be construed as, authorizing the delegation of the constitutional or statutory duties of the County, except to the extent constitution, state statute, and case law, permitted by the Florida 31. NON - RELIANCE BY NON- PARTIES. No person or entit reement to Y shall be entitled to rely upon the terms of this Agreement enforce or attempt to enforce any third -part claim or entitlement to or benefit of any service or program contemplated her y the PROVIDER agree that neither the County hereunder and the County and of either shall tY nor the PROVIDER or any agent, officer, or employee have the authority to inform, counsel, or otherwise indicate entity or entities,, that any particular individual or group of individuals Y have entitlements or benefits under this Agreement separate and apart, inferior to, or superior to the comm purposes contemplated in this Agreement. unity in general or for the contract - Hospice FY10; page 5 GENERAL 32. Execution in Counterparts. This counterparts, each of which shall be regarded , constitute one and the same instrument and Agreement by signing any such counterpart. Agreement may be executed in any number of s an original, all of which taken together shall any of the parties hereto may execute this 33. NOTICE. Any notice required or permitted under this agreement shall re- g all be in writing and hand - delivered or mailed p ostag e p paid, by certified mail, return receipt requested, to the other party as follows: For Board: Grants Administrator and 1100 Simonton Street Key West, FL 33040 Monroe County Attorney PO Box 1026 Key West, FL 33041 For PROVIDER Liz Kern, Chief Executive Officer Hospice of the Florida Keys, Inc. 1319 William St. Key West, FL 33040 305- 294 -8812 305- 294 -9348 FAX 34. GOVERNING LAW, VENUE, INTERPRETATION, COSTS AN and construe � D FEES. This Agreement shall be governed by d in accordance with the laws of the State of Florida applicable to contracts made and to be performed entirely in the State. In the event that any cause of action or administrative roceedin i Agreement, p 9 s instituted for the enforcement or interpretation of this A 9 t, the County and PROVIDER agree that venue will lie in the appropriate court or before the appropriate administrativ Florida. a body in Monroe County, The County and PROVIDER agree that, in the event of conflicting or betty 9 of the terms or a term of this Agreement by betwe any of them the issue shall be submitted to mediation prior to the institution of any other administrative or legal r g proceeding. 35. NON- WAIVER. Any waiver of any breach of covenants herein and performed by the PROVIDER shall not be deemed or considered as a contained to be kept continuing waiver and shall not operate to bar or prevent the Board from declaring 9 forfeiture for any succeeding breach, either of the same conditio or covenants or otherwise. 36. SEVERABILITY. If any term, covenant, condition or rovisi circumstan p on of this Agreement {or the application thereof to any e or person} shall be declared invalid or unenforceable to any extent by a court of competent jurisdiction, the remainin reement sh 9 terms, covenants, conditions and provisions of this Agreement, all not be affected thereby; and each remainin term covenant, condition and provision of this Agreement shall be valid and shall g fullest extent permitted by law unless the enforcement of the be enforceable to the remaining terms, covenants conditions and provisions of this Agreement would revent the e origina accomplishment of th intent of this Agreement . The Coun p possible l ty and PROVIDER agree to reform the Agreement to replace any stricken provision with a valid provision that comes as close as p stricken provision, p ble to the intent of the contract - Hospice FY10; page 6 37. ENTIRE AGREEMENT. This agreement constitutes the entire parties hereto with respect to the subject matter hereof and supersedes agreement of the any and all prior agreements with respect to such subject matter between the PROVIDER and the Board. [THIS SPACE INTENTIONALLY LEFT BLANK WITH SIGNATORY PAGE TO FOLLOW] contract - Hospice FY10; page 7 of the , - ,, ""` ��' T_ r r a ( S EAL n p ATTEST tier <•.HT Y' "� sy� EOF, the parties hereto have caused these presents to be executed as tten above. BOARD OF COUNTY COMMISSIONERS E, CLERK OF MO OE COUNTY, FLORIDA V_zk B y S Mayor /Chairman eputy Clerk Hospice of the Florida Keys, Inc. Witness Witness 1 By �! resident MONROE COUNTY ATTORNEY APPROVE AS TO FORM: CHRISTINE M. LIMBERT- BARROWS ASSIST COUNTY ATTORNEY Date T 11 U9169 - (Federal ID No. 59- 2386289 N E��� 28 , �Qi `��' •• =_ 9•.� � • •Ott :Z / � /i��9rpU see*** fillo 111 tenl�Q.�n V,<"\i <b�en Weser contract - Hospice FY10; page 8 p i�. ! CD �' r G=) C ...�, LL. t i (Federal ID No. 59- 2386289 N E��� 28 , �Qi `��' •• =_ 9•.� � • •Ott :Z / � /i��9rpU see*** fillo 111 tenl�Q.�n V,<"\i <b�en Weser contract - Hospice FY10; page 8 ATTACHMENT A Expense Reimbursement Requirements This document is intended to provide basic guidelines to Human Service and Community-Based y Organizations, county travelers, and contractual parties who have reimbursable expens associated with Monroe County business. These guidelines, a l, s they relate to travel, are from the Monroe County Code of Ordinances and State laws and regulations. A cover letter (see Attachment B) summarizing the major line items on the reimbursable request needs to also contain the following notarized certified stat ement: expense "I certify that the above checks have been submitted to the vendors as noted and that the attached expenses are accurate and in agreement with the records of this organization. Furthermore, these expenses are in compliance with this organization's contract with Commissioners an the Monroe County Board of County d will not be submitted for reimbursement to any other funding source." Invoices should be billed to the contracting agency. Third party payments will not be for reimbursement. Remember ease should be paid prior t the ex y considered p o requesting a reimbursement. Only current charges will be considered, no previous balances. Reimbursement requests will be monitored in accordance with the level of detail in th This document should not be considered all- inclusive. The contract. e Clerk's Finance Department reserves the right to review reimbursement requests on an individual basis. An q uestions guidelines should be directed to 305 -292 -3534. y q s r egarding these Data Processing, PC Time, etc. The vendor invoice is required for reimbursement. Inter- compan allocations are n ' y of c onsidered reimbursable expenditures unless approp payroll journals for the charging department are attached and certified. Payroll A certified statement verifying the accuracy and authenticity of the ex a roll a Payroll Journal is provided, it should include: p Y expense �s needed. If dates, employee name, salary or hourly rate, total hours worked, withholding information and payroll taxes, check number an provided, the f d check amount. If a Payroll Journal is not p following information must be provided: pay period, check amount, check number, date, payee, support for applicable payroll taxes. Postage, overnight Deliveries, Courier, etc. A log of all postage expenses as they relate to the Count contract is required i For overnight or express deliveries the q red for reimbursement. e vendor invoice must be included. Rents, Leases, etc. A copy of the rental or lease agreement is required. Deposits and advance allowable expenses. payments are not Reproductions, Copies, etc. A log of copy expenses as they relate to the County contract is required ' log must define the date number q for reimbursement. The of copies made, source document, purpose, and red recip ient. A reasonable fee for copy expenses will be allowable. For vendor services sample of the finished P q roduct are re ui ces, the vendor invoice and a . Supplies, Services, etc. For supplies or services ordered, a vendor invoice is required. contract - Hospice FY10; page 9 Telefax, Fax, etc. A fax log is required. The log must define the sender, the intended recipient,, the date th number called, and the reason for sending the f ax. p e Telephone Expenses A user log of pertinent information must be remitted including: the party called the caller, th telephone number, the date, and the purpose of the call. e Travel and Meal Expenses Travel expenses must be submitted on a State of Florida Voucher for Reimbursement of Travel Expenses. Travel reimbursement requests must be submitted and will be aid in accords Monroe County Code of Ordinances and State laws p accorda with and regulations. Credit card statements are not acceptable documentation for reimbursement. If attending a conference or meeting o f the agenda is needed. Airfare reimbursement requires the original g a pY o q passenger receipt portion of the airline ticket. A travel itinerary is appreciated to facilitate the audit trail. Auto rental reimbursement requires the vendor invoice. Fuel purchases should be documented with i pa d receipts. Taxis are not reimbursed if taken to arrive at a departure point: for example, taking taxi from one's residence to the airport for a business trip s n p g a p of reimbursable. Parking is considered a reimbursable travel expense at the destination. Airport parkin during a bu siness trip is not. 9 g siness A detailed list of charges is required on the lodging invoice. Balance due must be zero. traveler. The Room must be registered and paid for b Y County will only reimburse the actual room and related bed tax. Room service, movies, and personal telephone calls are not allowable a le expenses. Mileage reimbursement shall be at the rate established by ARTICLE XXVI TRAVEL PER ER DIEM, MEALS, AND MILEAGE POLICY of the Monroe County Code of Ordinances. An odometer reading must be included on the state travel voucher for vicinity travel. Mileage is not allowed fr residence or office to a poi of departure. rtu re. Fore g om a p example,, driving from one's home to the airport for a business trip is not a reimbursable expense. Meal reimbursement shall be at the rates established by ARTICLE XXVI TRAVEL PER MEALS, AND MILEAGE POLICY of the Monroe Co � R DIEM, County Code of Ordinances. Meal guidelines state that travel must begin prior to 6 a.m, for breakfast reimbursement before noon p.m, for lunch reimbursement and before 6 � f and end after 2 p.m. and end after 8 p.m. for dinner reimbursement. Non- allowable Expenses The following expenses are not allowable for reimbursement: capital outlay contri p Y expenditures (unless specifically included in the contract), butions, depreciation expenses (unless specifically included in the contract), entertainment expenses, fundraising on- suffici penalties and fines. g� ent check charges, contract - Hospice FY10; page 10 ATTACHMENT B ORGANIZATION LETTERHEAD Monroe County Board of County Commissioners Finance Department 500 Whitehead Street Key West, FL 33040 Date The following is a summary of the expenses for ( Organization name for the time period of to ) p od Check # Payee Reason Amount 101 Company A Rent $ X XXX.XX 102 Company B Utilities XXX.XX 104 Employee A P/R ending 05/14/01 XXX.XX 105 Employee B P/R ending 05/28/01 XXX.XX (A) Total (B) Total prior payments X XXX.XX (C) Total requested and paid (A + B) $ X XXX.XX (D) Total contract amount $ X,XXX.XX Balance of contract (D -C) 'R XgXXXM" I certify that the above checks have been submitted to the vendors as noted and that agreement with the expenses are accurate and in a 9 the records of this organization. Furthermore, these expenses are in compliance with this organization's contract with the Monroe County Board of County Commissioners and will not be submitted for reimbursement to any other funding source. Executive Director Attachments (supporting documentation) Sworn to and subscribed before me this day of who is personally known to me. Notary Public Notary Stamp 200_ by contract - Hospice FYI 0; page 11 ATTACHMENT C Services to be provided: Hospice and home health- related services for indigent and d medically needy patients. These include, but are not limited to, pain and symptom management, medical consul nursing, personal care, counseling, • • consultation, skilled 9, on, nutrition counseling, and medical social work. contract - Hospice FY09; page 11 PUBLIC ENTITY CRIME STATEMENT "A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a contract to provide any goods or services to a ublic entity, may not submit a bid on a contract with a public entity for t p p y e construction or repair of a public building or public work, may not submit bids on leases of real property to ublic entity, m work as a contractor, supplier, p y� may not be awarded or perform pplier, subcontractor, or consultant under a contract with any public entity, and may not transact business with any public entity n excess of the threshold amount provided in Section 287.017 for CATS y . GORY TWO for a period of 36 months from the date of being placed on the convicted vendor list.' contract - Hospice FY10; page 13 SWORN STATEMENT UNDER ORDINANCE NO. 10 -1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE Hospice of the Florida Keys, Inc warrants that he/it has as not employed retained or otherwise had act on his /its behalf any former County officer or employee in violation of Section 2 of Ordinance No. 10 -1990 or any County officer or employee in violation of Section 3 of Ordinan No. 10 -1990. For breach or violation of this provision the County may, in its discretion terminate this contract without liability and may also, in its discretion e contract or purchase deduct from the e price, or otherwise recover, the full amount of any fee, commission, percentage., gift or Y p consideration paid to the former Count officer or employee. g g (signature) Date: 0<1 STATE OF Florida COUNTY OF Monroe PERSONALLY APPEARED BEFORE ME, the undersigned authority, TjQ!gA - who, after first being sworn by me, affixed his /her signature (name of individual signing) in the space provided above on this day of (0 Liu 20 , NOTARY PUBLIC My commission expires: -"� - OMB - MCP FORM #4 � 'of .��� �e.•' �1sSI0�y''l�'p��'i oy 28, ?�A f � �� Ot w So lo #DD 523450 9 �'•:�� y e�ded m" vl l / /j�� /c, STAIE \� °�� I / 1 ��11�i1l1 1 � 1 contract - Hospice FY10; page 14 DRUG -FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that: Hospice of the Florida Keys, Inc. (Name of Business) 1. Publishes a statement notifying employees that the unlawful manufacture, distribution d ispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Informs employees about the dangers of drug abuse in the workplace, the business's olic of maintaining a drug -free workplace, any available drug r ' ' p y 9 rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug buse violations. g 3. Gives each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in subsection (1). 4. In the statement specified in subsection (1), notifies the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide the employer e by the terms of the statement and will notify p oyer of any conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 893 (Florida Statutes) or of an controlled substa law of the United States or any state for a violation o y a e occurring in the workplace no later than five (5) days after such conviction. 5. Imposes a sanction on, or require the satisfactory participation in a drug buse assistance rehabilitation program if such is available in the em g ce or ployee's community, or any employee who is so convicted. 5. Makes a good faith effort to continue to maintain a drug -free workplace through implementation of this section. p g As the person authorized to sign the statement, above requirements. STATE OF Florida COUNTY OF Monroe certify that this firm complies fully with the 1)� J# V I /4 A au\.� (Signatwe of Respondent) C/a to PERSONALLY APPEARED BEFORE ME, the undersigned authority, ZIOCA* Yom' n who, after first being sworn by me, (name of individual signing) affixed his /her signature in the space provided above on this day of 1 200 LaL�=& My commission expires: NOTARY PUBLIC 2 2 CD contract - Hospice FY10; page 15 arY 28 .� °►': #DD 523450 o Q` ��yp • �blic Un�*09 • q, x