FY1995 11/23/1994
Dann!, 1... itolbagt
BRANCH OFFICE
3117 OVERSEAS HIGHWAY
MARA THON, FLORIDA 33050
TEL. (305) 289-6027
CLERK OF THE CIRCUIT COURT
MONROE COUNTY
500 WHITEHEAD STREET
KEY WEST, FLORIDA 33040
TEL. (305) 292-3550
BRANCH OFFICE
88820 OVERSEAS HIGHWAY
PLANTATION KEY, FLORIDA 33070
TEL. (305) 852-7145
MEMORANDUM
TO: Peter lorton, Director
Divisic: n of Community Services
FROM:
Ruth t<nn Jantzen, Deputy Clerk "tJJ.A/.
Decem~)er 13, 1994
DATE:
-------------------------- ---------------------------------------------------------------------------------------------
On November 23, 1994, the Board of County Commissioners granted approval
and authorized execlttion of the following documents:
Contract between Monroe County and the Monroe Association for Retarded
Citizens, in the amou,nt of $30,695.00.
Contract between Monroe County and Helpline, Inc., in the amount of $18,000.00.
Contract between Monroe County and Hospice of the Florida Keys, Inc., in the
amount of $SO,OOO.Oft.
Contract between Monroe County and Big Pine Key Athletic Association, Inc., in
the amount of $18,000.00.
Contract betw<<~en Monroe County and Care Center for Mental Health of the
Lower Keys, Inc., in the amount of $214,629.00.
Contract betw(~en Monroe County and Heart of the Keys Recreation Association,
Inc., in the amount of $18,000.00.
Contract between Monroe County and the Domestic Abuse Shelter, Inc., in the
amount of $23,010.OO'lJ
Contract between Monroe County and Upper Keys Youth Association, Inc., in the
amount of $33,600.00.1
Peter Horton
December 13, 1994
Page 2
Contract between Monroe County and Wesley House, in the amount of $25,000.00.
Contract between Monroe County and Big Brothers - Big Sisters of Monroe
County, in the amount of $20,000.00.
Contract between Monroe County and Big Brothers - Big Sisters of Monroe
County, in the amount of $20,000.00.
Contract between Monroe County and the American Red Cross of the Upper
Keys, in the amount of $10,000.00.
Contract between Monroe County and the Guidance Clinic of the Middle Keys,
Inc., in the amount of $501,266.00.
Contract between Monroe County and Handicapped Job Placement Council of
the Florida Keys, Inc., in the amount of $12,000.00.
Contract between Monroe County and the Florida Keys Youth Club, in the
amount of $30,000.00.
Contract between Monroe County and Literacy Volunteers of America - Monroe
County, Inc., in the amount of $5,000.00.
Enclosed please find a fully executed copy of each of the above Contracts for
return to the providers.
me.
H you have any questions concerning the above, please do not hesitate to contact
cc: County Attorney
Finance
County Administrator, w/o document
File
AGREEMENT
This Agreement is made and entered into this :}-3> day of ND V '
199.1, between the BOARD OF COUNTY COMMISSIONERS OF MONROE
COUNTY, FLORIDA, hereinafter referred to as "Board" or "County," and CARE
CENTER FOR MENTAL HEALTH OF THE LOWER KEYS, INC., hereinafter referred
to as "Provider."
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WHEREAS, the Board and the Provider desire to enter i~ ~ a&em~t
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wherein the Board contracts for services from the Provider fogJie rencijringjof
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mental health services to the citizens of the Lower Keys, Monro~~.untyl!lo~,
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and 0
WHEREAS, the Board is vested and charged with certain duties and
responsibilities relating to the mental health and guidance of the citizens of
Monroe County, and
WHEREAS, such services have been rendered by the Provider in the past
and have been invaluable to the citizens of the Lower Keys, and
WHEREAS, it is proper and fitting to enter into an agreement for services to
be rendered in the forthcoming fiscal year 1994-95, now, therefore,
IN CONSIDERATION of the mutual promises and covenants contained
herein, it is agreed as follows:
1.
AMOUNT OF AGREEMENT.
The Board, in consideration of the
Provider substantially and satisfactorily performing and carrying out the duties
and obligations of the Board as to rendering counsel to the citizens of the Lower
Keys, Monroe County, Florida, in matters of mental health and guidance, drug
rehabilitation and providing transportation to treatment facilities as required by
Florida Statute 394.461 for Monroe County patients, agrees to:
A. Pay to the Provider the sum of One Hundred Fifty-Four Thousand Six
Hundred Twenty-Nine Dollars ($154,629.00) for rendering counseling services.
B. Pay an additional sum not to exceed Sixty Thousand Dollars
($60,000.00) for the providing of transportation of patients in Monroe County to
treatment facilities (Baker Act Transportation).
2. TERM. This Agreement shall commence on October 1, 1994,
and terminate September 30, 1995, unless earlier terminated pursuant to other
provisions herein.
3. PAYMENT. Payment will be paid monthly as hereinafter set forth.
Certified monthly financial and service load reports will be made available to the
Board to validate the delivery of services under this contract. The monthly
financial report is due in the office of the Clerk of the Board no later than the 15th
day of the following month. After the Clerk of the Board pre-audits the certified
report, the Board shall reimburse the Provider for its monthly expenses.
However, the total of said monthly payments in the aggregate sum shall not
exceed the total amount of $154,629.00 for counseling, and $60,000 for Baker Act
transportation cost during the term of this agreement. To preserve client
confidentiality required by law, copies of individual client bills and records shall
not be available to the Board for reimbursement purposes but shall be made
2
available only under controlled conditions to qualified auditors for audit
purposes.
4. SCOPE OF SERVICES. The Provider, for the consideration named,
covenants and agrees with the Board to substantially and satisfactorily perform
and carry out the duties of the Board in rendering counsel in the matter of mental
health and guidance to the citizens of the Lower Keys, Monroe County, Florida,
and transporting patients in Monroe County to treatment facilities in accordance
with Florida Statute 394.459. The Provider shall provide these services in
compliance with Florida Statutes Chapter 394.
5. RECORDS. The Provider shall maintain appropriate records to
insure a proper accounting of all funds and expenditures, and shall provide a
clear financial audit trail to allow for full accountability of funds received from
said Board. Access to these records shall be provided during weekdays, 8 a.m.
to 5 p.m., upon request of the Board, the State of Florida, or authorized agents
and representatives of the Board or State.
The Provider shall be responsible for repayment of any and all audit
exceptions which are identified by the Auditor General of the State of Florida, the
Clerk of Court for Monroe County, an independent auditor, or their agents and
representatives. In the event of an audit exception, the current fiscal year
contract amount or subsequent fiscal year contract amounts shall be offset by
the amount of the audit exception. In the event this agreement is not renewed or
continued in subsequent years through new or amended contracts, the Provider
3
shall be billed by the Board for the amount of the audit exception and the
Provider shall promptly repay any audit exception.
INDEMNIFICATION AND HOLD HARMLESS.
The
Provider
6.
covenants and agrees to indemnify and hold harmless Monroe County Board of
County Commissioners from any and all claims for bodily injury (including death),
personal injury, and property damage (including property owned by Monroe
County) and any other losses, damages, and expenses (including attorney's fees)
which arise out of, in connection with, or by reason of services provided by the
Provider occasioned by the negligence, errors, or other wrongful act or omission
of the Provider's employees, agents or volunteers. The extent of liability is in no
way limited to, reduced, or lessened by the insurance requirements contained
elsewhere within this agreement.
7.
INDEPENDENT CONTRACTOR.
At all and for all purposes
hereunder, the Provider is an independent contractor and not an employee of the
Board. No statement contained in this agreement shall be construed so as to
find the Provider or any of its employees, contractors, servants or agents to be
employees of the Board.
8. COMPLIANCE WITH LAW. In providing all services pursuant to
this agreement, the Provider shall abide by all statutes, ordinances, rules and
regulations pertaining to or regulating the provision of such services, including
those now in effect and hereinafter adopted. Any violation of said statutes,
4
ordinances, rules and regulations shall constitute a material breach of this
agreement and shall entitle the Board to terminate this contract immediately upon
delivery of written notice of termination to the Provider.
PROFESSIONAL RESPONSIBiliTY AND liCENSING.
The
9.
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 appropriate local, state and/or federal
certification and/or licensure of the Provider's program and staff.
10. INSURANCE. As a pre-requisite of the services supplied under
this contract, the Provider shall obtain, at its own expense, insurance as
specified in any attached schedules, which are made part of this agreement.
The Provider shall maintain the required insurance throughout the entire
term of this agreement. Failure to comply with this provision may result in
immediate suspension of all work until the required insurance has been
reinstated or replaced.
The Provider shall provide, to the County, as satisfactory evidence of the
required insurance, either:
*
Certificate of insurance
or
A certified copy of the actual insurance policy.
*
5
The Board, at its sole option, has the right to request a certified copy of
any or all insurance policies required by this agreement.
All insurance policies must specify that they are not subject to
cancellation, non-renewal, material change, or reduction in coverage unless a
minimum of thirty (30) days prior notification is given to the Board by the insurer.
The acceptance and/or approval of the Provider's insurance shall not be
construed as relieving the Provider from any liability or obligation assumed under
this agreement or imposed by law.
The Monroe County Board of County Commissioners, its employees and
officials shall be included as "additional insureds" on all policies, except for
Worker's Compensation.
Any deviations from these general insurance requirements must be
requested in writing on the County-prepared form entitled "Request for Waiver or
Modification of Insurance Requirements" and approved by Monroe County Risk
Management.
11. MODIFICATIONS AND AMENDMENTS.
Any and all modifi-
cations of the services and/or reimbursement of services shall be amended by an
agreement amendment, which must be approved in writing by the Board.
6
12. NO ASSIGNMENT.
The Provider shall not assign this
agreement except in writing and with the prior written approval of the Board,
which approval shall be subject to such conditions and provisions as the Board
may deem necessary. This agreement shall be incorporated by reference into
any assignment and any assignee shall comply with all of the provisions herein.
Unless expressly provided for therein, such approval shall in no manner or event
be deemed to impose any obligation upon the Board in addition to the total
agreed upon reimbursement amount for the services of the Provider.
13. NON-DISCRIMINATION. The Provider shall not discriminate against
any person on the basis race, creed, color, national origin, sex or sexual
orientation, age, physical handicap, or any other characteristic or aspect which is
not job-related in its recruiting, hiring, promoting, terminating or any other area
affecting employment under this agreement. At all times, the Provider shall
comply with all applicable laws and regulations with regard to employing the
most qualified person(s) for positions under this agreement. The Provider shall
not discriminate against any person on the basis of race, creed, color, national
origin, sex or sexual orientation, age, physical handicap, financial status or any
characteristic or aspect in its providing of services.
7
14. AUTHORIZED SIGNATURES. The signatory for the Provider below,
certifies and warrants that:
(a) The Provider's name in this agreement is the full name as designated
in its corporate charter, if a corporation, or the full name under which the
Provider is authorized to do business in the State of Florida.
(b) He or she is empowered to act and contract for the Provider; and
(c) This agreement has been approved by the Board of Directors of the
Provider if the Provider is a corporation.
15. NOTICE.
Any notice required or permitted under this agreement
shall be in writing and hand-delivered or mailed, postage pre-paid, by certified
mail, return receipt requested, to the other party as follows:
For Board:
Monroe County Attorney
310 Fleming Street, upstairs
Key West, Florida 33040
For Provider:
Marshall Wolfe, Ed.D.
Executive Director
Care Center for Mental Health
of the Lower Keys, Inc.
1205 Fourth Street
Key West, Florida 33040
16. CONSENT TO JURISDICTION. This agreement shall be construed by
and governed under the laws of the State of Florida and venue for any action
arising under this agreement shall be in Monroe County, Florida.
17. NON-WAIVER.
Any waiver of any breach of covenants herein
contained to be kept and performed by the Provider shall not be deemed or
8
considered as a continuing waiver and shall not operate to bar or prevent the
Board from declaring a forfeiture for any succeeding breach, either of the same
conditions or covenants or otherwise.
18. AVAilABiliTY OF FUNDS.
If funds cannot be obtained or cannot
be continued at a level sufficient to allow for continued reimbursement of
expenditures for services specified herein, this agreement may be terminated
immediately at the option of the Board by written notice of termination delivered
to the Provider. The Board shall not be obligated to pay for any services or
goods provided by the Provider after the Provider has received written notice of
termination, unless otherwise required by law.
19. PURCHASE OF PROPERTY. All property, whether real or
personal, purchased with funds provided under this agreement, shall become the
property of Monroe County and shall be accounted for pursuant to statutory
requirements.
20. ENTIRE AGREEMENT. This agreement constitutes the entire
agreement of the parties hereto with respect to the subject matter hereof and
supersedes any and all prior agreements with respect to such subject matter
between the Provider and the Board.
IN WITNESS WHEREOF, the parties hereto have caused these presents to
be executed as of the day and year first written above.
9
(SEAL)
ATTEST:DANNYL.KOLHAGE,CLERK
By: 8j~d~?;~~
Duty rk
If v~- i ~ ;~it!l~LC/~'
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.~/ --4!lvL<Cf. v'\' ,~X ~ I. O--t.-O..'
-
Witness
b/CONS/guidanc1.doc
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
By:
CARE CENTER FOR MENTAL
HEALTH OF THE LOWER KEYS, INC.
(FederallD No. S q -* ,) ? 3 ; 30 2 - )
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By ~r ~ ri;:~to;/ -
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By .,-/
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President
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iDannp lL. ltolbage
BRANCH OFFICE
3117 OVERSEAS HIGHWAY
MARATHON, FLORIDA 33050
TEL. (305) 289-6027
CLERK OF THE CIRCUIT COURT
MONROE COUNTY
500 WHITEHEAD STREET
KEY WEST, FLORIDA 33040
TEL. (305) 292-3550
BRANCH OFFICE
88820 OVERSEAS HIGHWAY
PLANTATION KEY, FLORIDA 33070
TEL. (305) 852-7145
Dear Human Service Organizations,
In an effort to streamline the expense reimbursement process,
please note the change of address for submitting your requests.
Effective with your fiscal year 1995 contracts (October 1, 1994
thru September 30, 1995), all reimbursement requests should be
mailed to:
Clerk of the Court
500 Whitehead Street
Key West, FL 33040
Attn: Finance Department
You will also find several attachments to the contract.
document titled "Expense Reimbursement Requirements."
prepared in an attempt to eliminate any confusion
required supporting documentation.
One is a
This was
regarding
A "prototype cover sheet" has been provided in an effort to assist
you in packaging your request, as well as to facilitate the review
process in our office. Please let me know if you want blank copies
of the cover sheet for your reimbursement requests.
Please contact me at 292-3528 with any questions or comments
regarding this change.
Sincerely,
~tWM
Stephanie Griffiths
Chief Accountant
. .' ~
ATTACHMENT A i
Expense Reimbursement Requirements
This document is intended to provide "basic" guidelines to Human
Service Organizations, county travellers, and contractual parties
who have reimbursable expenses associated with Monroe County
business. These guidelines, as they relate to travel, are
interpreted from Florida Statute 112.061, whtch is attached for
reference.
A cover letter summarizing the major line items on the reimbursable
expense request should also contain a certified statement such as:
I certify that the attached expenses are accurate and in
agreement wi th the records of this organization. Furthermore,
these expenses are in compliance with this organization's
contract with the Monroe County Board of County Commissioners.
Invoices should be billed to the contracting agency. Third party
payments will not be considered for reimbursement. Remember, the
expense should be paid prior to 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 the contract. This document should not be
considered all-inclusive. The Clerk's Finance Department reserves
the right to review reimbursement requests on an individual basis.
Any questions regarding these guidelines should be directed to
stephanie Griffiths at 305-292-3528.
Payroll:
A certified statement verifying the accuracy and authenticity of
the payroll expenses.
If a Payroll Journal is provided, it should include:
Payroll Journal dates
employee name, salary, or hourly rate
hours worked during the payroll journal dates
withholdings where appropriate
check number and check amount
If a Payroll Journal is not provided the following must be listed:
check number, date, payee, check amount
support for applicable payroll taxes
Original vendor invoices must be submitted. for Worker's
Compensation and liability insurance coverage.
Telephone expenses:
A user log of pertinent information must be remitted: the party
called, the caller, the telephone number, the date, and the purpose
of the call must be identified.
Telefax, fax, etc.:
A fax log is required. The log must define the sender, the
intended recipient, the date, the number called, and the reason for
sending the fax.
Supplies, services, etc.:
For supplies or services ordered the County requires the original
vendor invoice.
Rents, leases, etc.:
A copy of the rental agreement or lease is required. Deposits and
advance payments will not be allowable expenses.
Postage, overnight deliveries, courier, etc.:
A log of all postage expenses as it relates to the County contract
is required for reimbursement. For overnight or express
deliveries, the original vendor invoice must be included.
Reproductions, copies, etc.:
A log of copy expenses as it relates to the County contract is
required for reimbursement. The log must define the date, number
of copies made, source document, purpose, and recipient. A
reasonable fee for copy expenses will be allowable. For vendor
services, the original vendor invoice is required and a sample of
the finished product.
Travel expenses: please refer to Florida statute 112.061.
Travel expenses must be submitted on a state of Florida Voucher for
Reimbursement of Travel Expenses. Credit card statements are not
acceptable documentation for reimbursement.
Airfare reimbursement requires
portion of the airline ticket.
to facilitate the audit trail.
the original passenger receipt
A travel itinerary is appreciated
Auto rental reimbursement requires the original vendor invoice.
Fuel purchases should be documented with original paid receipts.
Original taxi receipts should be provided. However, reasonahle
fares will be reimbursed without receipts. Taxis are not
reimbursed if taken to arrive at a departure point: for example,
taking a taxi from one's residence to the airport for a business
l~
~
/f.
trip is not reimbursable.
Original toll receipts should be provided.
tolls will be reimbursed without receipts.
However, reasonable
Parking is
destination.
considered a reimbursable travel expense at
Airport parking during a business trip is not.
the
Lodging reimbursement requires a detail listing of charges. The
original lodging invoice must be submitted. The County will only
reimburse the actual room and related bed tax. Room service,
movies, and personal telephone calls (see previous guidelines) are
not allowable expenses. Per diem lodging expenses may apply.
Again, refer to Florida statute 112.061.
Meal reimbursement is breakfast at $3. 00, lunch at $6. 00, and
dinner at $12. 00. Meal guidelines are that travel must begin prior
to 6 am for breakfast reimbursement, before noon and end after 2pm
for lunch reimbursement, and before 6pm and end after 8 pm for
dinner reimbursement.
Mileage reimbursement is calculated at 20 cents per mile for
personal auto mileage while on county business. Effective October
1, 1994, mileage will be reimbursed at 25 cents per mile. An
odometer reading must be included on the state travel voucher for
vicinity travel. A mileage map is attached for reference to
allowable miles from various Florida destinations.
Mileage is not allowed from a residence or office to a point of
departure: for example, driving from one's home to the airport for
a business trip is not a reimbursable expense.
Data processing, PC time, etc.:
The original vendor invoice is required for reimbursement.
Intercompany allocations are not considered reimbursable
expenditures unless appropriate payroll journals for the charging
department (see Payroll above) are attached and certified.
The following expenses are not allowable for reimbursement:
penalties and fines
non-sufficient check charges
fundraising
contributions
capital outlay expenditures (unless specifically included in
the contract)
depreciation expenses (unless specifically included in the
contract)
SGRIFFITHS
WP51\PROCEDUR\EXP_REIM
ATTACHMENT B
HUMAN SERVICE ORGANIZATION LETTERHEAD
Monroe County Board of County Commissioners
Finance Department
500 Whitehead street
Key West, Florida 33040
November 4, 1994
The following is a summary of the expenses for
Orqanization name) for the time period of
(Human Service
to
Check # Payee Reason Amount
101 A Company rent $xxxx.xx
102 B Company utilities $xxxx.xx
103 D Company phones $xxxx.xx
104 Person A payroll $xxxx.xx
105 Person B payroll $xxxx.xx
(A) Total $xxxx.xx
(B) Total prior payments $xxxx.xx
(C) Total requested and paid (A + B) $xxxx.xx
(D) Total contract amount $xxxx.xx
Balance of contract (0 - C) $xxxx.xx
I certify that the above checks have been submitted to the vendors
as noted and that the expenses are accurate and in agreement with
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 and subscribed before me this ____ day of
199_
Notary Public
Notary stamp
MILEAGE CHART
KEY WFST TO:
Bay Point 15
Big Coppitt 10
Big Pine 31
Big Torch Key 29
Clearwater Beach 399
Coco Beach 350
Conch Key 55
Cudjoe Key 22
Dania 180
Daytona Beach 416
Duck Key 62
Ft. Lauderdale 183
Ft. Myers 275
Gainesville 476
Grassy Key 56
Hollywood 175
Homestead 127
Islamorada 83
Jacksonville 505
Key Colony Beach S3
Key Largo 101
Lakeland 365
Layton 70
Little Torch Key 28
Long Key 70
Lower Matecumbe Key 7S
Marathon 48
Marathon Shores 53
Marco Island 221
Miami 155
Miami Beach 170
Middle Torch Key 26
Naples 236
Ocean Reef 118
Opa Locka 180
Orlando 378
Palm Beach 223
Palm Beach Gardens 238
Panama City 702
Plantation Key 87
Ramrod Key 27
Rock Harbor 100
Stock Island OS
Sugarloaf Key 17
Summerland Key 24
W. Summerland Key 31
Sunshine Key 39
Tallahassee 606
Tampa 391
Tavernier 92
Vacation Village 84
MARA THON TO:
Big Pine Key 17
Conch Key 12
Islamorada 3S
Key Largo SO
Long Key 22
Miami 110
Plantation Key 39
Summerland Key 24
Sunshine Key 09
Tavernier 45
BOOT KEY TO: IDNG KEY TO:
Long Key 20 Boot Key 20
Middle Torch 22 Cudjoe Key 47
HOMF...'\TEAD TO: Homestead 61
Islamorada 16
Key West 127
Marathon 22
Plantation 42
Miami 109
Tavernier 35
Middle Torch 43
KEY LARGO TO:
Plantation Key 20
Big Pine Key 70
MIAMI TO:
Homestead 27
Islamorada 72
Islamorada 36
Key Largo S4
Long Key 40
Marathon 110
Marathon 50
PLANTA nON TO:
Miami 57
Big Pine S6
Ocean Reef 17
Duck Key 26
Plantation 14
Homestead 42
Key Largo 14
Key West 87
Layton 17
Marathon 39
Miami 67
Sunshine Key 48
^pril 22. 1')9.1
11\1 l'rintint~
GENEI~^L LIAnllJITY
INSUIV\NCE I{I~QU IJ{EM I~NrrS
Ir() I {
C()N~l~I{^crr MENTAL HEALTH CLINICS
UI~rJ~VI~EN
MONI~OE COIJN']'Y, FI..,OJ{II)A
AN])
CARE CENTER FOR MENTAL HEALTH OF THE LOWER KEYS INC.
Prior to the COlll111CnCCnlcnt of work governed by this c()ntract, the Contractor shall obtain
General !."iability Insurance. Coverage shall be 1l1aintained throughout the life of lhe contract and
incluuc, a~; a nlininlum:
· Prcrniscs Operations
· Products and Cornplelcd Operations
· Blanket Contraclual Liability
· Personal Injury Liability
· Expanded Definition of Pr()pcrty Danlage
l~hc rninil11Um Jinlits accCIJlablc shaH be:
$1,000,000 Cornuincd Single Linl;l (CSL)
If split linlits arc providcd, the nlinimulll linlils acceptable shall be:
$ 500,000 pcr J>crson
$ 1,000,000 per Occurrence
$ 100,000 !)r()pCrly Danlagc
An Occurrence Form policy is preferred. If coverage is provided on a Claims Made policy, its
proyisions should include coveragc for clairns filed on or atlcr the cflcctivc datc of (his contract.
In addili9n, the pcriod lor which clainls ,nay be reported should exlend lor a 111ini,l1uIll of twelve
(12) nlonths following the acceptance ofwark by the County.
']'hc Monroe Counly [laara. of County (~oll1lnissjoncrs shaH be nanlcd as Additional Insured on all
policies issued to saLisfy the above rcquirclTIcnts.
.,
^dmilli:;h arivc In~;tnIl1jon
Glj]
1I~1709.1
5G
^pril 22. 1<.19.1
J st PrinC illg
. VEIIICIJE l~l^nll~ITY
INSUI{ANCI~ It~QUII{I~l\'IIGN~rS
FOI{
CON~rl~Acrr MENTAL HEALTH CLINICS
IJI~']1\VEEN
MONI~()E COUN1.Y, IcIJOI{II)A
AND
CARE CENTER FOR MENTAL HEALTH OF THE LOWER KEYS, INC.
Jtccognizing that the work governed by lhis contract requires the use ()f vehicles, the Conlraclor,
pl;or to the COllllncnccnlcnt of work, shall obtain Vehicle Liabilily Insurance. Coverage shall be
rnaintaincd throughout the life of'the contract and include, as a rninil11Ulll, liability coverage for:
· OWlled, Non-Owned, and Ilircd Vehicles
. The Inininlum Jinlits acceptable shall be:
$1,000,000 COlnbincd Single Lilllil (CSt,)
If split limits are provided, the nlini.llulll lirnilS acceptable shall be:
$ 500,000 per Person
$1,000,000 per Occurrence
$ 100,000 })ropcrty Darnagc
~rhc Monroe County Board of County COl1l1nissioncrs shall be nanlcd as Additional Insured on all
policies issued to satisfy the above rcquircnlcnls.
Ad.ninistral ivc InstnK1 ion
VL,)
11470? .1
77
,\ I >i H i. '-. . )j'.)
I~ll'rinlilll~
WOI{I(I~I~S' COMIJENSArrlON
INSUI{ANCE It~:QUII{Ef\tII~Nrrs
14'01{
CON1~r{^Cl' . MENTAL HEALTH CLINICS
II I~T"V E E N
MONltOI~ COUNll', FI..40J{II)A
AND
CARE CENTER FOR MENTAL HEALTH OF THE LOWER.KEYS, INC,
J>rior to the conunCnCCJllcnt of work governed by this contracl, the Contractor shall obtain
Workers' COlnpcnsation Insurance with Jirnits sullicicnt to respond to the applicable state statutes.
In addition, the Contractor shall obtain Ernploycrs' Liability Insurance \vilh lilnits ()f nollcss than:
$1,000,000 Bodily Injury by Accident
$1 ~OOO,OOO Dodily Injury by Disease, policy liJllils
$1,000,000 130dily Irtiury by Disease, each cnlployec
Coverage shall be Inaintained throughoullhc enlire term of the contract.
Coverage shall be provided by a C0J11pany or C0J11paliics aulhorized to transact business in the
state of Florida and the cornpany or cOlllpanics rnust nlainlain a 1l1inirnuln rating of A- VI, as
assigned by the A.M. Best COrnlJany.
I f the Contractor has been aPJJrovcd by the '"4Jorida'sDcpartnlcnl of l..,abor, as an authorized sclf-
insurer, the County shall recognize and honor the Contractorls status. The Cc)nlractor nlay be
required Lo subrnit a Lctter of Authorization issued by the Dcpartnlcnt of L,abor and a Certificate
of I nsurancc, providing details on lhe (~ontractorls Excess Insurance ProgralTI.
If the Contractor participates in a self-insurance fund, a Certificate of Insurance will be required.
In addition, the Contractor may be required to subnlit updated financial statements from the fund
upon rcqu~est from the County.
^tlrninistrnlivc Jn~nJ(.1ion
/14709.1
we)
83
1\l'til 22. I f)(j J
J ~I Prin'int;
1\11~1)ICAl~ 1)I{Olrl~SSION^I.J LIAIlll-lrrv
INSUltANCE I{EQUII{I~M(GN"rs
If 0 J{
COl'Crl"J{ACrr MENTAL HEALTH CLINICS
IJ lc:'r'VEI~N
MONI{OI~ C()UN'I~Y, IcL()I{IDA
AND
CARE CENTER FOR MENTAL HEALTH OF THE LOWER"KEYS, INC.
- Recognizing that the work govcrned by lhis contract involves the providing ()f professional
Incdical trcatrncnt't the Contractor shall purchase and 1l1aintain, throughout the life of the contract.
Professional Liability Insurance \vhich ,viII respond to the rendering or: or failure to render
l11cdical professional services under this contracl.
rrhe rninimulTl Iinlils of liability shall be:
$1,000,000 per Occurrencc/$3,OOO,OOO Aggregate
I r coverage is provided on a clainls JllaUC basis, an c~lcnc.Jcd claillls reporting period of f()ur (4)
years will be required.
Ad.nini5tralivc In.\1n.(.1ion
ME[)2
1I~17(J9.1
GG
l:i~~~~.!!~....ltt\.lllll1_llrlillt.!I~..II'lflf~1\1faYj. "'N~~Og/:
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
DOES NOT AMEND, EXTEND OR AlTER THE COVERAGE AFFORDED IV THE
POUCIEI BELOW.
POE . IRCJ\N INC.
P . 0 . BOX 2~ 12
DAVTONA BEACH, FL 321'1-2412
CCN'ANlES AFFORDING COVERAGE
104-252-1101
FL
33040
CQAlPANV A
LETTER
CO~ANV B
LETTER
CQAlPANV C
LETTER
CO~AtN D
LETTER
CQIIFAW E
LETTER
M.ntal H.alth C.r. C.nt.r of
1205 Fourth Str..t
K.y W..t
THS IS TO CERTFY THA T THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE NSURED NA~D ABOVE FOR THE POLICY PERIOD
INDICA TED. NOTWITHST ANDING ANY REQUIREMENT, TE~ OR CONDITION OF ANY CONTRACT OR OTHER OOClMENT WITH RESPECT TO WHICH THS
CERTFiCA TE MAY BE SSUED OR MAY PERT AIN, iHE INSURANCE AFFQRUED BY THE POLICES DESCRIBED t-EREN 15 SUBJECT TO ALL THE TEFNS.
EXCLUSIONS AND COtOTIONS OF SUCH POLICIES. LMTS SHQWNMAY HAVE BEEN REDUCED BY PA() CLAMS.
oe
L
TVPII. .....
NL.'''''-
....., ....T. POL., ".'1
DAm (MM/OO/VV) DAm (..../OO/VV)
L....
....& UML'"
CCMtiEACIAl GENERAL lIABllI TV
CLAIMS MADE D OCCUR.
OWNER'S & CONTRACTOR'S PROT.
AUTO...... LIML'"
AtIt AUTO
ALL OWNED AUTOS
SCHEDUlED AUTOS
HIRED AUTOS
NON-OWNfD AUTOS
&ARA. lIAIllI TV
6fNERAl A8ME&A TE
PROOUCTS-C~/OP A68.
PERSONAL & AIW. INJURY
EACH OCCURRENCE
FIRE 0AMA6f (A
MiD. EXPENSE (A
C~INED SJ_E
LMT
B DOll V INJURY
(Per penoN
.
.
.
.
.
.
.
.
BODIlV INJUIW
(Per ace'"
.
PROPERTV llAMA.
D0U8 LIMIJ1'Y
lMMllA fDIN
OTHER THAN tMUUllA FORM
....... ......1...
..
......... L.....n
EACH OCCURRENCf .
AGGREGATE .
1 ~1~ 1~1 ~ 1~1~1n ~;~1~ 1~1~;~;~1 ~ 1~1~; ~~~ ~~1~1~ i ~~1 ~1~1~1~~~1~1 ~;~;~1~ 1~~~i~i~i~i ~i ~
7/01/14
STA TUTORY LIMITS
7/0 1 III EACH ACCIDENT
. . . . . . . . . . . . . . . . . ~
.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.;
::::::::::::::::::::::::::::::::::: :
A
00410
. 1000000
DiStASi-rOli;;, iiMI i
DISEASE-EACH EMPLOYEE
'uCCCQ\i
.
1000000
OTH8
DUCAPrION 01 OPDAllONM.OOAllONIIVBt1OLDl1PU1M. 11'1:"
10 ~.Y n.tic. ef c.nc.ll.tieR will ~. liv.n f.r nen-,.y..nt of ,r..iu..
t;~~~ SHOUlD ANY OF T HE ABOVE OESCRtBED POLICES BE CANCELLED BEFORE T ~
~~~~~~~~ EXPRATION DATE T~REOF, T~ ISSl>>JG COMPANY WLL E~AVOR TO
~~1~1~~~ MAL -.!!.. DAYS WRIT TENNOTICE TO TtECERTFICA TE HOLDERNAMEDTO TtE
Menr.. Ceunty le.r" ef COllnty ~I~~~ LEFT,BUT FALUAETOMALSUCHNOTICESHALLMPOSE NO OBlIGATION OR
Co.. i.. ion. r., K.y a.h I.... ~:;::~:.~:~.i.~::~.~. LlABLITY F ANY KN[) UPON THE COMPANY .ITS AGENTSOR REPRESENT A TIVES.
Wing II, Roo. 207 '.S.8. QMI
5100 C.'I.g. R.... M 0700140
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